Pharmacology

Question 1

FFP

Answer 1

• Fresh frozen plasma
• 1 unit is the plasma from 1 unit of whole blood
• Approximate volume is 250-300ml
• Contains proteins / clotting factors
• Used for coagulation factor deficiencies, rapid warfarin reversal, massive transfusion protocols.
• Must be ABO compatible
• AB+ is the universal plasma donor (no antibodies against A, B, or RhD)

Question 2

Slowing Ostomy Output

Answer 2

• Imodium (Loperamide)
  
  • mu opioid agonist in the myenteric plexus.
  • Decreases tone of intestinal smooth muscles
• Lomotil (Diphenoxylate/Atropine)
  
  • Diphenoxylate is an opioid agonist
    
    • Decreases smooth muscle tone
• Tincture of Opium (Laudanum)
  
  • 10% powdered opium by weight
  • Decrease smooth muscle tone

Question 3

What is the risk of severe side effects from pelvic radiation?

Answer 3

• 7-8%

Question 4

DVT Prophylaxis

Answer 4

• Heparin
• Lovanox
• Fondaparinix - used for patients with history of HITT
• SCD’s

Question 5

Heparin

Answer 5

• Anticoagulant
• Binds antithrombin III and activates it –> ATIII inhibits clotting factors, especially Thrombin and Xa
• Effects measured by aPTT
• Peak effect: IV = instant, SQ = 30min.
• Dosing for DVT PPX is 5,000 units SQ 2h pre-op and then 5,000 units BID or TID.

Question 6

Lovenox (Enoxaparin)

Answer 6

• Anticoagulant - Low molecular weight heparin
• Binds antithrombin III and activates it –> ATIII inhibits clotting factors, especially Thrombin and Xa
• Effects measured by aPTT (Intrinsic / Combined pathway)
• Peak effect 3-5h after administration
• DVT PPX: 30mg BID or 40mg QD. May increase up to 60mg BID for morbid obesity
• Therapeutic: 1mg/kg BID or 1.5mg/kg QD
• Dosing may need to be adjusted for Cr clearance <30 [renal dosing]

Question 7

Fondaparinux (Arixtra)

Answer 7

• Anticoagulant - Antithrombin III mediated inhibition of factor Xa
• Effects measured by aPTT (Intrinsic / Combined pathway)
• Peak effect 2-3h after administration
• DVT PPX: 2.5mg SQ QD. Prophylactic dosing CI in patients <50kg
• Therapeutic:
  
  • <50kg = 5mg SQ QD
  • 50-100kg = 7.5mg SQ QD
  • >100kg = 10mg SQ QD

Question 8

Treatment of Neutropenic Fever

Answer 8

• Empiric antibiotics
  
  • At Loyola - Mirapenam
  • add Vancomycin if history of MRSA or if patient not improving on Mirapenam alone
• Neupogen

Question 9

Neupogen (Filgrastim)

Answer 9

• Granulocyte colony stimulating factor (G-CSF)
• Stimulates production, maturation, and stimulation of Neutrophils
• Start dosing at 5mcg/kg/day SQ or IV
• Do not give within 24h of the chemo
• Maximum ANC 3-5d after administration

Question 10

Meropenam

Answer 10

• Antibiotic
• Inhibits cell wall synthesis by binding penicillin binding proteins
• Off label for neutropenic fever - 1g IV TID
• Penetrates body fluids very well (peritoneal fluid, CSF)
• Spectrum of activity includes some Gram+, Gram- including Pseudomonas, and anaerobes

Question 11

Albumin

Answer 11

• Usually comes as 5% solution = .05g/ml
• 1 unit of albumin is approximately 250ml (12.5g)
• Colloid given

Question 12

Hespan (Hetastarch)

Answer 12

• Plant colloidal starch
• One unit is 500ml and 6% starch = 30g
• Used for plasma volume expansion
• Maximum daily dose 1-1.5L, which is limited by interference with platelet function.

Question 13

Perioperative Anti-Hypertensives in Chronic Hypertension

Answer 13

• Beta blockers are the only hypertensives that have to be continued in the perioperative period.

Question 14

WBC Nadir Following Chemotherapy

Answer 14

• 5-7 days

Question 15

NSAIDs and Anticoagulants

Answer 15

• NSAIDs should not be used in patients on therapeutic doses of anticoagulants.
• NSAID use likely OK in patients on prophylactic doses of anticoagulants.

Question 16

Pyridium / Azo-Gesic / Baridium (Phenazopyridine)

Answer 16

• Azo dye
• Exerts analgesic and anesthetic effect on urinary tract mucosa through an unknown mechanism
• 100-200mg PO TID after meals

Question 17

Gemzar (Gemcitabine)

Answer 17

• Chemotherapeutic
• Nucleoside analog (cytidine)
• Used for:
  
  • Ovarian CA (in combination with Carboplatin)
  • Cervical CA (off label for recurrent or persistent)
  • Uterine Sarcomas (off label)
  • First line for metastatic breast CA that has failed adjuvant chemo. (in combination with Paclitaxel)
• Major side effect is Neutropenia and N/V

Question 18

Carboplatin

Answer 18

• Chemotherapeutic
• Alkylating agent, cross link DNA
• Used for:
  
  • first line for advanced ovarian CA
  • Recurrent or metastatic cervical CA (off label)
  • Endometrial CA (off label)
  • Metastatic breast CA (off label)
• Myelosuppression is dose limiting, especially thrombocytopenia
• Neurotoxic, nephrotoxic, ototoxic to a lesser degree

Question 19

Cisplatin

Answer 19

• Chemotherapeutic
• Alkylating agent, cross link DNA
• Used for:
  
  • Metastatic ovarian CA
  • Cervical CA (off label)
  • Endometrial carcinoma (off label)
• Nephrotoxicity is dose limiting
• Neurotoxic, ototoxic, and myelosuppression to a lesser degree