Test #2 Herbal and illicit drug PPt-Josh Flashcards by Josh Newby

Herbal Supplements:

are they regulated by FDA?

NOpe

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Herbal Supplements:

is there rigorus testing such as with Rx meds?

nope

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Herbal Supplements:

are the adverse effects all know?

nope

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Herbal Supplements:

should be stoped how long prior to Sx

2 weeks

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Herbal Supplements:

what is the most popular herbal remedy in currently in the US

Echinacea

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Herbal Supplements: Echinacea

is beleived to improve immune system by how?

modulation of cytokine signaling

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Herbal Supplements: Echinacea

is used for tx of what?

viral, bacterial, and fungal infections (especially URI)

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Herbal Supplements: Echinacea

Chronic use can resut in what?

immunosupression and hepatic faiuler

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Herbal Supplements: Echinacea

what are some periop considerations?

avaoid hepatotoxic drugs

avoid in immunosupressed pts (transplant)

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Herbal Supplements: Echinacea

other names

purple coneflower

coneflower

American coneflower

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Herbal Supplements: Ephedra

other names?

ma Huang

Herbal ecstasy

Cloud 9

(sounds bad ass)

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Herbal Supplements: Ephedra

Sale is restricted in the US to Chinese Herbal Medicine only d/t adverse effects r/t dietary suppliments. what are some of those SE

Palpatations
HTN
Tacjycardia
Stroke
Seizures
Cardiomyopathy
MI
Dysrhythmias
Acute hepatitis
psychosis
death

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Herbal Supplements: Ephedra

it contains what alkaloids?

ephedrine
pseudoephedrine
methylephredrine
nor-pseudo-ephedrine

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Herbal Supplements: Ephedra

has direct effect on ____ and ___ receptors and can indirectly increase the release of norepi for presynaptic neurons

alpha

beta

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Herbal Supplements: Ephedra

Used for what 3 things

Weight loss

CNS stimulant

Asthma

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Herbal Supplements: Ephedra

periop considerations

when combined with other sympathomimetics can cause
HTN
Dysrhythmias
Hyperthermia
CV instability

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Herbal Supplements: Garlic

also called what?

Allium sativum

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Herbal Supplements: Garlic

has been used for centuries to treat what?

CV disease

Infections

Tumors

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Herbal Supplements: Garlic

the _____ in garlic is beleived to decrease thromboxane formation and alter arachidonic metabolism

Cysteine

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Herbal Supplements: Garlic

since it decreases thromboxane formation it can inhibit what?

platelet aggregation

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Herbal Supplements: Garlic

can potentiate the anti-platelet effects of what drugs (2)?

Aspirin

NSAIDs

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Herbal Supplements: Garlic

preop considerations

Assess bleeding risk
D?C 7 days b4 sx

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Herbal Supplements: Ginger

also called what?

Ziingiber officinale

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Herbal Supplements: Ginger

used to treat what?

Arthritis

GI d/o

Vertigo

antiemetic

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Herbal Supplements: Ginger the active component ______ is thought to inhibit prostaglandin and leukotriene sysnthesis

Gingerol

Herbal Supplements: Ginger is also thought to inhibit ________ synthatase, thus decreasing platelet agregation

thromboxane

Herbal Supplements: Ginger may ________ the effect of medications with anticoagulation properties

potentiate

Herbal Supplements: Ginger periop considerations

* assess for bleeding * Avoid in combination w/ other anticoagulants

Herbal Supplements: Gingko Biloba is thought to do what?

protect vascular walls and nerve cells

Herbal Supplements: Gingko Biloba is thought to protect vascular walls and nerve cells by acting as a \_\_\_\_\_-\_\_\_ scavengers and ________ platelet activating factor

* free-radical scavenger * inhibiting

Herbal Supplements: Gingko Biloba was approved in Germany for the tx of \_\_\_\_\_\_

dementia

Herbal Supplements: Gingko Biloba is also beleived to decrease blood viscosity and improve blood flow to tissues and is used to treat \_\_\_\_\_

PVD

Herbal Supplements: Gingko Biloba periop considerations

* Assess bleeding * Avoid w/ NSAIDs, Aspirin, Warfarin * D/C 36 hours prior to sx

Herbal Supplements: Ginseng used in traditional Chinese medicine for what? (3 main things)

immunomodulation Mood enhancement aphrodisiac

Herbal Supplements: Ginseng has mild sympathomimetic effect and may interact with what enzyme? tremors and mania have beenreported

Monoamine Oxidase Enzyme (MAO)

Herbal Supplements: Ginseng does what to BGL

Hypoglycemia

Herbal Supplements: Ginseng does what to platelet aggregation

interferes

Herbal Supplements: Ginseng periop considerations

* Monitor BGL * May increase bleeding (Assess) * D/c 7 days prior to sx

Herbal Supplements: Herbal Diuretics what are 5 types

* Dandelion * Green tea * Goldenseal * Saw Palmetto Berries * Spearmint

Herbal Supplements: Herbal Diuretics the MOA is uncertain but it is thought to interfers with the _____ system

RAAS

Herbal Supplements: Herbal Diuretics do to the diuretic effects significant ____ and _____ disturbances are associated with their use?

fluid and electrolyte

Herbal Supplements: Herbal Diuretics periop considerations

monitor fluid and electrolytes correct prior to sx

Herbal Supplements: KAVA another name

Piper methysticum

Herbal Supplements: KAVA derived for the dried root of the ___ plant family

pepper

Herbal Supplements: KAVA what is it used for

anxiolytic and Sedative effects

Herbal Supplements: KAVA the anxiolytic and seditive effect are mediated by potentiation of what?

GABA Gamma-aminobutyric acid

Herbal Supplements: KAVA potentiated effects of what drugs

barbs Benzos

Herbal Supplements: KAVA SE are seen in what organ

hepatotoxicity | (LIVER)

Herbal Supplements: KAVA Perioperative considerations

may reduce MAC Avaoid hepatotoxic drugs D/C 24hrs prior to sx

Herbal Supplements: St. John's Wort Another name

Hypericum perforatum

Herbal Supplements: St. John's Wort is widely used in western societies as what?

antidepressant for mood disorders

Herbal Supplements: St. John's Wort similar to more convential antidepressents , and it's effects are thought to be b/c of thr inhibition of \_\_\_\_\_\_\_, \_\_\_\_\_\_, and _______ re-uptake by neurons

Serotonin Noorepinephrine Dopamine

Herbal Supplements: St. John's Wort found to be equal to \_\_\_\_\_\_\_antidepressants (drug class) in the treatment of mild to moderate depressive d/o

tricyclic

Herbal Supplements: St. John's Wort periop considerations

* can lead to serotonergic syndrome * may increase metabolism of Drugs (d/t potent inducer of CYP450) * reduces anticoagulation effect of drugs * Sedative properties may prolong anesthestic drugs * D/C 5 days b4 sx

Herbal Supplements: Valerian another name?

Valeriana Officnialis

Herbal Supplements: Valerian has been used as what?

Anxiolytic sedative

Herbal Supplements: Valerian produces dose dependent sedation and hypnosis, possiably d/t inhibition of _____ breakdown and re-uptake

GABA

Herbal Supplements: Valerian acutly stopping will cause what?

withdrawl

Herbal Supplements: Valerian periop considerations

* Decrease MAC * Benzo like withdrawl if sudden stop

Illicit Drug Use: what are signs that indicate illicit drug use?

Track marks thrombotic veins Phlebitis Tattoos ablation of venous return (unilateral edema) Sub Q abcess

Illicit Drug Use: Opthalmologic Changes opiods

constriction (miosis)

Illicit Drug Use: Opthalmologic Changes Amphetamines

Dilation (Mydriasis)

Illicit Drug Use: Opthalmologic Changes PCP

Nystagmus

Illicit Drug Use: malnourishment is usually seen in what obusers opiod or amphetamines?

Amphetamines

Illicit Drug Use: Poor dentation is usually associated with abusers of what drugs

Amphetamines

Illicit Drug Use: nasal perforation is isually from what drug abuse

Cocaine

Illicit Drug Use: S/S of withdrawl (abstinence)

HTN Tachycardia Abdominal pain Cramping Diahrrea Tremors anxiety irritability Lacrimation Mydriasis algid sweating yawning

Illicit Drug Use: suspection of Drug abuse should be followed up with what?

urine drug screen

Illicit Drug Use: Marijuana other names

pot hash grass weed THC

Illicit Drug Use: Marijuana obtained from what plant

Cannabis Sativa

Illicit Drug Use: Marijuana What is the active ingrediant

Delta-9-tetrahydrocannabinol (THC)

Illicit Drug Use: Marijuana effects

possible antiemetic analgesia anticonvulsant appatite stimulant

Illicit Drug Use: Marijuana 1/2 life

56 hours for occasional users 28 hrs for chronic users

Illicit Drug Use: Marijuana why is the tissue half life so long? (1 weeks)

d/t sequestering in adipose tissue

Illicit Drug Use: Marijuana complete elimination of a single dose may take up to how many days

30 days

Illicit Drug Use: Marijuana metabolized by the _____ into more than 20 metabolites (most w/ psychoactive properties)

Liver

Illicit Drug Use: Marijuana frequent use can lead to what?

* cognative impairment * Shorted memory span * Confusion * altered time perception * Dulled reflexes * diff with ADLs

Illicit Drug Use: Marijuana low or moderate doses _______ sympathetic activity and ________ parasympathetic activity. which results in what?

1. increases 2. decreases 3. tachycardia and increased CO

Illicit Drug Use: Marijuana High doses ______ sympathetic activity but not parasympathetic activity, leading to what

* inhibit * Hypotension & bradycardia

Illicit Drug Use: Marijuana combination with other sedatives (ETOH, Benzo) may enhance _____ Depression

CNS

Illicit Drug Use: Marijuana effects on CV * Myocaridal depression and and HR * BP and HR drugs * What drugs should you avoid

* increased Myocadial depression and tachycardia * Potentiates BP and HR drugs * Avoid drugs that increase HR (ketamine, panc, atropine, ephedrine)

Illicit Drug Use: Marijuana respiratory effects

* Upper airway irritability * Cough/bronchitits/ COPD/ bronchospasm * Upper airway edema

Illicit Drug Use: Marijuana some reccomend administration of what drug as prophylaxis from airway edema and irritation prior to GA

Dexamethasone

Illicit Drug Use: Opioids S/S of opioid craving

lacrimation Rhinorrhea yawning Piloerection

Illicit Drug Use: Opioids S/S of opiod overdose

* Slow RR * Increased TV * Miotic pupils

Illicit Drug Use: Opioids s/s of withdrawl

* restlessness * insomnia * mydriasis * tachycardia * tachypnea * HTN * Dysphoria * Unconciousness *

Illicit Drug Use: Opioids when does withdrawl occur? when does it peak?

4-6 hours post last intake peaks 48-72 hours

Illicit Drug Use: Opioids treatment for withdrawl

Opioids Methadone Clonidine

Illicit Drug Use: Opioids what drugs do you want to avoid, bc they can cause withdrawl

Nubain Narcan

Illicit Drug Use: Opioids Anesthestic considerations Acute opiiod intoxication does what to MAC

decreases

Illicit Drug Use: Opioids Anesthestic considerations Chronic opioid abuse does what to MAC

increases it

Illicit Drug Use: Opioids Anesthestic considerations why do abusers usually have exaggerated pain post op?

* decreased pain tolerance * decreased productionof endogenous opioids (endorphins, Enkephalins) * increased post op Opioid requirement

Illicit Drug Use: Cocaine extracted from the leaves of what plant?

Erythroxylon coca

Illicit Drug Use: Cocaine available in what hydrochloride forms

powder granules crystals

Illicit Drug Use: Cocaine alkalinizide form (highly addictive) is called what

Crack rock free base

Illicit Drug Use: Cocaine When Smoked injected, snorted or ingested orally inhibits _________ uptake of sympathomimetic NT (AKA NE, Serotonin, Dopamine)

Presynaptic

Illicit Drug Use: Cocaine produces a pwerful euphoria lasting \_\_\_\_-\_\_\_ min as a result of free catecholamines stimulation

5-30 min

Illicit Drug Use: Cocaine blood flow to arteries in areas like the ___ & \_\_\_\_may be compromised as the vessels vasoconstrict or vasospasm temporarily, severly compromising oxygenation and supply; this may lead to irreversable brain damage, stroke, and MI

Heart and brain

Illicit Drug Use: Cocaine metabolism \_\_\_\_\_ _____ across lipid membranes d/t low molecular weight and High lipid solubility

Easilly diffused

Illicit Drug Use: Cocaine metabolism metabolised to water soluble metabolites abd excreted in \_\_\_\_\_

urine

Illicit Drug Use: Cocaine metabolism biological 1/2 life?

0.5-1.5 hr

Illicit Drug Use: Cocaine metabolism \_\_\_\_\_\_ cholenesterases metabolizes 75-90% of cocaine into ____ INACTIVE metabolites, which can be detected 15-60 min after intacke! Also name the metabolites

* Plasma * 2 * ecgonine methyl ester & Benzolecgonine

Illicit Drug Use: Cocaine metabolism \_\_\_\_\_ cholinesterase metabolizes 10% of cocaine into \_\_\_\_\_\_, an ACTIVE metabolite that produce similar actions as cocaine

LIver norcocaine

Illicit Drug Use: Cocaine metabolism Plasma cholinesterase deficiences results in greater liver cholinesterase metabolism whch can ______ the effects of cocaine and increase the risk of complications

Prolong

Illicit Drug Use: Cocaine metabolism only 1-1.5% is cleared unmetabolized in the urine allowing ots detection only ___ hours after its use

3-6

Illicit Drug Use: Cocaine Anesthesia considerations: although rare acute aortic dissection can occur, perhaps a consequence of abrupt, sever HTN, from ______ release

catecholamine

Illicit Drug Use: Cocaine Anesthesia considerations: Why must you be careful with regional

Cocain induced thrombocytopenia can occur form cocaine use

Illicit Drug Use: Cocaine Anesthesia considerations: why may HTN occur with regional

peripheral vasoconstriction

Illicit Drug Use: Cocaine Anesthesia considerations: Regional Ephdrine resitant Hypotension may occur. what drug may correct this

Phenylephrine

Illicit Drug Use: Cocaine GETA What drugs are contraindicated to treat Severe HTN an dCardiac arrhythmias

* BBs *

Illicit Drug Use: Cocaine GETA why is hydralazine good for HTN in these ots?

vasodilation effects and decreased SVR (watch for tachycardia relfex)

Illicit Drug Use: Cocaine GETA VAAs and especially _______ may produce arrhythmias

Halothane

Illicit Drug Use: Cocaine GETA why is ketamine avoided

CNS stimulat effects- increases catecholamines

Illicit Drug Use: Cocaine GETA why shoud etomidate be avoided

myoclonus seizures hyperreflexia

Illicit Drug Use: Cocaine GETA what may happen to SCh duration and why?

prologation d/t depletion of cholinesterase by cocaine metabolism

Illicit Drug Use: Cocaine GETA what drug may delay cocain induced seizure activity and increase the cumulative doses of cocaine necessary to produce seizures

Dexmedetomidine