Pharmacology Flashcards
Which of the following herbal supplements is linked to an increased risk of bleeding and prolonged emergence?
Ginkgo biloba
The anesthesiologist is performing a digital block with a 50/50 mix of Lidocaine and Bupivacaine. What is the purpose of mixing these medications?
Lidocaine is fast acting and Bupivacaine is long acting. The mixture provides the advantages of both
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?
it inhibits oral secretions
Albuterol or glycopyrrolate may be used to
control secretions
Your patient is having cataract extracapsular extraction with implantation of an intraocular lens which medication would you question giving?
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.
St. John’s Wort
can prolong anesthesia,
Echinacea
Can cause liver damage
Ephedra
Cardiac effects especially when paired with atropine
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?
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Decades ago Lidocaine was given IV but this is an outdated treatment.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
The trade name for sublimaze (generic name)
Fentanyl
-100 times stronger than morphine
-Push slowly
Trade name for diazepam (generic name)
Valium
-Benzodiazepine
-Burns on IV administration
-Potent respiratory depressant
Dilaudid is trade name for
Hydromorphone (generic name)
-push slowly, can cause chest wall rigidity
-7 times more potent than morphine
Trade name for versed
Midazolam (generic name)
Fasciculation to which depolarizing muscle relaxant
Succinylcholine chloride (Anectine)
Midazolam (versed)
Benzodiazepine
-Amnesic/anti-anxiety
-Used for general, regional, and moderate sedation
-short acting
Fentanyl (Sublimaze)
Narcotic analgesic- opioid
Use with caution in head injuries, bradycardia, CNS depressants, GI obstruction
Adverse reactions: respiratory depression, arrest, laryngospasm
*Romazicon (flumazenil)
Reversal for benzodiazepine (diazepam, midazolam)
-contraindicated in patients with seizures and those taking tricyclic antidepressant
Naloxone (Narcan)
Opioid reversal for fentanyl, sufentanil, morphine, demoral, dilaudid
Herbal supplements- Alter or prolong anesthesia
Kava kava
St. John wort
Valerian
Black cohosh
Herbal supplements- increase blood pressure
Ephedra
Ginseng
Licorice
Green tea
Herbal supplements- anticoagulant effects
Aloe Vera
Chamomile
Cinnamon
Garlic
Ginger
Ginkgo biloba
Cayenne pepper
Ginseng
Licorice
Some fish oils
Vitamin E
Green tea
Turmeric
Rights of medications
- Right patient.
- Right medication.
- Right dosage.
- Right time
- Right route.
- Right strength and concentration (new)
- Right infusion rate (New)
Compounding medications
No more than three meds mixed together, unless by pharmacy
What is the new expiration date of medication when withdrawn from multidose vial?
28 days from initial use
Acetyl salicylic acid therapy (aspirin) should be stopped
2 weeks before surgery
