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KM (Spring 2024) Anesthesia Pharm ** > *MAGA (Exam II) > Flashcards

*MAGA (Exam II) Flashcards

(70 cards)

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1
Q

What are the components of today’s Multimodal practice?

A
  • Preoperative Fluid
  • Carbohydrate Loading
  • Short Acting Anesthetic Agents
  • Opioid Sparing
  • Temperature Management
  • Cerebral/neuromuscular

S2

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2
Q

What are Nonopioid Alternatives for the treatment of pain?

This is a list

A
  • PT & OT
  • Massage Therapy
  • Acupuncture
  • Chiropractic Care
  • Osteopathic Manipulative Treatment (OMT)
  • Behavioral Interventions
  • Topical Treatments and Medications
  • Cold & Heat
  • Exercise
  • Weight Loss
  • Diet and Nutrition
  • Yoga & Tai Chi
  • TENS
  • OTC Medications
  • Interventional Pain Management
  • Nonopioid Anesthesia

S11

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3
Q

What refers to the anesthetic technique of using medications to provide anesthesia and post-operative pain relief in a way that does not require opioids?

A

Nonopioid Anesthesia

S11

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4
Q

What is the pain response pathway? (5)

A

(this was in the pain pathway slide set too)

S17

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5
Q

What is the MOA of Gabapentin?

A

GABA analogue
(not act like GABA)

Binds voltage gated Ca++ channels:
enhances descending inhibition
inhibits excitatory neurotransmitter release

S25*

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6
Q

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

A
  • Yes, Lipid soluble
  • 0% protein-bound
  • Brief E 1/2 time – need redosing required

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7
Q

Does Gabapentin have any drug-drug interactions?

A

No drug interactions

S25

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8
Q

What are indicated uses for gabapentin?

A
  • Seizures
  • Neuropathic pain
  • Chronic pain syndromes.

S26

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9
Q

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

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

S27

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10
Q

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

A

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

start slow then build up

S27

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11
Q

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

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

S27

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12
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

S29

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13
Q

Evidenced based slide

What evidence based conclusion was found with the study “Efficacy of preoperative gabapentin in spinal surgery: a meta-analysis of randomized controlled trials”

A

despite of 10 RCTs and low sample size, Gabapentin is:
* effective in reducing post operative opioid consumption
* it also lessen the side effects after spinal surgery
* lower dose should be given to elderly

S30

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14
Q

What are the effects of NSAIDs?

A
  • Decrease activation of peripheral nociceptors
  • No addictive potential
  • Preemptive analgesia
  • Absence of ventilatory depression
  • Less nausea and vomiting
  • Absence of cognitive effects
  • Long duration of action

S32

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15
Q

What enzyme catalyzes the synthesis of prostaglandins?

A

COX (Cyclooxygenase)

S33

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16
Q

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

A

COX-1

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17
Q

COX-1 or COX-2?

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

A

COX-1

S33

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18
Q

COX-1 or COX-2?

Pathophysiologic, expressed at sites of injury, not protective.

A

COX-2

S33

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19
Q

COX-2 propagation is responsible for which symptoms?

A

Pain, inflammation, and fever

S33

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20
Q

What are the three main properties of NSAID drugs?

A

Analgesic
Anti-inflammatory
Antipyretic

S34

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21
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

S34

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22
Q

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

A

COX-2 Selective NSAIDs

S34

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23
Q

Do COX-2 selective NSAIDs effect platelets?

A

No

S35

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24
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)

S35

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25
COX-2 selective and nonspecific inhibitors have _____________ analgesia
Comparable ## Footnote S35
26
What was the first COX-2 inhibitor that decreases PG synthesis?
Celecoxib (Celebrex) ## Footnote S36
27
What is the dosage for Celebrex?
200 to 400 mg PO QD ## Footnote S36
28
Celebrex reaches its peak in...
3 hours ## Footnote S36
29
What is the MOA for Ofirmev?
- Reduces prostaglandin metabolites - No significant anti-inflammatory property - Analgesic/antipyretic ## Footnote S38
30
What is the contraindication of Ofirmev?
Hepatic Dysfunction ## Footnote S38
31
What is the dose and max dose of Ofirmev?
**1000 mg IV Q4-6H** max **3000-4000 mg QD** *make sure to report administration to PACU! ## Footnote S38
32
What is the peak of Ofirmev in PO and IV?
PO: **1-3 hours** IV: **30 mins to 1 hour** ## Footnote S38
33
What is the duration of Ofirmev?
6 - 8 hours ## Footnote S38
34
What is the MOA of Ketorolac?
**Inhibits PG synthesis by inhibiting COX 1 and COX 2** Potent analgesic property Only moderate anti-inflammatory May potentiate opioid antinociception ## Footnote S40
35
What are some contraindications to consider when giving Toradol?
- Severe Renal impairment - Risk for bleeding -- low platelet count - CAD - CABG - Pregnant - NSAID allergy - Allergy to Tylenol ## Footnote S40
36
What is the peak of Ketorolac?
45 to 60 minutes IV ## Footnote S40
37
What is the dose and max dose of Ketorolac?
Dose: **15 to 30mg q6h** (*1/2 dose in elderl*y) Max Dose: **60-120mg QD** ## Footnote S40
38
Ketorolac has *no effects* on what?
* biliary tract * ventilatory/cardiac depression ## Footnote S40
39
What is the MOA of Ibuprofen?
* anti-inflammatory * analgesic * antipyretic * **inhibits COX 1 and 2** ## Footnote S41
40
What is the contraindication for Ibuprofen?
* Allergies to NSAIDs * CABG * bleeding ulcers, etc ## Footnote S41
41
What is the dose and max dose of Ibuprofen?
200 to 800 IV over 30 mins Q6H PRN max: 3200 mg/day ## Footnote S41
42
What is the peak of Ibuprofen?
1 - 2 hours ## Footnote S41
43
Where is Ibuprofen excreted?
Urine and Bile ## Footnote S41
44
What short acting anesthestic agents are used for multimodal practice?
* Propofol (Diprivan) * Ketamine ## Footnote S42
45
What are the doses for Lidocaine? What to monitor for?
Initial bolus = **1 to 2 mg/kg IV over 2 - 4 min** Drip = **1 to 2 mg/kg/hour** terminated at 12-72 hours monitor: *cardiac, hepatic, & renal dysfunction* ## Footnote S44
46
Lidocaine plasma concentration of ____ causes what? 1-5 mcg/ml = ? 5-10 mcg/ml = ?
1-5 = analgesia 5-10 = circum-oral numbness; tinnitus; skeletal muscle twitching; systemic HYPOtension; myocardial depression ## Footnote S45
47
Lidocaine plasma concentration of ____ causes what? 10-15 mcg/ml = ? 15-25 mcg/ml = ?
These are OD levels 10-15 = Sz's; unconsciousness 15-25 = apnea (*pons & medullary depression*); coma ## Footnote S45
48
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?
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!!! ## Footnote CLASS question
49
This med has anti-nociceptive effects by antagonizing the NMDA receptor and "probably" potentiates opioids centrally and peripherally.
Magnesium ## Footnote S47
50
Mg++ regulates which four cellular functions?
- Ca++ access intracellularly. - Neurotransmission - Cell signaling - Enzyme function ## Footnote S47
51
Which ion has limited movement across the BBB?
Mg⁺⁺ ## Footnote S47
52
What conditions are contraindicative for magnesium administration?
Myasthenia Gravis & Renal Failure ## Footnote S47
53
What is Mg⁺⁺ dosing for the following two situations? Preop: Intraop:
- Preop: **50 mg/kg IV** - Intraop: **8 mg/kg/hr IV** ## Footnote S48
54
Which patients receive magnesium sulfate most often per Castillo?
Preeclamptic & eclamptic OB patients. ## Footnote Slide 46
55
What opioid requirement does the use of Mg++ significantly decrease?
Fentanyl ## Footnote S48
56
What adverse side effects could occur with Mg++?
**- Hypotension - bradycardia** * ataxia * somnolence * decreased muscular tone -- check DTR ## Footnote S48
57
# Evidence-based slide What evidence based conclusion was found with the study "Perioperative systemic magnesium to minimize postoperative pain"?
a lot of these procedures used Fentanyl, Morphine PCA, Toradol, Tramadol and Meperadine as part of their pain pathway (not specific multimodal) they did test for early and late pain at rest and movement further findings: **there is significant pain relief or pain control or reduction at intraop and post-op vs intraop only** also cited in their findings that **there are opioid side effects of dizziness headache and post op nausea and vomiting** ## Footnote S49
58
What is the MOA of Ondansetron and the use?
* First 5-HT3 antagonist * Approved for CINV ## Footnote S50
59
Ondansetron is equivocal to what two drugs in its treatment of N/V?
Droperidol & Metoclopramide
60
What are the side effects of Ondansetron? ## Footnote S50
* HA * Constipation * some QT prolongation ## Footnote S50
61
What is the dose of Ondansetron?
**4 mg IV** (up to 8 mgs) Pediatrics: **0.1 mg/kg IV** ## Footnote S50
62
What is the duration of Ondansetron?
plasma half life is 4 hours! ## Footnote S50
63
What is the MOA of Corticosteroids in the treatment of N/V?
MOA is unknown It works on glucocorticoid receptors in Nucleus Tractus Solitarius (NTS). ## Footnote S51
64
Why are Corticosteroids used with 5-HT3 (Ondansetron) & Droperidol?
Increase effectiveness for 5 HT3 antagonists and Droperidol ## Footnote S51
65
What is the dose for Dexamethasone (Decadron)?
8 - 10 mg IV ## Footnote S52
66
What is the MOA of Dexamethasone (Decadron)?
* Anti-inflammatory * inhibition of phospholipase and cytokines and stabilization of cellular membrane. ## Footnote S52
67
What is the delay of onset of Dexamethasone (Decadron)?
2 hours ## Footnote S52
68
What is the efficacy of Dexamethasone (Decadron)?
24 hours ## Footnote S52
69
Are there any adverse effects of a single dose of Dexamethasone (Decadron)? What occurs if it is pushed fast?
- Nope - Perineal burning/itching ## Footnote S52
70
According to the TXWES medication guide, what are the doses for Acetaminophen (Ofirmev), Ketorlac (Toradol), & Ibuprofen (Caldor).
Slide 60

KM (Spring 2024) Anesthesia Pharm ** (101 decks)

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