PBL I: Subarachnoid Hemorrhage Flashcards Preview

Anesthesia Pharmacology > PBL I: Subarachnoid Hemorrhage > Flashcards

Flashcards in PBL I: Subarachnoid Hemorrhage Deck (54)
1

where do cerebral aneurysms usually occur?

most are anterior near bifurcation of vessels

2

What are symptoms of cerebral aneurysm?

"worst headache of their life"
syncopal episode
nausea/vomiting
neck pain
photophobia
focal deficits

3

Should you defer to Vancomycin because of a mild or distant reaction?

Rash reactions do not preclude cephalopsporins perioperatively
defferment is not recommended
at 1/10 test dose is reasonable for documentation but be aware it will not always give an immediate reation

4

What products are used to formulate propofol? what was it originally formulated with?

Originally formulated with Creamophor- a surfactant associated with severe anaphylactic reaction
Propofol is currently formulated with egg lecithin and soybean oil.

5

Why is there a rather small chance of egg allergy with propofol?

The egg in propofol is phoshatide extrated from the yolk to reduce allergenicity. most egg allergic people react to albumin.
Propofol allergy is often attributed to diisopropyl sided chain or phenol group

6

What is the purpose of taking 81mg aspirin q day?

vascular anticoagulation. Inhibits platelet aggregation and provides a cardio-protective effect

7

What kind of drug is Valsartan?

Blood pressure control
Angiotensin II receptor antagonist
Is a member of the Renin-agiotensnsin system inhibitors
These are same class but different mechanism as ACE inhibitors

8

Should AM dose of ACE inhibitor be taken prior to surgery?

not if HTN is well controlled

9

What is Lorcet (Lortab, vicodin)

Pain medication consisting of Hydrocodone, a modified morphine (5-10mg) combined with Acetominiphen

10

Waht is the class, use and example of dose for napoxen?

NSAID
used for pain/inflammation
dose is 250mg q4dayor 500mgq2day

11

What is Novolin-

REcombinant engineered human insulin used to treat diabetes. supplined as 100units/ml

12

Waht is metformin and how does it work?

Biguanide class hypoglycemic drug.
it works to decrease glucose levels.
decreases hepatic glucose production
increses insulin action on muscle and fat
Is used primarily in Type II diabetes

13

What are containdications for metformin?

renal impairment
history of lactic acidosis
hepatic disease
cardiac failure

14

What type of drug is Nimodipine (Nimotop)? how is it used?

Calcium channel blocker used for angina, cardiac dysrythmias.
often combined with other medications for treatment of patients with heart disease and HTN
Indicated for use in patients for improvement of neurological outcome where deficits secondary to vasospasm after cerebral aneurysm rupture
Also indicated for vasospasm after cerebral aneurysm coiling

15

What are the effects fo calcium channel blockers?

Decrease systemic BP
Increase coronary blood flow
delaying of A-V conduction
decrease HR

16

What is simvastatin (Zocor) used for?

treatment of dyslipidemia

17

What is the indication for vicodin?

moderate to moderately severe pain

18

what are warning for vicodin?

REspiratory depression
increased ICP

19

how can vicodin lead to increased ICP?

CO2 building up for hypoventilation is a vasodilator which will increase ICP

20

What is colace (docusate sodium)?

anionic surfactant which lowers the surface tension of stool, allowing easier defacation

21

What is pepcid (famotidine) used for and how does it work?

Used to treate GERD and gastric and duodenal ulcers
It is an Histamine H2 receptor blocker
Inhibits gastric acid production
70% reduction in acid secretion
Most effective on basal acid secretion which is responsible for nocturnal acid secretion

22

what are other drugs in pepsids class?

tagamet (cimetidine), Zantac (Ranitidine), Axid (Nizatidine)

23

Surgical mortality rates in the diabetic population is __ times higher than the non-diabetic population when end organ dysfunction extists.

5

24

What is the pathophysiology of diabetes mellitus?

Pancreatic Beta cells either do not produce insulin or not enough

25

This DM is an autoimmune disease that affects young nonobese patients.

Type I

26

DM with low or nonmeasurable insulin levels

Type I

27

90% (18 million) of all diabetics are this type,

Type II

28

This type of DM is susceptible to keto acidosis

Type I

29

How is type II diabetes diagnosed?

Fasting blood glucose > 125 mg/dl
Normal plasma insulin levels or elevated but low for glucose level, A1c levesl, urine ketones

30

how do sulfonylureas and Repaglinide treat DM?

Stimulate insulin release

31

What are concerns with DM and surgical wounds?

Wound healing-Granulocytic function and collagen synthesis are suppressed with glucose levels above 200 mg/dl
Wound infection--prevelance fo vacular and renal disease in diabetics contributes to higher rate of infection

32

What are the goals of Perioperative management of a DM patient?

Prevent ketoacidosis (hypoglycemia)
Prevent hyperglycemia

33

Diabetics should be the ___ case of the day

first

34

What is the greatest concern with diabetics. how is it treated?

Hypoglycemia
glucose <50mg/dl must be treated with 50% dextrose, starting with a 15ml bolus

35

What should be done before insulin infusion is started?

first 50 ml discarded
Separate IV started for insulin and glucose infusions

36

What are starting rates for insulin and D5W/.45NS with 20 meq of KCl?

Insulin at 1 units/hr and D5W at 100 cc/hr

37

When should glucose be checked in DM pt receiving infulsion?

every 1-2hours before surgery, every hour during

38

how is an insulin infusion titrated?

Aim for blood glucose 100-200 mg/dL by adjusting insulin infusion rate in 0.5 unit/hr

39

how is glucose checked intraoperatively?

Accucheck, arterial or venous

40

What are causes of asthma?

inhaled allergens-dust, animal dander, industrial pollutants
stress
Airway instrumentation
REcurrent pulmonary infections

41

What is the physiologic response of asthma?

Mast cell release fo Histamine

42

What is the pathology of Asthma?

Bronchoconstriction or Spasm
Aiway infllamation

43

What size aerosols make it to the alveolar level?

0.5um

44

What is the advantage of a nebulizer for use in the pediatric patient?

Does not require hand-breathing coordination like an MDI does

45

What is the onset and duration of short acting beta-2 agonists?

onset-1-5 min
duratine 2-6 hours

46

can long acting Beta 2 agonists be used for perioperative prophylaxis?

NO, also not to treat an acute attack

47

What is the onset and duration of Long acting beta 2 agonists? Give 2 examples.

Onset > 20 minutes
duration 12 hours
examples: salmeterol, formoterol

48

how do steroids work to treat asthma?

Not categorized as bronchodilators, but do have that effect by decreasing mucosal edema and preventing the release of bronchoconstricting substances

49

How can steroids be administered for asthma?

Oral or aerosolized

50

How do accolate or singulair treat asthma

leukotriene receptor antagonist
leukotriens 1000x more potent brochoconstrictors than histamine

51

How does Xolair treat asthma?

Anti-IgE therapy
REcombinant humanized monoclonal antibody targeting IgE receptors on mast cells, thus preventing bronchoconstriction

52

How does theophylline treat Asthma?

theophylline is a methylxanthine that acts as a phosphodiesterase inhibitor--prevents the breakdown of cAMP

53

What are anesthetic considerations for cerebral aneurism coiling?

1. Immobility--general anesthesia with neuromusclular blockade
2. Hemodynamic stability--Direct arterial monitoring is needed to maintain cerebral perfusiona nd prevent aneurysm rupture
3. Anticoagulation-heparin
4. Rapid emergence for neurologic assessment

54

What are possible complications of aneurysm coiling?

1. Aneurysm rupture with hemorrhage
2. Thromboembolism
3. Vasospasm