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Anesthesia Pharmacology > PBL II > Flashcards

Flashcards in PBL II Deck (23)
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1
Q

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

A

Immunosupressive agent used to tx rheumatoid arthritis

2
Q

What type of drug is piperacillin-tazobactam and what is it use for?

A
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
Q

How often do pts with penicillin react to cephalosporins?

A

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
Q

How prevalent are tape allergies? Which tape? What is the typical reaction?

A

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
Q

Irbesartan (Avapro)-What class of drug and what is is used for?

A

Angiotensin II receptor antagonist used for blood pressure control
Member of Renin-Angiotnesin System Inhibitors

6
Q

What are the uses of pyridostigmine?

A

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
Q

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?

A

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
Q

Besides reaction to relaxants what are other anesthetic considerations for MG pts?

A

Assess preoperative disease management
Medication should be continued preoperatively
Counsel patient concerning the possibility of postoperative endotracheal intubation and ventilation

9
Q

Which muscle relaxant appears to be preferred with MG pts?

A

cisatracurium

10
Q

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

A

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

11
Q

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

A

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

12
Q

How much less potent is Oxycodone delivered enterally vs parenterally?

A

2-6 times less potent

13
Q

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

A

Percodan
Percoset
Roxicodine

14
Q

what doses of morphine are used in pain management?

A

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
Q

How does 325 mg affect bleeding time

A

doubles bleeding time 4-7 days

16
Q

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

A

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

17
Q

What are symptoms of acute withdrawal of predisone?

A

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

18
Q

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

A

1 week-OK

Long term-disabling and potentially lethal effects

19
Q

What are clinical uses prednisone?

A

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

20
Q

What is a stress dose of steroids for a 70 kg pt in minor vs major surgery?

A

Major (colectomy) 100-150 mg hydrocortisone

Minor (herniorrhaphy) 25-100 mg hydrocortisone

21
Q

What is the recommendation for giving a stress dose of steroids?

A

If the pt was on a glucocorticoid in the last year, then arguably they should receive a dose of steroid properatively

22
Q

Why would a stress dose of steroids be necessary?

A

Deep general Anesthesia or regional postpones glucocorticoid surge usually seen with sympathetic surgical stimulation until the post op period

23
Q

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

A

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