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From Flashcardlet > Fall Pharm Exam 2 > Flashcards

Fall Pharm Exam 2 Flashcards

1
Q

What changes take place during pregnancy in the mother’s body?

A

Increased plasma volume, increased cardiac output, increased GFR by 30-50%, decreased plasma albumin, nausea, vomiting, delayed gastric emptying and increased gastric pH. Also, increased estrogen and progesterone alter liver enzyme activity.

How well did you know this?
1
Not at all
2
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2
Q

What changes take place during pregnancy in the mother’s body?

A

Increased plasma volume, increased cardiac output, increased GFR by 30-50%, decreased plasma albumin, nausea, vomiting, delayed gastric emptying and increased gastric pH. Also, increased estrogen and progesterone alter liver enzyme activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to drug clearance as a result of these changes?

A

Increased GFR means faster clearance of renally cleared drugs
Decreased plasma albumin means that highly protein bound drugs have a higher free concentration and can be cleared faster by the liver and kidney.
N/V, delayed gastric emptying and increased pH alter the absorption of drugs.
Altered liver enzyme activity can either enhance elimination or allow accumulation of some drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

During the first two weeks following conception, exposure to a teratogen has what effect on the embryo?

A

All or nothing effect, could have severe damage or no damage at all depending on the exposure and amount of teratogen exposed to.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

During the period of 18-60 days post conception, exposure to a teratogen has what effect on the embryo?

A

Structural anomalies because this is the period of organogenesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some of the common results of teratogen exposure?

A

Growth retardation, CNS abnormalities, death - abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some drugs that are teratogenic during the organogenesis phase?

A

Chemotherapy, sex hormones, lithium, retinoids, thalidomide, certain antiepileptic drugs and coumarin derivatives.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does risk category A mean?

A

Adequate studies fail to demonstrate risk to the fetus in the first trimester, and there is no evidence of risk in later trimesters.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does risk category B mean?

A

Animal reproduction studies have not shown a risk to the fetus, but there are no adequate studies in humans. Considered relatively safe but not tested in humans.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does risk category C mean?

A

Animal reproduction studies show adverse effects on the fetus, and there are no studies in humans but the benefit may outweigh the risk. So, there are effects on animals but no studies are done on humans so weigh risk and benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does risk category D mean?

A

There is evidence of human fetal risk because of investigational or marketing experience or studies, but benefits may outweigh the risk. So, there are effects on human fetus, but still weigh risk and benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does risk category X mean?

A

Studies on animals and/or humans demonstrate fetal abnormalities and therefore the risk outweighs the benefits in this case – do not use!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is constipation in pregnancy treated?

A

First – behavioral approaches such as light exercise and fluid intake. Second – fiber supplementation. Third – stool softener. Fourth – osmotic laxative such as polyethelene glycol, lactulose, sorbitol, magnesium and sodium salts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should not be used to treat constipation in pregnancy?

A

Caster oil and mineral oil because they may induce labor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should be used to treat GERD in pregnancy?

A

Antacids such as aluminum, calcium, or magnesium preps or sucralfate. Ranitidine and Cimetidine can be used, and there is no evidence for or against the use of PPIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should not be used to treat GERD in pregnancy?

A

Sodium bicarb and magnesium trisilicate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should be used to treat nausea and vomiting in pregnancy?

A

First – behavioral approaches such as small, frequent, bland meals, avoiding fatty foods. Also, applying pressure to acupressure point P6 on the volar aspect of the wrist. Second – pyridoxine (Vit. B6), antihistamines (doxylamine). 5-HT antagonists are category B if all else fails.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is diabetes monitored & treated in pregnancy?

A

Daily self-monitoring and treatment with insulin therapy and dietary modification. Goal fasting glucose is 90-99mg/dL, 1-hr post prandial goal is <120-127mg/dL. Glyburide is an alternative to insulin because it minimally crosses the placenta. Metformin does not have studies to support use in pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is HTN treated in pregnancy?

A

Take them off all ACE-I or ARB therapy! First – supplemental Ca++ 1-2g/day. Approved drugs include methyldopa, lebatalol and Ca++ channel blockers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is recommended for seizure prevention in patients with epilepsy or eclampsia in pregnancy?

A

Magnesium sulfate. Diazepam and phenytoin should be avoided!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is post-partum thyroiditis that does not resolve on its own treated?

A

Beta blockers (propranolol or labetalol can provide symptomatic relief of the adrenergic sx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is acute thromboembolism treated in pregnancy?

A

Unfractionated heparin or adjusted-dose low-molecular weight heparin (LMWH is preferred). Treatment should be continued throughout pregnancy and for 6 wks after delivery. Warfarin is NOT recommended.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the risk associated with Warfarin in pregnancy?

A

Nasal hypoplasia, stippled epiphyses, limb hypoplasia and eye abnormalities if taken between weeks 6 and 12 of gestation, and CNS anomalies if taken in the second or third trimester.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How should UTI be treated in pregnancy?

A

Cephalexin.
Nitrofurantoin is effective but not against Proteus and should not be used after week 37 in patients with glucose-6-phosphate dehydrogenase deficiency because of hemolytic anemia risk in the fetus.
Sulfa containing drugs can contribute to the development of newborn kernicterus so use should be avoided during the last weeks of gestation. Trimethoprim is a folate antagonist and is relatively contraindicated in the first trimester because of associated cardiac malformations.
Fluroquinolones and tetracyclines are contraindicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is allergic rhinitis treated in pregnancy?

A

First line – intranasal corticosteroids (beclomethasone and budesonide), nasal cromolyn, and first generation antihistamines (chlorpheniramine, hydroxyzine).
Second generation antihistamines (loratadine, cetirizine) are category B
Oral decongestants like pseudoephedrine are associated with increased risk of gastroschisis. Use of external nasal dilator, short-term topical oxymetazoline or inhaled corticosteroids are preferred over oral decongestants, esp. in early pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a Tacolytic agent?

A

Delays delivery long enough to allow for fetal growth or transport of the mother to an equipped facility. Examples: beta agonists, magnesium, calcium channel blocker, and NSAIDs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Terbutaline

A

A beta-agonist. Higher incidence of maternal side effects such as hyperkalemia, arrhythmias, hyperglycemia, hypotension and pulmonary edema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Nifedipine

A

Calcium Channel Blocker. Fewer side effects than magnesium or beta agonist therapy. Studies suggest that it’s more effective or prolonging labor than beta agonists. Primary concern is hypotensive effect and change in uteroplacental blood flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Indomethacin

A

NSAID that has been used for tocolysis. Primary concern is rate of premature constriction of the ductus arteriorsus in infants after 32 weeks gestation. Not commonly used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why would an antental corticosteroid be used in pregnancy?

A

For fetal lung maturation to prevent respiratory distress syndrome. Benefits begin within 24 hours.
Betamethasone IM, Dexamethasone IM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Prostaglandin E2 and F2 analgos

A

Increase collagenase activity in the cervix leading to thinning and dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the most common indications for induction?

A

Postdatism and pregnancy induced hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Dinoprostone

A

Prostaglandin E2 analog that is used for cervical ripening. Patients must be attached to a fetal heart rate monitor for the duration of use and for 15 minutes after its removal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Misoprostol

A

Prostaglandin E1 analog that ripens the cervix. Intravaginal administration. More effective than other prostaglandin agents and results in a shorter time to delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Mifepristone

A

An antiprogesterone agent that results in a shorter time to delivery and fewer c-sections. Limited information on fetal and maternal outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Oxytocin

A

An antiprogesterone agent. Most commonly used labor induction agent after cervical ripening. Effective in low and high dose regimens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Epidural analgesia

A

An opioid and/or anesthetic injected into the epidural space – fentanyl and/or bupivacaine. Side effects are hypotension, pruritus and inability to void. Associated with prolongation of the first and second stages of labor, higher numbers of instrumental deliveries and maternal fever.
Patient controlled dosing allows the patient to control the timing and results in lower total dosing than continuous infusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the factors that affect drug transfer from maternal circulation into breast milk?

A

Degree of protein binding in maternal plasma – increased binding causes increased crossing
Molecular weight of the drug – lower weight passively diffuse while larger molecules don’t transfer in lg. amounts.
Lipid solubility of the drug and corresponding fat content of milk – increased lipid solubility increases transfer
Maternal plasma concentration
Drug half-life – shorter half lives accumulate less
Drug pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When should a mother take her medication when breast feeding?

A

Before the infant’s longest sleep period and increase the interval to the next feeding.
Pump and discard if the medication is not compatible with breast feeding – need to consider the amount of milk produced by the mother daily.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How should postpartum depression be treated?

A

Sertraline is first line – minimal transfer to breast milk, lack of reported adverse events
Paroxetine and nortriptyline are second-line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Metoclopramide

A

Stimulates prolactin secretion to cause relactation if nonpharmacologic measures are ineffective.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is mastitis

A

Infectious due to Staph aureus, E. Coli or Strep, or noninfectious due to milk stasis. S/sx are breast tenderness, redness, warmth and flulike sx. Risk factors include breast engorgement, plugged milk ducts and cracked nipples.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is mastitis treated?

A

Abx: penicillinase-resistant penicillins (dicoloxacillin, oxacillin) and cephalosporins (cephalexin) for 10-14 days.
Anti-inflammatory drugs like ibuprophen (but remember that it’s not allowed in peds under 6 mo. so use acetaminophen if possible.
Continue Breast feeding on non-effected side and pump/dump effected side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What happens to drug clearance as a result of these changes?

A

Increased GFR means faster clearance of renally cleared drugs
Decreased plasma albumin means that highly protein bound drugs have a higher free concentration and can be cleared faster by the liver and kidney.
N/V, delayed gastric emptying and increased pH alter the absorption of drugs.
Altered liver enzyme activity can either enhance elimination or allow accumulation of some drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

During the first two weeks following conception, exposure to a teratogen has what effect on the embryo?

A

All or nothing effect, could have severe damage or no damage at all depending on the exposure and amount of teratogen exposed to.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

During the period of 18-60 days post conception, exposure to a teratogen has what effect on the embryo?

A

Structural anomalies because this is the period of organogenesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are some of the common results of teratogen exposure?

A

Growth retardation, CNS abnormalities, death - abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are some drugs that are teratogenic during the organogenesis phase?

A

Chemotherapy, sex hormones, lithium, retinoids, thalidomide, certain antiepileptic drugs and coumarin derivatives.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What does risk category A mean?

A

Adequate studies fail to demonstrate risk to the fetus in the first trimester, and there is no evidence of risk in later trimesters.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What does risk category B mean?

A

Animal reproduction studies have not shown a risk to the fetus, but there are no adequate studies in humans. Considered relatively safe but not tested in humans.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What does risk category C mean?

A

Animal reproduction studies show adverse effects on the fetus, and there are no studies in humans but the benefit may outweigh the risk. So, there are effects on animals but no studies are done on humans so weigh risk and benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What does risk category D mean?

A

There is evidence of human fetal risk because of investigational or marketing experience or studies, but benefits may outweigh the risk. So, there are effects on human fetus, but still weigh risk and benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What does risk category X mean?

A

Studies on animals and/or humans demonstrate fetal abnormalities and therefore the risk outweighs the benefits in this case – do not use!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How is constipation in pregnancy treated?

A

First – behavioral approaches such as light exercise and fluid intake. Second – fiber supplementation. Third – stool softener. Fourth – osmotic laxative such as polyethelene glycol, lactulose, sorbitol, magnesium and sodium salts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What should not be used to treat constipation in pregnancy?

A

Caster oil and mineral oil because they may induce labor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What should be used to treat GERD in pregnancy?

A

Antacids such as aluminum, calcium, or magnesium preps or sucralfate. Ranitidine and Cimetidine can be used, and there is no evidence for or against the use of PPIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What should not be used to treat GERD in pregnancy?

A

Sodium bicarb and magnesium trisilicate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What should be used to treat nausea and vomiting in pregnancy?

A

First – behavioral approaches such as small, frequent, bland meals, avoiding fatty foods. Also, applying pressure to acupressure point P6 on the volar aspect of the wrist. Second – pyridoxine (Vit. B6), antihistamines (doxylamine). 5-HT antagonists are category B if all else fails.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How is diabetes monitored & treated in pregnancy?

A

Daily self-monitoring and treatment with insulin therapy and dietary modification. Goal fasting glucose is 90-99mg/dL, 1-hr post prandial goal is <120-127mg/dL. Glyburide is an alternative to insulin because it minimally crosses the placenta. Metformin does not have studies to support use in pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How is HTN treated in pregnancy?

A

Take them off all ACE-I or ARB therapy! First – supplemental Ca++ 1-2g/day. Approved drugs include methyldopa, lebatalol and Ca++ channel blockers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is recommended for seizure prevention in patients with epilepsy or eclampsia in pregnancy?

A

Magnesium sulfate. Diazepam and phenytoin should be avoided!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How is post-partum thyroiditis that does not resolve on its own treated?

A

Beta blockers (propranolol or labetalol can provide symptomatic relief of the adrenergic sx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is acute thromboembolism treated in pregnancy?

A

Unfractionated heparin or adjusted-dose low-molecular weight heparin (LMWH is preferred). Treatment should be continued throughout pregnancy and for 6 wks after delivery. Warfarin is NOT recommended.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the risk associated with Warfarin in pregnancy?

A

Nasal hypoplasia, stippled epiphyses, limb hypoplasia and eye abnormalities if taken between weeks 6 and 12 of gestation, and CNS anomalies if taken in the second or third trimester.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How should UTI be treated in pregnancy?

A

Cephalexin.
Nitrofurantoin is effective but not against Proteus and should not be used after week 37 in patients with glucose-6-phosphate dehydrogenase deficiency because of hemolytic anemia risk in the fetus.
Sulfa containing drugs can contribute to the development of newborn kernicterus so use should be avoided during the last weeks of gestation. Trimethoprim is a folate antagonist and is relatively contraindicated in the first trimester because of associated cardiac malformations.
Fluroquinolones and tetracyclines are contraindicated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How is allergic rhinitis treated in pregnancy?

A

First line – intranasal corticosteroids (beclomethasone and budesonide), nasal cromolyn, and first generation antihistamines (chlorpheniramine, hydroxyzine).
Second generation antihistamines (loratadine, cetirizine) are category B
Oral decongestants like pseudoephedrine are associated with increased risk of gastroschisis. Use of external nasal dilator, short-term topical oxymetazoline or inhaled corticosteroids are preferred over oral decongestants, esp. in early pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is a Tacolytic agent?

A

Delays delivery long enough to allow for fetal growth or transport of the mother to an equipped facility. Examples: beta agonists, magnesium, calcium channel blocker, and NSAIDs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Terbutaline

A

A beta-agonist. Higher incidence of maternal side effects such as hyperkalemia, arrhythmias, hyperglycemia, hypotension and pulmonary edema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Nifedipine

A

Calcium Channel Blocker. Fewer side effects than magnesium or beta agonist therapy. Studies suggest that it’s more effective or prolonging labor than beta agonists. Primary concern is hypotensive effect and change in uteroplacental blood flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Indomethacin

A

NSAID that has been used for tocolysis. Primary concern is rate of premature constriction of the ductus arteriorsus in infants after 32 weeks gestation. Not commonly used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Why would an antental corticosteroid be used in pregnancy?

A

For fetal lung maturation to prevent respiratory distress syndrome. Benefits begin within 24 hours.
Betamethasone IM, Dexamethasone IM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Prostaglandin E2 and F2 analgos

A

Increase collagenase activity in the cervix leading to thinning and dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the most common indications for induction?

A

Postdatism and pregnancy induced hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Dinoprostone

A

Prostaglandin E2 analog that is used for cervical ripening. Patients must be attached to a fetal heart rate monitor for the duration of use and for 15 minutes after its removal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Misoprostol

A

Prostaglandin E1 analog that ripens the cervix. Intravaginal administration. More effective than other prostaglandin agents and results in a shorter time to delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Mifepristone

A

An antiprogesterone agent that results in a shorter time to delivery and fewer c-sections. Limited information on fetal and maternal outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Oxytocin

A

An antiprogesterone agent. Most commonly used labor induction agent after cervical ripening. Effective in low and high dose regimens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Epidural analgesia

A

An opioid and/or anesthetic injected into the epidural space – fentanyl and/or bupivacaine. Side effects are hypotension, pruritus and inability to void. Associated with prolongation of the first and second stages of labor, higher numbers of instrumental deliveries and maternal fever.
Patient controlled dosing allows the patient to control the timing and results in lower total dosing than continuous infusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the factors that affect drug transfer from maternal circulation into breast milk?

A

Degree of protein binding in maternal plasma – increased binding causes increased crossing
Molecular weight of the drug – lower weight passively diffuse while larger molecules don’t transfer in lg. amounts.
Lipid solubility of the drug and corresponding fat content of milk – increased lipid solubility increases transfer
Maternal plasma concentration
Drug half-life – shorter half lives accumulate less
Drug pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

When should a mother take her medication when breast feeding?

A

Before the infant’s longest sleep period and increase the interval to the next feeding.
Pump and discard if the medication is not compatible with breast feeding – need to consider the amount of milk produced by the mother daily.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How should postpartum depression be treated?

A

Sertraline is first line – minimal transfer to breast milk, lack of reported adverse events
Paroxetine and nortriptyline are second-line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Metoclopramide

A

Stimulates prolactin secretion to cause relactation if nonpharmacologic measures are ineffective.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is mastitis

A

Infectious due to Staph aureus, E. Coli or Strep, or noninfectious due to milk stasis. S/sx are breast tenderness, redness, warmth and flulike sx. Risk factors include breast engorgement, plugged milk ducts and cracked nipples.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How is mastitis treated?

A

Abx: penicillinase-resistant penicillins (dicoloxacillin, oxacillin) and cephalosporins (cephalexin) for 10-14 days.
Anti-inflammatory drugs like ibuprophen (but remember that it’s not allowed in peds under 6 mo. so use acetaminophen if possible.
Continue Breast feeding on non-effected side and pump/dump effected side

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85
Q

What is the most common organism involved in Gonorrhea?

A

Gram – negative diplococcic N. gonorrheae

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86
Q

What is the main complication of Gonorrhea?

A

PID

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87
Q

What is a pregnancy concern with Gonorrhea?

A

Ophthalmia neonatorum if not treated prior to delivery of the fetus

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88
Q

What is the treatment for Gonorrhea?

A

Ceftriaxone 250mg IM single dose, PLUS Azithromycin 1g PO single dose OR doxycycline 100mg PO BID x7 days
Cefixime 400mg PO PLUS azithromycin 1g PO single dose OR doxycycline 100mg PO BID x 7 days.
If severe cephalosporin allergy: single dose of 2g azithromycin.

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89
Q

What is the primary organism involved in Chlamydia?

A

C. trachomatis

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90
Q

What is the treatment for Chlamydia?

A

Azithromycin 1g PO single dose OR doxycycline 100mg PO BID x 7days
Alternatives are Erythromycin base, Levofloxacin or Ofloxacin

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91
Q

How do you treat Chlamydia in pregnancy?

A

Azithromycin 1g PO single dose OR amoxicillin 500 mg PO TID x7 days
Erythromycin base or erythromycin ethylsuccinate

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92
Q

How do you treat Opthalmia Neonatorum?

A

Erythromycin base or Erythromycin ethylsuccinate 50mg/kg/day PO QID x 14 days

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93
Q

What is the primary organism involved in Syphilis?

A

Treponema pallidum

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94
Q

How does syphilis present?

A

Skin rashes and/or sores in mouth, vagina or anus in the secondary stage.

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95
Q

What is the preferred treatment for syphilis?

A

PCN G

If PCN allergic, desensitize and use doxycycline

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96
Q

What are the therapy options for syphilis?

A

Benzathine Penicillin G 2.4million units IM single dose
Peds: Benzathine PCN G 50,000 units/kg IM up to the adult dose of 2.4 million units, in a single dose.
Alternatives: doxycycline 100mg PO BID x14 days or tetracycline 500mg QID x 14days

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97
Q

What is the organism responsible for recurrent and persistent urethritis?

A

U. urealyticum or M. genitalium are doxycycline resistant

T. vaginalis is known to cause urethritis in men

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98
Q

How is urethritis treated?

A

Metronidazole 2g PO in a single dose
Tinidazole 2g PO in a single dose PLUS azithromycin 1g PO single dose
Alternatives: moxi 400mg PO QDx7days – highly effective against M. genitalium

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99
Q

What are the primary organisms involved in PID?

A

N. gonorrhoreae and C. trachomatis
Others are those that comprise the vaginal flora (anaerobes, gram negative rods, etc)
CMV and other viruses may be implicated in PID

100
Q

What is the preferred treatment for PID?

A

Cefotetan 2g IV every 12 hours
Cefoxitin 2g IV every 6 hours PLUS doxycycline 100mg PO or IV every 12 hours.
If the condition improves, d/c the IV tx after 24 hours and continue on doxycycline PO for 14 days).
Alternatives: clindamycin plus gentamycin, or ampicillin/sulbactam plus doxycycline

101
Q

What is the preferred oral treatment for PID?

A

Ceftriaxone 250mg IM in a single dose plus doxycycline 100mg PO BID x14 days with or without metronidazole 500mg PO BID x14 days.
Ceftriaxone for the gram negatives, staph and strep. Doxy for gram positives and atypical. Metro for anaerobes.

102
Q

What are the most common strains of HPV to cause genital warts?

A

6 & 11

103
Q

What is the recommended treatment for genital warts?

A

Patient applied: podofilox .5% solution or gel OR imiquimod 5% cream OR sinecatechins 15% ointment.
Provider administered: cryotherapy with repeat tx in 1-2 wks. OR podophyllin resin 10-25% OR Tricholoracetic Acid 80-90% OR surgical removal.

104
Q

How is HSV treated?

A

No cure. Tx helps to shorten outbreaks and relieve symptoms.
First clinical episode: Acyclovir 400mg PO TID x7-10 days OR famciclovir 250mg PO TID x7-10 days OR valacyclovir 1g PO BID x7-10 days.
For recurrent episodes: Acyclovir 800mg PO TID x 2 days
Suppressive therapy: Acyclovir 400mg PO BID OR famiciclovir 250mg PO BID. Duration depends on patient response.

105
Q

What is the treatment for Trichomoniasis?

A

Metronidazole 2g PO single dose OR Tinidazole 2g PO single dose.
Metronidazole 500mg PO BID x7 days

106
Q

When is ART therapy initiated?

A

When CD4 < 350 cells/mm^3. With higher counts, it depends on how the patient is doing.

107
Q

What are the goals of therapy with ART?

A

Reduce HIV-assoc. morbidity and prolong the duration and quality of survival.
Restore and preserve immunologic function
Maximally and durably suppress plasma HIV viral load
Prevent HIV Transmission.

108
Q

What are the two subtypes of reverse transcriptase inhibitors?

A

NRTIs – nucleoside/nucleotide reverse transcriptase inhibitors
NNRTIs – nonnucleoside reverse transcriptase inhibitors.

109
Q

What is the MOA of NRTIs?

A

They require phosphorylation to become active. Competes with endogenous DNA for the catalytic site of reverse transcriptase and prematurely terminates DNA elongation as it lacks a hydroxyl for linking.

110
Q

What are the toxicities associated with NRTIs?

A 
Peripheral neuropathy
Pancreatitis
Lipoatrophy (subcutaneous fat loss)
Myopathy
Anemia
Rare life threatening lactic acidosis with fatty liver
111
Q

What NRTI is renally cleared, so a CrCl needs to be run?

A

Tenofovir

112
Q

What are the preferred NRTIs?

A

Emtricitabine
Lamivudine
Tenofovir
All above are preferred over stavudine and didanosine.

113
Q

What is the MOA of NNRTIs?

A

Do not require intracellular activation, they do not compete against endogenous DNA and do not have potent antiviral activity against HIV-2.

114
Q

What are the toxicities associated with NNRTIs?

A

Rash

Elevated liver function tests (especially high with nevirapine)

115
Q

What are the available NNRTIs?

A

Efavirenz, delavirdine, nevirapine and etravirine.

116
Q

What are the Protease Inhibitors?

A

Amprenavir, fosamprenavir (prodrug of amprenavir), atazanavir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, and tipranavir.
“-navir”

117
Q

What is the MOA for PIs?

A

Competitively inhibit the cleavage of the gag-pol polyprotein which is critical in viral maturation resulting in immature noninfectious virons being produced.

118
Q

What are the toxicities associated with PIs?

A

GI distress
Metabolic changes – increased lipids, insulin insensitivity, change in fat distribution.
CYP3A inhibitor, so interacts with statins.
Indinavir has an increased risk of nephrolithiasis, so hydrate well!!!

119
Q

What are the types of entry inhibitors?

A

Fusion inhibitors and CCR5 antagonists

120
Q

What is the fusion inhibitor available at this time?

A

Enfuvirtide – Subcutaneous injectable

121
Q

What is the MOA of Enfuviritide?

A

binds gp41, which inhibits fusion of the HIV with the target cell.

122
Q

What are the toxicities associated with Enfuvirtide?

A

Injection site reaction

Cleared by protein catabolism and amino acid recycling – so makes itself available again.

123
Q

What is a CCR4 inhibitor?

A

Maraviroc

Not preferred, but used when others fail.

124
Q

What is the MOA of Maraviroc?

A

Blocks the human receptor to inhibit fusion of the HIV with the target cell.

125
Q

What are the toxicities associated with maraviroc?

A

Drug-drug interactions because it is a CYP3A substrate

126
Q

What are the InSTIs?

A

Raltegravir and Elvitegravir

127
Q

What is the MOA of an InSTI?

A

Binds HIV integrase while it is in a specific complex with viral DNA so that it cannot become incorporated into the human genome.

128
Q

What are the toxicities associated with InSTIs?

A

They are metabolized by CYP3A.

Taking Elvitegravir with low dose ritonavir or a CYP3A inhibitor will increase its plasma concentration.

129
Q

What should be considered when choosing a drug regimine for ART?

A

Individualized care based on virologic efficacy, toxicity, pill burden, frequency, drug-drug interactions, potential resistance testing, and patient’s comorbid conditions.

130
Q

What are the 4 preferred regimens for an ART naïve patient?

A

Efavirenz/tenofovir/emtricitabine (Atripla): PREFERRED
Ritovanir-boosted atazanavir + tenofovir/emtricitabine
Ritonavir-boosted darunavir + tenofovir/emtricitabine
Raltegravir + tenofovir/emtricitabine (Complera): use when viral load <100,000

131
Q

What are some considerations to look at when starting ART?

A

No rilpivirine should be an alternative for NNRT based regimen when pre treatment viral load is use Complera
Elvitegravir/cobicistat/tenofovir/emtricitabine (Stribid) is recommended for patients with CrCl >70
Abacavir containing drugs will cause an allergic response if HLA-B*5701 is present.

132
Q

What are other common ART drugs?

A

Viread + Emtriva (Truvada)

133
Q

When should you use Efavirenz with caution/disadvantages of Efavirenz?

A

Should not be used during the first trimester of pregnancy

Has neuropsych side effects

134
Q

When should you use Tenofovir with caution?

A

renal insufficiency

135
Q

When should you use Atazanavir with caution?

A

In patients that require >20mg of omeprazole equivalent per day.

136
Q

When should you use Ritonavir with caution?

A

In patients with HIV RNA >100,000

Contraindicated to use a PPI with ritonavir

137
Q

When should you use Abacavir with caution?

A

In patients with HLA-B*5701 because of allergic reaction.

138
Q

What are the disadvantages of NNRTIs?

A

Cross resistance, skin rash, CYP450 drug interactions

139
Q

What are the disadvantages of Nevirapine?

A

Incidence of hepatotoxicitiy

Contraindicated in those with moderate to severe hepatic impairment.

140
Q

What are the disadvantages of PIs?

A

Dyslipidemia, insulin resistance, hepatotoxicity, GI adverse effects, and CYP3A inhibitors and substrates will have interactions.

141
Q

What is the disadvantage of Indinavir specifically?

A

Increased risk of nephrolithiasis – need to hydrate the patient well!

142
Q

What is the most common organism of osteomyelitis?

A

Staph aureus

143
Q

What are the types of osteomyelitis?

A

Hematogenous - to long bones and joints in young, and to vertebrae if >50
Contiguous - to femur, tibia and mandible, generally >50
Vascular insufficiency - to feet and toes, generally >50

144
Q

Infectious arthritis is most common in which joints?

A

knee, hip, ankle, elbow, wrist and shoulder

145
Q

What lab findings are seen in most cases of infectious arthritis?

A

Elevated ESR and WBC with a left shift. Blood cultures are generally positive, and synovial cultures are positive. Generally have a fever of 38-40.

146
Q

What is the most common organism in infectious arthritis?

A

Staph aureus. H. influenza type B in an immunosuppressed or un-immunized child.

147
Q

What is the most common cause of bacterial arthritis in adults 18-30?

A

N. gonorrhoeae, most common in women.

148
Q

What is the IV therapy for Osteomyelitis?

A

Dapto - to cover MRSA and gram pos.
Nafcillin - to cover some gram pos and neg, but not MRSA
Vanco - to cover MRSA with a target trough of 15-20.
Duration of 4-6 weeks.

149
Q

When should you not use Daptomycin?

A

In patients with PNA because the surfactant in the lungs deactivates the drug.

150
Q

What outpatient treatment do you use for osteomyelitis following IV abx treatment?

A

Clindamycin, Linezolid or Daptomycin because they need to be PO.

151
Q

What is the criteria for oral therapy for osteomyelitis?

A

Treat IV for one week then switch to PO.
Initial clinical response to parenteral abx must have been achieved.
Suitable oral agents are available to cover the pathogen.
Compliance is ensured.

152
Q

What is effective against gram negative organisms?

A

PO quinolones or third generation cephalosporin

153
Q

When is Rifampin used and what does it do?

A

It is used synergistically with abx to prevent the rapid rise of resistant strains. Has good intercellular concentrations and works on the biofilm (so if a patient has a prosthetic then this is a great option) thereby increasing the sensitivity of MRSA.

154
Q

What is the treatment of choice for a newborn with osteomyelitis?

A

Nafcillin or oxacillin IV plus cefotaxime

155
Q

What is the treatment of children under age 5 with osteomyelitis?

A

Nafcillin IV or cefazolin IV

If H. influenza use cefuroxime IV

156
Q

What is the treatment of children over 5 with osteomyelitis?

A

Nafcillin IV or cefazolin IV

157
Q

What is the treatment of adults with osteomyelitis?

A

Nafcillin IV or Cefazolin IV

158
Q

What is the treatment for IV drug abusers with osteomyelitis? Why is it so different?

A

Deftazidime IV plus Tobramycin IV or Ciprofloxacin PO.

Needs to cover pseudomonas

159
Q

What is the treatment of post op or post trauma osteomyelitis?

A

Nafcillin IV plus Ceftazidime to cover both gram positive and gram negative organisms.

160
Q

What is the treatment of patients with vascular insufficiency and osteomyelitis? Why is the treatment different?

A

Nafcillin or Cefazolin plus Ceftazidime.
IF anaerobes are suspected then use Cefotetan IV or clindamycin IV plus Ceftazidime IV.
Need to consider whether or not it is an anaerobic pathogen.

161
Q

What is the treatment for infectious arthritis?

A

Similar to osteomyelitis, need to cover Staph aureus, strep and gonococci.

162
Q

What antibiotics are used for diabetic foot infections?

A

broad spectrum antibiotics like beta lactams to cover MRSA, gram + and -, and anaerobes.
I.E. Vanco + Zosyn, Vanco + Meropenem, Linezolid + Zosyn, if outpatient Linezolid, Mertronidazole and Keflex together.

163
Q

What abx do you use for a diabetic foot infection if the patient has a PCN allergy.

A

metronidazole or clindamycin plus either a fluoroquinolone, aztreonam or a third generation cephalosporin.

164
Q

What are other abx that can be used in the treatment of diabetic foot infections?

A

Vanco (MRSA), Linezolid, Daptomycin, Tigecycline (gram negative aerobes and anaerobes)

165
Q

Pentoxifylline (Trenta)

A

Hemorrhelogic agent. Alters the flow of RBCs by inhibiting platelet aggregation and increasing RBC flexibility by inhibiting PDE. Contraindicated in those with recent retinal or cerebral hemorrhage. Interacts with Warfarin.

166
Q

Cilostazol

A

Hemorrhelogic agent. Inhibits PDEIII causing inhibition of platelet aggregation. Contraindicated in CHF patients.

167
Q

What antiplatelet agents can be used as hemorrhelogic agents in a diabetic with a foot infection?

A

Clopidrogel (Plavix) or Aspirin

168
Q

Becaplermin (Regranex)

A

A platelet derived growth factor that is topically applied to help the surface skin heal better, like a non-diabetic wound.

169
Q

What is the recommended dose of Vitamin D and Calcium for regular maintenance?

A

2,000IU Vit D and <800 Ca++

170
Q

What is the MOA of the bisphosphonates

A

mimic pyrophosphate which is an endogenous bone resorption inhibitor.

171
Q

What are the bisphosphonates?

A

Alendronate, Risedronate, IV Zoledronic acid, and ibandronate (IV and PO).
Ibandronate is only for postmenopausal osteoporosis.

172
Q

Contraindications for bisphosphonates?

A

Creatinine clearance <30-35ml/min, serious GI conditions, and pregnancy.

173
Q

Side effects of bisphosphonates?

A

osteonecrosis of the jaw and subtrochanteric femoral atypical fractures.

174
Q

How should bisphosphonates be taken?

A

with 6oz plain tap water. Remain upright for at least 30 minutes (1hr for ibandronate) to avoid heartburn sensation. Take weekly with Vitamin D.

175
Q

Raloxifene

A

estrogenic agonist in the bone and antagonist in the breast and uterine tissue.

176
Q

Contraindications and Side effects of Raloxifene?

A

Contraindicated in those with active or past venous thromboembolic events. Stop if patient will be immobile for an extendedperiod of time.
Side effect: hot flushes, some positive lipid effects but no reduction in cardiovascular effects.

177
Q

Calcitonin

A

endogenous hormone released from the thyroid when serum Ca is elevated. Can be used if at least 5 years past menopause. Does not decrease risk of hip fracture. Caution in patients with fish/salmon allergy.

178
Q

Teriparatide

A

recombinant portion of PTH that increases bone formation, remodeling rate and osteoblast number and activity. Helps to improve bone mass and architecture. Approved for postmenopausal women, men and patients on steroids with a high risk of fracture.

179
Q

What are the side effects of Teriparatide?

A

may cause orthostatic hypotension at the time of injection.
Transient hypercalcemia, so decrease calcium intake and monitor serum levels in 1 month after initiation.
Black box warning for patients with increased risk of osteoscarcoma (ie. Paget’s, elevations in ALK PHOS, young patients, open epiphyses, or patients with prior radiation treatment)

180
Q

What can be used for symptomatic relief of RA?

A

NSAIDs and corticosteroids, they should not be long term and do not help in the progression of the disease.

181
Q

What are the non-biologic DMARDs for RA?

A

Methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide

182
Q

What are the biologic DMARDs for RA?

A

Anit-TNF agents (entercept, infliximab, adalimumab, certolizumab, golimumab), costimulation modulators (abatacept and rituximab), IL-1 receptor antagonists (anakinra, azathioprine, D-penicillamine, gold, minocycline, cyclosporine, and cyclophosphamide).

183
Q

What are the major side effects of hydroxychloroquine?

A

macular damage, rash, diarrhea.

184
Q

What are the major side effects of Methotrexate?

A

myelosuppression, hepatic fibrosis, cirrhosis, pulmonary infiltrates or fibrosis, stomatitis, rash.

185
Q

What are the major side effects of corticosteroids in the treatment of RA?

A

hypertension, hyperglycemia, osteoporosis.

186
Q

What is the MOA of Methotrexate?

A

inhibits cytokine production & inhibits purine bio-synthesis. Need to supplement with folic acid!

187
Q

What is the MOA of Leflunomide?

A

inhibits pyrimidine synthesis to decrease lymphocyte proliferation and modulate inflammation. Risk of liver toxicity and do not use if pregnant or planning to become pregnant.

188
Q

Why hydroxychloroquine?

A

Advantage: not myelosuppressive, hepatic and renal tox not see.
Disadvantage: onset is delayed up to 6 weeks.
Short term toxicities: GI effects
Ocular toxicities may cause accomodation defects, bening corneal deposits, blurred vision, scotomas and night blindness.

189
Q

What are 2 other main options for RA?

A

Sulfasalazine and Minocycline

190
Q

What is a contraindication for all Anti-TNF agents?

A

congestive heart failure

191
Q

What is the MOA of Abatacept?

A

costimulation modulator. Binds CD80/CD86 receptors.

192
Q

What is the MOA of Tocilizumab?

A

binds IL-6 receptors to prevent cytokine interaction with cells.

193
Q

What is the MOA of Anakinra?

A

IL-1 receptor antagonist.

194
Q

What is the 1st line treatment for OA?

A

Acetaminophen dosed appropriately (max 4g per day)

195
Q

Where is COX 1 present?

A

gastric mucosa, vascular endothelial cells, platelets and renal collecting tubules.

196
Q

Where is COX 2 present?

A

widely expressed in most body tissues but rapidly induced by inflammatory mediators, local injury and cytokines.

197
Q

In what patients should you avoid COX inhibitors?

A

Cardiac patients because it increases their risk of clot. If they must have it, give the smallest dose possible.

198
Q

What are the adverse reactions of COX 1 and 2 inhibtors?

A

GI bleed, renal injury, nausea, dyspepsia, anorexia, abdominal pain, flatulence, diarrhea. Take with food or mile to help with these symptoms (unless it is enteric coated!) Can also give the patient a PPI or misoprostol to help with these side effects.

199
Q

Capsaicin cream

A

topical agent isolated from hot peppers that depletes substance P from afferent nociceptive nerve fibers. Side effects: burning, stinging, erythema. Possible side effect is coughing during applicaiton.

200
Q

What are the topical therapies besides capsaicin cream can be used for OA?

A

topical NSAIDs, methylsalicylate, trolamine salicylate, and other salicylates.

201
Q

What are some alternative therapies for OA?

A

Glucosamine 1,500mg/day and Chondroitin 1,200 mg/day. Corticosteroids, hylauronic acid IM, Tramadol and low dose opoids.

202
Q

What is Colchicine?

A

An antimitotic drug that relieves acute gout attacks if given within 24 hours of onset.

203
Q

What is the MOA of Allopurinol and febuxostat?

A

Lower uric acid concentration by inhibiting Xanthine Oxidase.
Side effects are skin rash, leukopenia, GI problems, headache, urticaria.
Febuxostat is very expensive but does not require renal or hepatic dosing adjustments.

204
Q

What is the MOA of uricosuric drugs?

A

increse the renal clearance of uric acid by inhibiting postsecretory renal proximal tubular reabsorption of uric acid. (Probenecid and Sulfinpyrazone).
Disadvantage: salicylates may interrupt the mechanism resulting in tx failure.

205
Q

When are uricosuric drugs contraindicated?

A

patients with allergies and creatinine clearance <50ml/min and history of renal calculi.
Major side effects are GI irritation, rash, hypersensitivity, precipitation of acute gouty arthritis and stone formation.

206
Q

What is the max daily dose of Acetaminophen?

A

4g/day

207
Q

What is the max dose of ibuprofen?

A

3,200 mg/day

208
Q

What is the max dose of naproxen?

A

1,000 mg/day

209
Q

What is the max dose of naproxen sodium?

A

600 mg/day

210
Q

What is the max dose of Pyrazols like Celecoxib (Celebrex)?

A

400mg per day. If below 200mg/day then the CV risk does not increase.

211
Q

Which NSAID has the lowest CV risk?

A

Naproxen.

212
Q

Which opioid analgesics have the highest risk of histamine release?

A

Morphine and Codeine because they are naturally occuring.

213
Q

What patients should not take Meperidine?

A

Patients with renal failure.

214
Q

What is a side effect of Fetanyl?

A

Decreases the renal threshold.

215
Q

What is the side effect of Methadone?

A

Sedation - respriatory depression also is a result, decrease the dose to avoid this.

216
Q

What drug reverses the effects of opoids?

A

Naloxone.

217
Q

What patients should have a decreased dose of Tramadol?

A

Those with renal impariment and the elderly.

218
Q

What are the major adverse effects of opioids?

A 
dysphoria, euphoria
Sedation
N/V
decreased respiratory rate
Constipation
Biliary spasm and urinary retention
Urticaria, puritis, and exacerbation of asthma
Tolerance and Dependance.
219
Q

What should be given for a pain score of 1-3?

A

Acetaminophen and/or NSAIDs +/- adjunctant therapy

220
Q

What should be given for a pain score of 4-6?

A

Combination of opioid, +/- non-opioid, +/- adjunctant

221
Q

What should be given for a pain score >7?

A

Opioid, + non-opioid, +/- adjunctant

222
Q

What are adjunctant therapies?

A

Flexeril (increased sedation risk), Skelaxin (decreased sedation risk), Celebrex, SSRIs for neuropathic pain

223
Q

Which opioids are processed by CYP2D6 and therefore ineffective if there is a mutation in the CYP2D6 gene?

A

Codeine, Hydrocodone, Oxycodine, Methadone

224
Q

Which opioids are processed by CYP3A4 and therefore interact with CYP3A4 inhibitors?

A

Oxycodone, Methadone, Tramadol, Fetanyl

225
Q

Which opioid increases the risk of seratonin syndrome when taken with an SSRI or MAO-I?

A

Tramadol

226
Q

Which opioids are safest for patient with renal impairment?

A

Hydrocodone - still monitor
Tramadol - only a problem if the patient has severe impairment
Methadone and Fetanyl - need dose adjustment with severe renal impairment

227
Q

Which opioids are safest for a patient with hepatic impariment?

A

Hydrocodone - still monitor
Fetanyl - may not need adjustments
Methadone - need dose adjustment with severe hepatic impairment

228
Q

What opioid is contraindicated in hepatic impairment?

A

Oxymorphone

229
Q

What are teh 2 phases of anesthesia?

A

Induction (IV) and maintenance (inhaled)

230
Q

What are the goals of anesthesia?

A

To maintain unconscious state
To keep patient pain free
To provide short term amensia
To decrease risk of nausea/vomiting

231
Q

What are the common side effects of anesthesia?

A

Decreased BP, vasodilation, myocardial depression, blunting of baroreceptor control, generalized decrease in sympathetic tone.
Be sure to give plenty of fluids pre-op to decrease hypotension and use Una boot during procedure to prevent DVT formation.

232
Q

What is the effect of anesthesia on the respiratory system?

A

decrease drive and eliminate gag revlex.

233
Q

What happens to the body temperature under anesthesia?

A

hypothermia of <36. Heat is redistributed from the core to the periphery.

234
Q

How is nausea and vomiting impacted by anesthesia?

A

anesthetics have action on the chemoreceptor trigger zone in the brain stem causing vomiting through Serotonin, histamine, acetylcholine and dopamine receptors.

235
Q

How is potency measured?

A

MACs. 1 MAC is the point at which 50% of patients will be asleep. Goal is to achieve 1/3 MAC so that 95% of patients will be asleep.

236
Q

What is the MOA of IV general anesthetics?

A

GABA receptor and NMDA receptor inhibition and activation of K+ channels.

237
Q

What is the MOA of halogenated inhalational agents?

A

various molecular targets

238
Q

What is the MOA of Nitrous Oxide, Ketamine and Xenon?

A

inhibition of the NMDA receptor and activation of K+ channels.

239
Q

What are the barbituates?

What are the side effects of Barbituates?

A
  • Sodium thiopental, thiamylal and methohexital.

- suppression of EEG, reduction of cerebral metabolic rate, blood pressure reduction and respiratory depression.

240
Q

Propofol

A

First line for induction. Agonism of GABA receptor to increase chloride conduction and hyperpolarize neurons. Metabolized by the liver, with reduced clearance in the elderly and neonates. If there is large central volume then the dose needs to be increased to induce and maintain anesthesia. Does not have significant effect on hepatic, renal or endocrine organ systems.

241
Q

What are the side effects of propofol?

A

EEG suppression, decreased CMRO2, cerebral blood flow and intracranial and intraocular pressure. More respiratory depression than thiopental. Not the best option for an already hypotensive patient.
Does not have anti-analgesic effect, but does have anti-emetic action.
There is a risk of anaphylaxis.

242
Q

Etomidate

A

used to induce patients with a high risk of hypotension. Lacks analgesic activity. Associated wtih patin at injection site and myoclonic movements. Less respiratory depression than thiopental. Mildly and transiently reduces cortisol levels, can cause vomiting and lower the seizure threshold.

243
Q

What is a main advantage of propofol?

A

Does not cause malignant hyperthermia

244
Q

What is a main advantage of Etomidate?

A

Maintains good cardiovascular stability after induction.

245
Q

Ketamine

A

good anesthetic for patients at risk of hypotension, but significant side effects are present. Typically given IV. Increases HR, BP and CO, also is a potent bronchodilator so respiratory depression is less.

246
Q

Side effects of Ketamine

A

Increased cerebral blood flow and ICP, direct negative inotropic and vasodilating activity, increased myocardial O2 consumption, hallucinations, and emergence dilirium.

247
Q

Thiopental

A

has a slight increase in HR, but large decrease in Cerebral blood flow, cerebral O2 consumption, and ICP, and minimal decreases in MAP, CO and respiratory rate.

From Flashcardlet (30 decks)

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