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Quarter 4 > Pharmacology Final > Flashcards

Pharmacology Final Flashcards

1
Q

(3) Natural catecholamines

A

Epinephrine, Norepinephrine, and Dopamine

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2
Q

(2) synthetic catecholamines

A

Isoproterenol and Dobutamine

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3
Q

(2) Synthetic Non-Catecholamines

A

Ephedrine and Phenylephrine

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4
Q

Which catecholamines do not stimulate Alpha?

A

Isoproterenol and Dobutamine

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5
Q

Which catecholamine has no affect on Beta-1?

A

Phenylephrine

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6
Q

Which catecholamines have a negative effect CO and HR?

A

Norepinephrine and Phenylephrine

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7
Q

Which catecholamines cause the greatest increase in peripheral vascular resistance?

A

Norepinephrine and Phenylephrine

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8
Q

Which (3) catecholamines cause the greatest decrease in airway resistance?

A

Epinephrine, Isoproterenol, and Ephedrine

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9
Q

Which catecholamine has a direct and indirect mechanism of action?

A

ephedrine

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10
Q

Which catecholamines cause the greatest increase in MAP?

A

Norepinephrine and Phenylephrine

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11
Q

Example of Prototype Sympathomimetic

A

Epinephrine

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12
Q

Where is Epineprhine synthesized and stored?

A

adrenal medulla

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13
Q

Why shouldn’t Epi be given orally?

A

rapidly metabolized by the GI and liver

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14
Q

What explains Epi’s lack of cerebral effects?

A

poor lipid solubility

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15
Q

Primary locations of Alpha-1 receptors

A

cutaneous, splanchnic, and renal vascular beds

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16
Q

Which catecholamines have the greatest risk of dysrhythmia?

A

Epinephrine and Isoproterenol

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17
Q

How does epinephrine affect the cardiac cycle?

A

accelerates rate of spontaneous depolarization (phase 4)

  • increases HR
  • increases likelihood of dysrhythmia
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18
Q

Avoidance of Epi in Beta Blockades

A

Epi induces bronchoconstriction from stimulation of alpha-receptors in the presence of a beta-blockade

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19
Q

Which catecholamine has the greatest effect on metabolism?

A

Epinephrine

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20
Q

Ocular effects of Epinephrine

A

mydriasis

(dilation of the pupil)

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21
Q

(3) Coagulation effects of Epinephrine

A
  • accelerates coagulation due to hypercoagulable state
  • increases total leukocyte, but causes eosinopenia
  • increases factor V activity
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22
Q

Synthesis and storage of Norepinephrine

A

postganglionic sympathetic nerve endings

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23
Q

Norepinephrine produces arterial and venous vasoconstriction in all vascular beds except in _____

A

coronary arteries

  • Norepinephrine dilates coronary arteries
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24
Q

Why should Norepinephrine be used cautiously in patients with right ventricular failure?

A

increases venous return and pulmonary artery pressure

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25
Q

Pathway of Catecholamine Systhesis

A

Phenylalanine

Tyrosine

Dopa

Dopamine

Norepinephrine

Epinephrine

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26
Q

Unique features of Dopamine

A

able to increase contractility, renal blood flow, GFR, sodium excretion, and urine output simultaneously

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27
Q

Renal dose of Dopamine

A

1 - 3 ug/kg/min

increass splanchnic and renal blood flow

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28
Q

Negative side effects of Dopamine

A

tachycardia and increase PVR

  • not good for right heart failure
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29
Q

Most potent sympathomimetic with Beta activity

A

Isoproterenol

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30
Q

Clinical uses for Isoproterenol

A

heart block and RV failure

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31
Q

Clinical uses for Dobutamine

A

CHF, weaning from CPB, and pulmonary hypertension

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32
Q

Effects of Ephedrine

A

increases:

HR, CO, BP, and coronary blood flow

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33
Q

In which two disease states is Phenylephrine particularly useful?

A

aortic stenosis and CAD

  • increases coronary perfusion without chronotropic side effects
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34
Q

Phenylephrine Overdose

A

activates SNS

(hypertension, tachycardia, and baroreceptor-mediated bradycardia)

  • Phentolamine
    • alpha-1 antagonist
  • may use NTG and nitroprusside
  • beta blockers are contraindicated
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35
Q

(3) most common Beta-2 Agonists

A

Albuterol, Metaproterenol, and Terbutaline

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36
Q

In addition to bronchospasm, what else can Beta-2 Agonists treat?

A

premature uterine contractions

(tocolytics)

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37
Q

Clinical uses for Digoxin

A

supraventricular tachydysrhythmias

(paroxysmal atrial tachycardia, A-fib, A-flutter)

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38
Q

Digoxin Features

A

cardiac glycoside that decreases conduction through the AV node

  • IV onset 10-30 minutes
  • inhibits Na+/K+ ATPase
    • increases CO, SV, renal perfusion
    • decreases LVEDP
  • can co-administer with beta blockers
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39
Q

(5) Causes of Digoxin Toxicity

A
  • renal dysfunction
  • hypoxemia
  • hypokalemia
  • hypercalcemia
  • hypermagnesemia
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40
Q

EKG changes in Digoxin

A

scaphoid effect

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41
Q

Diagnosis of Digoxin Toxicity

A

anorexia, nausea, and plasma concentration

  • will also see EKG changes
    • arrhythmias
    • long PR and heart block
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42
Q

Treatment of Digoxin Toxicity

A
  • correct the causes
  • treat cardiac dysrhythmias
    • phenytoin, lidocaine, or atropine
  • temporary pacemaker
    • if complete heart block
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43
Q

Contraindications for Digoxin

A

HOCM and WPW

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44
Q

Hypertrophic Obstructive Cardiomyopathies (HOCM)

A

idiopathic LVH and subaortic stenosis

  • leading cause of death in young athletes
  • Digoxin contraindicated
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45
Q

Wolff-Parkinson-White Syndrome (WPW)

A

pre-excitation syndrome due to secondary accessory AV pathway (bundle of Kent)

  • EKG shows delta wave and short PR interval
  • “circus rhythm”
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46
Q

(5) Adverse Drug Interactions with Digoxin

A
  • Quinidine
  • Succinylcholine
  • Sympathomimetics with B-agonist effects
  • IV calcium
  • some diuretics
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47
Q

Effects of Phosphodiesterase Inhibitors

A

positive inotropic effects with vasodilation

  • act independently of B-receptors; therefore, effective in B-blocked patients
  • enhance actions of catecholamines
  • improves location of Starling curve
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48
Q

(2) Types of Phosphodiesterase Inhibitors

A

Amrinone and Milrinone

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49
Q

Total serum calcium includes:

A

Ca2+ bound to albumin, complexed with citrate and phosphate, and free (ionized) Ca2+

  • free calcium is the active ion that can be measured
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50
Q

Events needing Calcium

A
  • massive transfusion
    • calcium binds to the citrate in PRBCs
  • CP bypass
    • due to multiple units of blood
  • parathyroidectomy
    • if hyperparathyroidism
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51
Q

How is Calcium Chloride administered?

A

through a central line

  • has a very low pH
  • always aspirate line first
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52
Q

Another term for the Sympathetic system

A

thoraco-lumbar

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53
Q

Another name for the Parasympathetic System

A

Cranio-Sacral

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54
Q

Major tissues affected by Alpha-1

A

Smooth muscle and sphincters

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55
Q

Major tissues affected by Alpha-2

A

nerve endings

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56
Q

Major tissues effected by Beta-1

A

Cardiac and Kidney muscle

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57
Q

Major tissues effected by Beta-2

A

smooth muscle, bronchi, liver, and skeletal muscle

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58
Q

Major tissue effected by Beta-3

A

Adipose

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59
Q

Major tissue effected by DA-1

A

Smooth muscle, renal, mesenteric, and cardiac

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60
Q

Major functions of Alpha-1

A

contraction and constriction

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61
Q

Major function of Alpha-2

A

decrease transmitter release

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62
Q

Major function of Beta-1

A

increase HR, contractility, and renal secretion

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63
Q

Major function of Beta-2

A

relax smooth muscle

increases gluconeogenesis, glycogenolysis, and potassium uptake

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64
Q

Major function of Beta-3

A

increase lipolysis

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65
Q

Major function of DA-1

A

relax renal vascular smooth muscle

(higher doses activates Beta-1 and alpha-1)

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66
Q

What two enzymes inactivate catecholamines?

A

MAO and COMT

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67
Q

Dose of Epinephrine for Cardiac Arrest

A

0.1 mL/kg of 1:1000 via ETT

or

0.1 mL/kg of 1:10,000 via IV/IO

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68
Q

Epinephrine dose for Status Asthmaticus

A

0.01 mg/kg of 1:1000 sq

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69
Q

(2) Non-Selective Alpha Antagonists

A

Phentolamine and Phenoxybenzamine

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70
Q

(4) Alpha-1 Antagonist

A

Prazosin, Doxazosin, Terazosin, and Tamulosin

-osin

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71
Q

(2) Alpha-2 Agonists

A

Clonidine and Dexmedetomidine

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72
Q

(2) Combined Alpha and Beta Antagonists

A

Lavetolol and Carvedilol

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73
Q

Which part of the nervous system uses Norepinephrine (rather than acetylcholine)?

A

sympathetic post-ganglionic

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74
Q

Alpha-2 (CNS) agonist acts like an ______ antagonist

A

Alpha-1

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75
Q

Phentolamine

(regitine)

A

non-selective alpha antagonist

  • peripheral vasodilation and decrease BP
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76
Q

Phentolamine Clinical Uses

A

treatment for acute hypertensive emergencies

  • pheochromocytoma
  • autonomic hyperreflexia
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77
Q

Phenoxybenzamine

(dibenzyline)

A

non-reversible and non-selective Alpha Antagonist

  • used preoperatively for Pheochromocytoma
  • Raynauds
    • preferentially dilates cutaneous arteries
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78
Q

Pheochromocytoma

A

tumor of the adrenal medulla

  • secretes excessive amounts of Epi and NE
  • Malignant hypertension
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79
Q

Pheochromocytoma

(preoperative preparation)

A
  • alpha blockade
    • phenoxybenzamine
  • add CCB if needed
  • Beta blocker for tachycardia
  • fluid replacement
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80
Q

In a patient treated with propranolol and phenoxybenzamine prior to resection of a solitary pheochromocytoma, would you expect postoperative hypotension or hypertension?

A

Hypotension

  • hypovolemia
  • residual BB and alpha blockade
  • adrenal insufficiency
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81
Q

Doxazosin

(cardura)

A

Alpha-1 Antagonist

  • treatment for hypertension and BPH
  • relaxes prostatic and vascular smooth muscle
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82
Q

Prazosin

(minipres)

A

alpha-1 Antagonist

  • used for HTN and CHF
  • dilates arterioles and veins
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83
Q

Terazosin

(hytrin)

A

Alpha-1 Antagonist

  • used for BPH
  • relaxes prostatic smooth muscle
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84
Q

Tamulosin

(flomax)

A

Alpha-1 Antagonist

  • used for BPH
  • may cause orthostatic hypotension and syncope
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85
Q

Alpha-2 Receptor Agonists

A

bind pre-synaptically and reduce NE release

  • mostly in CNS
  • uses a negative feedback mechanism
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86
Q

Clonidine

A

centrally-acting Alpha Agonist

  • decreases HR and BP
  • added to regional anesthetics
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87
Q

Dexmedetomidine

A

Alpha-2 Agonist

  • sedative and analgesic
    • central sympatholytic effects
  • avoid in liver failure
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88
Q

(3) Non-selective Beta Antagonists

A

Propranolol, Labetalol, and Sotalol

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89
Q

Blockade of Beta-1 in the kidney

A

decreases renin

  • vasodilation and decreased BP
  • decreased aldosterone
    • salt and water retention
  • decreased NE release
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90
Q

Best drug for controlling Torsades de Pointess in patients with prolonged QTc

A

Propranolol

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91
Q

Best drugs to give patients with CHF

A

Metoprolol and Carvedilol

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92
Q

Labetalol

(normodyne and trandate)

A

Alpha-1 and non-selective Beta Antagonist

  • used for hypertension and controlled hypotension
  • 1 - 5 min onset
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93
Q

Treatment for Beta Blocker Toxicity

A
  • Atropine
  • Isoproterenol
  • Dobutamine
  • Glucagon
  • Calcium Chloride
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94
Q

Blockade of Beta-2 receptors in the bronchi will cause _____

A

bronchoconstriction

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95
Q

Why should Beta-1 blockers be used with caution in diabetic patients?

A

can impair receovery from hypogylcemia and mask symptoms of hyperglycemia

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96
Q

Which beta blocker does not cross the placenta?

A

esmolol

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97
Q

Contraindications to Beta Blockers

A
  • heart blocks and sinus arrest
  • hypovolemic patients with compensatory tachycardia
  • COPD (relative)
  • conditions that would result in unopposed alpha stimulation
    • cocaine and pheochromocytoma
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98
Q

Propranolol decreases the clearance of _____ local anesthetics

A

amide

  • increased LA toxicity
    • especially bupivicaine
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99
Q

Esmolol

(brevibloc)

A

short-acting Beta-1 Antagonist

  • fast onset and half-life
  • hydrolysis by plasma esterases
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100
Q

Metoprolol

(lopressor)

A

Beta-1 Antagonist

  • large doses become non-selective
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101
Q

Atenolol

(tenormin)

A

most selective Beta-1 Antagonist

  • used in CAD patients at high risk of MI
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102
Q

Timolol

A

Beta Antagonist

  • eyedrops used for Glaucoma
  • systemic absorption can cause bradycardia and increase airway resistance
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103
Q

Carvedilol

(coreg)

A

Alpha-1 and non-selective Beta Antagonist

  • weak vasodilator
  • treats mild CHF and hypertension
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104
Q

Which types of CCB are selective for the AV node?

A

Benzothiazepines and Phenylalkylamines

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105
Q

Which type of CCB is selective for arteriolar beds?

A

Dihydropyridines

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106
Q

Calcium Channel Blockers

A

decrease HR by decreasing the speed of conduction through the SA and AV node

  • reduce contractility and relax vascular smooth muscle
  • treats coronary spasms, angina, and SVT
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107
Q

(1) Benzothiazepine example

A

Diltiazem

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108
Q

(1) Phenylalkylamine example

A

Verapamil

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109
Q

Verapamil

A

CCB

(phenylalkylamine)

  • slows conduction through AV node
  • negative chronotropic effect on SA node
  • avoid in WPW
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110
Q

Nifedipie

A

CCB

(dihydropyridines)

  • coronary and peripheral arterial vasodilation
  • no AV or SA node depression
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111
Q

Which CCB has the greatest vasodilating effects?

A

Nicardipine

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112
Q

Nimodipine

A

CCB

(dihydropyridine)

  • CNS vasodilation of large cerebral arteries
  • good for cerebral vasospasm following sub-arachnoid hemorrhage
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113
Q

What causes cerebral vasospasms?

A

influx of Ca2+ ions causing contraction of smooth muscle cells in large cerebral arteries

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114
Q

Diltiazem

(cardizem)

A

CCB

  • selective for AV node
  • used for SVT and angina

(benzothiazepine)

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115
Q

Which (2) CCB increase risk of LA toxicity

A

Verapamil and Diltiazem

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116
Q

(4) ACE inhibitor examples

A

Captopril, Enalopril, Lisinopril, and Ramipril

-pril

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117
Q

ACE Inhibitors

A

treat hypertension secondary to increases renin production

  • may delay onset of renal disease in DM
  • no bronchospasm or bradycardia
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118
Q

ACE Inhibitor side effects

A

cough and hypotension

119
Q

(4) ARB examples

A

candesartan, losartan, valsartan, and telmisartan

-sartan

120
Q

Angiotensin Receptor Blockers (ARB)

A

blocks vasoconstrictive action of Angiotensin II

  • no cough or allergy symptoms
121
Q

Aliskiren

(teckturna)

A

direct renin inhibitor

122
Q

Nitric Oxide

A

pulmonary arterial dilator used for primary pulmonary hypertension

  • improves V/Q mismatch
  • administered via inhalation
123
Q

Nitric Oxide Complications

A
  • Methemoglobinemia
    • treat with IV methylene blue
  • withdrawal symptoms
  • Silo-Filler’s disease
124
Q

Sodium Nitroprusside (SNP)

A

direct-acting peripheral vasodilator

  • relaxes arterial and venous smooth muscle
  • immediate onset and short duration
  • requires A-line
125
Q

Nitroprusside and Cyanide Toxicity

A

tachyphylaxis, metabolic acidosis, and increased mixed venous PO2

  • 2 mcg/kg/min
  • children at greater risk
126
Q

Cyanide Toxicity Treatment

A
  • 100% oxygen
  • sodium thiosulfate
  • sodium nitrate
  • methylene blue
127
Q

Nitroglycerin

A

venodilator and large coronary artery dilator

  • used for cardiac ischemia, reduce preload in CHF, and controlled hypotension
128
Q

Nicardipine

A

cerebral and coronary vasodilator

  • IV infusion for control of BP
129
Q

Hydralazine

A

direct arterial vasodilator

  • good for CHF
    • not indicated in ischemia or coronary disease
  • reflex tachycardia and increased contractility
130
Q

Fenoldopam

A

Dopamine-1 agonist

  • systemic arterial dilation
  • increases renal and splanchnic blood flow
    • increases urine output
131
Q

Carbonic Anhydrase Inhibitors

A

diuretic used for altitude sickness and glaucoma

  • proximal convoluted tubule and collecting duct
  • decreases reabsorption of Na+, HCO3, and water
132
Q

Acetazolamide

(diamox)

A

carbonic anhydrase inhibitor

  • treats altitude sickness and glaucoma
133
Q

Carbonic Anhydrase side effects

A

metabolic acidosis

134
Q

Loop Diuretics

A

most potent diuretic

  • acts on thick ascending Loop of Henle
  • inhibits reabsorption of Na+, K+, and Cl-
  • Treats CHF
135
Q

(2) Loop Diuretic examples

A

Furosemide and Bumetanide

136
Q

Loop Diuretic side effects

A

ototoxicity, alkalosis, and hypokalemia

  • nephrotoxicity
    • aminoglycoside antibiotics
    • cephalosporin
  • increased lithium levels
137
Q

Thiazide Diuretics

A

used for long-term treatment of hypertension

  • acts on cortical ascending Loop of Henle
  • inhibits Na2+ reabsorption
    • increases excretion of Na+, K+, and Cl-
138
Q

Thiazide Diuretic side effects

A

hypokalemia, hypochloremia, metabolic alkalosis, and diabetes

139
Q

Osmotic diuretic

A

inert substances that cause osmotic diuresis in the proximal renal tubules and Loop of Henle

  • example: mannitol
  • used for increased ICP
140
Q

Mannitol

A

osmotic diuretic

  • draws fluid from intracellular to extracellular space
  • increases renal blood flow
    • may protect transplanted kidneys
  • lowers ICP
141
Q

Mannitol side effects

A

rebound intracranial hypertension and hyperosmolarity

142
Q

Potassium-Sparing Diuretics

A

adjunct to other diuretics

  • two categories
    • pteridine and aldosterone receptor blockers
  • Na+ excretion without K+ excretion
143
Q

Pteridine analogs

A

Triamterene (dyazide) and Amiloride

  • prevent Na+ reabsorption in the cortical collecting duct
  • blocks ENa+ channels
144
Q

Spironolactone

A

Aldosterone receptor blocker

  • prevents the synthesis and activation of aldosterone via Na-K-ATPase pump
145
Q

Atrial Natriuretic Peptide

A

endogenous substance produced in response to myocardial wall stretch

  • acts on collecting duct
  • Nesiritide
    • synthetic ANP for CHF
146
Q

PNS and the respiratory system

A
  • regulates airway caliber and glandular activity via the Vagus nerve
  • Ach activates muscarinic receptors
    • bronchoconstriction
  • anticholinergics produce vasodilation
147
Q

Nonadrenergic-Noncholinergic system (NANC)

A

ANS derived influences on the bronchomotor tone through excitatory and inhibitory peptides

148
Q

(2) Short-Acting inhaled adrenergic agonists

A

albuterol and metaproterenol

149
Q

(2) Long-Acting adrenergic agonists

A

salmeterol and formoterol

150
Q

example of short-acting inhaled cholinergic antagonist

A

ipratropium

151
Q

Long-acting inhaled cholinergic antagonist

A

tiotropium

152
Q

Ipratropium

(atrovent)

A

inhaled cholinergic antagonist

  • short acting
  • used for COPD maintenance and asthma rescue
153
Q

Tiotropium

(spiriva)

A

inhaled cholinergic antagonist

  • long acting
  • maintenance of COPD
154
Q

COPD and Asthma involve which similar cells in inflammation?

A

macrophages, lymphocytes, and eosinophils

Asthma: mast cell

COPD: neutrophils

155
Q

example of inhaled corticosteroid

(monotherapy)

A

fluticasone

-nide or -sone

156
Q

Inhaled Corticosteroids

A

reduce inflammation

  • combine with long-acting Beta-2 agonist
157
Q

(2) Leukotriene Antagonists

A

Montelukast and Zafirlukast

158
Q

(1) Leuketriene inhibitor

A

Zileuton

159
Q

Cromolyn

A

mast cell stabilizer

  • prevents the release of histamine
160
Q

(2) Methylxanthines

A

Theophylline and Aminophylline

161
Q

IV anesthetic bronchodilators

A

propofol, ketamine, and midazolam

162
Q

(3) major causes of right heart failure

A

COPD, primary pulmonary hypertension, and OSA

163
Q

Four classes of Pulmonary Hypertension

A

I - normal

IV - right heart failure

164
Q

Ketamine

A

NMDA antagonist

  • stimulates release and inhibits uptake of catecholamines
  • maintains SVR
    • prevents right-to-left shunting
  • maintains coronary perfusion pressure
165
Q

Propofol

A

GABA agonist

  • decreases SVR
    • increases right-to-left shunt
    • may lead to right heart failure
166
Q

Etomidate

A

GABA agonist

  • no change in SVR
    • coronary perfusion pressure maintained
    • no change in R-to-L shunt
167
Q

Which neuromuscular blocker increases PVR?

A

pancuronium

168
Q

sympathetic stimulation ______ PVR

A

increases

169
Q

all volatile agents ____ HPV

A

inhibit

(although modern agents are very weak dilators)

170
Q

Management of PHTN

A

reduce right ventricular afterload while preserving coronary perfusion

171
Q

(4) phases of clot formation

A

initiation, amplification, propagation, and stabilization

172
Q

Thrombin

A

converts fibrinogen to fibrin

173
Q

Factor XIII

A

promotes cross-linking of fibrin polymers to form a stable clot

174
Q

(3) Anti-Coagulation agents

A

NO, prostacyclin, and anti-thrombin

175
Q

Thrombomodulin

A

activates Protein-C and keeps thrombin at site of injury

176
Q

Tissue Plasminogen Activator

(t-PA)

A

activates plasmin from plasminogen

177
Q

Protein C

A

inhibits factors Va and VIIIIa

178
Q

VII is part of the _____ system of the coagulation cascade

A

Extrinsic

179
Q

Prothrombin Time (PT)

A

evaluates the extrinsic and common pathways

  • affected by reductions in prothrombin, V, VII, and X
180
Q

International Normalized Ratio (INR)

A

standard measurement of PT

0.08 - 1.2

181
Q

Partial Thromboplastin Time (PTT)

A

assess intrinsic pathway

Heparin

182
Q

Activated Clotting Time (ACT)

A

used to measure high doses of Heparin

90-150 seconds

183
Q

Bleeding Time

A

general measure of platelet function

3 - 10 minutes

184
Q

Laboratory findings in Warfarin

(or Vitamin K deficiency)

A

prolonged PT and slightly prolonged PTT

185
Q

Laboratory findings in Von Willebrand’s disease

A

prolonged PTT and bleeding time

186
Q

Laboratory findings in Aspirin

A

prolonged bleeding time

187
Q

Laboratory findings in Factor V deficiency

A

prolonged PT and PTT

188
Q

DIC

A

Disseminated Intravascular Coagulation

189
Q

Disseminated Intravascular Coagulation (DIC)

A

consumption of platelets and an inability to prevent thrombin formation

  • coagulopathy and bleeding
  • 10-50% mortality
  • caused by a pathological activation of the hemostatic system
190
Q

DIC diagnosis

A
  • continued bleeding, petechiae
  • low fibrinogen
  • D-dimer levels (fibrin split products)
191
Q

Hemophilia A

A

factor VIII deficiency

192
Q

Hemophilia B

A

factor IX deficiency

193
Q

TRALI

A

Transfusion Related Acute Lung Injury

194
Q

Type A Blood

A

contains A antigens

(anti-B antibodies)

195
Q

When would you use FFP?

A

urgernt reversal of warfarn

196
Q

“unit” of blood

A

10% of patient’s estimated blood volume

197
Q

Cryoprecipitate

A

precipitate of frozen plasma

  • contains factor VIII, XIII, fibrinogen, and vonWillebrand
198
Q

Leukoreduction

A

reduces white blood cells

  • used in PRBC and platelets
  • decreases exposure to non-ABO antigens and CMV
199
Q

Which blood transfusions have the greatest risk of TRALI?

A

plasma > platelets > RBCs

200
Q

Transfusion-Related Acute Lung Injury (TRALI)

A

hypoxia and pulmonary edema within 6 hours of transfusion

201
Q

Which factors catalyze the transformation of Prothrombin to thrombin?

(II and IIa)

A

Factor Xa and Va

202
Q

Heparin

A

binds to anti-thrombin to enhance coagulation

  • highly charged acidic molecule
  • poorly lipid soluble with a high molecular weight
203
Q

Heparin Administration

A

IV (immediate onset)

Subcutaneous (1-2 hours)

204
Q

Heparin side effects

A

hemorrhage, spinal hematoma, and allergic reactions

205
Q

aPTT

(activated plasma thromboplastin time)

A

30 - 35 seconds

Heparin

206
Q

Enoxaparin

(lovenox)

A

low-MW Heparin

  • anti-factor Xa
  • no PTT necessary
207
Q

HIT

A

Heparin Induced Thrombocytopenia

208
Q

Heparin Induced Thrombocytopenia

A
  • Type I
    • drug induced platelet aggregation
    • 3-5 days after therapy
  • Type II
    • immune mediated response to prior exposure to Heparin
    • severe thrombocytopenia
    • 6-10 days after therapy
209
Q

HIT treatment

A

Argatroban or Lepirudin

  • warfarin is contraindicated
  • discontinue heparin, substitute with LMWH
210
Q

Protamine

A

reverses heparin-induced anticoagulation

  • strongly alkaline
  • 1.3 mg protamine per 100 units Heparin
  • administer slowly
211
Q

Protamine side effets

A
  • hypotension
  • pulmonary hypertension and vasoconstriction
  • bronchoconstriction
212
Q

Protamine allergic reactions

A

fish allergies, NPH insulin, and vasectomy

  • pretreat with histamine antagonist (H2 blockers)
213
Q

Warfarin

(coumadin)

A

inhibits vitamin K

(alters prothrombin, factors II, VII, IX, and X)

  • crosses the placenta
  • measured by PT and INR
  • does NOT alter platelet activity
214
Q

Reversal of Warfarin Therapy

A

Vitamin K or FFP

215
Q

How long should you wait before having surgery when using LMWH?

A

12 hours

216
Q

How long should you wait before having surgery with unfractionated Heparin?

A

4 - 6 hours

217
Q

How long should you wait before having surgery while using Warfarin?

A

5 days

(INR < 1.5)

218
Q

Aspirin

A

ADP inhibitor that stops thromboxane synthesis

  • irreversible effect
  • COX inhibitor
219
Q

Plavix

(clopidogrel)

A

blocks ADP on surface of platelets

  • blocks platelet activation
  • irreversible
220
Q

(3) GIIB/IIIA antagonists

A

Abciximab, Tirofiban, and Eptifibatide

221
Q

Bivalirudin

(angiomax)

A

direct thrombin inhibitor

  • used in patients at risk for HIT
  • monitor with ACT
222
Q

(2) Direct Xa inhibitor

A

Rivaroxaban (xarelto)

Apixaban (eliquis)

223
Q

Epsilon Aminocaproic Acid (EACA)

A

lysine analog that prevents lysis of clots

(anti-fibrinolytic)

224
Q

Tranexamic Acid

A

anti-fibrinolytic

225
Q

Massive Blood Transfusion

Definition

A
  • >10 RBC units
  • transfusion of >4 RBC in 1 hour
  • replacement of >50% of TBV within 3 hours
  • transfusion support to loss of blood > 150mL/min
226
Q

TEG

(picture)

A
227
Q

Lepirudin

(Refludan)

A

used for HIT and prevention of further VTE

  • monitor with aPTT
  • stop 24 hours before surgery
  • irreversible thrombin inhibitor
228
Q

Dabigatran

(pradaxa)

A

used for total hip/knee, VTE, and a-fib

  • monitor with thrombin times and aPTT
  • stop 48 hours before surgery if normal renal function
229
Q

(6) Pro-Hemostatic Agents

A
  • anti-fibrinolytic agents
    • aprotinin, tranexamic acid
  • DDAVP
  • Protamine
  • factor concentrates
  • recombinant factors
  • thrombin
230
Q

(6) Anticoagulants

A
  • heparin
  • warfarin
  • LMWH
  • direct thrombin inhibitors
  • platelet inhibitors
    • aspirin, plavix
  • platelet glycoprotein IIB/IIIA
231
Q

vomiting center

A

medulla oblongata

  • sends signals through CN X to vagal parasympathetic fibers and sympathetic chain to muscles
232
Q

Apfel scoring system

A

cateogorizes risk of PONV

233
Q

Scopolamine

A

transdermal anticholinergic

  • blocks transmission of impulses to the medulla
234
Q

Metoclopromide

(reglan)

A

Dopamine Antagonist used for PONV

  • increases gastric motility and contracts esophageal sphincter
  • readily crosses BBB
  • benzamide
235
Q

Midazolam in PONV

(versed)

A

benzodiazepine

  • decrease synthesis and release of dopamine in CRTZ
  • 2 mg
236
Q

Droperidol in PONV

A

Butyrophenone

  • 0.625 - 1.25 mg
  • concern for cardiac arrhythmias secondary to prolonged QT interval
237
Q

Dexamethasone

A

Glucocorticoid for PONV

  • relatively contraindicated in diabetics and obese patients
  • administer slowly or burning genitals
238
Q

Serotonin

A

5-HT3

  • endogenous vasoactive substance and inhibitor neurotransmitter of CNS
  • 90% present in enterochromaffin cells of the GI tract
239
Q

(3) 5-HT3 Antagonists

A

Ondansetron (zofran)

Graniestron (kytril)

Dolasetron (anzemet)

240
Q

Neurokinin-1 Antagonists

A

treatment for PONV

  • aprepitant and fosaprepitant
  • more effective when combined with dexamethasone
241
Q

Sodium Citrate

(bicitra)

A

non-particulate antacid

  • commonly used in parturients
242
Q

H1 Antagonists

A

anti-emetic

  • may cause sedation, urinary retention, and QT interval changes
  • contraindicated in patients with glaucoma or taking MAO inhibitors
  • examples
    • Benadryl and Phenergan
243
Q

Dimenhydrinate

(dramamine)

A

H1 Antagonist

  • used for motion sickness and strabismus surgery
244
Q

H1 Antagonist side effects

A

somnolence, dry mouth, urinary retention and QT prolongation

245
Q

H2 Antagonists

A

inhibits histamine binding to gastric parietal cells

  • examples:
    • rantidine (zantac), Famotadine (pepcid)
246
Q

Omeprazole

(prilosec)

A

proton-pump inhibitor

  • increases pH and decreases volume
  • crosses the BBB
247
Q

Metoclopromide side effects and contraindications

A
  • do not administer to:
    • Parkinson disease
    • restless leg
    • MAO inhibitors
    • tricyclic anti-depressants
  • may cause hypotension, tachycardia, bradycardia,
  • inhibitory effect on plasma cholinesterase activity
248
Q

Insulin secretion

A

pancreatic islets of Langerhans

249
Q

Insulin

(effects on cells)

A
  • facilitates glucose diffusion into cells
  • shifts intracellular glucose metabolism towards glyocogen storage
  • stimulates K+ uptake and protein synthesis
250
Q

Azotemia

A

Increased production and excretion of urea and ammonia

251
Q

Type I Diabetes

A

auto-immune destruction of pancreatic Beta cells

  • do not produce insulin
252
Q

A1C

A

reflects glucose control over 3 months

  • should be less than 7%
253
Q

(2) very rapid Insulin

A

Humalog and NovoLog

254
Q

(1) rapid-acting insulin

A

Humulin

(regular insulin)

255
Q

(2) Long-Acting Insulin

A

Lantus and Levemir

256
Q

Degludec

(Tresiba)

A

longest acting insulin

257
Q

What is the only insulin that can be given IV

A

regular insulin

258
Q

Insulin

site of injection

A

abdomen > arm > buttocks > thigh

259
Q

Rule of 1800

A

calculates insulin sensitivity

  • 1800/total daily dose of insulin (units)
    • = reduction of glucose/unit

Assuming 60 units per day, each unit of insulin should lower blood sugar by 30 mg/dL

260
Q

_____ results in a hyperadrenergic state

A

hypoglycemia

  • tachycardia, sweating, anxiety
261
Q

Glucagon

A

works opposite of insulin

  • synthesized in pancreatic islet A cells
  • reduced secretion by BB
    • can cause hypoglycemia
262
Q

SAMBA

A

glycemic control for the perioperative period

263
Q

(4) types of Hypoglycemic agents

A
  • sulfonylureas
  • meglitinides
  • biguanides
  • thiazolidinediones
264
Q

Pioglitazone

(actos)

A

oral hypoglycemic agent

  • thiazolidinedinones
265
Q

Rosiglitazone

(avandia)

A

oral hypoglycemic agent

  • thiazolidinediones
266
Q

Sulfonylureas

A

stimulate the release of insulin from pancreatic Beta cells

  • may cause hypoglycemia
267
Q

Meglitinides

A

stimulates insulin secretion

  • fast acting and short duration
  • example: Repaglinide (prandin)
268
Q

Biguanides

A

inhibits glucose production by the liver

  • example: Metformin (glucophage)
  • possible lactic acidosis
269
Q

Thiazolidinediones

A

increase sensitivity to insulin for glucose uptake by skeletal muscle

  • not a risk for hypoglycemia
  • Examples: avandia and actos
270
Q

Levothyroxine

A

T4

  • easily overlooked in post-op orders, may present as “failure to thrive”
271
Q

Treatment of Mineralcorticoid deficiency

A

Fludrocortisone

(florinef)

272
Q

Addison’s disease

A

adrenal failure where the body does not produce enough steroid hormones

  • low blood pressure, nausea, vitiligo
273
Q

Cushing’s Syndrome

A

exccess steroids

  • weight gain, slow healing, fatigue, gluocse intolerance
274
Q

Vasopressin

A

anti-diuretic hormone

  • secreted by posterior pituitary
  • arterial vasoconstrictor and reabsorbs water
275
Q

Vasopressin side effects

A
  • vasoconstriction and increased BP
  • increased pulmonary artery pressure
  • coronary ischemia
  • increased peristalsis
276
Q

Oxytocin

(pitocin)

A

indirect stimulation of uterine muscle to induce labor and reduce uterine atony

  • secreted by posterior pituitary
277
Q

Ocetreotide

(sandostatin)

A

somatostatin that inhibits release of growth hormone

  • used to treat acromegaly and acute carcinoid crisis
278
Q

SBE

A

subacute bacterial endocarditis

279
Q

____ do not need to distinguish between positive and negative

A

anaerobes

280
Q

Redose of antibiotics

A

2 1/2 half lives

281
Q

Cefazolin

(ancef)

A

1st generation cephalosporin

  • gram positive and negative
  • cross-reacts with PCN allergy
282
Q

Cefoxitin

(mefoxin)

A

gram positive and negative aerones AND anaerobes

283
Q

Clindamycin

(cleocin)

A

Lincosamides

  • gram positive aerobes AND anaerobes
  • may prolong NMD
  • may cause superinfection with C.diff
284
Q

recommended antibiotic for Urologic surgery

A

Fluroquinolones

285
Q

Ciprofloxacin

(cipro)

A

fluoroquinolones

  • gram positive and negative
  • pseudomonas
  • increases serum level of Theophylline
286
Q

Vancomycin

A

primary treatment for MRSA

  • infuse over 60 minutes
  • redman syndrome
287
Q

Redman Syndrome

A

hypersensitivity to Vancomycin

  • degranulation of mast cells and basophils
  • flushing, red skin, hypotension
288
Q

Fluoroquinolones side effects

A

tendonopathies

289
Q

Levofloxacin

(levaquin)

A

Fluroquinolones

avoid in patients with Myasthenia gravis

290
Q

Gentamicin

A

Aminoglycoside

  • may cause ototoxicity, nephrotoxicity, and potentiation of NMB
  • give over 60 minutes
291
Q

Metronidazole

(flagyl)

A

treats C. diff and H. pylori

  • give over 60 minutes
292
Q

antibiotics contraindicated in pregnancy

A

fluroquinolones

293
Q
A

Quarter 4 (15 decks)

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