PBL III: Splenectomy Flashcards Preview

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Flashcards in PBL III: Splenectomy Deck (19)

Is Lispro fast or slow acting insulin? What is onset, peak and time for it to become inactive?

Taken at mealtime it has an onset of 10 min, peak in 1-2 hours and is inactive in 4-6 hours


What is the onset, peak, and inactive time of humalog?

ONset 30 min-1 hour, peak 2-4 hour and inactive in 4-10 hours
Humalog better covers patient meals since blood sugar increases for 2-3 hours after meal time


What are the protocol for IV infusion of insulin.
Where do you start the infusion? HOw often do you check? How often once stable?

Start at .5-1 unit/hour.
Check at least hourly until stable, and q2hour once stable. Titrate as follows
70-120 Decrease .3 U/hour
121-180 No change
181-240 Increase 0.3 U/hour
241-300 Increase 0.6 U/hour
>300 Increase 1.0 U/hour


What class of drug is omeprazole? What effect does it have?

Proton pump inhibitor
Requires H+ for activation so may be considered a prodrug
Reduces gastric acid secretions and decreases daily H+ production by 80-95%
Used for GERD and ulcers


Carvedilol is a beta receptor antagonist. Does it have any alpha activity? What are the indications?

Indicated for HTN and heart failure, Cavedilol has 1:10 Alpha to beta activity


What is portal vein thrombosis?

Obstruction due to a clot or narrowing of the portal vein which brings blood to the liver from the intestines.
Because of the blocked or narrowed portal vein, pressure in the portal vein increases, which is referred to as portal hypertension.


What are results of portal HTN?

Esophageal Varices (dilated esophageal veins prone to bleeding)


What are the causes of portal HTN?
HOw is it diagnosed?

25% of adults with Hcirrhosis have portal HTN
Diagnosis 1. Doppler ultrasonography
2. Bleeding of esophageal or gastric varices
1. Sphenomegaly


How does splenomegaly affect platelets?

The spleen usually holds 1/3 of platelets, but with splenomegaly, this pool may icrease to 80%, decreasing the available circulating pool--thrombocytopenia
Splenctomy has been shown to be effecting in restoring platelet levels


How do esophageal varices affect cirrhosis related deaths? What is a short term bridge to liver transplant?

Bleeding of esophageal varices accounts for 1/3 of the cirrhosis- related deaths.

Lowering of the pressure in the portal vein by shunting the flow into the systemic venous circulation, (TIPPSS procedure) is used as a bridge to liver transplant.


What is fundoplications?

Surgical procedure used of the treatment of gastroesophageal reflux disease (GERD) and or a hiatal hernia.
The upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of the stomach muscle. This strengthens the lower esophageal sphincter and stops acid from backing up into the esophagus as easily.
This procedure is usually performed laparoscopically or open.


What is the usual tx for Type II diabetes?

Diet, exercise and oral medication


What are the two classes of drugs traditionally used to tx type II diabetes?

Sulfonylureas: Increase insulin release from Beta cells and reduce serum glucagon
Biguanides--reduce hepatic glucose production


What type of drug is metformin (glucophage)? how does it work?

Biguanide--reduces hepatic glucose production


Tolbutamide, chlorpropamide, glyburide and glipizide are all examples of __________. How do they work?

Sulfhonylureas--work by increaseing insulin release from B cells and reducing serum glucagon


What class of drug is clevidipine? How is it administered?

calcium channel blocker
Administered IV and titrated to effect reduction 25% of baseline systolic


What is starting dose of clevidipine? What is high does and what increments so you titrate?

Start 1-mg/hour and titrate up in 1-2 mg/hour increments every 5-10 minutes up to 16 mg/hour.
The plateau of a 25% reduction in systolic is usually achieved in approx. 10 min


How long does full recovery take after clevidipine infusion is stopped?

5-10 min


How long is clevidipine good after vial is punctured? Why?

Must be used w/in 4 hours after puncture, because it is supplied in a phospholipid preparation.