Flashcards in PBL II Deck (23)
What type drug is azathioprine and what is it used for?
Immunosupressive agent used to tx rheumatoid arthritis
What type of drug is piperacillin-tazobactam and what is it use for?
Beta lactam and Beta lactamace inhibitor
Penicillin class antibiotic
Effective against gram-negative bacteria
Hospital acquired infections
Penicillin and Ampicillin resistant
Post burn infections
How often do pts with penicillin react to cephalosporins?
Immunological studies: 20%
clinical studies: 1
Pts with a hx of mild or distant reactions to PCN are at a low risk of rash or other allergic reaction
How prevalent are tape allergies? Which tape? What is the typical reaction?
Tape allergies are rare
Most tape allergies are to adhesive tape which can contain latex and that may be the source of the reaction
Typically the reaction is a simple contact dermatitis
Irbesartan (Avapro)-What class of drug and what is is used for?
Angiotensin II receptor antagonist used for blood pressure control
Member of Renin-Angiotnesin System Inhibitors
What are the uses of pyridostigmine?
Treatment of Myasthenia Gravis
Neuromuscular disease > muscle weakness
skeletal muscle fatigability
Defect is in the synaptic transmission at the neuromuscular junction
Autoimmune response to Ach receptor at the post junctional end plate
HOw do myasthenia gravis pts react to Succinylcholine?
What if they are on Pyridostigmine?
Can you use non depolarizing relaxants?
How should you proceed if you need relaxation?
Myastenic patients have a resistance to Succinylcholine
On the other hand if the patient is on Pyridostigmine, they may have potentiation
Phase 2 block is not uncommon in the patients
MG patients may be extremely sensitive to non-depolarizing neuromuscular blockers
A smaller test dose should be used and close NMB monitoring is needed
Besides reaction to relaxants what are other anesthetic considerations for MG pts?
Assess preoperative disease management
Medication should be continued preoperatively
Counsel patient concerning the possibility of postoperative endotracheal intubation and ventilation
Which muscle relaxant appears to be preferred with MG pts?
What are benefits of stopping smoking after 8-12 weeks?
8-12 Decreased overall postoperative morbidity and mortality
6-8 Immun function and metabolism normalizes
4-6 weeks PFTs improve
What are the benefits 1-2 weeks after stopping smoking?
1-2 weeks Decreased sputum production
48-72 hours COHb levels normalized, ciliary function improves
12-14 hrs Decreased CO and nicotine levels
How much less potent is Oxycodone delivered enterally vs parenterally?
2-6 times less potent
What do you call oxycodone +aspirin?
non sustained release?
what doses of morphine are used in pain management?
30mg q3-4 hours oral
10 mg q3-4hours parenteral
may be used for baseline or breathrough pain
Intraoperative in a balanced anesthetic: 2-10mg bolus
How does 325 mg affect bleeding time
doubles bleeding time 4-7 days
What is the class, action, effect and dose of apirin?
COX 1 inhibitor-reduces production of prostogandins
Anti-inflammatory analgesic and antipyretic
Dose: 325-650 q4-6hours for pain
What are symptoms of acute withdrawal of predisone?
N/V, dehydration, hyponatremia, hypotension and severe weakness
What are effects of short term and long term use of prednisone?
Long term-disabling and potentially lethal effects
What are clinical uses prednisone?
Severe Bronchial Asthma
Colitis and Crohn’s Disease
What is a stress dose of steroids for a 70 kg pt in minor vs major surgery?
Major (colectomy) 100-150 mg hydrocortisone
Minor (herniorrhaphy) 25-100 mg hydrocortisone
What is the recommendation for giving a stress dose of steroids?
If the pt was on a glucocorticoid in the last year, then arguably they should receive a dose of steroid properatively
Why would a stress dose of steroids be necessary?
Deep general Anesthesia or regional postpones glucocorticoid surge usually seen with sympathetic surgical stimulation until the post op period