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Anesthesia Pharm I > Premedication > Flashcards

Premedication Flashcards

1
Q

what are goals of premedication?

A
  • reduce anxiety, amnesia
  • pain relief
  • sedation
  • reduce risk of aspiration
  • nausea and vomiting prophylaxis
  • antisialagogue
  • reduce MAC
  • prophylaxis of allergic reaction
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2
Q

what is the MOA of benzodiazepines?

A
  • sedation produced by intensification of GABA effects

- anxiolysis produced by glycine-mediated inhibitory effect on neuronal pathways in the brain

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3
Q

what are the advantages of benzos?

A
  • sedation
  • anxiolysis
  • amnesia
  • minimal effects on ventilation and cardiovascular
  • raise seizure threshold
  • reduce MAC
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4
Q

what are disadvantages of benzos?

A
  • no analgesia (must consider whether pain med is needed more in preop)
  • possible paradoxical reaction (confusion, agitation)
  • implicated as teratogenic during first trimester (cleft lip)
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5
Q

what is the MOA of droperidol (Inapsine)?

A

antagonizes the activation of dopamine receptors, interferes with transmission mediated by serotonin, NE, GABA; also alpha-adrenergic blocker

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6
Q

what are effects of droperidol?

A
  • outward appearance of calm
  • dysphoria, restlessness, fear of death
  • antiemetic effects
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7
Q

what is the MOA of opioids?

A

bind to specific receptors throughout the central nervous system, tissues

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8
Q

what are the advantages of opioids?

A
  • no direct myocardial depression
  • pre-emptive analgesia
  • analgesia in pre-existing pain, painful procedures
  • decreases incidence of increased HR during surgical procedure
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9
Q

what are disadvantages of opioids?

A
  • depresses ventilation, particularly RR; apneic threshold elevated; hypoxic drive decreased (not good w/ sleep apnea)
  • orthostatic hypotension
  • N/V
  • no amnestic effect
  • sphincter of Oddi spasm
  • dysphoria in patients without pain
  • histamine release
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10
Q

describe morphine

A
  • well absorbed IM
  • histamine release
  • may cause orthostatic hypotension, pruritus, respiratory depression
  • dose 0.1-0.2 mg/kg IM (15-30 min)
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11
Q

describe fentanyl

A
  • about 100x more potent than morphine
  • usually given just prior to induction
  • 5-8 mcg/kg blunts response to laryngoscopy
  • most commonly used opioid in anesthesia
  • dose IV 1-2 mcg/kg (30-60 sec) last about 30 min to an hour
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12
Q

describe NSAIDS

A
  • given to reduce the amount of opioids required postop
  • pre-emptive analgesia
  • beware: prostaglandin inhibition may decrease platelet aggregation
  • caution: elderly, h/o gastric ulcers, renal impairment
  • decision to give must involve surgeon
  • acetaminophen contraindicated w/ hepatic impairment
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13
Q

describe antihistamines

A
  • H1 antagonist given to pts. with h/o chronic atopy or at risk for allergic reaction
  • give along with a H2 antagonist
  • Benadryl dose: 0.5-1 mg/kg PO
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14
Q

describe alpha 2 agonist clonidine

A
  • centrally acting alpha 2 agonist which blunts the autonomic nervous system reflex responses to surgical stimulation (such as increased HR and BP)
  • can decrease anesthetic requirement, decrease MAC
  • potential for bradycardia and hypotension- give fluids
    dose: 5 mcg/kg PO (90 min)
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15
Q

describe anticholinergics

A
  • historical use
    advantages: vagolytic effect, antisialogue effect (turning prone), sedation and amnesia (atropine/scopolamine cross BBB)
    disadvantages: central anticholinergic syndrome, mydriasis and cycloplegia (caution w/ glaucoma), tachycardia and arrhythmias (don’t give to CAD pts.)
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16
Q

which anticholinergics are best for increase in HR, antisialogue effects, and sedation?

A
  • atropine increase in HR (give to infants 6 months or <)
  • scopolamine best for sedation
  • glycopyrrolate best antisialogue effect
17
Q

what are the different types of antiemetics

A
  • GI prokinetics (metoclopramide)
  • butyrophenones (droperidol)
  • phenothiazines (promethazine)
  • serotonin receptor antagonists (Zofran)
  • corticosteroids
18
Q

what are the goals to prevent aspiration?

A
  • gastric pH > 2.5

- gastric volume < 25 ml

19
Q

how do H2 antagonist provide prophylaxis against aspiration?

A
  • increase the pH of whatever is released in the stomach from the time medicine takes effect
  • takes time to change pH of contents already in stomach since that must be diluted over time
  • *does not change volume
  • *need to receive the night before and morning of
20
Q

what are different histamine2 receptor antagonists?

A
  • ranitidine (Zantac)
    dose: 150-300 mg PO; 50 mg IV
    onset: 60-90 min
    duration: up to 9 hrs
  • famotidine (Pepcid)
    dose: 20-40 mg PO; 20 mg IV
    onset: 60-90 min
    duration: 10-12 hrs
21
Q

how does gastrokinetic agents (metoclopramide) provide prophylaxis against aspiration?

A

enhances the effects of ACh on the intestinal smooth muscle to :

1) speed gastric emptying
2) increase lower esophageal sphincter tone
3) relax the pylorus and duodenum
4) lower gastric volume
* does not effect gastric pH

22
Q

what is the antiemetic effect of metoclopramide?

A

dopamine antagonist in the CTZ of the CNS

23
Q

what is the dose and onset of metoclopramide?

A

PO 10-15 mg (30-60 min)
IV 10 mg (15-30 min)
peds: 0.25 mg/kg

24
Q

what are contraindications of metoclopramide use?

A
  • intestinal obstructions
  • Parkinson’s disease (dopamine blockage)
  • push slow (potential for extrapyramidal effects; often r/t tardive dyskinesia
25
Q

describe antacids

A

raises the gastric pH of fluid already present in the stomach by neutralizing the hydrogen ions with a base

  • disadvantage: increases volume
  • use a nonparticulate (non colored, no Mylanta) like sodium citrate (Bicitra)
  • seen often in L&D; always prepare as if you may intubate
26
Q

what is the dose of sodium citrate?

A

15-30 ml PO (15-30 min)

27
Q

describe proton pump inhibitors

A
  • most effective in controlling gastric acidity and volume
  • limits the last step in secretion of hydrogen ions: hydrogen-potassium ATPase
  • clinical use in moderate to severe GERD
  • takes daily admin over 5 days to inhibit secretion 66%
  • better than H2 blockers in inhibiting secretion, healing duodenal and gastric ulcers, and treating reflux esophagitis
28
Q

what is the dose of omeprazole (Prilosec)?

A

20mg PO (single dose takes > 3 hrs to increase pH)

29
Q

describe pediatric anxiolysis

A
  • preop includes parents, patient, visual aids
  • empower by allowing to bring toy, blanket, source of security
  • explain as you go, allow to help, distract
  • reduce anxiety, sedate, provide amnesia
  • indicated for 6 mths and older
  • oral, nasal, or rectal
  • versed- PO
  • methohexital- PR
  • ketamine- IM

Anesthesia Pharm I (28 decks)

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