PBL I: Subarachnoid Hemorrhage Flashcards
where do cerebral aneurysms usually occur?
most are anterior near bifurcation of vessels
What are symptoms of cerebral aneurysm?
"worst headache of their life" syncopal episode nausea/vomiting neck pain photophobia focal deficits
Should you defer to Vancomycin because of a mild or distant reaction?
Rash reactions do not preclude cephalopsporins perioperatively
defferment is not recommended
at 1/10 test dose is reasonable for documentation but be aware it will not always give an immediate reation
What products are used to formulate propofol? what was it originally formulated with?
Originally formulated with Creamophor- a surfactant associated with severe anaphylactic reaction
Propofol is currently formulated with egg lecithin and soybean oil.
Why is there a rather small chance of egg allergy with propofol?
The egg in propofol is phoshatide extrated from the yolk to reduce allergenicity. most egg allergic people react to albumin.
Propofol allergy is often attributed to diisopropyl sided chain or phenol group
What is the purpose of taking 81mg aspirin q day?
vascular anticoagulation. Inhibits platelet aggregation and provides a cardio-protective effect
What kind of drug is Valsartan?
Blood pressure control
Angiotensin II receptor antagonist
Is a member of the Renin-agiotensnsin system inhibitors
These are same class but different mechanism as ACE inhibitors
Should AM dose of ACE inhibitor be taken prior to surgery?
not if HTN is well controlled
What is Lorcet (Lortab, vicodin)
Pain medication consisting of Hydrocodone, a modified morphine (5-10mg) combined with Acetominiphen
Waht is the class, use and example of dose for napoxen?
NSAID
used for pain/inflammation
dose is 250mg q4dayor 500mgq2day
What is Novolin-
REcombinant engineered human insulin used to treat diabetes. supplined as 100units/ml
Waht is metformin and how does it work?
Biguanide class hypoglycemic drug. it works to decrease glucose levels. decreases hepatic glucose production increses insulin action on muscle and fat Is used primarily in Type II diabetes
What are containdications for metformin?
renal impairment
history of lactic acidosis
hepatic disease
cardiac failure
What type of drug is Nimodipine (Nimotop)? how is it used?
Calcium channel blocker used for angina, cardiac dysrythmias.
often combined with other medications for treatment of patients with heart disease and HTN
Indicated for use in patients for improvement of neurological outcome where deficits secondary to vasospasm after cerebral aneurysm rupture
Also indicated for vasospasm after cerebral aneurysm coiling
What are the effects fo calcium channel blockers?
Decrease systemic BP
Increase coronary blood flow
delaying of A-V conduction
decrease HR
What is simvastatin (Zocor) used for?
treatment of dyslipidemia
What is the indication for vicodin?
moderate to moderately severe pain
what are warning for vicodin?
REspiratory depression
increased ICP
how can vicodin lead to increased ICP?
CO2 building up for hypoventilation is a vasodilator which will increase ICP
What is colace (docusate sodium)?
anionic surfactant which lowers the surface tension of stool, allowing easier defacation
What is pepcid (famotidine) used for and how does it work?
Used to treate GERD and gastric and duodenal ulcers
It is an Histamine H2 receptor blocker
Inhibits gastric acid production
70% reduction in acid secretion
Most effective on basal acid secretion which is responsible for nocturnal acid secretion