Pharm

Question 1

What Scopolamine?

Answer 1

Anticholinergic = used to reduce nausea and vomiting. postoperatively.

Question 2

What two drug classes can encourage patients to urinate after surgery and not retain>

Answer 2

Bethanecjol is an agonist of the parasympathetic system and increased bladder muscle tone to induce urinating.

Question 3

What is merperidine? Generic name?

Answer 3

DEMEROL! This is used for pain meds pos op. however due to tox metabolites it is used less now.

Question 4

If you have an ischemic toe post op, what drug can you give to try and encourage blood flow? (3)

Answer 4

1. Nifedipine with aspirin ( 81mg)

OR

2. Local anesthetic with epi = initial vasodilation!

OR

3. heating device

Question 5

What is Lantus?

Answer 5

Long acting insulin: Insulin Glargine

Question 6

What can be used to reverse Heparin?

When should I stop Coumadin before surgery? and when can be it be re-started?

Answer 6

Protamine Sulfate.

Coumadin: stop 3-5 days prior, and start 3-5 days after PT is therapeutic.

Question 7

Why doesnt Greg Doyle like to take Colchicine for his painful gouty attacks?

Answer 7

Colchicine is an alternative for those unable to tolerate NSAIDs in gout.[2] At high doses, side effects (primarily gastrointestinal upset) limit its use

Question 8

In somone with liver disease, which anesthetics should be avoided?

Answer 8

Halothane and amides!

Question 9

How do you calculate the Clark’s Rule regarding anesthesia in pediatric patients?

Answer 9

Clarks Rule: weight/150 = fraction of adult dose.

Question 10

What is the trade name for LMWH?

Answer 10

Lovenox/Enoxaprin: Factor Xa and II inhibitor.

Question 11

What is the name for a selective Factor 10a inhibitor?

Answer 11

Xarelto (Rivaroxaban)

Question 12

What is the MOA for Heparin?

Answer 12

Binds Antithrombin 3 and promotes the inhibition of thrombin 2, 10a, 9a, 11a, and 12a.

Question 13

How is LMWH different from Heparin?

Answer 13

LMWH: increased bioavilability, prolonged half life, predictable clearance, predictable antithrombic response allowing for treatment WITHOUT lab monitoring.

Question 14

What is the prophylaxis/ treatment for:

1. Heparin
2. LMWH

Answer 14

Heparin:

• prophylaxis: 500 U SQ TID
• treatment: IV 80 IU/kg.. continue to infuse at 18 IU/kg/hr

LMWH:

• prophylaxis: 1mg/kg sq q 12
• start Coumadin 12-24 hours after LMWH is given, do so until INR is between 2-3.

Question 15

How does bridging work with Coumadin/Heparin?

Answer 15

When coumadin treatment is initiated, there should be a 4-5d overlap with the use of Heparin when initiating DVT prophylaxis.

The peak effect of Coumadin does not take place for 24-72 hours.

treatment is intiated at 5mg/day po.
works on extrinisic pathyway. LMWH discontinued on 4th or 5th day.

Question 16

Coumadin:
potentiates what medications?
Decreased the effects of?
Raises the level of what medications?

Answer 16

Coumadin is metabolized by p450

Potentiates: ASA, NSAIDS, allopurinaol, bactrim

Decreases: oral contraceptives, dicloxacillin and facillin

Raises levels of: oral hypoglycemics and anticonvuldants. as well as levaquin.

Question 17

What are some common thrombolytics?

Answer 17

Streptokinase, urokinaase, tpa.

Question 18

What is Cliostazol and why is it used for anti-claudication?

Answer 18

Cliostazol 100 mg PO BID
• Phosphodiesterase (PDE) inhibitor: non homogenous vasodilation
• Reversibly inhibits platelet aggregation
• Improves symtoms and walking distance (40-60%)

Pentoxifylline 400 mg PO TID
• Similar as above, second line alternative to cilostazol