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Anes. Pharm I Test 3
Premedication
Question | Answer |
---|---|
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 |