Pharm Unit 3 - Aspiration/PONV Flashcards
(267 cards)
1
Q
Persistent suppression of bacterial growth after antibiotic concentration has fallen below the specified MIC is known as
A
post antibiotic effect
2
Q
Antibiotic which may prolong the neuromuscular blocking effects of rocuronium
A
levofloxacin
3
Q
When this agent is combined with ampicillin, it extends the spectrum of activity to be active against more gram negative and anaerobic bacteria
A
sulbactam
4
Q
The mechanism of action of cefotetan is
A
inhibition of crosslinking of peptidoglycan to inhibit bacterial cell wall synthesis
5
Q
Prolonged QT on ECG and cardiac arrhythmia is a possible risk with
A
quinolones
6
Q
antibiotic to avoid in a pregnant patient
A
doxycycline
7
Q
Agent that may be used for decolonization of patients who are nasal carriers of MRSA and MSSA
A
mupirocin
8
Q
vancomycin is associated with all of the following adverse effects except
A
bleeding
9
Q
Select the antiemetic agent that is associated with dry mouth, blurry vision, and may cause cognitive impairment in elderly patients:
A
scopalamine
10
Q
An agent that may be useful for late or delayed nausea and vomiting:
A
palonosetron
11
Q
Dexamethasone IV injection has been associated with:
A
perineal burning sensation
12
Q
A patient treated with droperidol in the PACU develops an acute and painful cervical dystonic reaction. Select appropriate therapy to relive the dystonia
A
diphenhydramine or glycopyrrolate
13
Q
Are beta lactams bactericidal or bacteriostatic?
A
bactericidal
14
Q
beta lactams MOA
A
Inhibition of cell wall synthesis: Interference with peptidoglycan crosslinking
15
Q
penicillins spectrum
A
G+, G-, anaerobes (broad spectrum)
16
Q
Penicillins: Adverse Effects
A
hypersensitivity reaction, seizure
17
Q
difference between cephalosporins and penicillins
A
more stable against bacterial beta lactamase
18
Q
1st gen cephalosporin
A
Cefazolin
19
Q
1st gen cephalosporin coverage
A
gram positive, some gram negative
20
Q
2nd gen cephalosporin
A
Cefotetan
21
Q
2nd gen cephalosporin coverage
A
gram positive, more gram negative
22
Q
3rd gen cephalosporin
A
Ceftriaxone
23
Q
3rd gen cephalosporin coverage
A
decreasing gram positive, increasing gram negative
24
Q
4th gen cephalosporin
A
Cefepime
25
4th gen cephalosporin coverage
G+, G-, pseudomonas
26
5th gen cephalosporin
Ceftaroline
27
5th gen cephalosporin coverage
MRSA
28
cephalosporin adverse effects
allergy, bleeding, disulfiram reaction
29
beta lactamase inhibitors
Clavulanate, Sulbactam
30
beta lactamase inhibitors MOA
inactivate beta lactamase to make other abx more active
31
carbapenems
Meropenem, Ertapenem
Doripenem
32
carbapenems MOA
inhibit cell wall synthesis (resistant to beta lactamases)
33
Carbapanems spectrum
gram positive, gram negative
anaerobes
pseudomonas
34
Carbapenems adverse effects
seizure, renal impairment
35
beta lactamase inhibitors spectrum
G+, G-
anaerobes
36
vancomycin MOA
inhibits synthesis of cell wall precursors
37
Vancomycin spectrum
Gram +: enterococcus
MRSA
C. Diff
38
Vancomycin adverse effects
nephrotoxicity, ototoxicity, red man syndrome
39
aminoglycosides
gentamicin, neomycin, amikacin
40
aminoglycosides MOA
inhibit bacterial protein synthesis (30S subunit)
41
Are aminoglycosides bactericidal or bacteriostatic?
bactericidal
42
Aminoglycosides adverse effects
ototoxicity, nephrotoxicity, prolong neuromuscular blockade
43
macrolides
erythromycin, clarithromycin, azithromycin
44
macrolides MOA
inhibit protein synthesis (50S subunit)
45
macrolides spectrum
G+, pneumococci
46
macrolides adverse effects
GI effects, inhibit CYP 450
47
tetracyclines
Tetracycline, Doxycycline
Minocycline
48
tetracyclines MOA
inhibit protein synthesis (30S subunit)
49
Are tetracyclines bacteriostatic or bactericidal?
bacteriostatic
50
tetracyclines spectrum
Gram (+), mycoplasma, H. pylori, Chlamydia
51
tetracyclines adverse effects
GI altered flora
52
tetracyclines contraindications
pregnancy
53
clindamycin MOA
inhibit protein synthesis (50S subunit)
54
Is clindamycin bacteriostatic or bactericidal?
bactericidal
55
clinda spectrum
most gram pos, most anaerobes
56
Clindamycin adverse effects
C. diff, GI effects
57
oxazolidinones
Linezolid
58
oxazolidinones MOA
prevents formation of ribosome complex
59
oxazolidinones spectrum
G+ (MRSA, VRE, VRSA), vanc resistant enterococci
60
oxazolidinones adverse effects
MAO activity, hematological (anemia, thrombocytopenia), neuropathy
61
DNA synthesis inhibitors
Quinolones
62
quinolones
Ciprofloxacin, Levofloxacin
Ofloxacin
63
quinolones MOA
inhibit topoisomerase
64
quinolones spectrum
Broad (G+ and G-)
65
Quinolones adverse effects
glycemia, QT prolongation
growing cartilage
tendonitics
enhance NMB
66
antimetabolites
sulfonamides
67
sulfonamides MOA
inhibit folate synthesis
68
sulfonamides spectrum
gram positives
69
sulfonamides adverse effects
megaloblastic anemia, leukopenia
granulocytopenia
vasculitis
cross reactivity
70
metronidazole use
add when worried about anaerobes
71
mupirocin use
MRSA nasal colonization
72
polymixins use
bactericidal for abdominal procedures
73
when should the antibiotic be administered?
60 min prior to incision
74
when should vanc be administered
120 min prior to incision
75
what is commonly used when there is a PCN allergy
vancomycin, clindamycin, erythromycin
76
What types of drugs are used for aspiration prevention
H1 blockers
H2 blockers
PPI's
Dopa receptor antagonists
77
H1 blockers MOA
decreased contraction of intestinal smooth muscle
78
H1 blockers uses
sedation, decreased GI motility
antimuscarinic
79
what is the H1 blocker
diphenhydramine
80
H2 blockers MOA
decrease acidity of gastric acid
81
H2 blockers uses
ulcers, GERD
82
H2 blockers common drugs
ranitidine, famotidine, nizatidine, cimetidine
83
PPI MOA
inhibit acid secretion
84
PPI uses
ulcers, GERD
85
PPI common drugs
pantoprazole, omeprazole, lansoprazole
86
dopamine receptor antagonist MOA
increase LES tone & GI motility
87
dopamine receptor antagonist uses
GERD, diabetic gastroparesis
88
dopamine receptor antagonist adverse effects
acute dystonic reaction
89
common dopamine receptor antagonist
metoclopramide
90
5HT3 antagonists MOA
block serotonin both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone
91
5HT3 antagonists uses
emesis due to vagal stimulation
92
5HT3 antagonists adverse effects
QT prolongation
93
5HT3 antagonists contraindications
use w/ drugs that inhibit CYP enzymes
94
common 5HT3 antagonists
ondansetron, granisetron
dolasetron
palonosetron
95
antimuscarinics uses
motion sickness, PONV
96
antimuscarinics adverse effects
dry mouth, blurry vision
cognitive impairment
97
common antimuscarinic for PONV
scopalamine patch
98
D2 receptor antagonist MOA
block D2 receptor in CTZ
99
D2 receptor antagonist adverse effects
acute dystonic reaction, prolonged QT
100
D2 receptor antagonist common drugs
droperidol, haloperidol
perphenazine
promethazine
prochlorperazine
101
Neurokinin receptor antagonists MOA
inhibits substance P
102
Neurokinin receptor antagonist drug
Aprepitant
103
dexamethasone adverse effects
perineal burning, impaired glucose tolerance
104
Class IA antiarrhythmics
Quinidine
Procainamide
Disopyramide
105
Class IA antiarrhythmics MOA
block VG Na+ and VG K+ in myocytes
106
quinidine indications
PVC's
Systained VT/VF
Afib/Aflutter
short QT syndrome
107
quinidine adverse effects
N/V
diarrhea
tinnitus/hearing loss
hypotension
QRS & QT prolongation, torsades
108
quinidine contraindications
prolonged QT
109
Procainamide Indications
sustained VT, Afib in WPW
110
procainamide adverse effects
rash, myalgia, vasculitis, hypotension, bradycardia, QT prolongation, torsades, drug induced lupus
111
Procainamide Contraindications
prolonged QT
112
disopyramide indications
PVC's, VT
Afib
113
dispyramide adverse effects
urinary retention, constipation, glaucoma, QT prolongation, torsades
114
disopyramide contraindications
prolonged QT
115
Class IB Antiarrhythmics
Lidocaine
Mexiletine
116
Class IB Antiarrhythmics MOA
block VG Na+ in myocytes
117
Class IB Antiarrhythmics indications
V tach, V fib
118
Class IB Antiarrhythmics adverse effects
increased potency in ischemic tissue, GI effects
119
lidocaine SE
visaul disturbances
tremor
seizure
drowsiness
hallucination/coma
asystole
hypotension
N/V
120
Mexiletine SE
GI upset
N/V
blurred vision
tremor
headache
ataxia
confusion
121
Class IB Antiarrhythmics contraindications
atrial tachyarrhythmias, HF/liver disease
122
Class IC antiarrhythmics
Flecainide, Propafenone
123
Class IC antiarrhythmics MOA
dramatically prolong phase 0 in myocyte AP (block VG NA+)
124
Class IC antiarrhythmics indications
AFib (w/o CAD), SVT
125
flecainamide adverse effects
dizziness, dyspnea, headache, blurred vision, nausea, HF exacerbation, AV block, VT/VF in pt's with CAD
126
flecainamide contraindications
heart failure
CAD
127
propafenone adverse effects
dizziness, dyspnea, headache, blurred vision, nausea, bradyccardia
bronchospasm
128
propafenone contraindications
heart failure
CAD
asthma
129
Class II antiarrhythmic drugs
beta blockers
130
beta blockers MOA
decreased slope of phase 4 depolarization
prolong depolarization at AV node
131
beta blocker indications
Afib/Aflutter (slow HR down)
SVT's
ventricular arrhythmia prevention
***will not convert back into normal sinus***
132
beta blocker adverse effects
fatigue
hypotension
bronchospasm
mask hypoglycemic symptoms
aggravation of heart failure
133
Class III antiarrhythmics
Amiodarone
134
Class III MOA
K+ blocker
-- prolongs QT interval
135
Class III SE
torsades the pointes
higher proarryhthmia risk
136
Amiodarone MOA
K+ blocker (high)
- prolongs AP duration
- phase 3
Na+ blocker
Ca2+ blocker
beta blocker (slow SA/AV conduction)
137
when does amiodarone work best?
at high heart rates due to use-dependence
138
amiodarone indications
VT/VF
SVT
Afib/Aflutter
139
amiodarone features
lg volume of distribution due to lipophilicity
requires loading dose (10g)
delayed onset
long half life (2 months)
140
amiodarone adverse effects
pulmonary toxicity
liver injury
hypotension
bradycardia
AV block
worsening dysrhthmias
thyroid abnormalities
141
amiodarone contraindications
hypersensitivity (iodine)
cardiogenic shock
bradycardia
AV blocks
142
amiodarone drug interactions
digoxin
warfarin
statins
143
amiodarone metabolism
hepatic by CYP3A4 and 2C8
144
amiodarone inhibits
CYP3A4
CYP2C9
P-glycoprotein
145
Class III drugs that can cause torsades
dofetilide
sotalol
146
dronedarone compared to amiodarone
less efficacy than amiodarone
does not contain iodine
147
dronedarone SE
GI impacts
148
dronedarone indications
atrial flutter
afib
149
Class IV antiarrhythmics
non-DHPR CCB's
verapamil
diltiazem
150
non-DHPR CCB MOA
inhibition of L-type Ca2+ channels (phase 0 in nodal tissue)
slow depolarization in pacemaker cells
151
non-DHPR CCB indications
SVT
Afib/Aflutter
152
non-DHPR CCB adverse effects
hypotension
bradycardia
AV block
decreased SV
153
adenosine adverse effects
dyspnea
bronchospasm
flushing
chest pressure
154
Adenosine indications
SVT
155
digoxin MOA
increases parasympathetic tone via vagus nerve
-- decr sinus node
-- prolongs AV node refractory
inhibits Na/K-ATPase pump
--incr Ca2+
--incr contractility
--incr proarrhythmic potential
156
digoxin indications
atrial fibrillation
aflutter
heart failure w/ reduced EF
157
digoxin CI
afib
aflutter
WPW
158
digoxin adverse effects
narrow therapeutic window
GI upset
halo vision
malaise
bradycardia
AV block
VT/VF
159
when is digoxin used?
on a resting heart rate
-- pt is just sitting not walking around
rate control in combination with BB/CCB
160
Antimuscarinics indications
bradycardia
AV block
161
antimuscarinic side effects
dry mouth
blurry vision
photophobia
tachycardia
162
antimuscarinic drugs
atropine
glyco
163
antimuscarinic MOA
block ACH from binding to muscarinic receptors
alters parasympathetic response
anti-parasympathetic drugs
164
mechanism of action of local anesthetics
Block voltage-gated sodium channels
165
what does Blockage of voltage-gated sodium channels do
blocks generation and conduction of action potentials
166
when do local anesthetics gain access to Na channels
during activated state
167
when is the affinity of LA for Na channels greater
when Na channels are open
168
what does the lipophillic region of LA affect
onset of action
potency
duration
169
increasing lipophilicity
increases potency
slower onset
170
what does ester or amide linkage of LAs affect
duration of action
171
if someone has an allergy to amid local anesthetics, can you safely give an ester?
yes (& vice versa)
172
what does a higher % neutral affect
enhanced absorption
173
how does % neutral affect absoprtion
neutral form penetrates the membrane
174
what do we want the pKa of the LA to be
closest to physiologic pH
175
what is the determining factor for LA toxicity
vascularity
176
Vascularity ranking Highest to lowest
HIGH
IV
tracheal
intercostal
caudal
paracervical
epidural
brachial plexus
subarachnoid/sciatic/femoral
subQ
LOW
177
what does the risk for systemic LA toxicity depend on
lipid solubility
amount of connective tissue in area
pH of tissue
% neutral
is epi added?
178
how does lipophilicity and tissue protein binding affect duration
remains in tissue longer
179
how does epi affect the LA
makes LA more acidic
180
what does bicarb addition to epi + LA
makes it neutral for a faster onset
181
what delays LA redistribution
vasoconstriction
182
why is epi added to local?
prolongs duration of action
reduced peak serum concentration
183
onset of LA: lipid solubility
less lipid soluble = less potent
(typically delays onset)
184
duration of action of LA
potency
lipid solubility - more = slower diffusion = longer DOA
185
what type of axon is more sensitive to LA blcok
myelinated
186
what is the most common feature of LAST
seizures
187
what does a low CC/CNS ratio mean
more cardiotoxic
188
what does a high CC/CNS ratio mean
more CNS toxiv
189
what type of pt is at increased risk for LAST
pregnant elderly
neonate
190
how to treat LAST
lipid emulsion 20% IV, 100 ml bolus over 2-3 min
rebolus 200 mil over 15-20 in
191
Lidocaine maximum dose
4.5 mg/kg
192
Lidocaine + Epi maximum dose
7 mg/kg
193
ropivacaine max dose
2.5 mg/kg
194
bupivacaine max dose
2.5 mg/kg
195
preop causes of volume derangements
bowel preps
bowel obstruction
pancreatitis
blood loss
196
anesthetic causes of volume derangements
anesthetic hypotension
(vasodilation)
sympathetic blockade
197
surgical causes of volume derangements
hemorrhage
coagulopathy
decreased venous return
long operative time
198
when is hypervolemia clincally significant
>10% above basewline
199
hypervolemia SE
incr morbidity
tissue edema
impaired wound healing
pulm edema
decr GI motility
200
what lab value reflects total body water status
serum sodium
201
what content in IV fluid dictates fluid distribution?
Na+
202
what factors influence total body water content
gender
age
nutritional status
disease state
203
TBW and age relationship
less water with increased age
204
neonates TBW
70-80% of body weight is water
205
calculating TBW
50-60% of body weight
206
ICF:ECF
2:1
2/3 ICF and 1/3 ECF
207
ECF
interstitial fluid (3)
plasma (1)
ISF: plasma = 3:1
208
electrolyte content of ECF
Na+
Cl-
209
electrolyte content of ICF
K+
Phosphate
210
what is colloid osmotic pressure
pulls fluid into vessels
211
what maintains fluid components of blood within vessels?
colloid osmotic pressure (oncotic pressure)
212
what changes oncotic pressure
allbumins
proteins
etc
213
what is hydrostatic pressure
pushes fluid out of vessels
214
what is osmolar force
push and pull in and out of vessels
215
what does lactate do in LR?
provides circulating bicarb to provide normal HCO3- levels during acidosis
???????
216
what is the main contributor of osmolarity
sodium
217
Tonicity of Crystalloids
isotonic
218
Distribution of water
ECF and ICF
219
distribution of saline/LR
distributes only to ECF
220
distribution of colloids
distributes only to intravascular space
221
colloid types
albumin
hetastarch
dextrans
222
HES SE
acute kidney
incr moprtaloity
incr need to PRBC transfusion
223
albumin
source of capillary oncotic pressure (80%)
224
types of albumin
hyperoncotic (25%)
5% albumin (isotonic to plasma)
225
pts low in albumin
nutritionally deficient
renal disease
liver disease
226
most potent colloid
25% albumin
227
Hetastarches (HES)
amylopectin and synthetic glycogen
228
HES molecular weight
high MW = slower degradation
229
Dextrans
long chains of glucose (polysaccharides)
230
Dextran unique property
rhological properties
-- moderate plt function
-- antithrombotic
used in vascular sx to prevent post-op stroke
231
typical water loss per day
2.5 L/day
232
causes of increased water loss
fever
sweating
gastric
colon
insensible losses
233
normal Na loss
77 mEq/day
234
normal K loss
40-60 mEq/day
235
normal Cl loss
same as sodium
236
lidocaine pKa
7.6
237
ropivacaine/bupivacaine pKa
8.1
238
how does pKa affect onset
pKa closer to physiologic pH = higher % neutral, faster onset
239
which local anesthetics can cause methemoglobinemia
prilocaine and benzocaine
240
which local anesthetics are more cardiotoxic
bupivacaine
241
which local anesthetics are more CNS toxic
mepivacaine
242
what does extreme lipophilicity promote
continued binding and increased duration of action
243
LA that is extremely lipophilic
bupivacaine
244
what LA property does protein binding affect
duration of action
245
what LA property does pKa affect
onset of action
246
what correlates with toxicity risk
Cmax
time to Cmax
247
what drugs could be used to manage LA systemic toxicity
epinephrine, amiodarone
midazolam
lipid emulsion
248
where will LR/Saline distribute
ECF- 1/4 IV 3/4 IS
249
where will D5W distribute
ECF and ICF proportionally
250
where will Albumin distribute
intravascular space
251
best fluid for maintenance
D5W + 0.225% NaCl
252
best fluid for metabolic acidosis
LR
253
preferred IVF in anesthesia
LR
254
which colloid solutions have a risk for bleeding
6% hetastarch, Dextran 40
255
how to calculate total body water
0.6L/kg
256
N/S SE
hyperchloremic acidosis
reduction of renal perfusion
257
water distribution
across all compartments
vascular compartment
Interstitial space
cell membranes
258
Na+ distribition
capillary membrane
interstitial fluid
pumped out of cell
259
colloids distribution
confined to vascular compartment
does not cross into capillary membrane
260
crystalloids use
mx
replacement of losses
treatments of symptoms
-- fluid or electrolyte deficits
261
colloids uses
add oncotic pressure
volume replacement
rheologic propoerties
262
sensible loses
measurable
263
insensible losses
respriation
fever
evaproration (surgical)
264
adult fluid maintenance
30mL/kg/day
265
minimal losses
0-2 mL/kg
266
moderate losses
2-4 mL/kg
267
severe losses
4-8 mL/kg
