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24 Anesthesia Pharm > MAGA (Brooke's Deck, Exam II) > Flashcards

MAGA (Brooke's Deck, Exam II) Flashcards

1
Q

What enzyme catalyzes the synthesis of prostaglandins?

A

COX (Cyclooxygenase)

Slide 33

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2
Q

This form of COX is responsible for gastric protection, hemostasis, and renal function…

A

COX-1

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3
Q

COX-1 or COX-2?

Ubiquitous, “physiologic”, inhibition of this enzyme is responsible for many adverse effects.

A

COX-1

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4
Q

COX-1 or COX-2?

Pathophysiologic, expressed at sites of injury, not protective.

A

COX-2

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5
Q

COX-2 propagation is responsible for which symptoms?

A

Pain, inflammation, and fever

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6
Q

What are the three main properties of NSAID drugs?

A

Analgesic
Anti-inflammatory
Antipyretic

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7
Q

Are the following drugs non-specific or COX-2 selective?

–Ibuprofen, naproxen, aspirin, and ketorolac–

What gastric symptomology would be seen with administration of these drugs?

A

Non-Specific
Increased gastric irritation with these drugs

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8
Q

Multimodal includes _____ acting anesthetics agents and _______ sparing components.

A

short acting; Opioid sparing.

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9
Q

Celecoxib (Celebrex), Rofecoxib (Vioxx), Valdecoxib (Extra), Parecoxib (Dynastat) are all examples of what?

A

COX-2 Selective NSAIDs

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10
Q

Do COX-2 selective NSAIDs effect platelets?

A

No

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11
Q

Because COX-2 selective NSAIDs have no effect on platelets, this would increase the chance of what pathology?

A

Clotting (think MI and CVA)

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12
Q

COX-2 selective and nonspecific inhibitors have _____________ analgesia

A

Comparable

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13
Q

What was the first COX-2 inhibitor that decreases PG synthesis?

A

Celecoxib (Celebrex)

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14
Q

What is the dosage for Celebrex?

A

200 to 400 mg PO QD

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15
Q

Celebrex reaches its peak in…

A

3 hours

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16
Q

Define non-opioid anesthesia. List some alternatives to treat pain.

A

PT & OT, Chiropractic care, acupuncture, massage, yoga, weight loss, cold/heat, OTC medications, TENS unit…etc.

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17
Q

What is the pain response pathway? (5)

A

(this was in the pain pathway slide set too)

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18
Q

What are the 2 classes of opioids?

A

1) Phenanthrenes (L-isomers have opioid activity; morphine, codeine)

2) Benzylisoquinolones (Lack opioid activity; Papaverine, noscapine)

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19
Q

What drug class does Ondansetron fall into?
What was it first developed for?
What CYP450 is relevant to ondansetron?

A

It is the first 5-HT3 antagonist
-It was approved for CINV
-Responsiveness decreased by variations in the CYP2D6 activity!

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20
Q

Ondansetron is equivocal to what two drugs in its treatment of N/V?

A

Droperidol & Metoclopramide

(Slide 51)

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21
Q

What are the side effects of Ondansetron?

A

HA, Constipation, and some QT prolongation!

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22
Q

What is the duration & dose of Ondansetron?

A

Duration/plasma half life is 4 hours!
Dose: Adults: 4 mg IV (up to 8 mgs)
Dose: Pediatrics: 0.1 mg/kg IV

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23
Q

What is the MOA of Corticosteroids in the treatment of N/V?

Why are Corticosteroids used with 5-HT3 (Ondansetron) & droperidol?
Hint: It was studied in CINV!

A
  • MOA is unknown: It works on glucocorticoid receptors in Nucleus Tractus Solitarius (NTS).
  • Corticosteroids potentiate 5 HT3 antagonists and droperidol!
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24
Q

What is the dose for Dexamethasone (Decadron)?

What is the MOA of Dexamethasone (Decadron)?

A

4 - 8 mg IV (8-10 mg)

MOA: Anti-inflammatory; inhibition of phospholipase and cytokines and stabilization of cellular membrane.

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25
Q

What is the delay of onset of Dexamethasone (Decadron)? How long does efficacy persist?

Are there any adverse effects of a single dose of Dexamethasone (Decadron)?

What occurs if it is pushed fast?

A
  • Onset: 2 hours. Efficacy: 24 hours.
  • Nope
  • Perineal burning/itching
26
Q

According to the TXWES medication guide, what are the doses for Acetaminophen (Ofirmev), Ketorlac (Toradol), & Ibuprofen (Caldor).

A

Slide 62

27
Q

A 50 y/o, 60 kg female patient received a Lidocaine initial dose of 1 mg/kg with a subsequent infusion of 1.5 mg/kg/hour for 1.5 hours. How much total Lidocaine in mgs did she receive in the PACU?

A

60kg x 1 mg/kg = 60 mg
60 kg x 1.5 mg/kg = 90 mg (1 hour)
(60 kg x 1.5mg/kg = 90 mg)/2 = 45 mg (30 minutes)

60+90+45 = 195 mg total!!!

28
Q

Multidose lidocaine vials are used for _____.

A

infiltration or peripheral nerve block.

29
Q

Lidocaine is an ______ structure local anesthetic.

Which drug is an exception to the amide/ester rule?

A
  • Amide (amides anesthetics have 2 “i”s)
  • Cocaine. Cocaine is also local amide anesthetic.
30
Q

How is lidocaine metabolized?

A

Liver

31
Q

What is the IV bolus and infusion dose of lidocaine?
When should the infusion be terminated?

A
  • 1 to 2 mg/kg IV bolus over 2-4 min.
  • 1 to 2 mg/kg/hr infusion
  • Terminated within 12-72 hours.
32
Q

Regarding Gabapentin’s preemptive analgesia, What 3 studies/ procedures is it used in?

A
  • Spine surgeries
  • Orthopedic procedures
  • Major abdominal procedures.

(slide 27)

33
Q

What is the PO dose of preemptive Gabapentin?
When should we give it?
What is it’s MOA?

A

300-1200mg PO
1-2 hrs prior to OR
GABA analogue

34
Q

For Preemptive Gabapentin, what patient population is it contraindicated for?

A
  • MG and Myoclonus patients
  • Reduce dose in elderly patients
35
Q

What are Gabapentin’s side effects?

A

Think ↑GABA effects

  • Somnolence
  • fatigue
  • ataxia
  • vertigo
  • GI disturbances: constipation
  • abrupt withdrawal in seizure pts (when Gaba is used as an antiepiliptic): causing seizures
  • wt gain
36
Q

For Ofirmev, what is the Dose, Peak effect time, and duration?

A
37
Q

What is the MOA for Ofirmev?

A

Reduces prostaglandin metabolites

38
Q

What is the absolute contraindications for Ketorolac per Castillo?

A
  • Allergy to Tylenol/NSAIDs
  • Chronic renal failure
  • Low platelet count
    (*relative contraindication pt >65 y/o. Use 1/2 doses “7.5 mg - 15 mg”)
39
Q

For Ketorolac, what is the:

  • MOA
  • Peak
  • Dosing
A

MOA: Inhibits PG synthesis by inhibiting COX 1 and COX 2

Peak: 45 to 60 minutes IV

Dose: 15 to 30mg q6h (1/2 dose in elderly)
Max Dose: 60-120mg QD

40
Q

What are some contraindications to consider when giving Toradol?

A
  • Severe Renal impairment
  • Risk for bleeding
  • CAD
  • CABG
  • Pregnant
  • NSAID allergy
41
Q

Lidocaine plasma concentration of ____ causes what?

1-5 mcg/ml = ?

5-10 mcg/ml = ?

A

1-5 = analgesia

5-10 = circum-oral numbness; tinnitus; skeletal muscle twitching; systemic HYPOtension; myocardial depression

42
Q

Lidocaine plasma concentration of ____ causes what?

10-15 mcg/ml = ?

15-25 mcg/ml = ?
>25 mcg/ml = ?

A

These are OD levels

10-15 = Seizures; unconsciousness

15-25 = apnea (pons & medullary depression); coma

> 25 = cardiovascular depression

43
Q

Which procedure would you expect to see a high use of Lidocaine?
(HINT: Castillo mentioned this)

A

EGD’s
Castillo gives a “boatload” of lidocaine in EGD’s

(per Castillo)

44
Q

If we give Lido w/ Epi, should the dose be higher or lower?
Why?

A

Higher: epinephrine will locally vasoconstrict and prevent lidocaine leakage into the intravascular space.

(Castrater)

45
Q

How is lidocaine overdose treated?

A

Lipid rescue

46
Q

Which patients receive magnesium sulfate most often per Castillo?

A

Preeclamptic & eclamptic OB patients.

47
Q

This med has anti-nociceptive effects by antagonizing the NMDA receptor and “probably” potentiates opioids centrally and peripherally.

A

Magnesium

48
Q

Mg++ regulates which four cellular functions?

A
  • Ca++ access intracellularly.
  • Neurotransmission
  • Cell signaling
  • Enzyme function
49
Q

Which ion has limited movement across the BBB?

A

Mg⁺⁺

50
Q

What conditions are contraindicative for magnesium administration?

A

Myasthenia Gravis & Renal Failure

51
Q

What adverse side effects could occur with Mg++?

A

*Hypotension, bradycardia,

(ataxia, somnolence, decreased muscular tone.)

52
Q

What is Mg⁺⁺ dosing for the following two situations?

Preop:
Intraop:

A
  • Preop: 50 mg/kg IV ( loading dose)
  • Intraop: 8 mg/kg/hr IV
53
Q

What opioid requirement does the use of Mg++ significantly decrease?

A

Fentanyl

54
Q

Ibuprofen:

  • MOA
  • Contraindications
  • Dose
  • Peak
  • Excretion
A
  • COX 1 & 2 Inhibition = ↓ PG synthesis
  • Nephropathy, CABG, bleeding disorders, wound healing
  • 200 - 800 mg QD
  • 1-2 hours
  • Urine & Bile
55
Q

Using multimodal anesthesia, what 2 meds might we give in preop to better control pain later?

A

Acetaminophen 1000 mg PO, Gabapentin 300 mg PO (slide 23)

56
Q

With non-opioid anesthesia, what medications are used for induction?

A

Proposal, Lidocaine, Ketamine, volatile anesthetics. Paralytic if needed.

57
Q

What is the MOA of gabapentin?

A

GABA Analog actions:

  • Blockage of VG Ca⁺⁺ channels
  • inhibits release excitatory neurotransmitters
  • Descending inhibitory tract enhancement
58
Q

Is gabapentin lipid soluble?
What percentage protein-binding occurs with gabapentin?
What’s it’s E 1/2 time?

A
  • Yes; Lipid soluble
  • 0% (not protein-bound)
  • Brief E 1/2 time
59
Q

Does gabapentin have any drug-drug interactions?

A

No drug interactions

60
Q

What are indicated uses for gabapentin?

A
  • Seizures
  • Neuropathic pain
  • Chronic pain syndromes.

24 Anesthesia Pharm (20 decks)

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