Pharm (Test 3)
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| 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
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| 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
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| What are some advantages to benzo's? | sedation, anxiolysis, amnesia, minimal effects on resp/CV, raise seizure threshold, dec. MAC
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| What are some disadvantages to benzo's? | no analgesia, possible paradoxical rxn (confusion, agitation), teratogenic during 1st trimester (cleft-lip)
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| True or False: Benzo's have replaced barb's as premedication of choice. | True
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| What is an example of a butyrophenone? | droperidol/inapsine
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| What is the mechanism of action of droperidol/inapsine? | antagonizes the activation of dopamine receptors, also alpha blocker
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| What are some advantages to droperidol/inapsine? | outward appearance of calm, antiemetic
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| What are some disadvantages to droperidol/inapsine? | dysphoria, restlessness, fear of death, hypotension, prolonged QT
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| 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
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| What receptors do opioids act on? | mu, kappa, delta, sigma
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| 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
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| What is the most commonly used opioid in anesthesia? | fentanyl
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| What is a typical dose of fentanyl? | 1-2mcg/kg
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| What are some advantages to NSAID's? | reduces amount of opioid required, pre-emptive analgesia
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| What are some disadvantages to NSAID's? | dec. platelet aggregation d/t prostaglandin inhibition, avoid in elderly/gastric ulcer pts/renal impairment/hepatic impairment
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| What is the most common NSAID used in anesthesia? | Ketoralac/Toradol
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| What should be given for anaphylaxis prophylaxis? | Benadryl (H1), Pepcid or Ranitidine (H2), prednisone
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| What is an example of an alpha 2 agonist given as a pre-medication? | clonidine
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| 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
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| What is the premedication dose of clonidine? | 5mcg/kg PO (takes 90 min to work)
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| What are some advantages to giving anticholinergics as premedication? | vagolytic effect, antisialagogue, sedation, amnesia
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| What are some disadvantages to giving anticholinergics as premedication? | central anticholinergic syndrome, mydriasis, cycloplegia, tachycardia, arrhythmias
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| In preventing aspiration, our goal is a gastric pH >______, and gastric volume < _______? | pH>2.5, gastric volume <25mL
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| 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
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| What are some examples of H2 receptor blockers? | Cimetidine/Tagamet, Ranitidine/Zantac, Famotidine/Pepcid
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| What is a therapeutic dose of Ranitidine/Zantac? PO? IV? Onset? Duration? | PO=150-300mg; IV=50mg; onset=60-90min; duration=9 hrs
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| What is a therapeutic dose of Famotidine/Pepcid? PO? IV? Onset? Duration? | PO=20-40mg; IV=20mg; onset=60-90min; duration=10-12 hrs
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| 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
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| True or False: Reglan lowers gastric pH. | False
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| What is a therapeutic dose of metoclopraminde/reglan? PO? IV? Onset? | PO=10-15mg (30-60min); IV=10mg (15-30min)
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| What are some contraindications for giving metoclopramide/reglan? | intestinal obstruction, parkinson's
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| How do antacids reduce risk of aspiration? | raises gastric pH of fluid already present in stomach by neutralizing H+ ions w/ a base
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| What is a disadvantage to use of antacids to reduce risk of aspiration? | increases volume
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| True or False: Particulate antacids are more effective, but can cause pulmonary damage if aspirated, so use non-particulate antacids in anesthesia. | True
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| What is an example of a non-particulate antacid? | Sodium citrate/Bicitra
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| What is a therapeutic PO dose of bicitra? Onset? | 15-30mL; 15-30min
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| How can proton pump inhibitors reduce risk of aspiration? | dec. gastric acidity AND gastric volume
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| What is a disadvantage to PPI? Why don't we use in anesthesia? | takes daily admin. over 5 days to inhibit secretion 66%
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| What are some side effects of PPI? | headache, agitation, confusion (crosses BBB), abdominal pain, flatulence, n/v
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| What meds are used for anxiolysis in peds? | Versed (PO), Brevital (PR), Ketamine (IM)
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| 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
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