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Premedication

Pharm (Test 3)

QuestionAnswer
What are some goals for premedication? reduce anxiety, amnesia, pain relief, sedation, dec. risk of aspiration, n/v prophylaxis, antisialagogue, dec. MAC, prophylaxis of allergic rxn
What causes sedation from benzo's? What causes anxiolysis? sedation=intensifying of GABA effects; anxiolysis=glycine-mediated inhibitory effect on neuronal pathways in the brain
What are some advantages to benzo's? sedation, anxiolysis, amnesia, minimal effects on resp/CV, raise seizure threshold, dec. MAC
What are some disadvantages to benzo's? no analgesia, possible paradoxical rxn (confusion, agitation), teratogenic during 1st trimester (cleft-lip)
True or False: Benzo's have replaced barb's as premedication of choice. True
What is an example of a butyrophenone? droperidol/inapsine
What is the mechanism of action of droperidol/inapsine? antagonizes the activation of dopamine receptors, also alpha blocker
What are some advantages to droperidol/inapsine? outward appearance of calm, antiemetic
What are some disadvantages to droperidol/inapsine? dysphoria, restlessness, fear of death, hypotension, prolonged QT
What are some advantages to opioids? no direct myocardial depression, pre-emptive analgesia, analgesia in pre-existing pain, dec. incidence of inc. HR during surgical procedures
What receptors do opioids act on? mu, kappa, delta, sigma
What are some disadvantages to opioids? depresses ventilation (esp. RR), inc. apneic CO2 threshold, dec. hypoxic drive, orthostatic hypotension, n/v, no amnestic effect, sphincter of oddi spasm, dysphoria in pts w/o pain, histamine release
What is the most commonly used opioid in anesthesia? fentanyl
What is a typical dose of fentanyl? 1-2mcg/kg
What are some advantages to NSAID's? reduces amount of opioid required, pre-emptive analgesia
What are some disadvantages to NSAID's? dec. platelet aggregation d/t prostaglandin inhibition, avoid in elderly/gastric ulcer pts/renal impairment/hepatic impairment
What is the most common NSAID used in anesthesia? Ketoralac/Toradol
What should be given for anaphylaxis prophylaxis? Benadryl (H1), Pepcid or Ranitidine (H2), prednisone
What is an example of an alpha 2 agonist given as a pre-medication? clonidine
What are the advantages to giving clonidine as a premedication? blunts autonomic nervous sys reflex responses to surgical stim (such as inc HR and BP), can dec. anesthetic requirement
What is the premedication dose of clonidine? 5mcg/kg PO (takes 90 min to work)
What are some advantages to giving anticholinergics as premedication? vagolytic effect, antisialagogue, sedation, amnesia
What are some disadvantages to giving anticholinergics as premedication? central anticholinergic syndrome, mydriasis, cycloplegia, tachycardia, arrhythmias
In preventing aspiration, our goal is a gastric pH >______, and gastric volume < _______? pH>2.5, gastric volume <25mL
How do H2 receptor blockers reduce risk of aspiration? changes pH of contents produced/excreted after admin; doesn't change pH of current gastric contents
What are some examples of H2 receptor blockers? Cimetidine/Tagamet, Ranitidine/Zantac, Famotidine/Pepcid
What is a therapeutic dose of Ranitidine/Zantac? PO? IV? Onset? Duration? PO=150-300mg; IV=50mg; onset=60-90min; duration=9 hrs
What is a therapeutic dose of Famotidine/Pepcid? PO? IV? Onset? Duration? PO=20-40mg; IV=20mg; onset=60-90min; duration=10-12 hrs
What is an example of a gastrokinetic agent? How does it prevent aspiration? metoclopramide/reglan; lowers gastric volume (inc. gastric emptying, inc. lower esophageal sphincter tone, relaxes pylorus and duodenum
True or False: Reglan lowers gastric pH. False
What is a therapeutic dose of metoclopraminde/reglan? PO? IV? Onset? PO=10-15mg (30-60min); IV=10mg (15-30min)
What are some contraindications for giving metoclopramide/reglan? intestinal obstruction, parkinson's
How do antacids reduce risk of aspiration? raises gastric pH of fluid already present in stomach by neutralizing H+ ions w/ a base
What is a disadvantage to use of antacids to reduce risk of aspiration? increases volume
True or False: Particulate antacids are more effective, but can cause pulmonary damage if aspirated, so use non-particulate antacids in anesthesia. True
What is an example of a non-particulate antacid? Sodium citrate/Bicitra
What is a therapeutic PO dose of bicitra? Onset? 15-30mL; 15-30min
How can proton pump inhibitors reduce risk of aspiration? dec. gastric acidity AND gastric volume
What is a disadvantage to PPI? Why don't we use in anesthesia? takes daily admin. over 5 days to inhibit secretion 66%
What are some side effects of PPI? headache, agitation, confusion (crosses BBB), abdominal pain, flatulence, n/v
What meds are used for anxiolysis in peds? Versed (PO), Brevital (PR), Ketamine (IM)
What makes for an ideal pt preop? anxiety-free, sedated, easily arousable, cooperative, gastric volume <25mL, gastric pH>2.5, minimal airway secretions, pain-free, medically tuned-up