Pharm B Final Flashcards
1
Q
MOA of Aspirin
A
Inhibits COX-1 and COX-2, but its 170x more potent for COX-1 than COX-2. This inhibition suppresses formation of prostaglandins and thromboxanes thus inhibiting platelet aggregation and inflammation
2
Q
Perioperative effects of aspirin
A
- Decreased hemostasis (theoretical)
- Renal dysfunction (theoretical)
- GI hemorrhage
- Poor bone healing
- Bronchospasm
3
Q
Aspirin is known to have cross reactivity with what other non-opioid pain reliever?
A
Tylenol
4
Q
Which COX is responsible for bone healing?
A
COX-1
5
Q
Before which procedure should the patient be on NO recent aspirin?
A
Tonsillectomy
6
Q
Before which procedures should the patient discontinue aspirin 7 days prior?
A
- Plastic surgery
- Retinal surgery
7
Q
How many days are required for full regeneration of platelets after a dose of aspirin?
A
7-10 days
8
Q
How long does it take for low dose aspirin (less than 650mg/day) to be completely cleared from the body?
A
24 hours
9
Q
How many platelets does the body make per day
A
70,000 platelets/mL blood
10
Q
How many platelets are contained in 1 unit of platelets?
A
5,000-7,000
11
Q
By how much will 1 bag of platelets raise a patient’s platelet count?
A
30-60k because platelet bags come “pooled”
12
Q
Options for emergency reversal of aspirin
A
- Platelet transfusion
- DDAVP
13
Q
How does DDAVP reverse aspirin?
A
Releases vWF and Factor 8
14
Q
A 55 year-old-woman is having reconstructive breast surgery. She takes aspirin 650mg daily for paroxysmal atrial fibrillation. Her aspirin regimen should:
A. Be discontinued 1 week prior to surgery.
B. Be discontinued 5 days prior to surgery.
C. Be discontinued the morning of surgery.
D. Not be discontinued.
A
A. Be discontinued 1 week prior to surgery.
15
Q
MOA of Plavix
A
Irreversibly inhibits ADP mediated platelet aggregation
16
Q
Perioperative effects of Plavix
A
- Decrease in surgical hemostasis
- Increased periop blood loss
- Increased mortality
- Increased need for blood products
17
Q
For most surgeries (including cardiac), how soon before surgery should the patient discontinue Plavix?
A
5-7 days
18
Q
Which surgeries may be OK for patients to continue their Plavix?
A
- PCI
- Vascular
- Cataract
19
Q
Emergent reversal for Plavix
A
Platelet transfusion
20
Q
Methods to monitor platelet function
A
- TEG/ROTEM
- PFA
21
Q
Which COX is responsible for gastric mucosa protection?
A
COX-1
22
Q
Which COX is responsible for platelet aggregation?
A
COX-1
23
Q
Which COX is responsible for inflammation?
A
COX-2
24
Q
Theoretically, after a dose of Plavix, how many days must minimally pass before a patient’s platelet count is safe for neurosurgery?
A. 1 day
B. 3 days
C. 5 days
D. 7 days
A
C. 5 days
25
Which "other" anti-platelet drugs work ACUTELY by inhibiting IIb/IIIa?
EAT
- Eptifibatide
- Acbiximab
- Tirofiban
26
Which "other" anti-platelet drugs are used for CHRONIC conditions and work by inhibiting ADP-mediated platelet aggregation?
- Prasugrel
| - Ticagrelor
27
Which "other" anti-platelet drug can be used for thromboembolism/stroke prophylaxis?
Ticagrelor
28
Which "other" anti-platelet may be used for CPB on a HIT patient?
Tirofiban
29
How soon before surgery should Prasurgrel be stopped?
7 days
30
How soon before surgery should Ticagrelor be stopped?
5 days
31
How soon before before surgery should the acute anti-platelet drugs (EAT) be discontinued?
24 hours
32
```
A 45 year-old-man is scheduled for a coronary artery bypass graft surgery 6 days after a cardiac catheterization for ACS. During the cath, an antiplatelet drug was given. Which antiplatelet drug will increase bleeding risk during the bypass surgery?
A. Tirofiban (Aggrastat)
B. Ticagrelor
C. Abciximab
D. Prasugrel
```
D. Prasugrel
33
MOA of Heparin
Upregulates anti-thrombin III which inactivates thrombin and factor Xa
34
CPB dose of heparin
300-400units/kg
35
Target ACT for CPB
Over 400-480
36
Heparin dosing for diagnostic cath
2500-5000u
37
Heparin dosing for interventional cardiology
10,000 units
38
Target ACT for interventional cardiology
Over 300
39
Target ACT for CEA
250-300
40
High risk patients that need a heparin drip
- Thrombolic stroke within a year
- Mechanical valves
- DVT
- PE
- Recent coronary artery stent/PCI
41
Half life of heparin
1-2 hours
42
How soon before surgery should a heparin drip be discontinued?
4-6 hours
43
MOA of protamine
Directly binds to and inhibits heparin
44
How are heparin and protamine cleared?
Renally
45
Side effects of protamine
- Vasodilation/hypotension (if pushed too quickly)
- Bronchoconstriction
- Increased PA pressures
- Anaphylactic reactions
46
Protamine dosing
1-1.3mg protamine for every 100 units of heparin
47
What is heparin rebound
Protamine is cleared quicker than heparin so heparin can leech back out from tissue and into the blood
48
Emory dosing for protamine
(Heparin IV dose + 10,000 units) x 0.005
49
Cap dose of protamine
250mg
50
How much protamine should you give after the initial dose if the ACT is still more than 1.1 times the baseline ACT
25mg
51
```
A 75kg, 65 year-old-female has a coronary artery bypass graft surgery. Before cardiopulmonary bypass, 5000u heparin is given for vein harvest and 30000u heparin is given for bypass anticoagulation. How much protamine should be administered, post bypass, to reverse heparinization?
A. 25mg
B. 125mg
C. 225mg
D. 325mg
```
C. 225mg
52
Percentage of patients exposed to heparin that develop HIT
5%
53
How soon after the initial dose of heparin does HIT begin?
5-14 days
54
When should you start to consider that your patient may have HIT?
- Greater than 50% drop in platelets
| - Platelet count under 100,000 after heparinization
55
Testing to confirm HIT
- ELISA
| - Serotonin platelet release assay
56
How long does it take for the heparin/immune complexes of HIT to clear?
3 months
57
Heparin protocol for acute HIT
No heparin, use alternative
58
Heparin protocol for recent HIT with strong positive ab tests and normal platelets
Heparin use debatable
59
Heparin protocol for recent HIT with weak positive ab tests and normal platelets
Heparin use probably OK
60
Heparin protocol for recent HIT with negative ab tests
Heparin is OK
61
When does ATIII deficiency occur
Heparin re-dosing causes ATIII to be cleared much more quickly, occurs when heparin binding clears out ATIII to less than 60% baseline levels
62
Diagnosis for ATIII deficiency
- ACT under 450 after 500units/kg heparin
| - ACT under 400 after CPB
63
Treatment for ATIII deficiency
- ATIII concentrate
- Recombinant ATIII
- FFP
64
Advantages of LMWH (Lovenox)
- Reduced dosing frequency
- Reduced monitoring
- Reduced bleeding tendencies
- Reduced risk of HIT
- Fewer effects on platelet function
- More predictable pharmacokinetic response
65
What lab value is used to monitor the effect of Lovenox (LMWH)?
Factor Xa
66
Can LMWH be fully reversed with protamine?
No, it's only partially effective
67
What clotting test is unaffected by Lovenox (LMWH)?
PTT
68
Examples of thrombin and Xa inhibitors
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Apixaben (Eliquis)
- Bivalirudin
- Argatroban
- Fondaparinux
- Edoxaban
69
Direct factor IIa (thrombin) inhibitors
BAD
- Bivalirudin
- Argatroban
- Dabigatran
70
Direct factor Xa inhibitor that works via ATIII
Fondaparinux
71
Direct factor Xa inhibitors
EAR
- Edoxaban
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
72
```
Which anticoagulant has a pharmacologic profile most suited for its use as a systemic anticoagulant for cardiopulmonary bypass?
A. Bivalirudin
B. Argatroban
C. Dabigatran (Pradaxa)
D. Rivaroxaban (Xarelto)
E. Edoxaban
```
A. Bivalirudin
73
Thrombin/Xa inhibitors that can be given for CPB for HIT patients
- Argatroban
| - Fondaparinux
74
MOA of Coumadin
Inhibits vitamin-K dependent synthesis of factors 2, 7, 9, 10 and proteins C and S
75
What clotting test monitors Coumadin
PT/INR
76
Medical uses for Coumadin
Long term anticoagulation for...
- A fib
- Low ejection fraction
- Mechanical heart valves
- DVT/PE
- Vascular disease
77
Recommendations for pre-op discontinuation of Coumadin for most procedures
2-5 days (4 average) -- must have normalized INR
78
For what surgeries might it be okay to continue taking Coumadin before surgery?
Cataract surgeries without retrobulbar blocks
79
Subacute reversal of Coumadin
Vitamin K - 10mg/day for 3 days
80
Methods for acute reversal of Coumadin
- FFP
- Factor VIIa
- Factor IX Concentrate
- Prothrombin Complex Clearance (factors II, VII, IX, X)
81
Dosage of FFP for acute reversal of Coumadin
5-8ml/kg
82
```
A 70 year-old-man with an acute abdomen presents to the operating room for an emergent laparotomy. Medical history includes congestive heart failure, diverticulosis, and atrial fibrillation on Coumadin. Left ventricular ejection fraction is unknown. Preoperative labs show an INR of 3.7. Pre-induction lung auscultation reveals bilateral basilar crackles. Which reversal agent is most appropriate to correct the INR?
A. Vitamin K
B. FFP
C. Factor VIIa
D. PCC
```
D. PCC
- Vitamin K isnt fast enough
- Don't want to give the volume of FFP because of the lung crackles
83
Common fibrinolytics
- tPA (Tissue Plasminogen Activator)
| - Urokinase
84
MOA of tPA
Activates fibrinolysis by converting plasminogen to plasmin (plasmin breaks down fibrin thus breaks down
85
MOA of Urokinase
- Activates fibrinolysis by converting plasminogen to plasma
- Decreases RBC aggregation
- Decreases plasma viscosity
86
Is Coumadin used in the OR?
No - increases risk of periop bleeding
87
Are fibrinolytics for use in the OR?
No - causes profound bleeding and possible cerebral hemorrhage
88
When is tPA given for a thrombotic CVA?
Within 3 hours of onset - if its given over 3 hours there is risk of conversion to a hemorrhagic stroke
89
Recommendation for pre-op discontinuation of tPA
1-3 hours
90
Recommendation for pre-op discontinuation of Urokinase
1 hour
91
Options for reversal of fibrinolytics (tpa + urokinase)
- Cryo
| - FFP
92
```
A 22 year-old female, postpartum day 2 from a NSVD, becomes hemodynamiclly unstable. Her left leg is swollen and spiral CT reveals a saddle pulmonary embolus. tPA is given emergently, but her condition does not improve and she is brought to the OR for emergent embolectomy. The most appropriate strategy for the reversal of tPA is:
A. Cryoprecipitate.
B. FFP.
C. Antifibrinolytics.
D. Expectant management.
```
D. Expectant management
93
What is TXA (tranexamic acid)
Antifibrinolytic
94
MOA of TXA
Prevents plasminogen/plasma from binding to fibrin. Promotes stability of the clot
95
Positive perioperative effects of TXA
-Improved clot stability and hemostasis
96
Negative potential perioperative effects of TXA
- Harmful clotting in DIC patients
- Harmful clotting in FV Leiden patients
- Possible seizures
97
Bolus dose for TXA
15mg/kg over 10min on heparinization
98
Infusion dose for TXA
7.5mg/kg/hr until CPB is over or the bag runs out
99
How should you consider dosing TXA?
On ideal body weight -- too much may cause seizures
100
High risk neuraxial procedures to have while on anticoagulants
- Spinal cord stimulator
- Intrathecal catheter and pump implant
- Vertebroplasty/kyphoplasty
- Epidural decompression
101
What is the electrophysiologic mechanism responsible for most clinically important arrhythmias?
Reentry
102
What causes reentry?
A propagating impulse fails to die out after normal activation of the heart and persists to re-excite the heart after the refractory period has ended
103
Underlying causes of dysrhythmias
- Myocardial ischemia
- Arterial hypoxemia
- Bradycardia
- Electrolyte imbalance
- Certain drugs
- Acid-base changes
- ANS changes
104
Negative effects of persistent dysrhythmias
- Compromised hemodynamic function
| - Predisposes to life threatening dysrhythmias such as v-tach and v-fib
105
Action of Class I antidysrhythmics
Membrane stabilizers
106
Action of Class II antidysrhythmics
Beta antagonists
107
Action of Class III antidysrhythmics
Prolong repolarization
108
Action of Class IV antidysrhythmics
Calcium channel blockers
109
Effects of Class I antidysrhythmics
- Decrease automaticity
- Decrease conduction through bypass tracts
- Decrease phase 0 depolarization
110
MOA of Class I antidysrhythmics
Blocking fast Na+ channels and decreasing phase 0 depolarization
111
Class IA drugs
- Quinidine
- Procainamide
- Disopyramide
112
Class IB drugs
- Lidocaine
- Tocainide
- Phenytoin
113
Class IC drugs
- Flecainide
| - Lorcainide
114
Indications for Quinidine
- A-fib
- Wolff Parkinson White syndrome
- PVCs
115
Oral dose of Quinidine
200-400mg QID
116
IV dose of Quinidine
50-75mg/hour
117
MOA of Quinidine
- Decreases slope of phase 4
| - Increases fibrillation threshold
118
Side effects of Quinidine
- Diarrhea (up to 40%)
- EKG changes (can prolong QRS and cause v-fib)
- Syncope/sudden death
- Hypotension
- Allergic reaction
119
Uses for Procainamide
- PVT
- PVCs
- VENTRICULAR tachydysrhythmias (not atrial)
120
Bolus dose of Procainamide
100mg IV every 5 minutes
121
Max dose of Procainamide
15mg/kg
122
Infusion dose of Procainamide
2-6mg/min
123
MOA of Procainamide
- Decreases slope of phase 4 like Quinidine but with less QT effects
- Prolongs QRS
124
Side effects of Procainamide
- Myocardial depression
- Hypotension
- Asystole or v-fib
- SLE-like syndrome
- Allergic rash
125
Uses for disopyramide
Atrial and ventricular tachydysrhythmias
126
Route of administration of Disopyramide
Oral
127
MOA of Disopyramide
Like quinidine (decreases slope of phase 4)
128
Side effects of Disopyramide
- Direct myocardial depression
- Anticholinergic activity
- Prolonged QT and PVT
129
Uses for lidocaine
-Ventricular dysrhythmias (PVC, v-tach)
130
IV dose of lidocaine
2mg/kg
131
Infusion dose for lidocaine
1-4mg/min
132
IM dose of lidocaine
4-5mg/kg
133
MOA of Lidocaine
Delays rate of phase 4 depolarization and blocks sodium channels in depolarized tissues
134
Side effects from plasma concentrations of lidocaine over 5mcg/ml
Stimulation of CNS
135
Side effects from plasma concentrations of lidocaine of 5-10mcg/ml
- Seizures
| - Hypotension
136
Side effects from plasma concentrations of lidocaine over 10mcg/ml
- CNS depression
- Apnea
- Cardiac arrest
137
Uses of Phenytoin
- Paradoxical VT
- Torsade de Pointes
- Digitalis toxicity
138
Dosage of Phenytoin
1.5mg/kg every 5 minutes (10-15mg/kg)
139
MOA of Phenytoin
- Shortens QT interval
| - Improves conduction through AV node
140
Side effects of Phenytoin
- CNS disturbances (cerebellar symptoms)
- Increased blood glucose
- Bone marrow suppression
- Hypotension
141
Uses for Mexiletine/Tocainide
Ventricular tachydysrhythmias
142
Dose of Mexiletine
150-200mg PO every 8 hours
143
Dose of Tocainide
800mg PO every 8 hours
144
Side effects of Mexiletine/Tocainide
- Epigastric burning
| - Neurologic effects
145
Rare side effects with Tocainide
- Bone marrow depression
| - Pulmonary fibrosis
146
Uses for Flecainide
- Atrial tachydysrhythmias
- Ventricular premature beats
- WPW
147
MOA of Flecainide
- Decrease conduction blocks through AV node
| - May decrease SA node function
148
Side effects of Flecainide
- Negative inotropic effect
- Prodysrhythmic effect
- Vertigo
- Visual accommadation problems
149
Class II antidysrhythmic drugs
- Propranolol
- Metoprolol
- Esmolol
150
Indications for Class II antidysrhythmics
- Afib
- A-flutter
- PAT
- Digitalis-induced ventricular dysrhythmias
151
MOA of Class II antidysrhythmics
- Blocks sympathetic activity
- Decreases rate of phase 4 depolarization
- Decreases rate of SA node discharge
152
Side effects of Class II antidysrhythmics
- Bradycardia
- CHF
- Bronchospasm
- Allergic rash
- Mental depression
- Fatigue
153
Class III antidysrhythmic drug
Amiodarone
154
Indications for Amiodarone (Class III antidysrhythmic)
- Refractory SVT or V-tach
| - WPW
155
Oral dose of Amiodarone
200-400mg per day
156
IV dose of Amiodarone
150mg over 10 minutes then 1mg/min
157
MOA of Amiodarone
Prolongs refractory period in all cardiac tissue (atrial + ventricular)
158
Side effects of Amiodarone
- Pulmonary toxicity
- Ventricular tachydysrhythmias
- Hypotension
- Bradycardia
- Heart block
159
Class IV antidysrhythmic drugs
- Verapamil
| - Diltiazem
160
Indication for Class IV antidysrhythmics
- PSVT
| - A-fib/a-flutter
161
IV dose of Verapamil
5-10mg
162
PO dose of Verapamil
80-120mg PO q 6-8hrs
163
IV dose of Diltiazem
20mg IV
164
MOA of Class IV antidysrhythmics
- Decrease phase 4
| - Depresses AV node and slows conduction
165
Metabolism and excretion of class IV antidysrhythmics
- Hepatic metabolism
| - Renal excretion
166
Side effects of class IV antidysrhythmics
- Hypotension
- AV block
- Direct myocardial depression
- PR prolongation (not great for patients with 1st degree block)
167
Indications for Digitalis
- Atrial tachydysrhythmias
| - Heart failure
168
Oral dose of Digitalis
0.5-1mg over 12-24 hours
169
MOA of Digitalis
- Increase phase 4 slope
| - Increase AV node refractoriness
170
Side effects of Digitalis
- Digitalis toxicity
- EKG changes
- Cardiac dysrhythmias
- Nausea
- Disturbances of cognitive function
171
Indications for Adenosine
- PSVT
| - WPW
172
Dose of Adenosine
6mg IV then repeat in 3 minutes with 6-12mg
173
MOA of Adenosine
Hyperpolarizes cell and increases refractory period (similar to CCB)
174
Side effects of Adenosine
- Transient AV block
- Bronchospasm
- Facial flushing
- Headache
- Dyspnea
175
What adjunct equipment should you consider when planning to use Adenosine?
External pacing pads
176
What is COX?
Cyclooxygenase - enzyme that catalyzes the synthesis of prostaglandins and arachidonic acid
177
Functions of prostaglandins
- Inflammation
- Renal perfusion
- Platelet aggregation
178
Where is COX-1 located?
- Gastric mucosa
- Platelets
- Renal parenchyma
179
Actions of COX-2
"Pain inducing enzyme" - mediates inflammation, pain, fever, and carcinogenesis
180
4 main properties of NSAIDS
- Analgesia
- Antiinflammatory
- Antipyretic
- Platelet inhibition
181
Why isn't Tylenol considered an NSAID?
It isn't anti-inflammatory
182
MOA of NSAIDS
Inhibits both COX enzymes without specificity
183
Do NSAIDS have high first pass metabolism?
No - limited 1st pass hepatic extraction
184
Protein binding of NSAIDS
Highly protein bound to albumin because they are acidic
185
pKa of NSAIDS
pK 3-5
186
Why are NSAIDS good for arthritis/joint pain?
They sequester in synovial tissue
187
How does elimination time correspond with therapeutic time of NSAIDS?
It doesnt -- aspirin is eliminated in 1 hour but effects are seen for 24 hours
188
Advantages of NSAIDS
- Decreases activation of nociceptors
- Less N/V
- No respiratory depression
- No addiction
- Long duration
- No pupil changes
- No cognitive effects
189
Disadvantages of NSAIDS
- Inhibits platelet aggregation
- Gastric ulceration
- Renal dysfunction
- Hepatocellular injury
- Asthma exacerbation
- Poor bone healing
- Displaces drugs that are protein bound
190
Adverse GI effects of NSAIDS
- Dyspepsia
- N/V
- Stomach pain
- Peptic ulcers
- GI hemorrhage
191
Adverse coagulation effects of NSAIDS
- Platelet dysfunction
| - Decreases thromboxane and makes platelets more slippery
192
Clinical uses of ASA
- Analgesia
- Antipyretic
- Antiplatelet
- 1st line fever reducer
193
Side effects of ASA
- GI upset
- Prolonged PT
- Induces asthma
- Prolonged bleeding
194
Which NSAID is safe for renal patients?
ASA
195
Uterine effects of ASA
- Can prolong labor
| - Risk of hemorrhage from placenta
196
NSAID that can induce Reye's Syndrome
ASA
197
Which patients should not receive ASA?
- Kids (Reye's syndrome)
| - Asthmatics
198
Acetominophen does not have which of the following properties
Anti-inflammatory
199
Dose of IV acetaminophen
1000mg every 6 hours
200
Max dose of acetaminophen
4g in 1 day
201
Per kilo dose of IV acetaminophen
15mg/kg (up to 75mg/kg/day)
202
Adverse side effects of Tylenol
- Hepatic toxicity
| - Prostaglandin inhibition and decrease in renal perfusion
203
Which patients should not receive tylenol?
Liver failure patients
204
How does acetominophen differ from ASA?
- No gastric irritation
| - No platelet aggregation effects
205
Actions of Ketorolac
- Potent analgesic
| - Minimal antiinflammatory
206
Adult dosage of Toradol
30mg IM or IV every 6 hours
207
Peds dose of Toradol
0.5mg/kg IM or IV every 6 hours
208
Patients cannot have Toradol if their Creatinine is over
1.2
209
Adverse effects of Toradol
- Renal toxicity
- Platelet inhibition
- Affects bone growth
210
Which NSAID is used to close the PDA after a baby is born?
Indomethacin
211
What common NSAID is a propionic acid derivatives?
Ibuprofen
212
NSAID used for gout
Phenylbutazone
213
What is Celebrex
COX-2 inhibitor
214
COX-2 inhibitors have a high incidence of what adverse effect
Thromboembolic events
215
Chest compressions begin when a neonate's heart rate drops below
60
216
Most common cause of respiratory arrest in peds
Hypoxia
217
Effects of pediatric renal physiology on drug administration
Babies have a lower GFR so medications excreted by glomerular filtration may have a prolonged half life. Less frequent dosing of antibiotics.
218
Hepatic physiologic differences in peds
- P450 system is 50% of adults
| - Phase II is impaired in neonates
219
Since phase II of drug metabolism is impaired in neonates, the excretion of what commonly used drugs are affected?
- Benzos
- Morphine
- Caffeine
220
Why do neonates have delayed excretion of medications?
- Large volume of distribution due to increased total body water content
- Lower protein binding
221
How are half lives of drugs different in neonates?
Shortened -- the half life of drugs increases as they approach adulthood
222
If a patient has a mitochondrial disease, what induction drug should be avoided?
Propofol
223
Peds propofol dosing for a pure IV induction
2.5-3mg/kg
224
Peds propofol dosing after an inhalation induction
1mg/kg
225
Contraindications to ketamine
- Active URI
- Increased ICP
- Open globe injury
- Psych/seizure disorder
226
Pediatric dose for IV ketamin
0.5-2mg/kg
227
Pediatric dose for IM ketamine
4-6mg/kg
228
Pediatric dose for oral ketamine
6-10mg/kg
229
Peds dosing for oral versed
0.5mg/kg
230
Max of oral versed in pediatrics
15mg
231
IV dose of succinylcholine in infants
2mg/kg
232
IM dose of succinylcholine in infants
5mg/kg
233
Im dose of succinylcholine in children over 6 months
4mg/kg
234
Side effect of sux
Can cause bradycardia - treat with atropine
235
What NMB may last longer in infants?
Roc - give 1/3 to 1/2 the usual dose
236
Former preemies are prone to apnea up to __ weeks PCA
60
237
Considerations for airway of Trisomy 21 patients
- C spine instability
| - Macroglossia
238
Trisomy 21 patients are good candidates for what anesthetic drug?
Precedex
239
Dose of precedex for peds
Under 0.5mcg/kg over an hour
240
Local anesthetics commonly used in caudal blocks
Ropivicaine or Marcaine with epi
241
What drug can be given in the caudal block to help potentiate it
1mcg/kg clonidine
242
Common acid/base disorder in peds patients coming in for pyloromyotomy
Metabolic alkalosis
243
Anesthetic considerations for pyloromyotomy
- RSI
- Tachypnea due to metabolic alkalosis
- Prone to post op apnea
- Avoid narcs or go very light
244
MOA of Sulfonylureas
Increase insulin release from pancreatic beta cells
245
MOA of biguanides
Reduces hepatic glucose production
246
Commonly used sulfonylureas
- Glipizide
- Glyburide
- Chlorpropamide
- Tolbutamine
247
Commonly used biguanide
Metform
248
Rapid acting insulin drug
Lisopro (Humalog)
249
Short acting insulin drug
Regular (Humulin L, Novolin R)
250
Intermediate acting insulin drug
NPH
251
Starting dose of Clevidipine
1-2mg/hr
252
Top end for Clevidipine dosing
16mg/hr
253
Clevidipine achieves about a __% reduction in systolic blood pressure
25
254
Antidysrhythmic with bone marrow suppression
Phenytoin
255
Adenosine dosage
6mg IV then 6-12mg
256
Warfarin - mechanism of action
Inhibits synthesis of vitamin K factors 2 7 9 10
257
Protamine - side effects
- Hypotension
- Bleeding
- Increased pulmonary pressures
- Bronchoconstriction
258
Action of tranexamic acid
Antifibrinolytic that prevents clot breakdown by preventing plasminogen/plasmin from binding to fibrin
259
Toradol IV and Morphine doses
30mg toradol=10mg morphine
260
Effects of heparin - FFP
ATIII deficiency is caused by re-dosing heparin. This is treated with FFP
261
Antidysrhythmic, class IV example
Verapamil, diltiazem
262
Antidysrhythmic, class IV mechanism
Ca2+ blocker
263
NSAID and renal dysfunction
Don't use Toradol in patients with renal dysfunction or Cr over 1.2
264
Antifibrinolytic therapy post bypass
TXA
265
NSAID for treatment of PDA
Indomethacin
266
Antidysrhythmic - beta blocker class
Class II
267
Vitamin K dependent coag factors
2, 7, 9, 10
268
Amiodarone infusion rate
1mg/min
269
Oral anticoagulants
Coumadin
270
Insulin - duration of action
6-8 hours
271
Hirudin - mechanism of action
Direct thrombin inhibitor
272
Ondansetron pediatric dosage
0.1mg/kg
273
Predmedication: children
0.5mg/kg oral
274
Lab value and ketorolac
Look at creatinine
275
Heparin-versal of
Protamine
276
INR after anticoagulation
2-3
277
Lab values with heparin administration
- PTT
| - A
278
Dose of heparin for CPB
400units/kg
279
NPH abbreviation
Neutral Protamine Hagedorn
280
Coumadin reversal
Subacute - Vitamin K
| Acute - FFP 5-8cc/kg, Factor 7a, factor 9, PCC
