Pre-Op Meds (Exam 1) Flashcards
H1 Receptor Antagonist Meds
-Promethazine (Phenegran)
-Diphenhydramine (Benadryl)
Promethazine (Phenegran): E 1/2 Time
9-16 Hours
Promethazine (Phenegran): Onset
5 mins
Promethazine (Phenegran): Side effects
Anticholinergic effects
(Blurry vision,dry mouth, drowsiness, Urinary Retention)
Promethazine (Phenegran): Adverse Effects
BLACK BOX WARNINGS
-Local site extravasation; -Respiratory depression in Peds
Promethazine (Phenegran): Dose
IV: 12.5mg - 25mg
Diphenhydramine (Benadryl):
E 1/2 Time
7-12 Hours
Diphenhydramine (Benadryl): Side effects
Anti-cholinergic effects
Diphenhydramine (Benadryl): Adverse Effects
Can cause sedation/drowsiness.
Diphenhydramine (Benadryl): Dose
IV: 25 - 50 mg
Diphenhydramine (Benadryl): Other
-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
H2 Antagonist Drugs
-Cimetidine (Tagamet)
-Ranitidine (Zantac)
-Famotidine (Pepcid)
Cimetidine (Tagamet): Metabolism
-Metabolized in liver: CYP450, excreted in urine
-CYP450 inhibitor: Warfarin, Phenytoin, Lidocaine, TCAs, Propanolol, Nifedipine, Merperidine.
Cimetidine (Tagamet): Side Effects
Basic H 2 side effects
headache, dizziness, drowsiness, joint pain, diarrhea, or nausea
Cimetidine (Tagamet): Adverse Effects
-Hypotension,Bradycardia from rapid infusions
-Confusion
-Increased Prolactin
-Inhibits Dihydrotestosterone from binding to androgen receptor →Decreased Testosterone - Impotence and Gynecomastia (man boobs!)
Cimetidine (Tagamet): Dose
IV: 150 - 300 mg
1/2 dose renal impairment pt.
Ranitidine (Zantac): Dose
IV: 50 mg diluted in 20 cc over 2 mins
1/2 Dose renal impairment pt.
Famotidine (Pepcid): E 1/2 Time
2.5 - 4 hrs
**MOST POTENT OF THE 3”
Famotidine (Pepcid): Metabolism
Metabolized in liver and renal clearance
No CYP450 inhibition
Famotidine (Pepcid): Side Effects
HYPOPHOSPHATEMIA: Interferes with phsophate absorption
Famotidine (Pepcid): Dose
IV: 20 mg
1/2 Dose of Renal Impairment
PPI Drugs
-Omeprazole (Priosec)
-Pantoprazole (Protonix)
Omeprazole (Prilosec): Metabolism
CYP;
no significant inhiibition of drugs
Omeprazole (Prilosec): Side effects
CROSSES BBB
‣ Headache, Confusion, Agitation
‣Abdominal pain
‣N/V
‣Flatulence
‣SMALL BOWEL BACTERIAL OVER GROWTH
Omeprazole (Prilosec): Dose
IV: 40 mg diluted in 100cc NS over 30 mins
PO: > 3 hrs prior to surgery
Omeprazole (Prilosec): Other
Decrease gastric volume and increase pH
Pantoprazole (Protonix): Onset
1 hr; Decrease gastric volume and increased pH
Pantoprazole (Protonix): Metabolism
CYP;
no significant drug interactions
Pantoprazole (Protonix): Dose
IV:40 mg diluted in 100cc NS over 2 -15 mins
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
Antacid Drugs
-Sodium Citrate (Bicitra)
Sodium Citrate (Bicitra): Onset
Immediate
Neutralizes gastric acid
Sodium Citrate (Bicitra): Peak
Last 30 - 60 mins
Sodium Citrate (Bicitra): Dose
PO: 15 - 30cc cups
Sodium Citrate (Bicitra): Other
-Increased gastric volume
-Frequently used in C-sections
Dopamine Blocker (Antagonists) Drugs
-Metoclopramide (Reglan)
-Domperidone
-Droperidol
Metoclopramide (Reglan): Onset
15-30 mins prior to induction
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
Metoclopramide (Reglan): Dose
IV: 10 - 20 mg over 3 - 5 mins
GIVE 15 -30 minutes before induction*
Metoclopramide (Reglan): Other
ONLY FDA drug for Diabetic Gastroparesis
Domperidone: Side effects
‣ Does NOT cross BBB;
‣ no anticholinergic activity
‣ Increases Prolactin Release more than reglan
‣ NO FDA approval:
‣ Dysrythmias and Sudden death”
Domperidone: Other
Not available in U.S.
Droperidol (Inaspine): Metabolism
LOTS OF SERIOUS DRUG INTERACTIONS
Droperidol (Inaspine):
‣ does not Crosses BBB:
‣ Extrapyramidal sxs
‣ Neuroleptic Malignant Syndrome;
‣Hypotension
‣Black Box: Prolonged QT; Torsades de pointes
Droperidol (Inaspine): Dose
IV: 0.625 - 1.25 mg
Equally effective as 4 mg of Zofran and more effective than Reglan
Droperidol (Inaspine): Other
AVOID OTHER CNS DEPRESSANTS
5HT3 Antagonist Drugs:
-Ondansetron (Zofran
Ondansetron (Zofran): E 1/2 Time
4 Hrs
Ondansetron (Zofran): Side Effects
‣ Does not cross BBB
‣ Headache
‣ Diarrhea
‣ Prolonged QT with high doses”
Ondansetron (Zofran): Dose
IV: 4 - 8 mg
Give zofran at end of procedure!
Ondansetron (Zofran): Others
Studies equivocal with droperidol, dexmethasone, reglan
Corticosteroid drugs:
-Dexmethasone (Decadrone)
Dexamethasone (Decadron): Onset
Delayed 2 hrs
given at start of case or 2 hrs prior to end of long case
Dexamethasone (Decadron): Peak
Last 24 hrs
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
Dexamethasone (Decadron): Dose
IV: 4 - 8 mg Antiemetic
IV: 12 - 16 mg Inflammation
Dexamethasone (Decadron): Other
Increases effectiveness of 5HT3 Antagonists and Droperidol
Anticholinergic (Muscarinic Antagonist): Drugs
Scopolamine
Scopolamine: E 1/2 Time
24 - 72 hrs
Scopolamine: Onset
4 hrs prior to surgery; place patch post-auricular
Scopolamine: Peak
8 - 24 hrs
Scopolamine: Side Effects
‣Crosses BBB- sedative effect
‣Headache; Ipsilateral pupil dilation - can mimic a hemorrhagic stroke
‣Pupil dilation can cause bright light senstivity.
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
