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Perf Tech 3 > Pharm Response To Bypass > Flashcards

Pharm Response To Bypass Flashcards

1
Q

Drugs affected by altered hepatic flow on CPB

A

Fentanyl

Propofol

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2
Q

Type of drug that sticks to coated surface of tubing

A

Lipopholic drugs

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3
Q

4 things to ensure before administering drugs

A

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

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4
Q

8 drugs always in drug box

A 
Heparin
Neo-Synephrine
NaHCO3
Lidocaine
MgSO4
Calcium 
Potassium 
Mannitol
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5
Q

Concentration of heparin in mg

A

100units=1mg

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6
Q

Drugs affected by lungs being remove from circulation on CPB

A

Valium
Propofol
Opioids

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7
Q

Action of heparin

A

Inhibits coagulation by Potentiation ATIII and inhibiting factors 9&11

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8
Q

Half life of heparin at CPB doses

A

2 or more hours

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9
Q

4 side effects of heparin

A

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

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10
Q

Heparin dosing

A

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

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11
Q

Action of Neo-Synephrine

A

Alpha-1 agonist causing vasoconstriction in arterioles

Duration: less than 5 min

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12
Q

Dosing of Neo-Synephrine

A

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

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

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13
Q

Action of NaHCO3

A

IV injection as electrolyte replenisher and alkalizer

Treats Hyperkalemia

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14
Q

Dosing of NaHCO3

A

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

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

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15
Q

Action and duration of lidocaine

A

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

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16
Q

Lidocaine dosing

A

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

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17
Q

Action of MgSO4

A

Controls transmembrane electrolytes and energy metabolism

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18
Q

Causes for hypomagnesia on CPB

A

Poor preop health
Albumin administration
Citrate blood product administration

Hypomagnesia can cause arrhythmias

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19
Q

MgSO4 dosing

A

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

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20
Q

Action of calcium chloride

A

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

21
Q

CaCl2 dosing

A

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

22
Q

Potassium chloride action

A

Normal cardiac contractions

23
Q

KCl dosing

A

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

24
Q

Action of mannitol

A

Osmotic diuretic prevents reabsorption in proximal tubule

Free radical scavenger

25
Q

Mannitol dosing

A

On CPB: 0.5-1g/kg

12.5g vials

26
Q

10 drugs that may be in drug box

A 
THAM
Amicar
Trasylol
Thrombate III
Benadryl
Solumedrol
Dextrose
Albumin
Insulin 
Forane
27
Q

Action of THAM (Tromethamine)

A

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

28
Q

THAM dosing

A

Concentration: 3.6g/100mL (30mEq)

Dose (mL)= weightBE1.1

29
Q

Action of Amicar

A

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

30
Q

Dosing of Amicar

A

Loading dose: 5g IV

31
Q

Action of Trasylol

A

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

32
Q

Trasylol dosing

A

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

33
Q

Action of Thrombate III

A

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

34
Q

Thrombate III dosing

A

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

35
Q

Action of Benadryl

A

Antihistamine, sedative, antiemetic, anticholinergic

36
Q

Benadryl dose

A

10-50mg

37
Q

Action of Solumedrol

A

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

38
Q

Dose of Solumedrol

A

125mg-1g

Sterile powder mixed with diluent, must be used within 48 hours of mixing

39
Q

3 inhalation anesthetics

A

Forane
Isoflurane
Sevoflurane

40
Q

Action of inhalation anesthetics

A

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

41
Q

Short term effects of Forane

A 
Liver and kidney disease
Headache
Irritability 
Fatigue 
Nausea
Drowsiness
Compromised performance
42
Q

Long term affects of Forane

A

Miscarriage (in exposed worker AND spouses)
Genetic damage
Cancer

43
Q

Action of Albumin

A

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

44
Q

Albumin dosing

A

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

45
Q

Action of insulin

A

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

46
Q

Insulin dosing

A 
Target glucose range: 110-180mg/dL
100units/mL
10-20 units IV
*Never shale vial!! Roll in hands to mix*
Use 1mL syringe
47
Q

Insulin dosing for Hyperkalemia

A

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

48
Q

Action of Dextrose D-50

A

Concentrated carbohydrate to fix hypoglycemia

49
Q

Dose of Dextrose D-50

A

10-25g

Perf Tech 3 (9 decks)

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