Peri-Operative Pharmacology Flashcards
what are pharmacodynamics?
drug effects on the body systems
what are pharmacokinetics?
body’s handling of the drug
what are the 4 components of pharmacokinetics?
- absorption
- distribution
- metabolism
- excretion
what cardiovascular drugs are omited prior to surgery?
- loop diuretics
- potassium sparing diuretics
- ACEi
- angiotensin iI inhibitors
- renin inhibitors
when are DOACs stopped before surgery?
48 hours before
when is warfarin stopped before surgery?
5 days before
when is aspirin stopped before surgery?
continue except for in neurosurgery and orthopaedic surgery
when is clopidogrel stopped before surgery?
7 days before
when are antipsychotics stopped before surgery?
12 hours before
when are bisphosphonates stopped before surgery?
omit on day of surgery
what 2 groups of antacids aer commonly prescribed?
- PPI (omeprazole)
- H2-receptor antagonist (ranitidine)
what different benzodiazepines can be used?
- midazolam
- temazepam
- lorazepam and diazepam
what is the mechanism of action of benzodiazepines?
- bind to GABA receptors in the CNS
- increase the receptor affinity for GABA
- ion movement across cell membrane is increased
- hyperpolarises the cells membrane
- reduces firing of neurons
- CNS is depressed –> patient drowsy, disinhibited, amnesia
name some IV anaesthetic induction agents
- propofol
- ketamine
- thiopentone
- etomidate
- midazolam
when are volatile anaesthetic agents used?
- maintenance anaesthetic
- difficult IV access
- children
- obstetric
why are neuromuscular blocking agents given in anaesthesia?
- given to relax or paralyse muscles
- facilitate intubation
- improve surgical condition (e.g relax abdominal wall)
what are the 2 catagories of neuromuscular blocking agents?
- non-depolarising
- depolarising
name non-opioid analgesics
- paracetamol
- NSAIDs
- ketamine
- clonidine
name strong opiods
- morphine
- diamorphine
- fentanyl
- alfentanil
- remifentanil
- methadone
name weak opioids
- codeine
- tramadol
name some NSAIDs
- ibuprofen
- ketoralac
- diclofenac
what is the mechanism of action of local anaesthetic?
reversible blockade of sodium channels, inibiting transmission of action potential in nerve cells
what does adrenaline do that prolongs local anaesthetic duration of action?
adrenaline is added to lidocaine to cause vasoconstriction
what is a peripheral nerve block?
bolus injection of infusion via catheter of local anaesthetic to target specific nerves
what is neuraxial anaesthesia?
spinal or epidural
what is an elastomeric ball?
- used with peripheral nerve blocks
- infue local anaesthetic via a catheter that is placed beside the nerves to be targeted
what is the mechanism of action of the anti-emetic ondansetron?
5HT3 receptor antagonist
what is the mechanism of action of the anti-emetic dexamethasone?
steroid receptor agonist
what is the mechanism of action of the anti-emetic cyclizine?
H1-receptor antagonist
what is the mechanism of action of the anti-emetic hycosine?
anti-cholinergic
what is the mechanism of action of the anti-emetic metoclopramide?
dopamine 2-receptor antagonist
what is the mechanism of action of the anti-emetic domperidone?
dopamine 2-receptor antagonist
what is the mechanism of action of the anti-emetic prochloperazine?
dopamine 2-receptor antagonist
what is the mechanism of action of the anti-emetic droperidol?
dopamine 2-receptor antagonist
what are the common side effects of opioids?
- nausea
- itch
- constipation
- euphoria
- respiratory depression
