Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Apex Flashcards > Regional Anesthesia and Anticoagulants > Flashcards

Regional Anesthesia and Anticoagulants Flashcards

1
Q

examples of cox 1 inhibitors

A

NSAIDS, aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

criteria to consider for neuraxial block when patient takes COX1 inhibitors

A

coagulation status appears normal, no other blood thinners in use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MOA of glycoprotein IIb/IIIa antagonists

A

inhibits platelet aggregation via surface receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

examples of glycoprotein IIb/IIIa antagonists

A

tirofiban
eptifibatide
abciximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

anesthetic management of patient on glycoprotein IIb/IIIa antagonists that requires neuraxial block

A

avoid until platelet function has recovered.
contraindicated within 4 weeks of surgery aka do not restart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hold tirofiban and eptifibatide how many hours before block placement?

A

4-8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

hold abciximab how many hours before block placement?

A

24-48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MOA of thienopyridine derivatives

A

inhibits platelet aggregation by blocking ADP transferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

examples of thienopyridine derivatives

A

clopidogrel
prasugrel
ticlopidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

post op anesthetic management of a patient on thienopyridine derivatives that require block placement

A

may restart 24h post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how long to hold clopidogrel before a block is placed?

A

5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how long to hold prasugrel until block is placed?

A

7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how long to hold ticlodipine until block is placed?

A

10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOA of unfractionated heparin

A

potentiates antithrombin, inhibits thrombin (factor 2) and factors 9, 10, 11, 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

anesthetic management of a patient on unfractionated heparin that requires a neuraxial block

A

coags are normal and no other blood thinners in use
obtain platelet count before block or removal of catheter if IV or SQ heparin for >4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how long after block placement can you restart heparin or catheter removal

A

1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

before block placement, hold low dose heparin (5000 units up to TID) for

A

4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

before block placement, hold higher dose heparin (less than or equal to 20,000 units daily) for

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

before block placement, hold heparin doses > 20,000 units daily in pregnant patients for

A

24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

hold heparin SQ for how many hours after last dose or discontinuation of IV infusion for neuraxial catheter removal?

A

4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MOA of LMW heparin

A

irreversibly inhibits 10a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

examples of LMW heparin include

A

enoxaparin
dalteparin
tinzaparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

anesthetic management of a patient on LMW heparin that requires a neuraxial block includes

A

coags WNL and no other blood thinners in use
obtain platelet count if on LMWH for >4 days

24
Q

before block or catheter placement, delay LMWH at least ___ hours after prophylactic dose

A

12 hours

25
Q

before block or catheter placement, delay LMWH at least ______ hours after therapeutic dose

A

24 hours

26
Q

after block placement, if LMWH is ordered-

A

delay first dose at least 12 hours after block and if single daily dosing, give second dose no sooner than 24 hours after first fose

27
Q

MOA of anti vitamin K drugs

A

impairs factors 2,7,9,10

28
Q

anesthetic management of a patient on warfarin that requires a neuraxial block

A

verify normal INR

29
Q

hold warfarin for how long before block placement?

A

5 days

30
Q

at what level should INR be before neuraxial catheter removal if patient is on warfarin

A

<1.5

31
Q

examples of PO anti factor 10a agents

A

apixiban
betrixiban
edoxaban
rivaroxaban

32
Q

how long should you discontinue anti factor 10a agents before catheter placement

A

at least 72 hours (3 days). if <72h, consider checking 10a

33
Q

how long should you wait to dose anti factor 10a agents before neuraxial catheter removal

A

6 hours before first postop dose

34
Q

MOA of thrombolytic agents

A

activates plasminogen

35
Q

examples of thrombolytic agents

A

TPA
streptokinase
alteplase
urokinase

36
Q

anesthetic management of patient on thrombolytic agent who requires neuraxial anesthesia

A

absolute contraindication to neuraxial

37
Q

MOA of herbal therapies

A

inhibits platelet aggregation

38
Q

examples of herbal therapies

A

garlic
ginkgo
ginseng

39
Q

anesthesia management of patient on herbal therapies that requires neuraxial block

A

proceed with neuraxial anesthesia if patient is not on other blood thinning drugs

40
Q

tx for PDPH

A

bed rest
NSAIDS
caffeine (cerebral vasoconstriction)
epidural blood patch
sphenopalantine ganglion block

41
Q

if PDPH doesn’t get better after how many epidural blood patches, consider other etiologies

A

2

42
Q

describe sphenopalatine ganglion block

A

-soak long cotton tipped applicator in LA (1-2% lido or .5% bupiv)
-place patient in sniffing
-insert cotton tip in each bare towards middle turbinate
-continue insertion until you each back wall of nasopharynx, which is the vicinity of the sphenopalantine ganglion
-leave applicator in place for 5-10m
-pt should notice sx improvement at this time

43
Q

most common culprits for post spinal bacterial meningitis

A

streptococcus veridians

44
Q

most effective preparation method to prevent post spinal bacterial meningitis

A

chlorhexidine and alcohol

45
Q

what is the threshold for spinal induced HoTN

A

<90SBP

46
Q

methods to minimize spinal induced HoTN risk

A

-vasopressors (neo)
-5HT3 antagonist (zofran) that inhibits bezold jarisch reflex
-“co loading” of IVF just after block with 15mL/kg IVF
-postioning (pelvic tilting)

47
Q

cauda equina syndrome
cause
s/sx
tx

A

cause: neurotoxicity is result of exposure to high concentrations of LA
s/sx: bowel and bladder dysfunction, sensory deficits, weakness, paralysis
tx: supportive

48
Q

transient neurological sx’s
cause
factors that increase risk
s/sx
tx

A

cause: patient positioning, stretching of sciatic nerve, myofascial strain, muscle spasm
factors that increase risk: lidocaine, lithotomy, ambulatory surgery, knee arthroscopy
s/sx: severe back and butt pain that radiates to both legs. generally develops within 6-36h and persists for 1-7d
tx: NSAIDS, opioid analgesics, trigger point injections

49
Q

what can you do if you encounter resistance when removing epidural catheter?

A

lateral decubitus
taping catheter to skin under gentle traction and trying again later
using a stylet to thread the catheter
injecting wire reinforced catheter with saline

50
Q

why is blood usually in epidural needle and how to fix

A

placed too laterally (in epidural vein)
redirect towards midline

51
Q

risk factors for epidural vein cannulation

A

multiple insertion attempts
pregnancy (epidural vein engorgement)
sniffing
using a stiff catheter
trauma to epidural veins during block placement

52
Q

if spinal does not set up after 15-20 min, you can

A

repeat injection

53
Q

what should you do if your spinal block is patchy

A

dont repeat spinal for fear or neuro toxicity. switch to IV or GA

54
Q

what should you do if your block is unilateral

A

position patient with poorly blocked side down and administer several mL of LA
if that doesn’t work, consider another technique

55
Q

most common cause of unilateral epidural block

A

catheter was inserted too far and tip has exited epidural space into intervertebral foramen
-pull catheter back 1-2cm, place patient in lateral decub, administer several mL of dilute concentration LA
-if this doesn’t work, replace catheter

Apex Flashcards (71 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions