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Pharm Spring 2024 > PreOperative Medications - Lecture 1/29/24 > Flashcards

PreOperative Medications - Lecture 1/29/24 Flashcards

1
Q

If histamine is released what receptor/receptors do we target with antagonists?

A

Both the H1 and H2 receptors

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2
Q

What drugs induce histamine release?

A

Morphine
Mivacurium (not available in USA)
Pancuron - in high doses
Protamine (heparin)
Atracurium (Tracrium)

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3
Q

What happens when histamine activates H1?

A

Hyperalgesia & inflammatory pain.

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4
Q

What happens when histamine activates H2?

A

Elevates CAMP (B1-like stimulation)
Increases acid/volume production in stomach

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5
Q

What does H1 activate?

A

Muscarinic, cholinergic, 5-HT3, & Alpha adrenergic receptors

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6
Q

What does H2 activate?

A

5-HT3 and B1

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7
Q

What are the signs of H1 & H2 activation by histamine?

A

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

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8
Q

How does an anti-histamine work? Does it prevent histamine release?

A

No, works by preventing or limiting the responses to the histamine release. Prevents reactions/effects of histamine on the receptor - has to compete with the inverse agonists.

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9
Q

What is Benadryl mainly used for?

A

Antipruritic

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10
Q

What is the E 1/2 time of Benadryl?

A

7-12 hours

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11
Q

What is the Oculo-emetic reflex? What H1 receptor antagonist is used to prevent this reflex? How does the drug prevent the reflex?

A

The oculo-emetic reflex causes increased nausea and vomiting due to extensive manipulation of extraocular muscles
Prevent with Benadryl
Inhibits the afferent arc of the oculo-emetic reflex.

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12
Q

What are the black box warnings for Phenergan? What years did they come out?

A

2005 - Respiratory arrest in children under 2
2009- Infiltration causing serious necrosis

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13
Q

What diseases are H2 antagonists primarily used in?

A

Duodenal Ulcers
GERD

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14
Q

What is the major side effect of H2 antagonist?

A

Weakend gastric mucosa d/t bacteria b/c stomach not acidic enough to kill off bacteria leading to increased pulmonary infections and candida albicans overgrowth. Usually seen with chronic OTC use.

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15
Q

By how much can a H2 antagonist increase serum creatinine? Why does this happen?

A

Increases by 15% b/c there is competition for tubular secretion

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16
Q

Name examples of H2 antagonists

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pecid)

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17
Q

Which H2 antagonist STRONGLY inhibits CYP450? What drugs last longer because of this?

A

Cimetidine
Warfarin, Phenytoin, Lidocaine, TCAs, Propranolol, Nifedipine, Meperidine, Diazepam

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18
Q

Name the 2 major adverse effects of Tagamet

A

Increased levels of prolactin (men develop boobs)
Inhibits dihydrotestosterone binding to androgen receptors causing impotence

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19
Q

Which H2 antagonist has a weaker binding to CYP enzymes & no significant interactions with other drugs?

A

Zantac

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20
Q

Which H2 antagonist has no interference with inhibition of other CYP450s, but is the most potent d/t longest E 1/2 time. What is this drug’s E 1/2 time?

A

Pepcid
E 1/2 time is 2.5-4 hrs; great for longer surgical cases.

21
Q

What is the downside of using Pecid?

A

Interferes with phosphate absorption

22
Q

What is the dose for Pepcid?

A

20 mg IV

23
Q

How are H2 antagonists dosed for renal impairment?

A

1/2 of the normal dose

24
Q

How is Zantac dosed?

A

50mg diluted to 20mL given over 2 mins

25
Q

What drug’s metabolism do PPI’s inhibit? How do they block activation of Plavix?

A

Warfarin
Block the enzymes that activate Plavix

26
Q

Which PPI is a prodrug?

A

Prilosec

27
Q

Where does Prilosec protonate to become the active form?

A

In parietal cells

28
Q

Can Prilosec cause confusion?

A

Yes; it crosses the BBB - don’t give to patients with neuro issues

29
Q

Which PPI has greater bioavaibility and a longer E 1/2 time than Prilosec?

A

Protonix

30
Q

What drug do you give for NSAID ulcerations?

A

Prilosec

31
Q

Name the PPIs mentioned in class

A

Protonix
Prevacid
Prilosec
Dexilent (newer)

32
Q

What can a Mg+ based antacid cause?

A

Neurologic and neuromuscular impairment

33
Q

What does a dopamine blocker do?

A

Stimulates gastric motility (prokinetic). Increases lower esophageal sphincter tone (constricts), stimulates peristalsis, and relaxes pylorus & duodenum sphincter

34
Q

Name the dopamine blockers mentioned in class

A

Reglan
Domperidone (new FDA not approved; can get in Mexico/Canada/Switzerland)
Droperidol

35
Q

What is the #1 drug for diabetic gastroparesis?

A

Reglan

36
Q

What syndrome can Reglan cause? What are the s/s of this syndrome?

A

Neuroleptic Malignant Syndrome
High temp, muscle rigidity, tachycardia, confusion

37
Q

What enzyme do dopamine antagonists decrease

A

Plasma Cholinesterase- leading to slow metabolism of succs, mivacurium, ester LAs
This is a theoretical argument - not significant - still okay to give.

38
Q

What drug is just as effective as 4mg of Zofran but is cheaper?

A

Droperidol

39
Q

Side effects of Droperidol? What is the black box warning for this drug?

A

Extrapyramidal symptoms, Neuroleptic Malignant Syndrome, FDA black box warning in 2001 for prolonged QT/torsades with higher doses.

40
Q

What other drugs have the same black box warning as Droperidol?

A

Phenergan & Zofran

41
Q

List the drug interactions Droperidol has

A

Amiodarone, diuretics, Sotalol, mineralcocorticoids, CCBs

42
Q

How does Serotonin cause vomiting

A

It is released from the chromaffin cell of the small intestine and then stimulates the vagal afferent thru the 5HT3 receptors

43
Q

Where are the 5HT3 receptors located?

A

Everywhere, ubiquitous (we are never getting away from this word). But highly concentrated in the GI tract and brain

44
Q

Name the drugs mentioned in class that are %HT3 antagonists. Do they have an effect on motion sickness/vestibular stimulation?

A

Zofran
Kytril
Anzemet
No they do not have an effect on motion sickness/vestibular stimulation

45
Q

What drug only works on the 5HT receptors?

A

Zofran

46
Q

How is Decadron dosed based on surgery length time?

A

2 hr surgery give with induction
4 hr surgery give halfway through surgery
Can redose if needed

47
Q

What is the big side effect of Decadron that you need to tell your patient’s about?

A

Perineal burning/itching

48
Q

What is SABA?

A

Short Acting Beta Agonist

Pharm Spring 2024 (7 decks)

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