Flashcards in Lecture 3: Subarachnoid Hemorrhage Deck (47)
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1
Where do cerebral aneurysms normally occur? Why?
At or near bifurcation of the vessels d/t more vulnerable geometry
2
What is a syncopal episode?
Fainting
3
What are the components of propofol that can trigger allergies? (Do keep in mind that propofol was reformulated to reduce anaphylactic reaction.)
Egg lecithin + soybean oil
4
What part of propofol usually causes allergic reactions?
Diisopropyl group + phenol group
5
What is valsartan/diovan?
Antihypertensive medication; angiotensin II receptor blocker
6
Common name of acetylated salicyclic acid?
Aspirin
7
Hydrocodone dose?
5-10 mg q3-4 hours
8
Acetominophen is what class of drug? Dose?
NSAID; 10-15 mg/kg q4 hours
9
Naproxen: common name? Class? Dose?
Aleve; NSAID; 250 mg q4 day or 500 mg q2 day
10
What disease does novolin treat?
Dose?
Supplied?
Diabetes
6 units subcutaneously q12hr
Supplied 100 units/ml
11
Common name of glucophage? Class? What disease does glucophage treat?
Metformin
Biguanide
Diabetes
12
Nimotop's generic name? Treats?
Nimodipine; Ca++ channel blocker that treats hypertension
13
Zocor's generic name? Treats?
Simvastatin; treats high cholesterol
14
Colace treats what problem?
Colace is an anionic surfactant that decreases the surface tension of stool-- a stool softener that treats constipation.
15
Mechanism of metformin?
Reduces glucose levels by decreasing hepatic glucose production and increasing insulin action in muscle and in fat
16
Mechanism of action of sulfonylureas:
Stimulate the insulin release from the Beta cells of the pancreas
17
Who shouldn't take metformin?
Patients with a history of renal impairment, lactic acidosis, hepatic disease or cardiac failure
18
Which Ca++ channel blocker has the most widespread effect on all aspects of the heart?
Verapamil
19
Which Ca++ channel blocker has its main effect in slowing conduction of both SA and AV nodes?
Diltiazam
20
Which Ca++ channel blocker improves neurological outcomes in patients where deficits secondary to vasospasm are present after cerebral aneurysm rupture and is also recommended to prevent vasospasm after cerebral aneurysm coiling?
Nimodipine
21
Why do we prescribe aneurysm patients stool softeners after surgery?
We don't want them to strain; that would increase ICP and cause aneurysm to burst.
22
What class of drug is pepcid? What does it inhibit?
Histamine H2 receptor blocker; inhibits gastric acid production
23
Pepcid results in what percentage drop in acid secretion?
70%
24
On what type of secretion is pepcid most effective?
Basal acid secretion, which is responsible for nocturnal acid secretion
25
Drug name of pepcid?
Famotidine
26
When end organ function exists, surgical mortality for diabetic patients is _____ times higher than normal patients.
5x higher
27
Which three patient groups demand perioperative tight control of blood sugar?
1) Pregnant patients
2) Patient undergoing cardiopulmonary bypass
3) Patient with global CNS ischemia
28
What is a common complications during surgery in patients with diabetes?
Cerebral CNS insult
29
Which type of diabetic patient is susceptible to ketoacidosis?
Type I diabetic
30
NIDDM is defined as a fasting blood glucose:
>125 mg/dl
31
Which type of diabetic medication increases insulin binding to the insulin receptors on target tissue?
Sulfonylureas
32
What effect does high glucose levels have on wound healing?
Decreased granulocytic function + collagen synthesis
33
What is another word for ketoacidosis?
Hyperglycemia
34
What glucose level is considered hypoglycemic? How do you treat hypoglycemia?
< 50 mg/dl
Treat with 50% dextrose, starting with 15 ml bolus.
35
Under what circumstances would you have your patient on an IV insulin infusion during surgery?
If your patient is having a major surgery and has DM on insulin or DM poorly controlled w/ oral meds
36
Why do you discard the first 50 ml of insulin infusion?
Insulin sticks to plastic tubing, so we use the first 50 ml to coat the system to prevent that.
37
What is the physiological response during an asthma attack?
Mast cell release of histamine
38
What is the pathology of an asthma attack?
Bronchoconstriction and airway inflammation
39
In what way do B2 agonists treat asthma?
They activate muscarinic receptors in the lungs to cause bronchodilation by relaxing smooth muscle.
40
Particle sizes of aerosolized spray in:
Mouth and oropharynx
Conducting and low airways
Alveolar level
1) 10 micrometer in mouth and oropharynx
2) 1-10 micrometer in conducting and low airways
3) Alveolar level
41
What are the two types of aerosols?
1) Metered dose
2) Nebulizers
42
Onset and duration of short-acting B2-agonists?
Onset: 1-5 min
Duration: 2-6 hours
43
Onset and duration of long-acting B2-agonists?
Onset: > 20 minutes
Duration: 12 hours
44
What are the two long-acting B2-agonists?
1) Salmeterol
2) Formoterol
45
What steroid (glucocorticoid) is used to treat asthma?
Beclomethasone
46
By what means do steroids have a bronchodilating effect?
They decrease mucosa edema and prevent the release of bronchoconstricting substances
47
