Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CV Perf Tech III > Pharmacologic Response to CPB- Exam 3 > Flashcards

Pharmacologic Response to CPB- Exam 3 Flashcards

1
Q

Pharmacokinetics

A

What the body does to the drug

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

Pharmacodynamics

A

How a drug interacts with the body to produce its effects

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

First order kinetics

A

elimination of a drug occurs at a constant fraction of drug remaining in the body per unit of time

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

Zero order kinetics

A

when drug administration exceeds the body’s ability to clear it, leading to drug accumulation

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

To prevent drug accumulation, what should be done?

A

Drug infusion rates should be adjusted according to patient response

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

To prevent drug accumulation, what should be done?

A

Drug infusion rates should be adjusted according to patient response

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

Changes in Pharmacokinetics due to CPB

A 
Hemodilution
Hypothermia
Perfusion
Acid-Base Status
Sequestration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Changes in Pharmacokinetics due to CPB

A 
Hemodilution
Hypothermia
Perfusion
Acid-Base Status
Sequestration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hemodilution

A

Reduction in circulating protein concentration
Reduction in RBC concentration
Reduction in concentration of free drug (unless your pump prime matches exactly)
Alterations in organ blood flow, affecting distribution and clearance

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

Hemodilution

A

Reduction in circulating protein concentration
Reduction in RBC concentration
Reduction in concentration of free drug (unless your pump prime matches exactly)
Alterations in organ blood flow, affecting distribution and clearance

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

What happens if you add drugs to your prime BEFORE RAP? or AFter RAP?

A

Lose some when you rap
most of the time you wont have time to add drugs after you rap
usually you’ll go on pump right after you rap

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

What happens if you add drugs to your prime BEFORE RAP? or AFter RAP?

A

Lose some when you rap
most of the time you wont have time to add drugs after you rap
usually you’ll go on pump right after you rap

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

Hypothermia

A

Fluid shifts from intravascular to interstitial space
(altered volume of distribution, increased 3rd spacing)
Vasoconstriction (changes in organ perfusion)
Reduction in enzyme-mediated biotransformation
increased solubility of volatile anesthetics

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

Hypothermia

A

Fluid shifts from intravascular to interstitial space
(altered volume of distribution, increased 3rd spacing)
Vasoconstriction (changes in organ perfusion)
Reduction in enzyme-mediated biotransformation
increased solubility of volatile anesthetics

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

What are two important things to keep in mind regarding patient during perfusion?

A

Lungs excluded form circulation (valium, propofol, opioids)

Altered hepatic blood flow - vasoconstriction (fentanyl, propofol)

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

What are two important things to keep in mind regarding patient during perfusion?

A

Lungs excluded form circulation (valium, propofol, opioids)

Altered hepatic blood flow - vasoconstriction (fentanyl, propofol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acid Base Status

A

Altered organ blood flow (ph stat= increase cerebral blood flow)
altered ionization and protein binding

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

Sequestration

A

Drugs may be taken up by various components of the CPB circuit

  • coated tubing
  • oxygenators
  • hemofilters (many factors influence the movmement of drug across the membrane; degree of protein binding is a major determinant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When administering medications

A

Ensure you have physician’s order or standing protocol authorizing you to administer the medication

The patient is not allergic to the medication
you should have the correct medication, the correct concentration and the correct dosage

Inspect the medication for expiration date, precipitates and sterility

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

When administering medications

A

Ensure you have physician’s order or standing protocol authorizing you to administer the medication

The patient is not allergic to the medication
you should have the correct medication, the correct concentration and the correct dosage

Inspect the medication for expiration date, precipitates and sterility

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

What is in your drug box?

A 
Heparin
Neo-Synephrine
NaHCO3
Lidocaine
MgSO4
Calcium
Potassium
Mannitol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is heparin sodium derived from?

A

Bovine lung tissue or porcine mucosa standardized for anticoagulant activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is the potency of heparin sodium determined?

A

By biological assay using a USP reference standard based on units of heparin activity per milligram

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

Units/Mg Heparin Conversation

A

100 units = 1 mg

Ex. 5,000 units = 50 mg

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

What is the action of heparin sodium?

A

Stops coagulation by potentiating antithrombin III and inhibiting the action of activated Factors IX and XI

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

What is the action of heparin sodium?

A

Stops coagulation by potentiating antithrombin III and inhibiting the action of activated Factors IX and XI

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

How is heparin eliminated?

A

kidneys

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

What is the half-life of heparin?

A

At CPB doses is 2 or more hours; prolonged by hypothermia and renal blood flow alterations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the half-life of heparin?

A

At CPB doses is 2 or more hours; prolonged by hypothermia and renal blood flow alterations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Heparin Side Effects

A

Activation of t-PA and platelets
Boluses decrease SVR by 10-20%
Anaphylaxis rarely occurs
HIT and HITT

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

Heparin Loading Dose

A

300-450 units/kg

Rarely needs to exceed 35,000 to 40,000 units

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

How does heparin distribute?

A

Primarily in plasma, so increasing dose with increasing body weight is only relevant to a certain point

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

How does heparin distribute?

A

Primarily in plasma, so increasing dose with increasing body weight is only relevant to a certain point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What concentration of heparin should be added to prime?

A

Priming solution should contain heparin at approx the same concentration of the patient’s blood stream

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

What prolongs the ACT?

A

Hypothermia, and hemodilution

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

What is target ACT?

A

Controversial (300 to 480 seconds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Most vials you will see for adult CPB will be what concentration?

A

1000 units/ mL

Ex. Loading dose: 30,000 units
30,000 units x 1mL/1000units = 30 mL

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

Neo-Synephrine Action

A

Synthetic selective alpha 1- adrenergic agonist that causes vasoconstriction in arterioles

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

Neo-Synephrine Duration

A

Less than 5 minutes

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

How is Neo dosed?

A

Titrated to effect

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

What should you always do when giving neo?

A

Start with a test dose

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

Neo-Synephrine Dosing

A

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

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

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

Neo-Synephrine Dosing

A

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

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

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

How many mg typically in Phenylephrine vial?

A

10 mg Phenylephrine in 1 mL vial

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

How many mg typically in Phenylephrine vial?

A

10 mg Phenylephrine in 1 mL vial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Sodium Bicarbonate

A

A sterile, nonpyrogenic, hypertonic solution of sodium bicarbonate (NaHCO3) in water for injection for administration by the intravenous route as an electrolyte replenisher and system alkalizer

Also used to treat hyperkalemia

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

NaHCO3 Dosing

A

Dose (mEq) = 0.3 x Weight (kg) x BD (mEq/L)

*Or just “1 amp” (50 mEq)

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

NaHCO3 Dose for Hyperkalemia

A

Adults: 50 mEq
Peds: 1-2 mEq/kg

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

Lidocaine Action

A

reduces cell membrane permeability for sodium and potassium which increases the stimulation thresholds in ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Lidocaine Site of Action

A

cell membrane

51
Q

Lidocaine Duration of Action

A

15-30 minutes post bolus

52
Q

Lidocaine Dosing

A

IV bolus: 1-2 mg/kg
Usually 100 to 200 mg bolus at XC removal
Not to exceed 300 mg/h r

53
Q

Magnesium Sulfate Action

A

Controls transmembrane electrolytes and energy metabolism; cardiac arrythmias may occur during hypomagnesemia

54
Q

What is heparin sodium derived from?

A

Bovine lung tissue or porcine mucosa standardized for anticoagulant activity

55
Q

When can hypomagnesemia occur during CPB?

A

Poor pre op health
Albumin administration
Citrated blood product administration

56
Q

MgSO4 Dosing

A

2 to 2.5 g initial bolus

1.75 g/hr infusion

57
Q

MgSO4 Dosing on CPB

A

usually given as 2 to 4 grams at XC removal with lidocaine

Often 0.5 g/L concentration

58
Q

Calcium Chloride Action

A

Involved in myocardial contractility, blood clotting, neurotransmission and muscle contraction
May be used for mixing with thrombin for platelet gel
Levels drop during CPB; may be necessary to replenish before coming off CPB; especially if citrated blood products are given

59
Q

CaCl2 Dosing

A

200 to 1000 mg slow IV
Often 100mg/mL concentration
Given post XC removal and before termination of CPB if levels are low

60
Q

Hyperkalemia CaCl2 Dosing

A

Adults: 0.5-1g CaCl2
Peds: 20 mg/kg Calcium Gluconate

61
Q

Hyperkalemia CaCl2 Dosing

A

Adults: 0.5-1g CaCl2
Peds: 20 mg/kg Calcium Gluconate

62
Q

Potassium Chloride

A

The major intracellular ion
Necessary for normal cardiac contractions
Hyperkalemia more of an issue than hypokalemia (cardiopleigia)

63
Q

Potassium Chloride

A

The major intracellular ion
Necessary for normal cardiac contractions
Hyperkalemia more of an issue than hypokalemia (cardiopleigia)

64
Q

KCl Dosing for Cardioplegia

A

15-30 mmol/L of solution delivered into the heart

i.e. 4 to 1 cdpg requires 5 times the delivery strength in the cardioplegia bag

65
Q

KCl Dosing for Hypokalemia

A

Dose (mEq) = weight (kg) x 0.3 x K+ deficit

66
Q

KCL Usual concentration

A

2 mEq/L

Give it slowly especially if XC not on

67
Q

KCL Usual concentration

A

2 mEq/L

Give it slowly especially if XC not on

68
Q

Mannitol Action

A

Osmotic diuretic prevents reabsorption in the proximal tubule (also thought to be a free radical scavenger)

69
Q

Mannitol Action

A

Osmotic diuretic prevents reabsorption in the proximal tubule (also thought to be a free radical scavenger)

70
Q

Mannitol Dosing

A

During CPB 0.5 to 1.0 g/kg
Often given as 12.5 g vials in prime or during warming

Inspect carefully for precipitate or cystals
Use a filtered needle during administration

71
Q

What else is in your drug box?

A 
THAM 
Amicar
Trasylol
Thrombate III
Benadryl
Solu-Medrol
Dextrose
Albumin
Insulin
Forane
72
Q

THAM

A

tromethamine

73
Q

THAM Action

A

Creates an alkaline environment by combining with hydrogen ions to form bicarbonate

74
Q

THAM Dosing

A

Each 100 mg contains tromethamine 3.6 g (30mEq)

Dose (mL) = wt (kg) x Base deficit (mEq/L) x 1.1

75
Q

THAM Dosing

A

Each 100 mg contains tromethamine 3.6 g (30mEq)

Dose (mL) = wt (kg) x Base deficit (mEq/L) x 1.1

76
Q

Amicar

A

Aminocaproic acid

77
Q

Amicar Action

A

Inhibits plasminogen activators to prevent conversion to plasmin
Reduces bleeding cased by hyperfibrinolysis

78
Q

Amicar Dosing

A

Loading Dose: 5g IV

Infusion: 1 - 1.25g/hr (30 g/day max)

79
Q

Trasylol Action

A

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

80
Q

Trasylol Action

A

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

81
Q

Trasylol Dosing Test Dose

A

1 mL at least 10 min before dosing

82
Q

Trasylol Dosing Loading Dose

A

200 mL (280 mg) over 20-30 min

83
Q

Trasylol Dosing Infusion dose

A

50 mL/hr

84
Q

Trasylol Dosing Pump Prime Dose

A

200 mL

85
Q

What’s important to remember about trasylol?

A

may artificially prolong act results

86
Q

What’s important to remember about trasylol?

A

may artificially prolong act results

87
Q

Thromate III (antithrombin) Action

A

inactivates thrombin and activated forms of clotting factors IX, X, XI, and XII which results in inhibition of coagulation

The anticoagulant effect of heparin is enhanced with thrombate III in patients with antithrombin III (AT-III) deficiency

88
Q

Thrombate III Dosing

A

Dose (IU)= (desire-baseline AT-III level) x Kg / (1.4)

89
Q

Each vial of thromate III will contain how many units?

A

500 units

90
Q

You should use Thrombate III within how many hours of reconstitution?

A

within 3 hours

91
Q

Benadryl Action

A

antihistamine, sedative, antiemetic, anticholinergic

Given on CPB after suspicion of allergic reaction

92
Q

Benadryl Dosing

A

10-50 mg

93
Q

Solu-Medrol Generic Name

A

methylprenisolone

94
Q

Solu-Medrol Action

A

Intermediate acting glucocorticoid used on bypass to combat inflammation, often during circulatory arrest cases
may cause hyperglycemia

95
Q

Solu-Medrol Dosing

A

125 mg - 1g

Sterile powder which must be mixed with the accompanying diluent

96
Q

Solu-Medrol must be used within how many hours of mixing?

A

48 hours

97
Q

What are some examples of inhalation anesthetics?

A

Halothane
Isoflurane
Sevorflurane

98
Q

Forane Action

A

ethers that modulate the GABA (A) receptor, use for induction and maintenance of anesthesia
Potent vasodilators
Pungent odor

99
Q

Forane Dosing

A

Bottle must be used with appropriate adapter to fill forane vaporizer on your pump; spillage can cause structural degradation of plastic

Scavenge oxygenator gas outflow when using anesthetic gas

100
Q

Set Vaporizer of forane at what percent after initiation of gas flow?

A

0.5 % to 2% ; can be temporarily increased for blood pressure control

101
Q

Set Vaporizer of forane at what percent after initiation of gas flow?

A

0.5 % to 2% ; can be temporarily increased for blood pressure control

102
Q

AmSECT Standard for Scavenging Gases

A

Standard 6.8: An anesthetic gas scavenge line shall be employed whenever inhalation agents are introduced into the circuit during CPB procedures

103
Q

AmSECT Standard for Scavenging Gases

A

Standard 6.8: An anesthetic gas scavenge line shall be employed whenever inhalation agents are introduced into the circuit during CPB procedures

104
Q

Short Term Anesthetic Gas Exposure

A 
Liver and kidney disease
Headache
Irritability
Fatigue
Nausea
Drowsiness
Compromised performance
-Decreased vigilance
-Slow reaction time
105
Q

Low Term Anesthetic Gas Exposure

A

Miscarriage
Genetic damage
cancer
miscarriage and birth defects in the spouses of exposed workers

106
Q

Low Term Anesthetic Gas Exposure

A

Miscarriage
Genetic damage
cancer
miscarriage and birth defects in the spouses of exposed workers

107
Q

What are the three approaches to scavenging gases?

A
  1. Nothing (adequate that air is being circulated)
  2. Active ventilation system
  3. Passive ventilation system
108
Q

What is one more approach to gas scavening?

A

Suction tubing attached to oxygenator gas outflow
-with tiny holes cut into it
-with a 1/4’’ x 1/4’’ x 1/4’’ Y connector on it
Attached to wall suction or waste suction set at - 100 mmHg

109
Q

Albumin

A

Concentration of proteins derived from human blood
Increases plasma volume or serum albumin levels
May not be consented for by jehovah’s witnesses patients

110
Q

Albumin Concentrations

A

Varying concentrations 5%, 20%, 25%

-25% contains 250 g of protein for every 1000 mL

111
Q

Albumin will increase circulating volume how much?

A

3.5 x the volume injected, in an adequately hydrated individual

112
Q

Albumin Dosing in Prime

A

12.5 to 25 g in prime, or as needed

113
Q

Most vials you will see for adult CPB will be what concentration?

A

1000 units/ mL

Ex. Loading dose: 30,000 units
30,000 units x 1mL/1000units = 30 mL

114
Q

What should you always do when giving neo?

A

Start with a test dose

115
Q

Sodium Bicarbonate

A

A sterile, nonpyrogenic, hypertonic solution of sodium bicarbonate (NaHCO3) in water for injection for administration by the intravenous route as an electrolyte replenisher and system alkalizer

Also used to treat hyperkalemia

116
Q

Magnesium Sulfate Action

A

Controls transmembrane electrolytes and energy metabolism; cardiac arrythmias may occur during hypomagnesemia

117
Q

Serum Albumin

A
118
Q

Insulin Action

A

stimulates glucose utilization by muscle nad fat, and acts on the liver to inhibit glycogenolysis and gluconeogenesis

119
Q

Insulin Action

A

stimulates glucose utilization by muscle nad fat, and acts on the liver to inhibit glycogenolysis and gluconeogenesis

120
Q

Glucose Target Range During Cardiac Surgery

A

110-180 mg/dL

121
Q

Insuling Dosing

A

Very anesthesia and hospital protocol dependent

100 u/mL
10-20 units IV on CPB
Never shake vial, roll in your hands to mix
Use 1 mL syringe or dedicated insulin syrgine

122
Q

Insulin Dosing for Hyperkalemia

A

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

123
Q

Dextrose D-50

A

Concentrated carbohydrate in the form of dextrose in water used to treat hypoglycemia

124
Q

Dextrose Dosing

A

10-25g

CV Perf Tech III (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions