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Anesthesia pharm > Pre-op meds - test 1 > Flashcards

Pre-op meds - test 1 Flashcards

1
Q

Histamines are endogenous substances that are released from ___________ and _______________.

A

Basophils; Mast Cells

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2
Q

What does histamine do to the airway?

A

Contraction of smooth muscles in the airway.

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3
Q

What does histamine do in the stomach?

A

Acid Secretions in the stomach.

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4
Q

Histamine causes what NTs to be released in the CNS?

A

Histamine will cause the release of serotonin, acetylcholine, and norepinephrine in the CNS.

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5
Q

What drugs will induce histamine release?

A

Morphine, Protamine, Mivacurium, Atracurium

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6
Q

When H1 histamine receptors are activated it can activate ______, _________, __________, and ________ receptors.

A

Muscarinic, Cholinergic, 5HT3, Alpha-adrenergic

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7
Q

When H2 histamine receptors are activated, it can activate ________ and ________ receptors.

A

5HT3, Beta-1

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8
Q

When histamine binds to an H1-receptor what will be the result?

A

Hyperalgesia and inflammatory pain (insect sting)

Allergic rhino-conjunctivitis symptoms

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9
Q

When histamine binds to an H2-receptor what will be the result?

A

Elevate cAMP (Beta1-like stimulation, tachycardia)

Increase acid and volume production

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10
Q

Activation of both H1 and H2 receptors will result in what symptoms?

A

Prostacyclin Release, Capillary permeability, Tachycardia, Hypotension d/t release of NO, Flushing

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11
Q

What is the most accurate description of an antihistamine?

A

Inverse Agonist

They don’t prevent the release of histamine but responses

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12
Q

What are the effects of H1 receptor antagonists on the following areas? Vestibular System, Airway Smooth Muscle, Cardiac Endothelial:

A

Vestibular System: Effective for motion sickness

Airway Smooth Muscle: protection against bronchospasms

Cardiac Endothelial: provide cardiac stability

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13
Q

The first-generation H1 antagonist causes a lot of ____________ as a side effect.

A

sedation

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14
Q

Can you develop tachyphylaxis from H1 receptors?

A

No

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15
Q

What are the side effects of H1 receptor antagonists?

A

Blurred Vision, Urinary Retention, Dry Mouth, Drowsiness/Sedation (first gen)

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16
Q

What are examples of H1 receptor antagonist drugs?

A

Diphenhydramine (Benadryl), Promethazine (Phenergan), Cetirizine (Zyrtec), Loratadine (Claritin)

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17
Q

This H1 receptor drug is mostly used as an antipruritic and pre-treat procedure-related allergy (IVP dye)

A

Benadryl

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18
Q

Diphenhydramine inhibits the afferent arc of the ________________.

A

Oculo-emetic reflex

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19
Q

Diphenhydramine can stimulate ventilation by augmenting the relationship of ____________ and ___________ drive.

A

Hypoxic, Hypercarbic

Only if given as a solo administration

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20
Q

What is the IV dose of Benadryl?

A

25-50mg IV

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21
Q

What is the half-time of Benadryl?

A

7-12 hours

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22
Q

Which H1 receptor antagonist is a great anti-emetic and is used as a rescue and reduces peripheral pain levels (anti-inflammatory effects).

A

Promethazine

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23
Q

What is the IV dose of Promethazine?

A

12.5-25mg IV (give less to the elderly)

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24
Q

How long does it take to onset for Promethazine?

A

5 minutes for onset

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25
Q

What is the half-time of Promethazine?

A

9-16 hours

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26
Q

What were the black box warnings for Phenergan?

A

Can cause death in children under the age of 2.

Can cause extravasation and ischemia to the tissue from IV injection.

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27
Q

H2 receptors antagonist are most commonly used in __________.

A

Duodenal ulcer disease / GERD

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28
Q

How does an H2 receptor antagonist work?

A

Decrease hypersecretion of gastric fluid (H+) from gastric parietal cells and decrease cAMP, which will decrease gastric volume and increase pH.

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29
Q

H2 receptor antagonist can increase serum creatine by _______% d/t competition for tubular secretion.

A

15%

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30
Q

What are the side effects of H2 receptor antagonists?

A

HA/Confusion (Elderly), Bradycardia, Diarrhea, Skeletal Muscle Pain, Weakened Gastric Mucosa, Creatine Increase

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31
Q

Overgrowth of ____________ can increase pulmonary infections d/t weakened gastric mucosa from prolonged administration of H2 antagonist.

A

Candida Albicans

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32
Q

What are examples of H2 receptor antagonists?

A

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

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33
Q

How is Cimetidine metabolized?

A

CYP450, hepatic metabolism, renal clearance

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34
Q

Cimetidine strongly inhibits CYP 450 and can affect the metabolism of which drugs?

A

Warfarin, Phenytoin, Lidocaine, Tricyclics, Propranolol (Inderal), Nifedipine, MEperidine, Diazepam

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35
Q

What are the adverse effects of Cimetidine?

A

Bradycardia, Hypotension (rapid infusion), Increase Prolactin, Impotence (Inhibits dihydrotestosterone binding to androgen receptors)

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36
Q

What is the dose of cimetidine?

A

150-300mg IV

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37
Q

What is the renal dosing for cimetidine?

A

75-150mg IV

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38
Q

How is Ranitidine metabolized?

A

CYP450, hepatic metabolism, renal clearance

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39
Q

What is the dose of Ranitidine?

A

50mg diluted to 20cc given over 2 minutes.

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40
Q

What is the renal dosing for Ranitidine?

A

25mg diluted to 20cc given over 2 minutes.

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41
Q

How is Famotidine metabolized?

A

CYP450, hepatic metabolism, renal clearance

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42
Q

What interference is Famotidine involved with?

A

Interferes with phosphate absorption and can result in phosphatemia.

Bone fractures or hips hurting

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43
Q

What is the dosing for famotidine?

A

20mg IV

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44
Q

What is the renal dosing for famotidine?

A

10mg IV

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45
Q

What is the half-time for famotidine?

A

2.5-4 hours (most potent and longest of all H2 receptor antagonist)

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46
Q

What group of drugs irreversibly bind to acid secretion pumps and inhibit the movement of protons (H+) across the gastric parietal cells?

A

Proton Pump Inhibitors

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47
Q

How many days does it take for the onset of PPIs?

A

3 to 5 days

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48
Q

What are PPIs most effective against?

A

Controlling gastric acidity, Decreasing Volume

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49
Q

PPIs are more effective than H2 receptors in what 4 areas?

A

Healing esophagitis, Healing ulcers, Relieving symptoms of GERD, Best treatment of Zollinger-Ellison Syndrome

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50
Q

What are examples of PPI?

A

Omeprazole (Prilosec), Pantoprazole (Protonix), Lansoprazole (Prevacid), Dexlansoprazole (Dexilent)

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51
Q

What have PPIs been associated with?

A

Bone Fractures, SLE, Acute Intestinal Nephritis, C-diff, Vitamin B12, Magnesium Deficiency

52
Q

PPI will inhibit ____________ metabolism.

A

Warfarin (Warfarin can work too well with PPI, watch the INR)

Clopidogrel (Clopidogrel won’t work as well with PPI)

53
Q

Omeprazole is enteric coated and is a prodrug that protonates in the _____________ to its active form.

A

Parietal Cells

54
Q

Omeprazole only inhibit pumps that are present, acid inhibition increases with repeated dosing, but it only covers about ____% maximum inhibition.

55
Q

How is omeprazole metabolized?

A

CYP metabolism

56
Q

What is the dosing of omeprazole?

If given PO, how long before surgery?

A

40mg in 100cc NS given over 30 minutes

PO- at least 3 hours prior to surgery

57
Q

What are the side effects of omeprazole?

A

HA (crosses BBB), Agitation (crosses BBB), Confusion (crosses BBB), Abdominal Pain, N/V, Flatulence, SB bacterial overgrowth

58
Q

How is Protonix metabolized?

A

CYP metabolism

59
Q

Protonix has a greater ____ and longer ____ compared to omeprazole.

A

Greater bioavailability and greater half time

60
Q

What is the dose of Protonix?

A

40mg in 100cc given over 2-15 minutes

61
Q

How long before surgery can you give protonix?

A

1 hour before surgery to decrease gastric volume and increase pH (works as fast as ranitidine)

62
Q

PPI’s are the treatment of choice for ______, _______, and _______.

A

GERD, Gastroduodenal Ulcers, Acute upper GI Hemorrhage (post EGD treatment)

63
Q

What is given to treat NSAID ulceration?

A

Omeprazole

64
Q

What will protect the acidity of aspiration pneumonitis and be the most cost-effective for intermittent symptoms?

A

H2 antagonist

65
Q

What is a particulate antacid?

A

Particulate antacids are Aluminum or Magnesium based. Aspiration equals acid aspiration.

66
Q

What is a non-particulate antacid?

A

Non-Particulate antacids are Sodium, Carbonate, Citrate, or Bicarb base. Neutralize Acid.

67
Q

What are long-term effects of all antacids?

A

If pH is too high, acid breakdown of food will be inhibited and acid rebound can occur.

68
Q

What are the long-term effects of magnesium-based antacids?

A

Magnesium-based: Osmotic diarrhea, neurological/neuromuscular impairment

69
Q

What are the long-term effects of calcium-based antacids?

A

Calcium-based: Hypercalcemia, Kidney stones

70
Q

What are the long-term effects of sodium-based antacids?

A

Sodium-based: Hypertension

71
Q

How does sodium citrate (Bicitra) neutralizes acid?

A

The Bicitra and acid are combined to make salt, CO2, and water, resulting in neutralization.

72
Q

Sodium citrate increases __________.

A

Intra-gastric volume

73
Q

What is the dose of sodium citrate?

74
Q

When does sodium citrate lose its effectiveness?

A

After 30-60 minutes

75
Q

Pregnancies are considered full stomach after _________ weeks.

76
Q

What types of drugs are known for stimulating gastric motility (prokinetic)?

A

Dopamine-blocking drugs for full stomachs.

77
Q

What do prokinetic drugs increase?

A

Lower Esophageal Sphincter tone.

78
Q

What do prokinetic drugs stimulate?

A

Peristalsis.

79
Q

What do prokinetic drugs relax?

A

Pylorus and Duodenum.

80
Q

Who is contraindicated by dopamine blockers?

A

Individuals who are dopamine depleted (Parkinson’s).

81
Q

What are the side effects of dopamine blockers?

A

Extrapyramidal reactions (easily crosses BBB), Orthostatic Hypotension, can affect the chemoreceptor trigger zone, no change in gastric pH.

82
Q

What are examples of dopamine blockers?

A

Metoclopramide (Reglan), Domperidone (not available in the US), Droperidol (Inapsine).

83
Q

What is the FDA-cleared drug for diabetic gastroparesis?

A

Metoclopramide (Reglan).

84
Q

What are the side effects of Reglan?

A

Abdominal cramps from rapid infusion, Muscle Spasm, Hypotension, Sedation, Increase Prolactin Release, Neuroleptic malignant syndrome, Decrease plasma cholinesterase levels.

85
Q

What is the dose of Reglan?

When do you give reglan before induction?

A

10-20mg given over 3 to 5 minutes.

15 to 30 minutes before induction

86
Q

Unlike Reglan, what drug does not cross the BBB and has no anticholinergic activity?

A

Domperidone.

87
Q

What does Domperidone increase secretion of?

A

Prolactin.

88
Q

Why is Domperidone not FDA-approved?

A

Due to Dysrhythmias and Sudden Death.

89
Q

What drug was initially developed for schizophrenia and psychosis?

A

Droperidol (Inapsine).

90
Q

What adverse side effects can Droperidol cause?

A

Extrapyramidal syndrome and Neuroleptic Malignant Syndrome.

91
Q

What CNS depressants should be avoided with Droperidol?

A

Barbiturates, Opioids, General Anesthesia.

92
Q

Droperidol is more effective than what for N/V?

93
Q

Droperidol is equally effective to how much of Zofran for N/V?

A

4 mg of Zofran.

94
Q

What is the black box warning for Droperidol?

A

Prolonged QT intervals, Torsades with higher doses, Serious Drug Interactions (amio, diuretics, beta blockers, CCB, steroids)

95
Q

What is the dose for Droperidol?

A

0.625 to 1.25mg IV.

96
Q

____________ is released from the chromaffin cells of the small intestine and stimulates ____________ through 5HT3 receptors that cause __________.

A

Serotonin
Vagal afferents
Vomiting

97
Q

Where is a large concentration of 5HT3 receptors?

A

Brain and GI Tract.

98
Q

What group of drugs is now used for PONV?

A

5HT3 antagonist.

Competitive antagonist with almost no side effects

99
Q

What is 5HT3 not effective against?

A

Motion sickness and vestibular stimulation.

100
Q

What are examples of 5HT3 antagonists?

A

Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet).

101
Q

Which drug is the first 5HT3 antagonist and does not cross the BBB?

A

Ondansetron (Zofran).

102
Q

What are the side effects of Zofran?

A

HA, Diarrhea, Slight QT prolongation.

103
Q

What is the dose of Zofran?

What is the plasma half-life?

A

4 or 8mg IV.

4 hours (give zofran at the end of the case)

104
Q

What group of drugs centrally inhibits prostaglandin synthesis and control endorphin release?

A

Corticosteroids.

also has an anti-inflammatory effect resulting in less post-op pain, and less opioid use

105
Q

What is the diabetic risk of Decadron?

A

Perioperative Hyperglycemia (minimal side effect with one dose)

106
Q

What is another side effect of Decadron?

A

Perineal Burning/Itching (rapid IV push)

107
Q

What is the dose of Decadron?

A

4mg or 8mg.

108
Q

What is the delay in onset for Decadron?

A

2 hours.

Give at the beginning of the case

109
Q

How long does the efficacy of Decadron persist?

110
Q

When will you consider giving an increased dose of Decadron?

A

Airway trauma d/t multiple intubation attempts. (12 or 16 mg)

111
Q

What are Scopolamine patches used for?

A

They are muscarinic antagonists (anticholinergic) for nausea and vomiting.

they have both central and peripheral effects (crossess the BBB - sedation)

112
Q

What are the side effects of Scopolamine patches?

A

Dilated pupils, Sedation.

113
Q

What are the peak concentration hours for Scopolamine patches?

A

8 to 24 hours.

114
Q

How long does it take the Scopolamine patch to work?

A

4 hours for onset of action.

115
Q

What is the priming dose of Scopolamine?

116
Q

How much scopolamine will be given over the next 72 hours?

117
Q

Where will the Scopolamine patch be placed?

A

Post-auricular.

118
Q

What group of drugs stimulates G-proteins and relaxes smooth muscles in the airway?

A

Beta-receptor agonists (Bronchodilators).

119
Q

Bronchodilators can reduce inflammatory cell activation, directly relax smooth muscles, and increase FEV1 by _________% within _____ minutes (2 puffs).

A

15% improvement in 6 minutes.

120
Q

How do you deliver an inhaled SABA?

A

Discharge inhaler while taking a slow deep breath over 5-6 seconds

121
Q

What percentage of the inhaled SABA reaches the lungs?

122
Q

What percentage of the inhaled SABA is delivered to the lungs through mechanical ventilation?

123
Q

How often are inhaled SABAs given?

A

Every 4 hours.

124
Q

What are the side effects of beta agonists?

A

Tremor, Tachycardia, Transient Decrease in arterial oxygenation, Hyperglycemia.

125
Q

What are examples of bronchodilators?

A

Albuterol (Proventil), Levo-albuterol (Xopenex).

126
Q

What are ways to deliver SABA?

A

Inhaler, Puff piece nebulizer, Syringe.

Anesthesia pharm (9 decks)

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