Pharmacotherapeutics (38-43) Flashcards
Most common fluid used within 48hrs post surgery
LR
Good fluid for post resuscitation.
D5 1/2 NS
Used commonly with hypovolemic hypernatremia.
1/2 NS
The only fluid to be used with administration of blood products.
NS
With acute and massive hemorrhage, give this colloid
Whole blood
What is commonly give to raise hematocrit in chronic or acute bleeding, anemia, trauma, or an aortic dissection?
Packed RBC’s
What are the 5 primary effects of general anesthesia?
Unconsciousness, amnesia, analgesia, inhibition of autonomic reflexes, and skeletal muscle relaxation
T/F General anesthesia is usually a combination of inhaled and IV medications
TRUE
Which is not a risk factor for general anesthesia? A) Smoking B) Sleep apnea C) Obesity D)HTN E) Sexiness
E) Sexiness. Nothing about being sexy makes you at increased risk during general anesthesia…oh wait…I take that back…all of them are risk factors;)
T/F N/V is not common with general anesthesia.
FALSE. 20-30% That’s why you are allowed to eat anything pre-op
A Bier block is a form of what?
Regional anesthesia
What is a bier block used for?
Short operative procedures on extremities
T/F A spinal is faster to take affect than an epidural
TRUE
What S/E is really common, especially in women, after spinal anesthesia?
HA
T/F A spinal offers longer pain control than an epidural.
FALSE. Spinal = Faster, Epidural = Longer
What happens if you inject epinephrine into someones blood stream accidentally during a local anesthesia attempt by a rookie?
Sympathetic response…it’s effing epi people!!!
What’s one thing to look out for when doing local anesthesia?
Unintentionally injecting into a vessel and causing cardiovascular issues and/or CNS problems (seizure)
When might topical anesthetics cause systemic issues?
If it’s used on broken skin or mucus membranes
Most common PCA medication used.
Morphine
How much does morphine is usually infused in a PCA when the button is pressed? How long until it can be pressed again?
1-3mg. 6-8min
The MOA of local anesthetics
Blocking sodium channels making it harder for nerve cells to reach action potential…LESS FIRING = LESS PAIN
T/F Using local with epi is good because it causes the anesthesia to wear off faster
FALSE. It causes vasoconstriction in the area and making the anesthesia take longer to wear off.
What do you ALWAYS want to do with the syringe prior to injecting with local anesthetic?
Aspirate to ensure you are not in a vessel!!!
The highest potency and longest lasting local anesthetic
Bupivacaine
Rapid onset medium duration local anesthetic
Lidocaine
Rapid onset short duration local anesthetic
Chloroprocaine
Moderate onset medium duration local anesthetic
Mepivacaine
Slow onset local anesthetic
Bupivacaine
You should use this local anesthetic with caution in myasthenia gravis
Chloroprocaine
You should NOT use this local anesthetic during labor or obstetrical events
Mepivacaine
This local anesthetic has cardiotoxicity potential
Bupivacaine
A combo drug using _____ and _____ is used as a topical cream to numb skin prior to venipuncture, LP, lido injection, minor burn procedures, or vaccinations.
Lidocaine/prilocaine
What might be an adverse effect associated with lidocaine/prilocaine cream use?
Methemoglobinemia (whatever the eff that is). Something to do with hemoglobin that can’t carry O2 or something.
Most common adverse reaction to morphine
Constipation
T/F Morphine is a pure opiate
TRUE
Brand name for hydromorphone
Dilaudid
What is hydromorphone
Morphine and codeine
Hydromorphone is ____x more potent than morphine
5x
T/F You should NOT use hydromorphone with MAOI’s
TRUE
Tylenol with codeine is (more/less) potent than morphine
Less
Tylenol with codeine is used for mild to moderate pain and is effective against what other symptom?
Cough
Hydrocodone has a similar potency to what other drug?
Morphine
What OTC medication would you want a person to discontinue taking with many of the opioid analgesics?
Acetaminophen as many of them contain it.
Brand name of hydrocodone.
Vicodin
Brand name for oxycodone
Percodan/percocet
Percocet consists of what two drugs?
Oxycodone and acetaminophen
What will happen if you crush sustained release tablets of oxycodone?
OD and death
Meperidine’s brand name is?
Demerol
Meperidine is not recommended for long term pain care, why?
Due to its active metabolite toxic metabolites, normeperidine, which has neurotoxic properties
You should not take meperidine within ____ days of taking an MAOI
14
A pt has all the symptoms of a negative response to opioids plus anxiety, tremors, muscle twitches, and anticholinergic effects.
Meperidine use
Oh no…his pupils are HUGE! But you’re sure he took some opioids and not a benzo. What might he have taken?
Meperidine
This drug is good and very commonly used for chronic pain
Methadone
What opioid commonly used can cause Torsades as well as other ventricular cardiac arrhythmia’s
Methadone
One advantage to this opioid mediation in acute pain is the rapid onset and short duration of action making it good for the evaluation of pts pain level more often.
Fentanyl
This opiate is 100x more potent than morphine.
Fentanyl
Contraindications to topical anesthetics are…
Allergy to medication.
