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Flashcards in PBL II Deck (23)
1

What type drug is azathioprine and what is it used for?

Immunosupressive agent used to tx rheumatoid arthritis

2

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
Uses:
Hospital acquired infections
Bacteremia
Penicillin and Ampicillin resistant
microorganisms
Post burn infections
Pneumonias
Pseudomonas infections

3

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

4

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

5

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

6

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

7

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

8

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

9

Which muscle relaxant appears to be preferred with MG pts?

cisatracurium

10

What are benefits of stopping smoking after 8-12 weeks?
6-8?
4-6?

8-12 Decreased overall postoperative morbidity and mortality
6-8 Immun function and metabolism normalizes
4-6 weeks PFTs improve

11

What are the benefits 1-2 weeks after stopping smoking?
48-72 hours?
12-24 hours?

1-2 weeks Decreased sputum production
48-72 hours COHb levels normalized, ciliary function improves
12-14 hrs Decreased CO and nicotine levels

12

How much less potent is Oxycodone delivered enterally vs parenterally?

2-6 times less potent

13

What do you call oxycodone +aspirin?
+acetaminophen?
non sustained release?

Percodan
Percoset
Roxicodine

14

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

15

How does 325 mg affect bleeding time

doubles bleeding time 4-7 days

16

What is the class, action, effect and dose of apirin?

NSAID
COX 1 inhibitor-reduces production of prostogandins
Anti-inflammatory analgesic and antipyretic
Dose: 325-650 q4-6hours for pain

17

What are symptoms of acute withdrawal of predisone?

N/V, dehydration, hyponatremia, hypotension and severe weakness

18

What are effects of short term and long term use of prednisone?

1 week-OK
Long term-disabling and potentially lethal effects

19

What are clinical uses prednisone?

Arthritis
Rheumatic disorders-Lupus
Allergic reactions
Severe Bronchial Asthma
COPD
Cerebral Edema
Colitis and Crohn’s Disease
Organ Transplantation

20

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

21

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

22

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

23

Where should the twitch monitor be placed on an MG pt?

Temporal branch of facial nerve stimulating orbicularis oculi--more sensitive for MG pts