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Perf Tech III (Exam 3) > Topic 12: Pharm > Flashcards

Topic 12: Pharm Flashcards

1
Q

Pharmacokinetics:

A

What the body does to the drug

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2
Q

Pharmacodynamics:

A

How a drug interacts with the body to produce its effects

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3
Q

First order kinetics?

A

elimination of a drug occurs at a constant fraction of drug remaining in the body per unit of time

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4
Q

Zero order kinetics:

A

when drug administration exceeds the body’s ability to clear it, leading to drug accumulation

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5
Q

Hemodilution

A

Reduction in circulating protein concentration
•Reduction in RBC concentration
•Reduction in concentration of free drug (unless your
pump prime matches exactly)
•Alterations in organ blood flow, affecting distribution and clearance

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6
Q

In perfusion Lungs excluded from circulation - examples of drugs this effects?

A

•Valium, propofol, opioids

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7
Q

Hypothermia

A

Fluid shifts from intravascular to interstitial space
•Altered volume of distribution
•Increased 3rd spacing
•Vasoconstriction
•Changes in organ perfusion
•Reductions in enzyme-mediated biotransformation
•Increased solubility of volatile anesthetics

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8
Q

In Perfusion Altered hepatic blood flow - examples of drugs this could effect?

A

Fentanyl, propofol

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9
Q

In Perfusion Altered hepatic blood flow - examples of drugs this could effect?

A

Fentanyl, propofol

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10
Q

Acid Base Status

A
  • Altered organ blood flow
  • pH stat = ↑ cerebral blood flow
  • Altered ionization and protein binding
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11
Q

Sequestration

Drugs may be taken up by various components of the CPB circuit

A

•Coated tubing
•Oxygenators
•Hemofilters
•Many factors influence the movement of drug across the
membrane
•Degree of protein binding is a major determinant

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12
Q

When Administering Meds ensure that? 4

A
  • you have a physician’s order or standing protocol authorizing you to administer the medication
  • the patient is not allergic to the medication
  • you have the correct medication, the correct concentration and the correct dosage
  • Inspect the medication for expiration date, precipitates, and sterility
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13
Q

What is in your drug box?

A
  • Heparin
  • Neo-Synephrine
  • NaHCO3
  • Lidocaine
  • MgSO4
  • Calcium
  • Potassium
  • Mannitol
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14
Q

Heparin Sodium

A

Derived from bovine lung tissue or porcine mucosa
standardized for anticoagulant activity
•The potency is determined by a biological assay using a
USP reference standard based on units of heparin activity
per milligram
•100 units = 1 milligram
•Example: 5,000 units = 50mg
•Action: stops coagulation by potentiating antithrombin III
and inhibiting the action of activated Factors IX and XI

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15
Q

Heparin Pharmokinetics

A
  • Eliminated by kidneys
  • Half life at CPB doses is 2 or more hours
  • Prolonged by hypothermia and renal blood flow alterations
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16
Q

Heparin side effects? (4)

A

-Activation of t-PA and platelets
•Boluses decrease SVR by 10 to 20%
•Anaphylaxis rarely occurs
•HIT and HITT

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17
Q

Heparin dosing rarely exceeds what? where does it distribute?

A

Loading dose: 300 to 450 units/kg
•Distributes primarily in plasma, so increasing dose with
increasing body weight is only relevant to a certain point
•Rarely need to exceed 35,000 to 40,000 units

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18
Q

Most vials of Heparin you will see for adult CPB will be units/mL?

A

1000 units/mL

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19
Q

Neo-Synephrine
Action?
Duration?
How to admin?

A

Action: Synthetic selective α 1-adranergic agonist that causes vasoconstriction in arterioles
•Duration: less than 5 minutes
•Titrated to effect
•Start with a test dose

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20
Q

Neo-Synephrine
IV bolus dose? 3
IV infusion dose? 1

A 
•IV bolus
•100 micrograms/mL
•200 micrograms/mL
•400 micrograms/mL
•
IV infusion
•10 or 15 mg in 250 mL IV fluid (40 to 60 micrograms/mL)
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21
Q

Sodium Bicarb is what?

A

A sterile, nonpyrogenic, hypertonic solution of sodium
bicarbonate (NaHCO3) in water for injection for
administration by the intravenous route as an electrolyte
replenisher and system alkalizer

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22
Q

Sodium bicarb used to treat what?

A

Also used to treat hyperkalemia

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23
Q

NaCHO3 dosing equation?

A

Dose (mEq) = 0.3 x Weight (kg) x BD (mEq/L)

*Or just “1 amp” (50 mEq)

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24
Q

NaCHO3 - normal amounts for hyperkalemia

adults and peds?

A
  • Hyperkalemia:
  • Adults: 50 mEq
  • Peds: 1-2 mEq/kg
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25
Q

Lidocaine
Action?
site of action?
duration of action?

A

•Actions: reduces cell membrane permeability for sodium
and potassium which increases the stimulation thresholds
in ventricles
•Site of Action: cell membrane
•Duration of Action: 15 to 30 minutes post bolus

26
Q

Lidocaine dosing?

A

IV bolus 1-2 mg/kg
•Usually 100 to 200 mg bolus at XC removal
•Not to exceed 300 mg/hr

27
Q

Mag Sulfate - Action?

A

Action: controls transmembrane electrolytes and energy metabolism

28
Q

Mag Sulfate - why does Hypomagnesemia occur?

A
  • Hypomagnesemia can occur during CPB
  • Poor pre op health
  • Albumin administration
  • Citrated blood product administration
29
Q

what occurs due to hypomagnesemia?

A

•Cardiac arrhythmias may occur during hypomagnesemia

30
Q

Mag Sulfate dose?

A 
•2 to 2.5 g initial bolus
•1.75 g/h infusion
•On CPB, usually given as 2 to 4 grams at XC removal
with Lidocaine
•Often 0.5 g/mL concentration
31
Q

Calcium Chloride - action?

what happens during CPB?

A

Action: Involved in myocardial contractility, blood
clotting, neurotransmission and muscle contraction
•May be used for mixing with thrombin for platelet gel
•Levels drop during CPB
•May be necessary to replenish before coming off CPB
•Especially if citrated blood products given

32
Q

CaCl2 dosing?? how?? when??? concentration?

A
  • 200 to 1000 mg slow IV
  • Often 100 mg/mL concentration
  • Given post XC removal and before termination of CPB if levels are low
  • Hyperkalemia:
  • Adults: 0.5-1g CaCl2
  • Peds: 20 mg/kg Calcium Gluconate
33
Q

CaCl2 dosing for hyperkalemia ?

adults and peds

A
  • Hyperkalemia:
  • Adults: 0.5-1g CaCl2
  • Peds: 20 mg/kg Calcium Gluconate
34
Q

Potassium Chloride - necessary for what?

A

The major intracellular ion
•Necessary for normal cardiac contractions
•Hyperkalemia more of an issue than hypokalemia
•Cardioplegia

35
Q

KCl dosing in CPG?

equation for HYPOkalemia

A

Cardioplegia: 15-30 mmol/L of solution delivered into the heart
•ie. 4 to 1 cpg requires 5 times the delivery strength in the
cpg bag

•Hypokalemia: Dose
(mEq) = weight (kg) x 0.3 x K +deficit
•GIVE IT SLOWLY especially if XC not on
•Usually 2 mEq/mL concentration

36
Q

Mannitol action?

A

Action: osmotic diuretic prevents reabsorption in the
proximal tubule (also thought to be a free radical
scavenger)

37
Q

Mannitol dosing? what must you do?

A

During CPB 0.5 to 1.0 g/kg
•Often given as 12.5 g vials in prime or during warming
•Inspect carefully for precipitate or crystals.
•Use a filtered needle during administration

38
Q

THAM (thromethomine) actions

A

Action: creates an alkaline environment by combining

with hydrogen ions to form bicarbonate

39
Q

THAM dosing equation?

A

Each 100 mL contains tromethamine 3.6g (30mEq)

Dose (mL) = wt (kg) x Base Deficit (mEq/L) x 1.1

40
Q

Amicar action?

A

Action: inhibits plasminogen activators to prevent conversion to plasmin
•Reduces bleeding caused by hyperfibrinolysis

41
Q

Amicar Infusion Dosing?

A

Loading Dose: 5 g IV

Infusion: 1-1.25g/hr (30g/day max)

42
Q

Trasylol

A

Action: inhibits fibrinolysis and turnover of coagulation

factors (serine protease inhibitor)

43
Q

Trasylol may do what?

A

*May artificially prolong ACT results

44
Q

Trasylol infusion dose?

A

Test dose: 1 mL at least 10 min before loading
•Loading dose: 200 mL (280mg) over 20-30 min

  • Infusion dose: 50 mL/hr
  • Pump prime dose: 200 mL
45
Q

Thrombate III (antithrombate) - action? #s!

A

Action: inactivates thrombin and activated forms of clotting factors IX, X, XI, and XII which results in inhibition of coagulation
•The anticoagulant effect of heparin is enhanced with
Thrombate III in patients with antithrombin III (AT-III) deficiency

46
Q

Thrombate III (antithrombate) dose equation

A

Dose (IU) = (desired-baseline AT-III level) x kg/ 1.4

47
Q

Benadryl (diphenhydramine) action?

A

Action: antihistamine, sedative, antiemetic, anticholinergic

•Given on CPB after suspicion of allergic reaction

48
Q

Solu-medrol (methylprednisolone) action?

A

Action: Intermediate acting glucocorticoid used on
bypass to combat inflammation, often during circulatory
arrest cases
•May cause hyperglycemia

49
Q

Solu-medrol how does it come?

A
  • Sterile powder which must be mixed with the accompanying diluent
  • Use within 48 hours of mixing
50
Q

Forane action?

A

Action: ethers that modulate the GABA
A receptor, used for induction and maintenance of anesthesia
•Potent vasodilators
•Pungent odor

Inhalation Anesthetics
•Halothane
•Isoflurane
•Sevorflurane

51
Q

Forane how to administer?

A

Bottle must be used with appropriate adaptor to fill forane vaporizer on your pump
•Spillage can cause structural degradation of plastic
•Set vaporizer at 0.5% to 2% after initiation of gas flow
•Can be temporarily increased for blood pressure control
•Scavenge oxygenator gas outflow when using anesthetic gas

52
Q

AMSECT Standard 6.8

A

An anesthetic gas scavenge line shall be employed whenever inhalation agents are introduced into the circuit during CPB procedures.

53
Q

Short term exposure to anesthetic gases can do what?

A 
Short term exposure
•Liver and kidney disease
•Headache
•Irritability
•Fatigue
•Nausea
•Drowsiness
•Compromised performance
•Decreased vigilance
•Slow reaction time
54
Q

Long term exposure to anesthetic gases can do what?

A
  • Miscarriage
  • Genetic damage
  • Cancer
  • Miscarriage and birth defects in the SPOUSES of exposed workers
55
Q

Scavenge anesthetic gas w/tube?

A

Suction tubing attached to oxygenator gas outflow
•With tiny holes cut into it
•With a ¼” ¼” ¼” Y connector on it
•Attached to wall suction or waste suction set at -100mmHg

56
Q

Albumin is what?

A

Concentration of proteins derived from human blood
•Increases plasma volume or serum albumin levels
•May not be consented for by Jehovah’s Witnesses patients

57
Q

Albumin will do what to the circulating bld vol?

A

Will increase circulating volume 3.5 times the volume
injected, in an adequately hydrated individual
•12.5 to 25g in prime, or as needed

58
Q

When to give albumin?

A

•Some give when serum albumin

59
Q

Insulin Action?

A

Action: stimulates glucose utilization by muscle and fat, and acts on the liver to inhibit glycogenolysis and gluconeogenesis

60
Q

Insulin Dosing

  • target glu?
  • mix?
A
  • Glucose target range of 110-180 mg/dL during cardiac surgery
  • *VERY anesthesia and hospital protocol dependent
  • 100 units/mL
  • 10-20 units IV on CPB
  • Never shake vial, roll in your hands to mix
  • Use 1 mL syringe or dedicated insulin syringe
61
Q

Insulin dosing for hyperlalemia

A
  • Adults: 25g Dextrose + 10 units Insulin

* Peds: 1-2 g/kg Dextrose + 0.3 units Insulin per gram of Dextrose

62
Q

Dextrose D 50

A

Concentrated carbohydrate in the form of dextrose in

water used to treat hypoglycemia

Perf Tech III (Exam 3) (4 decks)

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