Med exam from flood Flashcards
The use of corticosteroids for pain relief, although popular, has yet to gain wider acceptance because of concerns over side effects, such as
- adrenal suppression
- osteonecrosis
- impaired wound healing
- concerns about efficacy
clinical use of ketamine can be limited due to psychotomimetic adverse effects and other common adverse effects, including?
- dizziness
- blurred vision
- nausea and vomiting.
__________ and __________ patients are at increased risk for perioperative hyperglycemia when they receive a single dose of dexamethasone.
Obese and diabetic patients
At susbanesthetic doses Ketamine is used as an adjuvanct to provide post anesthtic pain relief in opioid dependent patients. What is the subanesthetic dose
0.15 to 1 mg/kg
Elimination half life of dexamethasone is
3 hrs
This. drug prevents postoperative nausea and vomiting only when administered near the beginning of surgery, probably by reducing surgery-induced inflammation due to inhibition of prostaglandin synthesis
Dexamethasone
Administration of higher doses __________mg of dexamethasone has a similar clinical effect to lower doses _________ mg.
8 to 10
4 to 5
Antiemetic effects of dexamethasone often persist as long as
24hrs
Dexamethasone at doses more than ___________ decreases acute postoperative pain and reduces opioid use, especially when administered preoperatively.
0.1 mg/kg
Dexamethasone dose for postintubation laryngeal edema
0.1 to 0.2 mg/kg IV
Dexamethasone dose for children with mild croup
0.6mg/kg
The side effects of chronic corticosteroid therapy include
- suppression of the HPA axis
- electrolyte and metabolic changes
- osteoporosis
- peptic ulcer disease
- skeletal muscle myopathy
- central nervous system dysfunction
- peripheral blood changes
- inhibition of normal growth.
These drugs attach to cytoplasmic receptors to enhance or suppress changes in the transcription of DNA and thus the synthesis of proteins. They also inhibit the secretion of cytokines via posttranslational effects.
Glucocorticoids e.g Dexamethasone
A polypeptide containing approximately 70% arginine residues and the only available agent to reverse unfractionated heparin
Protamine
Does protamine reverse lovenox
Protamine does not reverse low-molecular-weight heparin
What is the MOA of protamine
It inhibits platelets and serine proteases involved in coagulation.
Heparin rebound can occur after initial reversal and is generally observed ______________ hours after the first dose of protamine, when the patient is in the intensive care unit.
2 to 3
The ACT is not a sensitive indicator of low heparin concentrations because
platelet counts and fibrinogen levels may also affect values.
Protamine can cause adverse reactions including
- anaphylaxis
- acute pulmonary vasoconstriction
- right ventricular failure
- hypotension.
Patients at an increased risk for adverse reactions include
- exposure to neutral protamine Hagedorn (NPH)
- patients with vasectomy
- multiple drug allergies
- prior protamine exposure.
Esmolol can cause a minor prolongation of succs block due to?
Inhibition of butylcholinesterase
What is the elimination half time of esmolol
about 10 minutes
What is the typical initial dose of esmolol
0.5mg/kg IV over 60 seconds
The full therapeutic effect of an intitial doses of esmolol is evident after
5 minutes
Therapeutic duration of esmolol
10-30 minutes
Esmolol dose given 15 seconds prior to induction that has been reported to prevent intraop HTN and Tachycardia
100-200 mg IV
Widespread use of long-term hydralazine is limited due to?
Its ascociated with systemic lupus syndrome
What is the onset of hydralazine?
5-20 minutes
What is the half life and duration of hydralazine
Half life is 2-8
Duration 1-8 hrs
What is the bolus dose of hydralazine?
5-20 mg
What is the MOA of methergine
Ergot Derivative/Oxytocic - Acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions.
