Pharm B Test 2 Flashcards

1
Q

How does blocking alpha 2 receptors affect circulating levels of norepi

A

Blocking alpha2 blocks the reuptake of norepinephrine, thus increasing circulating levels of norepi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1st generation non-selective beta blockers, such as propranolol, should not be given to which patients?

A

Asthmatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Effect of beta-1 activation on the heart

A

Increase HR, contractility, and conduction velocity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Examples of beta-1 agonists (3)

A
  • Dobutamine
  • Dopamine
  • Isoproterenol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of commonly used beta-1 specific antagonists (2)

A
  • Metoprolol

- Esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Effect of beta-2 activation on blood vessels

A

Dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Effect of beta-2 activation on bronchioles

A

Dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Effect of beta-2 activation on uterus

A

Relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Effect of beta-2 activation on kidneys

A

Renin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Effect of beta-2 activation on pancreas

A

Insulin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Example of a commonly used beta-2 agonist

A

Albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effect of alpha-1 activation on blood vessels

A

Constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Effect of alpha-1 activation on pancreas

A

Inhibits insulin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Effects of alpha-1 activation on intestines/bladder

A

Constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Example of alpha-1 agonist

A

Phenylephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examples of alpha-1 antagonist (3)

A
  • Prazosin
  • Phentolamine
  • Labetolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Effect of alpha-2 activation on pre-synaptic sympathetic nerve endings

A

Inhibit norepinephrine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Alpha-2 affects the central nervous system by increasing conductance of which electrolyte

A

K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Effect of alpha-2 activation on platelets

A

Aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Examples of alpha-2 agonists (2)

A
  • Clonidine

- Dexmedetomidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Examples of alpha-2 antagonists (2)

A
  • Yohimbine

- Phentolamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinical uses for alpha antagonists

A
  • Pheochromocytoma
  • CHF
  • Benign prostatic hypertrophy
  • Raynaud’s phenomenon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Effect of a-2 blockade on sympathetic NS

A

Increases sympathetic outflow and increases the release of norepi from nerve endings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MOA of alpha antagonists

A

Binds selectively to alpha receptors and blocks activity of catecholamines at receptor sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Side effects of alpha antagonists

A

1) Orthostatic hypotension and syncope
2) Reflex tachycardia
3) Impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is phentolamine

A

Competitive non-selective alpha blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Clinical uses for phentolamine

A

Acute hypertensive emergencies that can be seen in patients with pheochromocytoma or autonomic hyperreflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Effects of phentolamine due to its effects on alpha-1 receptors

A
  • Decrease in systemic BP due to direct action on vascular smooth muscle
  • Reflex tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Effects of phentolamine due to its effects on alpha-2 receptors

A
  • Increases release of NE
  • Increase HR and CO
  • Abdominal pain/diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is Prazosin

A

Alpha 1 selective blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which vessels are affected by Prazosin

A

Both arterioles and veins are dilated by Prazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How is Prazosin used preoperatively?

A

Used to treat pre-op BP in patients with pheochromocytomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Prazosin is commonly taken by patients with what diseases? (3)

A
  • Pheochromocytoma
  • Raynauds
  • BPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What drug class does Terazosin (Hytrin) belong to?

A

Alpha1 blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What drug class does Tamulosin (Flomax) belong to?

A

Alpha1 blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Tamulosin (Flomax) acts preferentially on alpha-1 receptors located where?

A
  • Vesical trigone muscle
  • Urethra
  • Prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Tamulosin (Flomax) is primarily used to treat which disease?

A

BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is Yohimbine

A

Selective alpha2 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does Yohimbine work to increase BP

A

Causes increased release of NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Clinical uses for Yohimbine

A
  • Idiopathic orthostatic hypotension

- Impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is Phenoxybenzamine

A

Non-competitive, irreversible, non-selective alpha blocker that is taken orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Phenoxybenzamine has a greater effect on which alpha receptor?

A

Alpha-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MOA of Phenoxybenzamine

A

Prevents inhibitory action of epinephrine on the secretion of insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Clinical uses for Phenoxybenzamine

A
  • Orthostatic hypotension

- Pre-op tx for patients with pheo and Raynaud’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Major sites of action for beta blockers

A
  • Heart
  • Smooth muscles of airway
  • Smooth muscles of blood vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Should beta blockers be continued throughout the perioperative period?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

In which surgery should you NOT give beta blockers or have patient’s continue their beta blockers?

A

Aortic valve surgeries in which they are planning to pace them to 200+ bpm to decrease blood flow to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the first med you should consider when you see new ST changes on an EKG during surgery?

A

Beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Cardiovascular uses for beta blockers

A
  • Essential HTN
  • Angina pectoris
  • Acute coronary syndrome
  • Cardiac dysrhythmias
  • CHF
  • Preop prep of hyperthyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Therapeutic uses for beta blockers (other than cardiovascular)

A
  • Prevention of bleeding in portal hypertension
  • Treatment of migraine, tremor, anxiety, alcohol addiction
  • Treatment of glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What determines the receptor selectivity of beta blockers?

A

Dose - if you give enough esmolol, it can start blocking beta 2 also

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Negative cardiovascular side effects from beta blockers

A
  • Negative iontropy and chronotropy
  • Decrease AV node conduction
  • Accentuate AV block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Beta blockers can increase the concentration of which drugs/drug classes?

A
  • Local anesthetics

- Fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do beta blockers affect MAC values?

A

Decreases MAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Adverse effects of beta blockers on metabolism

A
  • Increase in triglycerides

- Hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Should patients who are lactating be given beta blockers?

A

No - it is contraindicated because they can cross into breast milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Beta blockers can aggravate which pre-existing diseases?

A
  • CHF
  • Asthma
  • AV blocks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How can beta blockers affect an anaphylactic reaction?

A

They can impair the body’s response to epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Prototype non-selective beta blocker

A

Propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

CV effects of Propranolol

A

Decrease heart rate, contractility, and cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Propranolol causes the retention of which electrolyte

A

Na+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Which beta blocker undergoes extensive first pass metabolism?

A

Propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

IV dose of propranolol

A

0.05mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which non-selective beta blocker has a long duration of action

A

Nadolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Which non-selective beta blocker is used to treat glaucoma and decrease IOP

A

Timolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which non-selective beta blocker prolongs cardiac action potential and can lead to v-tach

A

Sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which non-selective beta blocker is used to treat SVT

A

Sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How do non-selective beta blockers affect diabetics

A

May potentiate insulin induced hypoglycemia due to beta-2 blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How do non-selective beta blockers affect asthma/COPD

A

Increases airway resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is Metoprolol

A

B1 selective blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Dose of metoprolol

A

1-2mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Concentration of metoprolol

A

1mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Which beta blocker is the MOST beta 1 selective?

A

Atenolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Short acting beta-1 blocker

A

Esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

IV dose of esmolol

A

0.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Infusion dose of esmolol

A

0.1-0.3mg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How is esmolol metabolized

A

Hydrolysis by plasma esterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is labetalol

A

Alpha1 antagonist and beta1/beta2 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Ratio of beta:alpha effects in oral labetalol

A

3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Ratio of beta:alpha effects in IV labetalol

A

7:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

CV effects of labetalol

A
  • Decreases SVR (due to alpha1 activity)
  • Decrease HR
  • Blocks reflex tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Onset time of Labetalol

A

5-10minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

IV dose of Labetalol

A

0.1-0.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Elimination half life of Labetalol

A

5 hours, hangs around for a long time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is Carvedilol

A

Beta antagonist with alpha1 antagonist activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Ratio of beta:alpha activity of Carvediolol

A

10:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Clinical uses for Carvedilol

A
  • Essential HTN

- Symptomatic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Most common adverse reactions to Carvedilol

A
  • Edema
  • Dizziness
  • Bradycardia
  • Hypotension
  • Nausea
  • Diarrhea
  • Blurred vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is Clonidine

A

Non-selective alpha agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What can be caused by acute withdrawal of clonidine?

A

Hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Clinical uses for clonidine

A
  • Hypertension
  • Used in caudals and epidurals for post-op pain
  • Anxiety
  • Sleep aid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is dexmedetomidine

A

Short acting alpha-2 agonist with anxiolytic, anesthetic, hypnotic, and analgesic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Dexmedetomidine is a good drug to use for what airway management?

A

Awake fiberoptic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the method of action of an alpha-2 agonist?

A

It stimulates the reuptake of norepi, thus decreasing circulating levels. It’s a sympatholytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

2 main side effects of dexmedetomidine

A
  • Hypotension

- Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Under what circumstances should dexmedetomidine be used with caution? (7)

A

1) Hypovolemia
2) Hypotension
3) Chronic hypertension
4) Elderly
5) Diabetes mellitus
6) Advanced heart block
7) Severe ventricular dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

IV dose of dexmedetomidine

A

1mcg/kg over 10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Infusion dosing of dexmedetomidine

A

0.2-0.7mcg/kg/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

If you don’t start out with a bolus, how long will it take a dexmedetomidine infusion to reach effective plasma levels?

A

45 minutes to an hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the benefits of dexmedetomidine over other available sedative agents?

A
  • Lack of respiratory depression
  • Decreases the need for opioid analgesics
  • Less cardiovascular instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

IV dose of clonidine

A

4-8mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Infusion dose of clonidine

A

2mcg/kg/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Epidural dose of clonidine

A

6-8mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Intrathecal dose of clonidine

A

30-225mcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

A patient on chronic beta blockers must be given a beta blocker within __ hours of surgery

A

24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

For cardiac cases, all patients must be given a beta blocker dose within __ hours of surgery

A

6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

A beta blocker is contraindicated if the heart rate is below

A

50bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is insulin?

A

A hormone secreted by pancreatic beta cells that causes the uptake of glucose into skeletal muscle and fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Actions of insulin

A
  • Carries glucose across cell membranes
  • Increases synthesis of glycogen, protein, fatty acid (storage molecules)
  • Decreases glycogenolysis, gluconeogenesis, lipolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Insulin is used for treatment of what electrolyte imbalance?

A

Hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

How does insulin affect K+

A

Increases K+ entry into adipose and muscle tissue thus decreasing serum potassium levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What other drug is given in combination with insulin to treat hyperkalemia?

A

Dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What dose of insulin+dextrose is used to lower the serum K+ by 1meq/L?

A

10 units insulin + 25g dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Level of serum K+ at which T wave abnormalities appear

A

5.5mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Level of serum K+ at which EKG intervals widen

A

6.5mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Level of serum K+ at which P wave changes start

A

7.0mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Level of serum K+ at which P waves disappear (atrial arrest)

A

8.8mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

The EKG becomes a sine wave at what serum K+ level

A

9.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is the only type of insulin that is approved to be administered via IV route?

A

Humulin or Novolin (regular insulin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Onset of regular insulin

A

30-60min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Duration of regular insulin

A

6-8hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What percentage of regular insulin undergoes 1st pass metabolism by kidneys and liver?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Basal rate of insulin production

A

1unit/hour (40unit/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Rapid acting insulin medication

A

Lispro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Short acting insulin medication

A

Regular insulin (CZI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Intermediate acting insulin medication

A

Isophane (NPH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Long acting insulin medication

A

Ultralente

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What are the clinical uses for regular insulin?

A
  • Hyperglycemia
  • Hyperkalemia
  • Ketoacidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Subcutaneous regular insulin is not reliable under what circumstances

A
  • Peripheral edema
  • Volume overload
  • Temperature variations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

When should you not use subq insulin?

A
  • If there are expected electrolyte or acid/base changes during surgery
  • Critically ill patients (they have variable tissue perfusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Why is ultralente insulin so long acting?

A

Because of the large particle size and crystalline form

132
Q

By how much does 1 unit of insulin lower blood glucose levels?

A

25-30mg/dL

133
Q

What is the normal calculation for insulin dosing units/hr?

A

(Glucose-100)/40

134
Q

What calculation do we use in the OR to calculate the dosage of insulin in units/hr?

A

Glucose/150

135
Q

Most serious side effect of hypoglycemia

A

Irreversible brain damage

136
Q

Initial symptoms of hypoglycemia

A
  • Diaphoresis
  • Tachycardia
  • Hypertension
137
Q

Treatment options for severe intraop hypoglycemia

A
  • 50-100ml of 50% glucose

- 0.5-1.0mg glucagon

138
Q

What is a side effect of using glucagon to treat hypoglycemia?

A

Nausea and vomiting

139
Q

What diabetic medication should be held the day before surgery?

A

SGLT-2 inhibitors

140
Q

What diabetic medications should be held the day of surgery for a minimally invasive surgery?

A
  • Secretagogues

- SGLT-2 inhibitors

141
Q

Under what circumstances should ALL diabetic medications be held the day of surgery?

A
  1. Reduced post-op oral intake

2. Extensive surgery with expected hemodynamic changes or fluid shifts

142
Q

MOA of secretagogues

A

Stimulate beta cells to secrete insulin

143
Q

Examples of secretagogues

A
  • Sulfonylureas

- Glinides

144
Q

Examples of SGLT2 inhibitors

A
  • Dapaglifozin

- Canaglifozin

145
Q

MOA of thiazolidnediones (TZDs)

A

Increase insulin sensitivity by acting on tissues to increase glucose utilization and decrease glucose production

146
Q

2 currently available TZDs

A
  • Thiazolidinediones

- Pioglitazone

147
Q

MOA of DPP-4 inhibitors (gliptins)

A

Increases levels of active glucagon-like peptide1 which increases insulin secretion and reduces glucagon secretion

148
Q

MOA of biguanides

A

Decrease amount of glucose release into the bloodstream by the liver

149
Q

MOA of SGLT2 inhibitors

A

Block the reabsorption of glucose in the kidneys thus increasing glucose excretion

150
Q

Main example of a biguanide

A

Metformin

151
Q

MOA of metformin

A

Inhibits gluconeogenesis in the liver and kidney

152
Q

Side effects of metformin

A

1) Lactic acidosis
2) Anorexia
3) Nausea and diarrhea

153
Q

You should use metformin carefully in which patients?

A

Patients with renal dysfunction

154
Q

What blood molecule is an independent predictor for the development of cardiomyopathy and heart failure

A

Hemoglobin A1C

155
Q

Normal A1C levels

A

Less than 6

156
Q

Surgical goal for glucose levels in critically ill patients

A

110-180

157
Q

Surgical goal for glucose levels in non-critically ill patients

A

140-180

158
Q

What should be done if a patient is on an insulin pump on arrival to the hospital and their blood glucose is below 80

A

Turn off pump and correct per hypoglycemia protocol

159
Q

What should be done if a patient is on an insulin pump on arrival to the hospital and their blood glucose is over 80?

A

Turn off pump and start VRII at basal rate

160
Q

Insulin infusions should be considered when blood glucose levels are over

A

180

161
Q

How should starting infusion rates for insulin be calculated

A

Glucose/100 (units/hr)

162
Q

Units of insulin necessary for blood glucose of 181-200

A

2

163
Q

Units of insulin necessary for blood glucose of 181-200 in insulin resistant patients

A

3

164
Q

Units of insulin necessary for blood glucose of 201-250

A

3

165
Q

Units of insulin necessary for blood glucose of 201-250 in insulin resistant patients

A

4

166
Q

Units of insulin necessary for blood glucose of 251-300

A

4

167
Q

Units of insulin necessary for blood glucose of 251-300 in insulin resistant patients

A

6

168
Q

Units of insulin necessary for blood glucose of 300-350

A

6

169
Q

Units of insulin necessary for blood glucose of 300-350 in insulin resistant patients

A

8

170
Q

Units of insulin necessary for blood glucose over 350

A

7

171
Q

Units of insulin necessary for blood glucose over 350 in insulin resistant patients

A

10

172
Q

How often should glucose be checked if the patients glucose is under 100

A

Every 30 minutes until glucose is over 110

173
Q

How often should glucose be checked if patients glucose is under 70

A

Every 15 minutes until glucose is over 70

174
Q

Pharmacologic effects of Ca2+ channel blockers

A
  • Decrease contractility
  • Decrease heart rate by working at SA/AV node
  • Decrease BP via vasodilation
175
Q

3 classes of Ca2+ blockers

A
  • Phenylalkylamines
  • Dihydropyridines
  • Benzothiazepines
176
Q

Most commonly used phenylalkylamine

A

Verapamil

177
Q

Examples of dihydropyridines

A
  • Nicardipine
  • Nimodipine
  • Amlodipine
178
Q

Most common benzothiazepine

A

Diltiazem

179
Q

Clinical uses of Ca2+ channel blockers

A
  • Coronary artery spasm
  • Stable angina
  • Cerebral vasospasm
  • HTN
180
Q

Which dihydropyridine Ca2+ blocker crosses the BBB

A

Nimodipine

181
Q

How should Ca2+ blockers be administered to treat cerebral vasospasm

A

Intra-arterially

182
Q

Which CCB also works on Na+ channels?

A

Verapamil

183
Q

Actions of verapamil

A
  • SA/AV node depression
  • Negative inotropy
  • Vasodilator
184
Q

Clinical uses of verapamil

A
  • Treatment of SVT
  • Stable angina
  • Essential HTN
  • Maternal/fetal tachydysrhythmias
  • Cerebral vasospasm
185
Q

Actions of Nifedipine

A
  • VASODILATION (main action)

- Reflex tachycardia

186
Q

Clinical uses of Nifedipine

A
  • Angina

- HTN emergencies

187
Q

Actions of Nicardipine

A
  • VASODILATION
  • No SA/AV node action
  • Minimal myocardial depression so good for patients with bad hearts
188
Q

Most common concentrations of Nicardipine

A

100 or 200mcg/ml

189
Q

Dose of Nicardipine infusion

A

5mg/hour

190
Q

Clinical uses for Nicardipine

A
  • Periop HTN
  • Improving LV function during ischemia
  • Coronary spasm
191
Q

What is Nimodipine?

A

Lipid soluble analogue of Nifedipine that crosses the BBB

192
Q

Clinical use of Nimodipine

A

Cerebral vasospasm

193
Q

Actions of Diltiazem (Cardizem)

A
  • Decreases AV node conductance

- Coronary vasodilation

194
Q

Clinical uses for Diltiazam (Cardizem)

A
  • SVT

- Essential HTN

195
Q

How can CCBs affect the action of NMBs

A

Can prolong the effect

196
Q

How can CCBs affect local anesthetics

A

Can increase the chance of local anesthetic toxicity

197
Q

What is Clevidipine

A

Ultrafast acting 3rd generation dihydropyridine that vasodilates arterial

198
Q

How must Clevidipine be administered

A

Infusion since the half life is so short

199
Q

How is Clevidipine cleared

A

Plasma cholinesterase

200
Q

Clinical uses for peripheral vasodilators

A
  • HTN crisis
  • Maintain controlled hypotension
  • Improve LV stroke volume (CHF, regurgitant valves)
201
Q

How do peripheral vasodilators work

A

Decrease systemic blood pressure by decreasing SVR via nitric oxide release

202
Q

MOA of nitrovasodilators

A

Increase nitric oxide production, thus increasing cGMP production which causes vasodilation

203
Q

How is nitric oxide inactivated

A

Binding to hemoglobin

204
Q

Physiologic cardiovascular effects of nitric oxide

A
  • Maintain basal PVR/SVR
  • Distribute cardiac output
  • Negative inotrope and chronotrope
205
Q

Which part of the vasculature generates the most nitric oxide?

A

Arteries

206
Q

Effects (other than cardiovascular) of nitric oxide

A
  • Pulmonary vasodilation

- Inhibits platelet aggregation

207
Q

Negative effects that can stem from decreased levels of nitric oxide

A
  • Essential HTN
  • Atherosclerosis
  • Vasospasm after SAH
208
Q

Why does hypotension occur during septic shock?

A

Huge flood of nitric oxide is released

209
Q

How do you avoid toxicity from inhaled nitric oxide?

A

Set fresh gas flows higher than minute ventilation

210
Q

What is sodium nitroprusside

A

Iron molecule with 5 cyanide molecules that is an arterial and venous vasodilator

211
Q

MOA of sodium nitroprusside

A

Produces nitric oxide which causes the vasodilation on VASCULAR tissue and reduces preload and afterload

212
Q

Infusion dosing range for sodium nitroprusside

A

0.3-10mcg/kg/min

213
Q

Over what infusion rate do you begin to see CN- accumulation

A

2mcg/kg/min

214
Q

Potential toxicities associated with sodium nitroprusside

A

1) Cyanide
2) Thiocyanate
3) Methemoglobinemia

215
Q

Pros of using SNP

A
  • Short action
  • Pulmonary dilator
  • Effective for all HTNs
  • Greater decrease in afterload than preload (at low doses)
216
Q

Cons of using SNP

A
  • Toxicity
  • Light sensitive
  • Vascular steal
  • Ischemia
  • Rebound HTN
  • Increased ICP (headache)
  • Inhibits platelet aggregation
  • Decreased hypoxic pulmonary vasoconstriction
217
Q

Side effect of giving SNP to awake patients

A
  • N/V

- Headache

218
Q

Symptoms of cyanide toxicity

A
  • Headache

- N/V

219
Q

Treatment options for cyanide toxicity

A
  • Turn off infusion
  • Sodium nitrite (or something that will clear the cyanide)
  • 100% O2
  • Bicarb (for the acidosis)
220
Q

Why can thiocyanate toxicity occur with SNP administration?

A

Impaired renal clearance causes it to build up

221
Q

Symptoms of thiocyanate toxicity

A
  • Fatigue
  • N/V
  • Tinnitus
222
Q

Treatment for thiocyanate toxicity

A

Dialysis

223
Q

Clinical uses for SNP

A
  • Controlled hypotension before cross clamp, aneurysm clip, etc
  • Hypertensive emergencies (ruptured AAA, aortic dissection)
  • Cardiac disease (CHF)
  • Aortic surgery
224
Q

What is nitroglycerin

A

A venous dilator

225
Q

Effect of nitroglycerin on the heart

A

Decreases ventricular wall tension by decreasing preload

226
Q

What percentage of sublingual nitroglycerin is subject to first pass metabolism

A

15%

227
Q

MOA of NTG

A

Causes release of nitric oxide

228
Q

Clinical uses for NTG

A
  • Angina
  • Cardiac failure
  • Acute HTN
  • Controlled hypotension (i.e. during cannula insertion)
229
Q

What is hydralazine

A

An arterial dilator

230
Q

Onset time for hydralazine

A

15 min - wait for it to work!

231
Q

Duration of hydralazine

A

Several hours

232
Q

Dosage of hydralazine

A

2.5-5mg every 15 minutes

233
Q

Clinical uses for hydralazine

A

HTN

234
Q

Side effects of hydralazine

A
  • Reflex tachy
  • Coronary steal
  • Headache
  • Flushing
  • Angina
  • Rash
  • “Lupus like syndrome”
235
Q

How does hydralazine affect blood flow to the uterus

A

Maintains it

236
Q

When is papavarine used

A

To prevent spasm when vessels (i.e. LIMA) are harvested

237
Q

What is adenosine

A

Endogenous nucleotide that is a potent coronary vasodilator with a very quick half life (0.6-1.5sec)

238
Q

Clinical uses for adenosine

A
  • SVT treatment
  • Aneurysm clippings (slows C.O. for clip placement)
  • Thoracic stents
239
Q

What should you have available when administering adenosine

A

Pacing pads

240
Q

What is trimethaphan

A

A ganglionic blocker that is a vasodilator

241
Q

Dosing range for trimethaphan infusion

A

10-200mcg/kg/min

242
Q

Side effect of trimethaphan

A

Blurry vision

243
Q

MOA of ACE inhibitors

A

Inhibits the conversion of angiotensin I to angiotensin II thus decreasing SVR

244
Q

Most common side effect of ACE-Is

A

Coughing

245
Q

Most serious side effect of ACE-Is

A

Angioedema

246
Q

ACE-Is are contraindicated in patients with what?

A

Renal artery stenosis

247
Q

Patients on chronic ACE inhibitors may exhibit what during general anesthesia?

A

Exaggerated hypotension

248
Q

How can the chance of exaggerated hypotension in patients on ACE inhibitors be decreased?

A

Have the patients stop them 12 hours before surgery

249
Q

Benefits of inhaled nitric oxide

A

Improves pulmonary HTN without compromising systemic pressure

250
Q

Dose of inhaled nitric oxide

A

10-40ppm

251
Q

What is the current “go to” drug for pulmonary vasodilation?

A

Epoprostenol (Flolan)

252
Q

What is Epoprostenol (Flolan)

A

Metabolite of arachadonic acid that is a potent vasodilator

253
Q

Patient related risk factors for surgical site infections (SSI)

A
  • Extremes of age
  • Poor nutrition
  • Obese
  • DM
  • Glucose control perioperatively
  • Vascular disease
  • Smoking
  • Preexisting infections
  • Altered immune system
  • Corticosteroid therapy
  • Preop skin prep
  • Length of procedure
254
Q

SCIP guidelines for when prophylactic antibiotics should be received

A

1 hour prior to incision

255
Q

SCIP guidelines for when prophylactic antibiotics should be discontinued after general surgery

A

Within 24 hours

256
Q

SCIP guidelines for when prophylactic antibiotics should be discontinued after cardiac surgery

A

Within 48 hours

257
Q

SCIP guidelines for how long glucose should be monitored after cardiac surgery

A

24 hours

258
Q

According to SCIP guidelines, after what surgeries should patients have immediate postop normothermia

A

Colorectal surgeries

259
Q

Surgical techniques that can reduce chance of SSI

A
  • Gentle traction
  • Effective hemostasis
  • Removal of devitalized tissues
  • Obliteration of dead space with drains, suction
  • Irrigation with saline
  • Fine, non-absorbed sutures
  • Wound closure without tension
260
Q

Perioperative factors affecting incidence of SSI

A
  • Body temp
  • FiO2
  • Fluid management
  • Blood glucose
  • Blood transfusion
  • Antimicrobial prophylaxis
261
Q

Benefits of normothermia in preventing SSIs

A
  • Better wound healing

- Less vasoconstriction

262
Q

Why does hypothermia cause SSI

A
  • Decreases tissue perfusion
  • Decreases superoxide radicals
  • Decreases collagen
  • Induced anti-inflammatory profile
263
Q

Why does hyperglycemia increase chances of SSI

A
  • Decreases leukocyte count
  • Decreases neutrophil function
  • Deactivates immunoglobulines
264
Q

What blood product has the highest risk of infection

A

Platelets

265
Q

How can the risk of SSIs with blood transfusions be reduced

A
  • Use autologous PRBCs

- Use leukocyte reduced units

266
Q

How often should repeat doses of antibiotics be administered?

A

Every 1-2 half lives

267
Q

Which antibiotic classes are bactericidal?

A

Cephalosporins, aminoglycosides, fluoroquinollines, vancomycin, daptomycin, metronidazole

268
Q

Which antibiotic classes are bacteriostatic?

A

Macrolides (erythromycin), tetracyclins, trimethoprim, sulfonamide

269
Q

Clean procedures

A

Closed, elective procedures

270
Q

Clean-contaminated procedures

A

GI/GU, biliary, re-operation within 7 days, lap appy

271
Q

Contaminated procedures

A

Acute inflammation, penetrating trauma within last 4 hours

272
Q

Dirty procedures

A

Preexisting infection, perforated GI, trauma from over 4 hours ago

273
Q

MOA of cephalosporin

A

Inhibits cell wall synthesis

274
Q

The efficacy of cephalosporins depends on…

A

The percent time above minimum inhibitory concentrations

275
Q

How does the coverage against bacteria change as you move down the cephalosporin generations

A

As you get in later generations (3rd, 4th) there is more coverage against gram negative and less against gram positive

276
Q

1st generation cephalosporins

A
  • Cefazolin

- Ceftezole

277
Q

2nd generation cephalosporins

A
  • Cefuroxime (Zinacef)
  • Cefaclor
  • Cefoxitin
278
Q

3rd generation cephalosporin

A

Ceftizoxime

279
Q

4th generation cephalosporins

A
  • Cefclidine

- Cefepime

280
Q

Proper antibiotic and dose for clean procedures

A

Ancef 1-3 grams

281
Q

Ancef dose for patients under 40kg

A

1 gram

282
Q

Ancef dose for patients over 120kg

A

3grams

283
Q

Proper antibiotic and dose for thoracic/orthopedic cases

A

Cefuroxime 1.5grams (2nd generation)

284
Q

Antibiotic options and doses for bowel surgeries

A
  • Cefoxitin 1-2 grams (2nd generation) with mycin
  • Ancef 1-2g + flagyl 500mg
  • Unasyn 3g
285
Q

Antibiotic options and doses for PCN allergic patients

A
  • 1gram vancomycin

- 600-900mg clindamycin

286
Q

Antibiotics that cover gram negative bacteria

A
  • Gentamicin
  • Ciprofloxacin
  • Levaquin
  • Aztreonam
287
Q

MOA of vancomycin

A

Inhibits cell wall synthesis in most gram positive bacteria

288
Q

Dosage of vancomycin

A

15mg/kg q12hr

289
Q

Dose of vanc for patient under 90kg

A

1 gram

290
Q

Dose of vanc for patient over 90kg

A

1.5grams

291
Q

Repeat dosing is beneficial in surgeries lasting over __ hours

A

7

292
Q

Cases in which vancomycin is beneficial

A
  • Prosthetic heart valve

- Vascular graft

293
Q

Antibiotic used in neuro cases that must be re-dosed q2h

A

Nafcillin

294
Q

Recommendation for antibiotics for neurosurgeries

A

1) 1-2g ancef
2) 1-2g nafcillin
3) 1g vanc if PCN allergic

295
Q

Which neuro surgery is not clean?

A

VP shunt

296
Q

In terms of clean/contaminated/dirty/etc.- what is carotid surgery?

A

Clean

297
Q

In terms of clean/contaminated/dirty/etc.- what is tonsil/oropharynx surgeries?

A

Clean-contaminated

298
Q

Recommendation for antibiotics in clean-contaminated head/neck surgeries

A

1) 1-3g ancef

2) 600-900mg clinda + 1.5mg/kg gent

299
Q

In which cardiac surgery should you consider adding antibiotics to cover gram - bacteria?

A

Saphenous vein harvest

300
Q

Antibiotic of choice for cardiac surgery

A

Cefuroxime (2nd gen)

301
Q

Oral antibiotic regimen that most patients take before having colorectal surgery

A

Neomycin + erythromycin or flagyl

302
Q

IV regimen options for colorectal surgery

A

1) 1-2g ancef + 500mg flagyl
2) 1-2g cefoxitin or cefotetan (2nd gen)
3) 3g ampicillin-sulbactam (Unasyn)

303
Q

Gentamycin dose

A

1.5-2mg/kg

304
Q

Antibiotic options for PCN allergic patients coming in for colorectal surgery

A

1) Clindamycin + a “floxacin”

2) Flagyl + aztreoname + gent

305
Q

Antibiotic recommendations for normal lap appy/GI case

A

1) 1-2g ancef

2) 3g Unasyn

306
Q

Antibiotic recommendation for ruptured lap appy

A

2g ancef + 500g flagyl

307
Q

Antibiotic options for PCN allergic patients coming in for GI case

A

Clinda + gent

308
Q

Antibiotic for esophageal/gastroduodenal surgery

A

1-2g ancef

309
Q

Antibiotic for biliary tract

A

1-2g ancef

310
Q

In which orthopedic cases should antibiotics be considered

A
  • Hip repair
  • Joint replacement
  • Fixation
311
Q

Antibiotic options for C-section

A

1) 1 dose of ancef before incision

2) Clinda + gent

312
Q

Antibiotic recommendation for clean GU procedures (i.e. nephrectomy)

A

Ancef

313
Q

Antibiotic recommendation for clean-contaminated GU procedures (bladder reconstruction)

A

Aminoglycoside + flagyl or clinda

314
Q

Antibiotic recommendations for vascular surgeries

A

1) Ancef

2) Vanc + gentamycin 2mg/kg

315
Q

Antibiotic for a patient coming in with infected aorto byfem

A

Vanc

316
Q

Which timing of antibiotic administration was found to have the least incidence of SSI?

A

Preop (0-2hrs before incision)

317
Q

Which timing of antibiotic administration was found to have the highest incidence of SSI?

A

Early (2-24hrs before)

318
Q

How does SBE form?

A

1) Formation of non-infected thrombus
2) Infection of thrombus
3) Proliferation of bacteria

319
Q

High risk factors for SBE

A

1) Prosthetic heart valves
2) History of IE
3) Cyanotic congenital heart disease
4) Surgically constructed systemic and pulmonary conduits

320
Q

Moderate risk factors for SBE

A

1) Bicuspid aortic valve
2) Acquired valvular dysfunction (AS, MS)
3) Hypertrophic obstructive cardiomyopathy
4) Mitral valve prolapse with regurg on auscultation

321
Q

Low risk factors for SBE

A

1) Murmurs
2) Isolated ASD
3) Repair of ASD/VSD/PDA
4) MVP without regurg
5) MR
6) Sclerotic aortic valve
7) Mild TR
8) CAD
9) Rheumatic fever
10) Pacemaker
11) Stent

322
Q

Recommendation for antibiotics for SBE prophylaxis

A

1) 2g ampicillin

2) 1.5mg/kg gentamicin for GI and GU

323
Q

Max dose of gentamicin for SBE prophylaxis

A

150mg

324
Q

Recommendation for antibiotics for SBE prophylaxis in PCN allergic patients

A
  • 600mcg clinda
  • 1g ancef
  • 1g vanc
325
Q

Negative side effect of vancomycin and symptoms

A

Redman syndrome - pruritus, flushing, erythema, hypotension

326
Q

Negative side effect of gentamicin

A

Ototoxicity