Pre-Op Meds General (Exam 1)

Question 1

Drugs That Cause Histamine Release

Answer 1

-Protamine
-AtraCurium
-MivaCurium
-Morphine

Question 2

H1 & H2 Receptor Activation Effects

Answer 2

-Hypotension
-Capillary Permeability
-Flushing
-Prostacycline release
-Tachycardia

Question 3

H1 Antagonist Meds

Answer 3

-Promethazine (Phenegran)
-Diphenydramine (Benadryl)

Question 4

General Side Effects: H1 Antagonist 1st Gen.

Answer 4

-Drowsiness (1st generation) due to crossing BBB
-Blurred Vision
-Urinary Retention
-Dry mouth

Question 5

H2 Antagonist Meds

Answer 5

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

Question 6

Major Side Effects: H2 Antagonist

Answer 6

-Weakened gastric mucosa d/t bacteria (prolonged administration) →increased pulmonary infections and overgrowth of Candida albican

-LONG TERM USE: INCREASED SERUM CREATININE 15% d/t COMPETITION FOR TUBULAR SECRETION

Question 7

PPI Meds

Answer 7

-Omeprazole (Prilosec)
-Pantoprazole (Protonix)

Question 8

PPI Side Effects/Interaction

Answer 8

-Inhibits warfarin metabolism
-prevents clopidogrel (Plavix) activation

Side Effects:
‣ Bone fractures,
‣ SLE
‣acute interstitial nephritis
‣ C-Diff diarrhea
‣Vitamin B12/Magnesium deficie

Question 9

Antacids Meds

Answer 9

-Sodium Citrate (Bicitra)

Question 10

Antacids Side Effects

Answer 10

-Longterm Use of antacids: Breakdown of food inhibited and acid rebound can occur
-Sodium based: increased sodium load →HTN

Question 11

Dopamine Blockers

Answer 11

-Metoclopramide (Reglan)
-Domperidone
-Droperidol (Inaspine) = the story with dr. Kane feeling terrible on the way home

Question 12

Dopamine Blockers: how they work

Answer 12

Stimulates Gastrice Motility
(prokinetic)
‣ ↑ Lower esophageal tone
‣ ↑Peristalsis
‣ ↓tone of pylorus and duodeum

Question 13

Dopamine Blockers: Side Effects

Answer 13

‣ Extrapyramidal reactions (EASILY CROSSES BBB)
‣ Orthostatic hypotension

NO EFFECT ON GASTRIC pH

Question 14

5-HT3 Antagonist: Drugs

Answer 14

Ondansetron (Zofran)

Question 15

5-HT3 Antagonist: Other

Answer 15

-NO USE for motion sickness
- Preventative treatment for n/v

Question 16

Corticosteroid: Drugs

Answer 16

Dexamethasone (Decadron)

Question 17

Corticosteroid: MOA

Answer 17

MOA UNKNOWN: THEORIES

‣ Possibly centrally inhibits prostaglandin synthesis and control of endorphin release

‣ increase effectiveness for 5HT3 antagonsists and Droperidol

‣ We give it for other stuff, has antiinflammatory properties, so we use less opioids which means less PONV

Question 18

Anticholinergic: Drugs

Answer 18

Scopolamine

Question 19

Anticholinergic: MOA

Answer 19

Competitive antagonist of ACH
Crosses BBB
Has central and peripheral effects

Question 20

Brochodilators: Drugs

Answer 20

-Albuterol
-Xopenex

Question 21

Brochodilators: Side Effects

Answer 21

SIDE EFFECTS:
‣ Tremor → B2 stimulation in skeletal muscle

‣Tachycardia

‣ Hyperglycemia

Question 22

Brochodilators: Delivery of Med

Answer 22

DELIEVERY OF SABA:
‣ Discharge inhaler while taking breath over 5-6 sec

‣ Hold breath 5-6 sec

‣12% of drug reaches lungs

‣Of that 12%, 50-70% of it reaches lung with ETT d/t positive pressure ventilation (so even less of the dose)

‣ can repeat Q 4 hrs (we can do as many as we want though I think)

Question 23

Brochodilators: How are they beneficial?

Answer 23

Reduce inflammatory cell activation
Directly relaxes smooth muscle
15% increase FEV in 6 minutes or 2 puffs
Structurally similar to Epi