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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
Omeprazole (Prilosec): Dose
IV: 40 mg diluted in 100cc NS over 30 mins PO: > 3 hrs prior to surgery
26
Omeprazole (Prilosec): Other
Decrease gastric volume and increase pH
27
Pantoprazole (Protonix): Onset
1 hr; Decrease gastric volume and increased pH
28
Pantoprazole (Protonix): Metabolism
CYP; no significant drug interactions
29
Pantoprazole (Protonix): Dose
IV:40 mg diluted in 100cc NS over 2 -15 mins
30
Pantoprazole (Protonix): Other
-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
Antacid Drugs
-Sodium Citrate (Bicitra)
32
Sodium Citrate (Bicitra): Onset
Immediate Neutralizes gastric acid
33
Sodium Citrate (Bicitra): Peak
Last 30 - 60 mins
34
Sodium Citrate (Bicitra): Dose
PO: 15 - 30cc cups
35
Sodium Citrate (Bicitra): Other
-Increased gastric volume -Frequently used in C-sections
36
Dopamine Blocker (Antagonists) Drugs
-Metoclopramide (Reglan) -Domperidone -Droperidol
37
Metoclopramide (Reglan): Onset
15-30 mins prior to induction
38
Metoclopramide (Reglan): Side effects
‣CROSSES BBB → sedation ‣Abdominal Cramping ‣Muscle Spasms ‣Hypotension ‣ Increases Prolactin Release ‣Neuroleptic Malignant Syndrome ‣ ↓ PLASMA CHOLINESTERASE: slows metab. Of sux, mivacurium, ester LA
39
Metoclopramide (Reglan): Dose
IV: 10 - 20 mg over 3 - 5 mins **GIVE 15 -30 minutes before induction***
40
Metoclopramide (Reglan): Other
ONLY FDA drug for Diabetic Gastroparesis
41
Domperidone: Side effects
‣ Does NOT cross BBB; ‣ no anticholinergic activity ‣ Increases Prolactin Release more than reglan ‣ NO FDA approval: ‣ Dysrythmias and Sudden death"
42
Domperidone: Other
Not available in U.S.
43
Droperidol (Inaspine): Metabolism
LOTS OF SERIOUS DRUG INTERACTIONS
44
Droperidol (Inaspine):
‣ does not Crosses BBB: ‣ Extrapyramidal sxs ‣ Neuroleptic Malignant Syndrome; ‣Hypotension ‣Black Box: Prolonged QT; Torsades de pointes
45
Droperidol (Inaspine): Dose
IV: 0.625 - 1.25 mg Equally effective as 4 mg of Zofran and more effective than Reglan
46
Droperidol (Inaspine): Other
AVOID OTHER CNS DEPRESSANTS
47
5HT3 Antagonist Drugs:
-Ondansetron (Zofran
48
Ondansetron (Zofran): E 1/2 Time
4 Hrs
49
Ondansetron (Zofran): Side Effects
‣ Does not cross BBB ‣ Headache ‣ Diarrhea ‣ Prolonged QT with high doses"
50
Ondansetron (Zofran): Dose
IV: 4 - 8 mg Give zofran at end of procedure!
51
Ondansetron (Zofran): Others
Studies equivocal with droperidol, dexmethasone, reglan
52
Corticosteroid drugs:
-Dexmethasone (Decadrone)
53
Dexamethasone (Decadron): Onset
Delayed 2 hrs given at start of case or 2 hrs prior to end of long case
54
Dexamethasone (Decadron): Peak
Last 24 hrs
55
Dexamethasone (Decadron): Side Effects
‣Diabetic risk for hyperglycemia BUT WE STILL GIVE IT B/C 1 DOSE HAS MINIMAL SIDE EFFECTS; ‣ Perineal itching/burning with Rapid IVP
56
Dexamethasone (Decadron): Dose
IV: 4 - 8 mg Antiemetic IV: 12 - 16 mg Inflammation
57
Dexamethasone (Decadron): Other
Increases effectiveness of 5HT3 Antagonists and Droperidol
58
Anticholinergic (Muscarinic Antagonist): Drugs
Scopolamine
59
Scopolamine: E 1/2 Time
24 - 72 hrs
60
Scopolamine: Onset
4 hrs prior to surgery; place patch post-auricular
61
Scopolamine: Peak
8 - 24 hrs
62
Scopolamine: Side Effects
‣Crosses BBB- sedative effect ‣Headache; Ipsilateral pupil dilation - can mimic a hemorrhagic stroke ‣Pupil dilation can cause bright light senstivity.
63
Scopolamine: Dose
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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