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CNOR > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Which of the following herbal supplements is linked to an increased risk of bleeding and prolonged emergence?

A

Ginkgo biloba

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2
Q

The anesthesiologist is performing a digital block with a 50/50 mix of Lidocaine and Bupivacaine. What is the purpose of mixing these medications?

A

Lidocaine is fast acting and Bupivacaine is long acting. The mixture provides the advantages of both

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3
Q

Atropine is given to the patient just before induction in surgery. Atropine will help prevent bradycardia during induction. In what other way does atropine benefit the surgical patient?

A

it inhibits oral secretions

Albuterol or glycopyrrolate may be used to
control secretions

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4
Q

Your patient is having cataract extracapsular extraction with implantation of an intraocular lens which medication would you question giving?

A

Pilocarpine

The lens is delivered through a small incision in the junction of the cornea and sclera. Any medication that contracts the pupil would make
this very difficult. Pilocarpine is a medication
used to treat glaucoma and it causes the pupil
to constrict.

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5
Q

St. John’s Wort

A

can prolong anesthesia,

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6
Q

Echinacea

A

Can cause liver damage

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7
Q

Ephedra

A

Cardiac effects especially when paired with atropine

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8
Q

Unexpectedly, the 16-year-old female is displaying a Wide Complex QRS on her ECG immediately upon arrival in the OR. She is sweating and is becoming cyanotic. She has a weak rapid pulse. The CRNA applies oxygen and opens the IV fluid to run by gravity. The nurse expects anesthesia will give which of the following medications first?

A

Amiodarone

Wide Complex QRS can be either VT or SVT. In an adolescent the observable symptoms can be very similar. An adolescent or child may sometimes have a pulse with VT. If clinicians are unsure it’s always assumed to be VT and treated as such first.
Amiodarone followed by synchronized cardioversion is the treatment for VT with a pulse.
The cardioversion will also correct SVT.
Decades ago Lidocaine was given IV but this is an outdated treatment. The Berry and Kohn book still says to use Lidocaine for VT

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9
Q

The trade name for sublimaze (generic name)

A

Fentanyl
-100 times stronger than morphine
-Push slowly

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10
Q

Trade name for diazepam (generic name)

A

Valium
-Benzodiazepine
-Burns on IV administration
-Potent respiratory depressant

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11
Q

Dilaudid is trade name for

A

Hydromorphone (generic name)
-push slowly, can cause chest wall rigidity
-7 times more potent than morphine

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12
Q

Trade name for versed

A

Midazolam (generic name)

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13
Q

Fasciculation to which depolarizing muscle relaxant

A

Succinylcholine chloride (Anectine)

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14
Q

Midazolam (versed)

A

Benzodiazepine
-Amnesic/anti-anxiety
-Used for general, regional, and moderate sedation
-short acting

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15
Q

Fentanyl (Sublimaze)

A

Narcotic analgesic- opioid
Use with caution in head injuries, bradycardia, CNS depressants, GI obstruction
Adverse reactions: respiratory depression, arrest, laryngospasm

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16
Q

*Romazicon (flumazenil)

A

Reversal for benzodiazepine (diazepam, midazolam)
-contraindicated in patients with seizures and those taking tricyclic antidepressant

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17
Q

Naloxone (Narcan)

A

Opioid reversal for fentanyl, sufentanil, morphine, demoral, dilaudid

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18
Q

Herbal supplements- Alter or prolong anesthesia

A

Kava kava
St. John wort
Valerian
Black cohosh

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19
Q

Herbal supplements- increase blood pressure

A

Ephedra
Ginseng
Licorice
Green tea

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20
Q

Herbal supplements- anticoagulant effects

A

Aloe Vera
Chamomile
Cinnamon
Garlic
Ginger
Ginkgo biloba
Cayenne pepper
Ginseng
Licorice
Some fish oils
Vitamin E
Green tea
Turmeric

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21
Q

Rights of medications

A
  1. Right patient.
  2. Right medication.
  3. Right dosage.
  4. Right time
  5. Right route.
  6. Right strength and concentration (new)
  7. Right infusion rate (New)
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22
Q

Compounding medications

A

No more than three meds mixed together, unless by pharmacy

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23
Q

What is the new expiration date of medication when withdrawn from multidose vial?

A

28 days from initial use

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24
Q

Acetyl salicylic acid therapy (aspirin) should be stopped

A

2 weeks before surgery

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25
Q

First choice to treat bronchospasm

A

Inhaled bronchodilators

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26
Q

Local and moderate sedation can be done by RN for which classes?

A

ASA 1-3
-no beard, dentures, or sleep apnea (difficult mask ventilation)

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27
Q

Neuraxial anesthesia – epidural

A

Is placed in space before Dura
Catheter remains in place

28
Q

Neuraxial anesthesia– spinal

A

Goes into Dura
Very small needle, in and out

29
Q

When are patients at increased risk for an MI?

A

Induction and 2 to 3 days after surgery

30
Q

Sedative-hypnotics – Etomidate

A

“ vomit date”
Need antiemetic

31
Q

Midazolam initial dose

A

1-2.5mg IV over 2 minutes until slurred speech/sedation

32
Q

Midazolam adverse reactions

A

apnea
geriatrics require smaller dose/longer wait

33
Q

Meperidine (Demerol)

A

Weak opioid used for shivering 

34
Q

Duramorph (Morphine)

A

High incidents of nausea/vomiting
-morphine and codeine are naturally occurring opioids

35
Q

Narcan dosage

A

0.1-2mg IV q 2-3 minutes prn
-Start with small doses, want to partially reverse
-Not completely (painful)

36
Q

Narcan adverse reactions

A

Vtach
Vfib
cardiac arrest

37
Q

Narcan common reactions

A

hypertension
N/V
withdrawal
diaphoresis

38
Q

Narcan duration

A

30-45 minutes
Monitor for return of respiratory depression

39
Q

Flumazenil dosage

A

0.2mg IV q min x 1-5 doses
Maximum is 1mg total dose

40
Q

Flumazenil adverse reactions 

A

seizures
arrhythmias
resedation

41
Q

Flumazenil common reactions

A

dizziness
N/V
diaphoresis
blurred vision

42
Q

Depolarizing agents- succinylcholine

A

-Only depolarizing agent
-Used primarily for induction to facilitate tracheal intubation

43
Q

Succinylcholine onset

A

1 minute

44
Q

Succinylcholine duration

A

5 to 10 minutes

45
Q

What is succinylcholine metabolized by?

A

Pseudocholinesterase
-not the normal process of acetylcholinesterase
-Takes longer
-People lacking the enzyme, have to stay intubated as it takes days to get rid of

46
Q

Succinylcholine adverse reactions

A

Bradycardia
Increases intraocular pressure, contraindicated for glaucoma
Hyperkalemia
Oxygen depletion

47
Q

Succinylcholine contraindications

A

Malignant hyperthermia family history
Degenerative neuromuscular disorders
-no reversal agent

48
Q

Non-depolarizing muscle relaxants (NDMR)

A

Acetylcholine competitive antagonists
-Blocking agents
-all work slower than succinylcholine
-large doses rocuronium come close

49
Q

NDMR reversal agents

A

Anticholinesterases
-typically combined with a muscarinic antagonist (anticholinergic)
-Glycopyrrolate (always mixed with neostigmine)
-Atropine (pre-mixed with edrophonium)

50
Q

Sugammadex

A

Selectively binds rocuronium or vecuronium
-is able to reverse any depth of neuromuscular block due to its 1:1 binding
-Not an anticholinesterase

51
Q

Inhalation gases – halothane

A

Strongest
Can cause arrhythmias in conjunction with Epi
Associated with MH

52
Q

Inhalation gases- isoflurane

A

Rapid recovery (lucid in 15 to 30 minutes)
Can’t be used with tourniquet
Stinks, patients throw up

53
Q

Inhalation gases – sevoflurane

A

Rapid onset and offset
Sweet taste

54
Q

Inhalation gases – ethrane

A

Contraindicated in people with seizures

55
Q

Inhalation gases – desflurane

A

Fastest onset and offset
Coughing is common

56
Q

Inhalation gases – nitrous oxide

A

Gas
Odorless
Can support combustion like oxygen
Diffusion hypoxia

57
Q

Inhalation gases

A

All volatile agents, except for nitrous oxide
Not reversible, have to breathe it out

58
Q

What are Malignant hyperthermia triggers?

A

-A genetically susceptible patient
-Succinylcholine is one of the most common triggers
-Especially when used in conjunction with an inhaled anesthetic, such as desflurane, isoflurane, and halothane

59
Q

Malignant hyperthermia, early signs

A

-Trismus (jaw tightening, biting tube)
-Rapid increase in body metabolism (rise in exhaled CO2)
-Intense muscle rigidity
-Increased heart rate
-Increased blood pressure

60
Q

Malignant hyperthermia late signs

A

-rapidly rising body temperature
-Changing color of soda lime
-Hyperkalemia
-Hypoxia (O2 demand higher than what can be given)
-Myoglobinuria (tea colored urine, broken down muscle)
-Cardiac arrest

61
Q

Malignant hyperthermia treatment

A

-Immediately discontinue all triggering agents, change circuit
-Hyperventilate the patient with 100% oxygen
-Call MHAUS

62
Q

Medication for malignant hyperthermia

A

Dantrolene
2 to 3 mg per kilogram
Mix with sterile water

63
Q

Medication for metabolic acidosis with malignant hyperthermia

A

Sodium bicarbonate IV

64
Q

Medications for hyperkalemia in malignant hyperthermia

A

Calcium
Insulin
Glucose

65
Q

Medications for myoglobinuria in malignant hyperthermia

A

Diuretics
Bicarb
Fluids

66
Q

Malignant hyperthermia treatment continued

A

-no calcium channel blockers
-Ice packs/hypothermia blanket
-Give iced NSS, avoid ringers
-Send labs, correct electrolyte imbalances
-Monitor ECG, correct arrhythmias
-Transferred patient to ICU when stable and monitor for 36 hours for recurrence and complications

67
Q

Atropine

A

Contraindicated for patients with glaucoma

CNOR (14 decks)

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