PBL II

Question 1

What type drug is azathioprine and what is it used for?

Answer 1

Immunosupressive agent used to tx rheumatoid arthritis

Question 2

What type of drug is piperacillin-tazobactam and what is it use for?

Answer 2

Beta lactam and Beta lactamace inhibitor
Penicillin class antibiotic
Effective against gram-negative bacteria
Uses:
Hospital acquired infections
                  Bacteremia 
                  Penicillin and Ampicillin resistant
                  microorganisms
                  Post burn infections
                  Pneumonias
                  Pseudomonas infections

Question 3

How often do pts with penicillin react to cephalosporins?

Answer 3

Immunological studies: 20%
clinical studies: 1
Pts with a hx of mild or distant reactions to PCN are at a low risk of rash or other allergic reaction

Question 4

How prevalent are tape allergies? Which tape? What is the typical reaction?

Answer 4

Tape allergies are rare
Most tape allergies are to adhesive tape which can contain latex and that may be the source of the reaction
Typically the reaction is a simple contact dermatitis

Question 5

Irbesartan (Avapro)-What class of drug and what is is used for?

Answer 5

Angiotensin II receptor antagonist used for blood pressure control
Member of Renin-Angiotnesin System Inhibitors

Question 6

What are the uses of pyridostigmine?

Answer 6

Treatment of Myasthenia Gravis
Neuromuscular disease > muscle weakness
skeletal muscle fatigability
Defect is in the synaptic transmission at the neuromuscular junction
Autoimmune response to Ach receptor at the post junctional end plate

Question 7

HOw do myasthenia gravis pts react to Succinylcholine?
What if they are on Pyridostigmine?
Can you use non depolarizing relaxants?
How should you proceed if you need relaxation?

Answer 7

Myastenic patients have a resistance to Succinylcholine
On the other hand if the patient is on Pyridostigmine, they may have potentiation
Phase 2 block is not uncommon in the patients
MG patients may be extremely sensitive to non-depolarizing neuromuscular blockers
A smaller test dose should be used and close NMB monitoring is needed

Question 8

Besides reaction to relaxants what are other anesthetic considerations for MG pts?

Answer 8

Assess preoperative disease management
Medication should be continued preoperatively
Counsel patient concerning the possibility of postoperative endotracheal intubation and ventilation

Question 9

Which muscle relaxant appears to be preferred with MG pts?

Answer 9

cisatracurium

Question 10

What are benefits of stopping smoking after 8-12 weeks?
6-8?
4-6?

Answer 10

8-12 Decreased overall postoperative morbidity and mortality
6-8 Immun function and metabolism normalizes
4-6 weeks PFTs improve

Question 11

What are the benefits 1-2 weeks after stopping smoking?
48-72 hours?
12-24 hours?

Answer 11

1-2 weeks Decreased sputum production
48-72 hours COHb levels normalized, ciliary function improves
12-14 hrs Decreased CO and nicotine levels

Question 12

How much less potent is Oxycodone delivered enterally vs parenterally?

Answer 12

2-6 times less potent

Question 13

What do you call oxycodone +aspirin?
+acetaminophen?
non sustained release?

Answer 13

Percodan
Percoset
Roxicodine

Question 14

what doses of morphine are used in pain management?

Answer 14

30mg q3-4 hours oral
10 mg q3-4hours parenteral
may be used for baseline or breathrough pain
Intraoperative in a balanced anesthetic: 2-10mg bolus

Question 15

How does 325 mg affect bleeding time

Answer 15

doubles bleeding time 4-7 days

Question 16

What is the class, action, effect and dose of apirin?

Answer 16

NSAID
COX 1 inhibitor-reduces production of prostogandins
Anti-inflammatory analgesic and antipyretic
Dose: 325-650 q4-6hours for pain

Question 17

What are symptoms of acute withdrawal of predisone?

Answer 17

N/V, dehydration, hyponatremia, hypotension and severe weakness

Question 18

What are effects of short term and long term use of prednisone?

Answer 18

1 week-OK

Long term-disabling and potentially lethal effects

Question 19

What are clinical uses prednisone?

Answer 19

Arthritis
Rheumatic disorders-Lupus
Allergic reactions
Severe Bronchial Asthma
COPD
Cerebral Edema
Colitis and Crohn’s Disease
Organ Transplantation

Question 20

What is a stress dose of steroids for a 70 kg pt in minor vs major surgery?

Answer 20

Major (colectomy) 100-150 mg hydrocortisone

Minor (herniorrhaphy) 25-100 mg hydrocortisone

Question 21

What is the recommendation for giving a stress dose of steroids?

Answer 21

If the pt was on a glucocorticoid in the last year, then arguably they should receive a dose of steroid properatively

Question 22

Why would a stress dose of steroids be necessary?

Answer 22

Deep general Anesthesia or regional postpones glucocorticoid surge usually seen with sympathetic surgical stimulation until the post op period

Question 23

Where should the twitch monitor be placed on an MG pt?

Answer 23

Temporal branch of facial nerve stimulating orbicularis oculi–more sensitive for MG pts