Pharm Response To Bypass

Question 1

Drugs affected by altered hepatic flow on CPB

Answer 1

Fentanyl

Propofol

Question 2

Type of drug that sticks to coated surface of tubing

Answer 2

Lipopholic drugs

Question 3

4 things to ensure before administering drugs

Answer 3

Have surgeons permission or written protocol
Patient is not allergic to drug
Have correct drug and dosage
Check for expiration date, precipitates, and sterility

Question 4

8 drugs always in drug box

Answer 4

Heparin
Neo-Synephrine
NaHCO3
Lidocaine
MgSO4
Calcium 
Potassium 
Mannitol

Question 5

Concentration of heparin in mg

Answer 5

100units=1mg

Question 6

Drugs affected by lungs being remove from circulation on CPB

Answer 6

Valium
Propofol
Opioids

Question 7

Action of heparin

Answer 7

Inhibits coagulation by Potentiation ATIII and inhibiting factors 9&11

Question 8

Half life of heparin at CPB doses

Answer 8

2 or more hours

Question 9

4 side effects of heparin

Answer 9

Activate tPA and platelets
Bolus decreases SVR by 10-20%
Anaphylaxis rarely
HIT and HITT

Question 10

Heparin dosing

Answer 10

Loading dose: 300-450 units/kg (distributes in plasma so rarely exceeds 35000-40,000units)
Priming soln: same conc. as patients blood
Most vials will be 1000units/mL

Question 11

Action of Neo-Synephrine

Answer 11

Alpha-1 agonist causing vasoconstriction in arterioles

Duration: less than 5 min

Question 12

Dosing of Neo-Synephrine

Answer 12

IV bolus: 100, 200, or 400ug/mL

IV infusion: 10 or 15mg in 250mL vial (40-60ug/mL)

Question 13

Action of NaHCO3

Answer 13

IV injection as electrolyte replenisher and alkalizer

Treats Hyperkalemia

Question 14

Dosing of NaHCO3

Answer 14

1 amp= 50mEq
Dose (mEq)= 0.3weightBE

Hyperkalemia: adults 50mEq, Peds 1-2mEq/kg

Question 15

Action and duration of lidocaine

Answer 15

Reduces cell membrane permeability to Na and K, increasing stimulation threshold in ventricles
Duration: 15-30min post bolus

Question 16

Lidocaine dosing

Answer 16

IV bolus: 1-2mg/kg
XC removal: 100-200mg
Don’t exceed 300mg/hr

Question 17

Action of MgSO4

Answer 17

Controls transmembrane electrolytes and energy metabolism

Question 18

Causes for hypomagnesia on CPB

Answer 18

Poor preop health
Albumin administration
Citrate blood product administration

Hypomagnesia can cause arrhythmias

Question 19

MgSO4 dosing

Answer 19

2-2.5g bolus
XC removal: 2-4g with Lidocaine
Concentration: 0.5g/mL

Question 20

Action of calcium chloride

Answer 20

Myocardial contractility, blood clotting, neurotransmission, and muscle contraction
Levels drop on CPB: must replenish if give citrate blood products

Question 21

CaCl2 dosing

Answer 21

Concentration: 100mg/mL
Given post XC
Hyperkalemia: adults 0.5-1g CaCl2, Peds 20mg/kg Ca Gluconate

Question 22

Potassium chloride action

Answer 22

Normal cardiac contractions

Question 23

KCl dosing

Answer 23

CPG: 15-30mmol/L
Hypokalemia dose= weight0.3K deficit
Concentration: 2mEq/mL
GIVE SLOWLY

Question 24

Action of mannitol

Answer 24

Osmotic diuretic prevents reabsorption in proximal tubule

Free radical scavenger

Question 25

Mannitol dosing

Answer 25

On CPB: 0.5-1g/kg | 12.5g vials

Question 26

10 drugs that may be in drug box

Answer 26

``` THAM Amicar Trasylol Thrombate III Benadryl Solumedrol Dextrose Albumin Insulin Forane ```

Question 27

Action of THAM (Tromethamine)

Answer 27

Combines with H ions to form Bicarb, causing alkaline environment (buffer)

Question 28

THAM dosing

Answer 28

Concentration: 3.6g/100mL (30mEq) | Dose (mL)= weight*BE*1.1

Question 29

Action of Amicar

Answer 29

Inhibits plasminogen activators to prevent conversion to plasmin Reduces bleeding caused by fibrinolysis

Question 30

Dosing of Amicar

Answer 30

Loading dose: 5g IV

Question 31

Action of Trasylol

Answer 31

Inhibits fibrinolysis and turnover of coagulation factors (serine protease inhibitor)

Question 32

Trasylol dosing

Answer 32

Test dose: 1mL 10min before loading Loading dose: 200mL (280mg) over 20-30min Prime dose: 200mL *May artificially prolong ACT results*

Question 33

Action of Thrombate III

Answer 33

Inactivated thrombin and factors 9,10,11,&12 which results in inhibited coagulation Enhances heparin if have ATIII deficiency

Question 34

Thrombate III dosing

Answer 34

Dose= (desired-actual ATIII)*kg/1.4 Each vial has 500 IU Use within 3 hours of reconstitution

Question 35

Action of Benadryl

Answer 35

Antihistamine, sedative, antiemetic, anticholinergic

Question 36

Benadryl dose

Answer 36

10-50mg

Question 37

Action of Solumedrol

Answer 37

Intermediate acting glucocorticoid used to combat inflammation, often during circ arrest Can cause hyperglycemia

Question 38

Dose of Solumedrol

Answer 38

125mg-1g | Sterile powder mixed with diluent, must be used within 48 hours of mixing

Question 39

3 inhalation anesthetics

Answer 39

Forane Isoflurane Sevoflurane

Question 40

Action of inhalation anesthetics

Answer 40

Ethers that modulate GABA-a receptor used for induction and maintenance of anesthesia Potent vasodilators

Question 41

Short term effects of Forane

Answer 41

``` Liver and kidney disease Headache Irritability Fatigue Nausea Drowsiness Compromised performance ```

Question 42

Long term affects of Forane

Answer 42

Miscarriage (in exposed worker AND spouses) Genetic damage Cancer

Question 43

Action of Albumin

Answer 43

Concentration of proteins derived from human blood Increases plasma volume or serum albumin levels Don't use on Jehovah's Witness!

Question 44

Albumin dosing

Answer 44

Concentrations: 5, 20, or 25% (25% contains 250mg/1000mL) Increases circulating volume 3.5x volume injected Prime: 12.5-25g Give when serum albumin

Question 45

Action of insulin

Answer 45

Stimulate glucose utilization by muscle and fat and acts on liver to inhibit glycogenolysis and gluconeogenesis

Question 46

Insulin dosing

Answer 46

``` Target glucose range: 110-180mg/dL 100units/mL 10-20 units IV *Never shale vial!! Roll in hands to mix* Use 1mL syringe ```

Question 47

Insulin dosing for Hyperkalemia

Answer 47

Adults: 25g Dextrose+ 10units insulin Peds: 1-2g/kg Dextrose + 0.3units insulin per gram Dextrose

Question 48

Action of Dextrose D-50

Answer 48

Concentrated carbohydrate to fix hypoglycemia

Question 49

Dose of Dextrose D-50

Answer 49

10-25g