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Sp: Pharm 1 > Pharm Unit 3 - Aspiration/PONV > Flashcards

Pharm Unit 3 - Aspiration/PONV Flashcards

1
Q

Persistent suppression of bacterial growth after antibiotic concentration has fallen below the specified MIC is known as

A

post antibiotic effect

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2
Q

Antibiotic which may prolong the neuromuscular blocking effects of rocuronium

A

levofloxacin

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3
Q

When this agent is combined with ampicillin, it extends the spectrum of activity to be active against more gram negative and anaerobic bacteria

A

sulbactam

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4
Q

The mechanism of action of cefotetan is

A

inhibition of crosslinking of peptidoglycan to inhibit bacterial cell wall synthesis

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5
Q

Prolonged QT on ECG and cardiac arrhythmia is a possible risk with

A

quinolones

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6
Q

antibiotic to avoid in a pregnant patient

A

doxycycline

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7
Q

Agent that may be used for decolonization of patients who are nasal carriers of MRSA and MSSA

A

mupirocin

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8
Q

vancomycin is associated with all of the following adverse effects except

A

bleeding

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9
Q

Select the antiemetic agent that is associated with dry mouth, blurry vision, and may cause cognitive impairment in elderly patients:

A

scopalamine

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10
Q

An agent that may be useful for late or delayed nausea and vomiting:

A

palonosetron

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11
Q

Dexamethasone IV injection has been associated with:

A

perineal burning sensation

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12
Q

A patient treated with droperidol in the PACU develops an acute and painful cervical dystonic reaction. Select appropriate therapy to relive the dystonia

A

diphenhydramine or glycopyrrolate

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13
Q

Are beta lactams bactericidal or bacteriostatic?

A

bactericidal

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14
Q

beta lactams MOA

A

Inhibition of cell wall synthesis: Interference with peptidoglycan crosslinking

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15
Q

penicillins spectrum

A

G+, G-, anaerobes (broad spectrum)

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16
Q

Penicillins: Adverse Effects

A

hypersensitivity reaction, seizure

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17
Q

difference between cephalosporins and penicillins

A

more stable against bacterial beta lactamase

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18
Q

1st gen cephalosporin

A

Cefazolin

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19
Q

1st gen cephalosporin coverage

A

gram positive, some gram negative

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20
Q

2nd gen cephalosporin

A

Cefotetan

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21
Q

2nd gen cephalosporin coverage

A

gram positive, more gram negative

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22
Q

3rd gen cephalosporin

A

Ceftriaxone

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23
Q

3rd gen cephalosporin coverage

A

decreasing gram positive, increasing gram negative

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24
Q

4th gen cephalosporin

A

Cefepime

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25
Q

4th gen cephalosporin coverage

A

G+, G-, pseudomonas

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26
Q

5th gen cephalosporin

A

Ceftaroline

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27
Q

5th gen cephalosporin coverage

A

MRSA

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28
Q

cephalosporin adverse effects

A

allergy, bleeding, disulfiram reaction

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29
Q

beta lactamase inhibitors

A

Clavulanate, Sulbactam

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30
Q

beta lactamase inhibitors MOA

A

inactivate beta lactamase to make other abx more active

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31
Q

carbapenems

A

Meropenem, Ertapenem
Doripenem

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32
Q

carbapenems MOA

A

inhibit cell wall synthesis (resistant to beta lactamases)

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33
Q

Carbapanems spectrum

A

gram positive, gram negative
anaerobes
pseudomonas

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34
Q

Carbapenems adverse effects

A

seizure, renal impairment

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35
Q

beta lactamase inhibitors spectrum

A

G+, G-
anaerobes

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36
Q

vancomycin MOA

A

inhibits synthesis of cell wall precursors

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37
Q

Vancomycin spectrum

A

Gram +: enterococcus
MRSA
C. Diff

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38
Q

Vancomycin adverse effects

A

nephrotoxicity, ototoxicity, red man syndrome

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39
Q

aminoglycosides

A

gentamicin, neomycin, amikacin

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40
Q

aminoglycosides MOA

A

inhibit bacterial protein synthesis (30S subunit)

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41
Q

Are aminoglycosides bactericidal or bacteriostatic?

A

bactericidal

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42
Q

Aminoglycosides adverse effects

A

ototoxicity, nephrotoxicity, prolong neuromuscular blockade

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43
Q

macrolides

A

erythromycin, clarithromycin, azithromycin

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44
Q

macrolides MOA

A

inhibit protein synthesis (50S subunit)

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45
Q

macrolides spectrum

A

G+, pneumococci

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46
Q

macrolides adverse effects

A

GI effects, inhibit CYP 450

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47
Q

tetracyclines

A

Tetracycline, Doxycycline
Minocycline

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48
Q

tetracyclines MOA

A

inhibit protein synthesis (30S subunit)

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49
Q

Are tetracyclines bacteriostatic or bactericidal?

A

bacteriostatic

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50
Q

tetracyclines spectrum

A

Gram (+), mycoplasma, H. pylori, Chlamydia

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51
Q

tetracyclines adverse effects

A

GI altered flora

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52
Q

tetracyclines contraindications

A

pregnancy

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53
Q

clindamycin MOA

A

inhibit protein synthesis (50S subunit)

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54
Q

Is clindamycin bacteriostatic or bactericidal?

A

bactericidal

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55
Q

clinda spectrum

A

most gram pos, most anaerobes

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56
Q

Clindamycin adverse effects

A

C. diff, GI effects

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57
Q

oxazolidinones

A

Linezolid

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58
Q

oxazolidinones MOA

A

prevents formation of ribosome complex

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59
Q

oxazolidinones spectrum

A

G+ (MRSA, VRE, VRSA), vanc resistant enterococci

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60
Q

oxazolidinones adverse effects

A

MAO activity, hematological (anemia, thrombocytopenia), neuropathy

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61
Q

DNA synthesis inhibitors

A

Quinolones

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62
Q

quinolones

A

Ciprofloxacin, Levofloxacin
Ofloxacin

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63
Q

quinolones MOA

A

inhibit topoisomerase

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64
Q

quinolones spectrum

A

Broad (G+ and G-)

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65
Q

Quinolones adverse effects

A

glycemia, QT prolongation
growing cartilage
tendonitics
enhance NMB

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66
Q

antimetabolites

A

sulfonamides

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67
Q

sulfonamides MOA

A

inhibit folate synthesis

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68
Q

sulfonamides spectrum

A

gram positives

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69
Q

sulfonamides adverse effects

A

megaloblastic anemia, leukopenia
granulocytopenia
vasculitis
cross reactivity

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70
Q

metronidazole use

A

add when worried about anaerobes

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71
Q

mupirocin use

A

MRSA nasal colonization

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72
Q

polymixins use

A

bactericidal for abdominal procedures

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73
Q

when should the antibiotic be administered?

A

60 min prior to incision

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74
Q

when should vanc be administered

A

120 min prior to incision

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75
Q

what is commonly used when there is a PCN allergy

A

vancomycin, clindamycin, erythromycin

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76
Q

What types of drugs are used for aspiration prevention

A

H1 blockers
H2 blockers
PPI’s
Dopa receptor antagonists

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77
Q

H1 blockers MOA

A

decreased contraction of intestinal smooth muscle

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78
Q

H1 blockers uses

A

sedation, decreased GI motility
antimuscarinic

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79
Q

what is the H1 blocker

A

diphenhydramine

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80
Q

H2 blockers MOA

A

decrease acidity of gastric acid

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81
Q

H2 blockers uses

A

ulcers, GERD

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82
Q

H2 blockers common drugs

A

ranitidine, famotidine, nizatidine, cimetidine

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83
Q

PPI MOA

A

inhibit acid secretion

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84
Q

PPI uses

A

ulcers, GERD

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85
Q

PPI common drugs

A

pantoprazole, omeprazole, lansoprazole

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86
Q

dopamine receptor antagonist MOA

A

increase LES tone & GI motility

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87
Q

dopamine receptor antagonist uses

A

GERD, diabetic gastroparesis

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88
Q

dopamine receptor antagonist adverse effects

A

acute dystonic reaction

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89
Q

common dopamine receptor antagonist

A

metoclopramide

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90
Q

5HT3 antagonists MOA

A

block serotonin both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone

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91
Q

5HT3 antagonists uses

A

emesis due to vagal stimulation

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92
Q

5HT3 antagonists adverse effects

A

QT prolongation

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93
Q

5HT3 antagonists contraindications

A

use w/ drugs that inhibit CYP enzymes

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94
Q

common 5HT3 antagonists

A

ondansetron, granisetron
dolasetron
palonosetron

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95
Q

antimuscarinics uses

A

motion sickness, PONV

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96
Q

antimuscarinics adverse effects

A

dry mouth, blurry vision
cognitive impairment

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97
Q

common antimuscarinic for PONV

A

scopalamine patch

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98
Q

D2 receptor antagonist MOA

A

block D2 receptor in CTZ

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99
Q

D2 receptor antagonist adverse effects

A

acute dystonic reaction, prolonged QT

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100
Q

D2 receptor antagonist common drugs

A

droperidol, haloperidol
perphenazine
promethazine
prochlorperazine

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101
Q

Neurokinin receptor antagonists MOA

A

inhibits substance P

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102
Q

Neurokinin receptor antagonist drug

A

Aprepitant

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103
Q

dexamethasone adverse effects

A

perineal burning, impaired glucose tolerance

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104
Q

Class IA antiarrhythmics

A

Quinidine
Procainamide
Disopyramide

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105
Q

Class IA antiarrhythmics MOA

A

block VG Na+ and VG K+ in myocytes

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106
Q

quinidine indications

A

PVC’s
Systained VT/VF
Afib/Aflutter
short QT syndrome

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107
Q

quinidine adverse effects

A

N/V
diarrhea
tinnitus/hearing loss
hypotension
QRS & QT prolongation, torsades

108
Q

quinidine contraindications

A

prolonged QT

109
Q

Procainamide Indications

A

sustained VT, Afib in WPW

110
Q

procainamide adverse effects

A

rash, myalgia, vasculitis, hypotension, bradycardia, QT prolongation, torsades, drug induced lupus

111
Q

Procainamide Contraindications

A

prolonged QT

112
Q

disopyramide indications

A

PVC’s, VT
Afib

113
Q

dispyramide adverse effects

A

urinary retention, constipation, glaucoma, QT prolongation, torsades

114
Q

disopyramide contraindications

A

prolonged QT

115
Q

Class IB Antiarrhythmics

A

Lidocaine
Mexiletine

116
Q

Class IB Antiarrhythmics MOA

A

block VG Na+ in myocytes

117
Q

Class IB Antiarrhythmics indications

A

V tach, V fib

118
Q

Class IB Antiarrhythmics adverse effects

A

increased potency in ischemic tissue, GI effects

119
Q

lidocaine SE

A

visaul disturbances
tremor
seizure
drowsiness
hallucination/coma
asystole
hypotension
N/V

120
Q

Mexiletine SE

A

GI upset
N/V
blurred vision
tremor
headache
ataxia
confusion

121
Q

Class IB Antiarrhythmics contraindications

A

atrial tachyarrhythmias, HF/liver disease

122
Q

Class IC antiarrhythmics

A

Flecainide, Propafenone

123
Q

Class IC antiarrhythmics MOA

A

dramatically prolong phase 0 in myocyte AP (block VG NA+)

124
Q

Class IC antiarrhythmics indications

A

AFib (w/o CAD), SVT

125
Q

flecainamide adverse effects

A

dizziness, dyspnea, headache, blurred vision, nausea, HF exacerbation, AV block, VT/VF in pt’s with CAD

126
Q

flecainamide contraindications

A

heart failure
CAD

127
Q

propafenone adverse effects

A

dizziness, dyspnea, headache, blurred vision, nausea, bradyccardia
bronchospasm

128
Q

propafenone contraindications

A

heart failure
CAD
asthma

129
Q

Class II antiarrhythmic drugs

A

beta blockers

130
Q

beta blockers MOA

A

decreased slope of phase 4 depolarization
prolong depolarization at AV node

131
Q

beta blocker indications

A

Afib/Aflutter (slow HR down)
SVT’s
ventricular arrhythmia prevention

will not convert back into normal sinus

132
Q

beta blocker adverse effects

A

fatigue
hypotension
bronchospasm
mask hypoglycemic symptoms
aggravation of heart failure

133
Q

Class III antiarrhythmics

A

Amiodarone

134
Q

Class III MOA

A

K+ blocker
– prolongs QT interval

135
Q

Class III SE

A

torsades the pointes
higher proarryhthmia risk

136
Q

Amiodarone MOA

A

K+ blocker (high)
- prolongs AP duration
- phase 3
Na+ blocker
Ca2+ blocker
beta blocker (slow SA/AV conduction)

137
Q

when does amiodarone work best?

A

at high heart rates due to use-dependence

138
Q

amiodarone indications

A

VT/VF
SVT
Afib/Aflutter

139
Q

amiodarone features

A

lg volume of distribution due to lipophilicity

requires loading dose (10g)
delayed onset
long half life (2 months)

140
Q

amiodarone adverse effects

A

pulmonary toxicity
liver injury
hypotension
bradycardia
AV block
worsening dysrhthmias
thyroid abnormalities

141
Q

amiodarone contraindications

A

hypersensitivity (iodine)
cardiogenic shock
bradycardia
AV blocks

142
Q

amiodarone drug interactions

A

digoxin
warfarin
statins

143
Q

amiodarone metabolism

A

hepatic by CYP3A4 and 2C8

144
Q

amiodarone inhibits

A

CYP3A4
CYP2C9
P-glycoprotein

145
Q

Class III drugs that can cause torsades

A

dofetilide
sotalol

146
Q

dronedarone compared to amiodarone

A

less efficacy than amiodarone
does not contain iodine

147
Q

dronedarone SE

A

GI impacts

148
Q

dronedarone indications

A

atrial flutter
afib

149
Q

Class IV antiarrhythmics

A

non-DHPR CCB’s
verapamil
diltiazem

150
Q

non-DHPR CCB MOA

A

inhibition of L-type Ca2+ channels (phase 0 in nodal tissue)

slow depolarization in pacemaker cells

151
Q

non-DHPR CCB indications

A

SVT
Afib/Aflutter

152
Q

non-DHPR CCB adverse effects

A

hypotension
bradycardia
AV block
decreased SV

153
Q

adenosine adverse effects

A

dyspnea
bronchospasm
flushing
chest pressure

154
Q

Adenosine indications

A

SVT

155
Q

digoxin MOA

A

increases parasympathetic tone via vagus nerve
– decr sinus node
– prolongs AV node refractory
inhibits Na/K-ATPase pump
–incr Ca2+
–incr contractility
–incr proarrhythmic potential

156
Q

digoxin indications

A

atrial fibrillation
aflutter
heart failure w/ reduced EF

157
Q

digoxin CI

A

afib
aflutter
WPW

158
Q

digoxin adverse effects

A

narrow therapeutic window
GI upset
halo vision
malaise
bradycardia
AV block
VT/VF

159
Q

when is digoxin used?

A

on a resting heart rate
– pt is just sitting not walking around

rate control in combination with BB/CCB

160
Q

Antimuscarinics indications

A

bradycardia
AV block

161
Q

antimuscarinic side effects

A

dry mouth
blurry vision
photophobia
tachycardia

162
Q

antimuscarinic drugs

A

atropine
glyco

163
Q

antimuscarinic MOA

A

block ACH from binding to muscarinic receptors
alters parasympathetic response

anti-parasympathetic drugs

164
Q

mechanism of action of local anesthetics

A

Block voltage-gated sodium channels

165
Q

what does Blockage of voltage-gated sodium channels do

A

blocks generation and conduction of action potentials

166
Q

when do local anesthetics gain access to Na channels

A

during activated state

167
Q

when is the affinity of LA for Na channels greater

A

when Na channels are open

168
Q

what does the lipophillic region of LA affect

A

onset of action
potency
duration

169
Q

increasing lipophilicity

A

increases potency
slower onset

170
Q

what does ester or amide linkage of LAs affect

A

duration of action

171
Q

if someone has an allergy to amid local anesthetics, can you safely give an ester?

A

yes (& vice versa)

172
Q

what does a higher % neutral affect

A

enhanced absorption

173
Q

how does % neutral affect absoprtion

A

neutral form penetrates the membrane

174
Q

what do we want the pKa of the LA to be

A

closest to physiologic pH

175
Q

what is the determining factor for LA toxicity

A

vascularity

176
Q

Vascularity ranking Highest to lowest

A

HIGH
IV
tracheal
intercostal
caudal
paracervical
epidural
brachial plexus
subarachnoid/sciatic/femoral
subQ
LOW

177
Q

what does the risk for systemic LA toxicity depend on

A

lipid solubility
amount of connective tissue in area
pH of tissue
% neutral
is epi added?

178
Q

how does lipophilicity and tissue protein binding affect duration

A

remains in tissue longer

179
Q

how does epi affect the LA

A

makes LA more acidic

180
Q

what does bicarb addition to epi + LA

A

makes it neutral for a faster onset

181
Q

what delays LA redistribution

A

vasoconstriction

182
Q

why is epi added to local?

A

prolongs duration of action
reduced peak serum concentration

183
Q

onset of LA: lipid solubility

A

less lipid soluble = less potent

(typically delays onset)

184
Q

duration of action of LA

A

potency
lipid solubility - more = slower diffusion = longer DOA

185
Q

what type of axon is more sensitive to LA blcok

A

myelinated

186
Q

what is the most common feature of LAST

A

seizures

187
Q

what does a low CC/CNS ratio mean

A

more cardiotoxic

188
Q

what does a high CC/CNS ratio mean

A

more CNS toxiv

189
Q

what type of pt is at increased risk for LAST

A

pregnant elderly
neonate

190
Q

how to treat LAST

A

lipid emulsion 20% IV, 100 ml bolus over 2-3 min
rebolus 200 mil over 15-20 in

191
Q

Lidocaine maximum dose

A

4.5 mg/kg

192
Q

Lidocaine + Epi maximum dose

A

7 mg/kg

193
Q

ropivacaine max dose

A

2.5 mg/kg

194
Q

bupivacaine max dose

A

2.5 mg/kg

195
Q

preop causes of volume derangements

A

bowel preps
bowel obstruction
pancreatitis
blood loss

196
Q

anesthetic causes of volume derangements

A

anesthetic hypotension
(vasodilation)
sympathetic blockade

197
Q

surgical causes of volume derangements

A

hemorrhage
coagulopathy
decreased venous return
long operative time

198
Q

when is hypervolemia clincally significant

A

> 10% above basewline

199
Q

hypervolemia SE

A

incr morbidity
tissue edema
impaired wound healing
pulm edema
decr GI motility

200
Q

what lab value reflects total body water status

A

serum sodium

201
Q

what content in IV fluid dictates fluid distribution?

A

Na+

202
Q

what factors influence total body water content

A

gender
age
nutritional status
disease state

203
Q

TBW and age relationship

A

less water with increased age

204
Q

neonates TBW

A

70-80% of body weight is water

205
Q

calculating TBW

A

50-60% of body weight

206
Q

ICF:ECF

A

2:1

2/3 ICF and 1/3 ECF

207
Q

ECF

A

interstitial fluid (3)
plasma (1)

ISF: plasma = 3:1

208
Q

electrolyte content of ECF

A

Na+
Cl-

209
Q

electrolyte content of ICF

A

K+
Phosphate

210
Q

what is colloid osmotic pressure

A

pulls fluid into vessels

211
Q

what maintains fluid components of blood within vessels?

A

colloid osmotic pressure (oncotic pressure)

212
Q

what changes oncotic pressure

A

allbumins
proteins
etc

213
Q

what is hydrostatic pressure

A

pushes fluid out of vessels

214
Q

what is osmolar force

A

push and pull in and out of vessels

215
Q

what does lactate do in LR?

A

provides circulating bicarb to provide normal HCO3- levels during acidosis

???????

216
Q

what is the main contributor of osmolarity

A

sodium

217
Q

Tonicity of Crystalloids

A

isotonic

218
Q

Distribution of water

A

ECF and ICF

219
Q

distribution of saline/LR

A

distributes only to ECF

220
Q

distribution of colloids

A

distributes only to intravascular space

221
Q

colloid types

A

albumin
hetastarch
dextrans

222
Q

HES SE

A

acute kidney
incr moprtaloity
incr need to PRBC transfusion

223
Q

albumin

A

source of capillary oncotic pressure (80%)

224
Q

types of albumin

A

hyperoncotic (25%)
5% albumin (isotonic to plasma)

225
Q

pts low in albumin

A

nutritionally deficient
renal disease
liver disease

226
Q

most potent colloid

A

25% albumin

227
Q

Hetastarches (HES)

A

amylopectin and synthetic glycogen

228
Q

HES molecular weight

A

high MW = slower degradation

229
Q

Dextrans

A

long chains of glucose (polysaccharides)

230
Q

Dextran unique property

A

rhological properties
– moderate plt function
– antithrombotic

used in vascular sx to prevent post-op stroke

231
Q

typical water loss per day

A

2.5 L/day

232
Q

causes of increased water loss

A

fever
sweating
gastric
colon
insensible losses

233
Q

normal Na loss

A

77 mEq/day

234
Q

normal K loss

A

40-60 mEq/day

235
Q

normal Cl loss

A

same as sodium

236
Q

lidocaine pKa

A

7.6

237
Q

ropivacaine/bupivacaine pKa

A

8.1

238
Q

how does pKa affect onset

A

pKa closer to physiologic pH = higher % neutral, faster onset

239
Q

which local anesthetics can cause methemoglobinemia

A

prilocaine and benzocaine

240
Q

which local anesthetics are more cardiotoxic

A

bupivacaine

241
Q

which local anesthetics are more CNS toxic

A

mepivacaine

242
Q

what does extreme lipophilicity promote

A

continued binding and increased duration of action

243
Q

LA that is extremely lipophilic

A

bupivacaine

244
Q

what LA property does protein binding affect

A

duration of action

245
Q

what LA property does pKa affect

A

onset of action

246
Q

what correlates with toxicity risk

A

Cmax
time to Cmax

247
Q

what drugs could be used to manage LA systemic toxicity

A

epinephrine, amiodarone
midazolam
lipid emulsion

248
Q

where will LR/Saline distribute

A

ECF- 1/4 IV 3/4 IS

249
Q

where will D5W distribute

A

ECF and ICF proportionally

250
Q

where will Albumin distribute

A

intravascular space

251
Q

best fluid for maintenance

A

D5W + 0.225% NaCl

252
Q

best fluid for metabolic acidosis

A

LR

253
Q

preferred IVF in anesthesia

A

LR

254
Q

which colloid solutions have a risk for bleeding

A

6% hetastarch, Dextran 40

255
Q

how to calculate total body water

A

0.6L/kg

256
Q

N/S SE

A

hyperchloremic acidosis
reduction of renal perfusion

257
Q

water distribution

A

across all compartments

vascular compartment
Interstitial space
cell membranes

258
Q

Na+ distribition

A

capillary membrane
interstitial fluid

pumped out of cell

259
Q

colloids distribution

A

confined to vascular compartment

does not cross into capillary membrane

260
Q

crystalloids use

A

mx
replacement of losses
treatments of symptoms
– fluid or electrolyte deficits

261
Q

colloids uses

A

add oncotic pressure
volume replacement
rheologic propoerties

262
Q

sensible loses

A

measurable

263
Q

insensible losses

A

respriation
fever
evaproration (surgical)

264
Q

adult fluid maintenance

A

30mL/kg/day

265
Q

minimal losses

A

0-2 mL/kg

266
Q

moderate losses

A

2-4 mL/kg

267
Q

severe losses

A

4-8 mL/kg

Sp: Pharm 1 (9 decks)

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