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Anes. Pharm I Test 3

Premedication

QuestionAnswer
What are the goals for premedication of a patient in the pre-op holding area? reduce anxiety, amnesia, pain relief, sedation, reduce risk of aspiration, PONV prophylaxis, antisialogogue, decrease MAC, prophylaxis of allergic reaction
What are some factors in determining goal priority with premedication? age, weight, allergies, medical condition, mental status, current medication, surgical procedures, elective vs. emergency, previous response to medications
What are some contraindications to depressant premedication drugs? less than 1 year old, elderly, decreased LOC, intracranial pathology, severed pulmonary disease, hypovolemia, & be careful with patients with full stomachs
What are some indications for depressant premedication? cardiac or cancer surgery, co-existing pain, regional anesthesia
As far as reducing anxiety goes, a study presented in class showed that what in combination with anxiolytics or even in place of anxiolytics helped reduce anxiety? adequate preoperative preparation (CRNA can make a huge difference here)
What are the advantages of using benzodiazepines for premedication? sedation, anxiolysis, amnesia, minimal ventiatory and CV effects, raise seizure threshold, reduce MAC
What are the disadvantages of using benzodiazepines for premedication? no analgesia, possible confusion/agitation, teratogenic during 1st trimester
What are the advantages of using droperidol (inapsine) for premedication? outwardly calm appearance, cost effective, anti-emetic effects
What are the disadvantages of using droperidol (inapsine) for premedication? dysphoria, restlessness, fear of death, prolonged QT (FDA black box)
What are the advantages of using opioids for premedication? no direct myocardial depression, preload reduction, pre-emptive analgesia, decreased incidence of increased HR during case
What are the disadvantages of using opioids for premedication? depresses ventilation (RR), apneic threshold increased, hypoxic drive decreased, orthostatic hypotension, N/V, NOT amnestic, sphincter of Oddi spasm, dysphoria, histamine release
What are the advantages of using NSAIDs for premedication? reduces opioid requirement post-op, pre-emptive analgesia
What are the disadvantages of using NSAIDs for premedication? decreased platelet aggregation, careful in patients with gastric ulcers or renal impairment; acetaminophen CI in patients with hepatic impairment
What are the advantages of using H1 antagonists for premedication? good for patients with atopy or at risk for allergic reaction
What are the advantages of using H2 antagonists for premedication? increases gastric pH of contents released from that time of admin forward (aspiration prophylaxis); DOES NOT increase pH of contents already present in the stomach
What are the advantages of using alpha-2 agonist drugs (clonidine) for premedication? blunts ANS response to surgical stimulation, prevents increases in HR and BP with surgical stimulation, can decrease anesthetic requirements
What are the disadvantages of using alpha-2 agonist drugs (clonidine) for premedication? will see greater drops in BP and HR during case
What are the advantages of using anticholinergics for premedicatation? vagolytic effects (not good for CAD pts), antisialogogue effect, sedation, amnesia
What are the disadvantages of using anticholinergics for premedication? central anticholinergic syndrome, mydriasis, cycloplegia, tachycardia, dysrhythmias
What anti-emetic drugs cannot be used in Parkinson's patients? Reglan, droperidol, trimethobenzamide, promethazine
What is the advantage of using gastrokinetic agents for premedication? speeds gastric emptying, increases lower esophageal sphincter tone, relaxes pylorus and duodenum, lowers gastric volume, slight antiemetic effect
What is the disadvantage of using gastrokinetic agents for premedication? does NOT affect gastric pH, increases pressure in GI system, can't be used in Parkinson's patients
Why must you use non particulate antacids as premedication? the particulates actually cause worse effects if aspirated, must be clear like bicitra for pre-anesthetic use
In terms of gastric conditions, how would an ideal patient present in pre-op? Gastric contents < 25 ml and pH > 2.5
Created by: Mary Beth
 

 



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