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Pharmacology II > Pre-Op Meds (Exam 1) > Flashcards

Pre-Op Meds (Exam 1) Flashcards

1
Q

H1 Receptor Antagonist Meds

A

-Promethazine (Phenegran)
-Diphenhydramine (Benadryl)

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2
Q

Promethazine (Phenegran): E 1/2 Time

A

9-16 Hours

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3
Q

Promethazine (Phenegran): Onset

A

5 mins

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4
Q

Promethazine (Phenegran): Side effects

A

Anticholinergic effects
(Blurry vision,dry mouth, drowsiness, Urinary Retention)

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5
Q

Promethazine (Phenegran): Adverse Effects

A

BLACK BOX WARNINGS
-Local site extravasation; -Respiratory depression in Peds

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6
Q

Promethazine (Phenegran): Dose

A

IV: 12.5mg - 25mg

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7
Q

Diphenhydramine (Benadryl):
E 1/2 Time

A

7-12 Hours

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8
Q

Diphenhydramine (Benadryl): Side effects

A

Anti-cholinergic effects

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9
Q

Diphenhydramine (Benadryl): Adverse Effects

A

Can cause sedation/drowsiness.

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10
Q

Diphenhydramine (Benadryl): Dose

A

IV: 25 - 50 mg

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11
Q

Diphenhydramine (Benadryl): Other

A

-Salt dimenhydrinate :Inhibits afferent arc of oculo-emetic reflex when extra ocular muscles are stimulated (eye surgeries!)

-Stimulate ventilation by augmenting relationship of hypoxic and hypercarbic drives if given SOLO, but if given with narcotics it will not help ventilation

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12
Q

H2 Antagonist Drugs

A

-Cimetidine (Tagamet)
-Ranitidine (Zantac)
-Famotidine (Pepcid)

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13
Q

Cimetidine (Tagamet): Metabolism

A

-Metabolized in liver: CYP450, excreted in urine

-CYP450 inhibitor: Warfarin, Phenytoin, Lidocaine, TCAs, Propanolol, Nifedipine, Merperidine.

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14
Q

Cimetidine (Tagamet): Side Effects

A

Basic H 2 side effects

headache, dizziness, drowsiness, joint pain, diarrhea, or nausea

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15
Q

Cimetidine (Tagamet): Adverse Effects

A

-Hypotension,Bradycardia from rapid infusions

-Confusion

-Increased Prolactin

-Inhibits Dihydrotestosterone from binding to androgen receptor →Decreased Testosterone - Impotence and Gynecomastia (man boobs!)

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16
Q

Cimetidine (Tagamet): Dose

A

IV: 150 - 300 mg

1/2 dose renal impairment pt.

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17
Q

Ranitidine (Zantac): Dose

A

IV: 50 mg diluted in 20 cc over 2 mins

1/2 Dose renal impairment pt.

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18
Q

Famotidine (Pepcid): E 1/2 Time

A

2.5 - 4 hrs
**MOST POTENT OF THE 3”

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19
Q

Famotidine (Pepcid): Metabolism

A

Metabolized in liver and renal clearance

No CYP450 inhibition

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20
Q

Famotidine (Pepcid): Side Effects

A

HYPOPHOSPHATEMIA: Interferes with phsophate absorption

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21
Q

Famotidine (Pepcid): Dose

A

IV: 20 mg

1/2 Dose of Renal Impairment

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22
Q

PPI Drugs

A

-Omeprazole (Priosec)
-Pantoprazole (Protonix)

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23
Q

Omeprazole (Prilosec): Metabolism

A

CYP;
no significant inhiibition of drugs

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24
Q

Omeprazole (Prilosec): Side effects

A

CROSSES BBB
‣ Headache, Confusion, Agitation

‣Abdominal pain
‣N/V
‣Flatulence
‣SMALL BOWEL BACTERIAL OVER GROWTH

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25
Q

Omeprazole (Prilosec): Dose

A

IV: 40 mg diluted in 100cc NS over 30 mins

PO: > 3 hrs prior to surgery

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26
Q

Omeprazole (Prilosec): Other

A

Decrease gastric volume and increase pH

27
Q

Pantoprazole (Protonix): Onset

A

1 hr; Decrease gastric volume and increased pH

28
Q

Pantoprazole (Protonix): Metabolism

A

CYP;
no significant drug interactions

29
Q

Pantoprazole (Protonix): Dose

A

IV:40 mg diluted in 100cc NS over 2 -15 mins

30
Q

Pantoprazole (Protonix): Other

A

-Decreases gastric content and increase pH
-Greater bioavailbility and longer 1/2 time than Prilosec
-Works as fast as Ranitidine,
-ADMINISTER 1 HR PRIOR SURGERY TO ↓ GASTRIC VOLUME

31
Q

Antacid Drugs

A

-Sodium Citrate (Bicitra)

32
Q

Sodium Citrate (Bicitra): Onset

A

Immediate
Neutralizes gastric acid

33
Q

Sodium Citrate (Bicitra): Peak

A

Last 30 - 60 mins

34
Q

Sodium Citrate (Bicitra): Dose

A

PO: 15 - 30cc cups

35
Q

Sodium Citrate (Bicitra): Other

A

-Increased gastric volume
-Frequently used in C-sections

36
Q

Dopamine Blocker (Antagonists) Drugs

A

-Metoclopramide (Reglan)
-Domperidone
-Droperidol

37
Q

Metoclopramide (Reglan): Onset

A

15-30 mins prior to induction

38
Q

Metoclopramide (Reglan): Side effects

A

‣CROSSES BBB → sedation
‣Abdominal Cramping
‣Muscle Spasms
‣Hypotension
‣ Increases Prolactin Release ‣Neuroleptic Malignant Syndrome
‣ ↓ PLASMA CHOLINESTERASE: slows metab. Of sux, mivacurium, ester LA

39
Q

Metoclopramide (Reglan): Dose

A

IV: 10 - 20 mg over 3 - 5 mins

GIVE 15 -30 minutes before induction*

40
Q

Metoclopramide (Reglan): Other

A

ONLY FDA drug for Diabetic Gastroparesis

41
Q

Domperidone: Side effects

A

‣ Does NOT cross BBB;
‣ no anticholinergic activity
‣ Increases Prolactin Release more than reglan
‣ NO FDA approval:
‣ Dysrythmias and Sudden death”

42
Q

Domperidone: Other

A

Not available in U.S.

43
Q

Droperidol (Inaspine): Metabolism

A

LOTS OF SERIOUS DRUG INTERACTIONS

44
Q

Droperidol (Inaspine):

A

‣ does not Crosses BBB:
‣ Extrapyramidal sxs
‣ Neuroleptic Malignant Syndrome;
‣Hypotension
‣Black Box: Prolonged QT; Torsades de pointes

45
Q

Droperidol (Inaspine): Dose

A

IV: 0.625 - 1.25 mg

Equally effective as 4 mg of Zofran and more effective than Reglan

46
Q

Droperidol (Inaspine): Other

A

AVOID OTHER CNS DEPRESSANTS

47
Q

5HT3 Antagonist Drugs:

A

-Ondansetron (Zofran

48
Q

Ondansetron (Zofran): E 1/2 Time

A

4 Hrs

49
Q

Ondansetron (Zofran): Side Effects

A

‣ Does not cross BBB
‣ Headache
‣ Diarrhea
‣ Prolonged QT with high doses”

50
Q

Ondansetron (Zofran): Dose

A

IV: 4 - 8 mg

Give zofran at end of procedure!

51
Q

Ondansetron (Zofran): Others

A

Studies equivocal with droperidol, dexmethasone, reglan

52
Q

Corticosteroid drugs:

A

-Dexmethasone (Decadrone)

53
Q

Dexamethasone (Decadron): Onset

A

Delayed 2 hrs
given at start of case or 2 hrs prior to end of long case

54
Q

Dexamethasone (Decadron): Peak

A

Last 24 hrs

55
Q

Dexamethasone (Decadron): Side Effects

A

‣Diabetic risk for hyperglycemia BUT WE STILL GIVE IT B/C 1 DOSE HAS MINIMAL SIDE EFFECTS;
‣ Perineal itching/burning with Rapid IVP

56
Q

Dexamethasone (Decadron): Dose

A

IV: 4 - 8 mg Antiemetic
IV: 12 - 16 mg Inflammation

57
Q

Dexamethasone (Decadron): Other

A

Increases effectiveness of 5HT3 Antagonists and Droperidol

58
Q

Anticholinergic (Muscarinic Antagonist): Drugs

A

Scopolamine

59
Q

Scopolamine: E 1/2 Time

A

24 - 72 hrs

60
Q

Scopolamine: Onset

A

4 hrs prior to surgery; place patch post-auricular

61
Q

Scopolamine: Peak

A

8 - 24 hrs

62
Q

Scopolamine: Side Effects

A

‣Crosses BBB- sedative effect
‣Headache; Ipsilateral pupil dilation - can mimic a hemorrhagic stroke
‣Pupil dilation can cause bright light senstivity.

63
Q

Scopolamine: Dose

A

Post-auricular patch: First layer of patch is 140 mcg loading dose; then the other 1.5 mg absorbs into the skin over 72 hours

1.5 mg @ 5 mcg/hr for 72 hrs

Pharmacology II (8 decks)

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