Pharmacology Final Flashcards
(293 cards)
1
Q
(3) Natural catecholamines
A
Epinephrine, Norepinephrine, and Dopamine
2
Q
(2) synthetic catecholamines
A
Isoproterenol and Dobutamine
3
Q
(2) Synthetic Non-Catecholamines
A
Ephedrine and Phenylephrine
4
Q
Which catecholamines do not stimulate Alpha?
A
Isoproterenol and Dobutamine
5
Q
Which catecholamine has no affect on Beta-1?
A
Phenylephrine
6
Q
Which catecholamines have a negative effect CO and HR?
A
Norepinephrine and Phenylephrine
7
Q
Which catecholamines cause the greatest increase in peripheral vascular resistance?
A
Norepinephrine and Phenylephrine
8
Q
Which (3) catecholamines cause the greatest decrease in airway resistance?
A
Epinephrine, Isoproterenol, and Ephedrine
9
Q
Which catecholamine has a direct and indirect mechanism of action?
A
ephedrine
10
Q
Which catecholamines cause the greatest increase in MAP?
A
Norepinephrine and Phenylephrine
11
Q
Example of Prototype Sympathomimetic
A
Epinephrine
12
Q
Where is Epineprhine synthesized and stored?
A
adrenal medulla
13
Q
Why shouldn’t Epi be given orally?
A
rapidly metabolized by the GI and liver
14
Q
What explains Epi’s lack of cerebral effects?
A
poor lipid solubility
15
Q
Primary locations of Alpha-1 receptors
A
cutaneous, splanchnic, and renal vascular beds
16
Q
Which catecholamines have the greatest risk of dysrhythmia?
A
Epinephrine and Isoproterenol
17
Q
How does epinephrine affect the cardiac cycle?
A
accelerates rate of spontaneous depolarization (phase 4)
- increases HR
- increases likelihood of dysrhythmia
18
Q
Avoidance of Epi in Beta Blockades
A
Epi induces bronchoconstriction from stimulation of alpha-receptors in the presence of a beta-blockade
19
Q
Which catecholamine has the greatest effect on metabolism?
A
Epinephrine
20
Q
Ocular effects of Epinephrine
A
mydriasis
(dilation of the pupil)
21
Q
(3) Coagulation effects of Epinephrine
A
- accelerates coagulation due to hypercoagulable state
- increases total leukocyte, but causes eosinopenia
- increases factor V activity
22
Q
Synthesis and storage of Norepinephrine
A
postganglionic sympathetic nerve endings
23
Q
Norepinephrine produces arterial and venous vasoconstriction in all vascular beds except in _____
A
coronary arteries
- Norepinephrine dilates coronary arteries
24
Q
Why should Norepinephrine be used cautiously in patients with right ventricular failure?
A
increases venous return and pulmonary artery pressure
25
Pathway of Catecholamine Systhesis
Phenylalanine
Tyrosine
Dopa
Dopamine
Norepinephrine
Epinephrine
26
Unique features of Dopamine
able to increase contractility, renal blood flow, GFR, sodium excretion, and urine output simultaneously
27
Renal dose of Dopamine
1 - 3 ug/kg/min
increass splanchnic and renal blood flow
28
Negative side effects of Dopamine
tachycardia and increase PVR
* not good for right heart failure
29
Most potent sympathomimetic with Beta activity
Isoproterenol
30
Clinical uses for Isoproterenol
heart block and RV failure
31
Clinical uses for Dobutamine
CHF, weaning from CPB, and pulmonary hypertension
32
Effects of Ephedrine
increases:
HR, CO, BP, and coronary blood flow
33
In which two disease states is Phenylephrine particularly useful?
aortic stenosis and CAD
* increases coronary perfusion without chronotropic side effects
34
Phenylephrine Overdose
activates SNS
## Footnote
(hypertension, tachycardia, and baroreceptor-mediated bradycardia)
* Phentolamine
* alpha-1 antagonist
* may use NTG and nitroprusside
* **beta blockers are contraindicated**
35
(3) most common Beta-2 Agonists
Albuterol, Metaproterenol, and Terbutaline
36
In addition to bronchospasm, what else can Beta-2 Agonists treat?
premature uterine contractions
| (tocolytics)
37
Clinical uses for Digoxin
supraventricular tachydysrhythmias
## Footnote
(paroxysmal atrial tachycardia, A-fib, A-flutter)
38
Digoxin Features
cardiac glycoside that decreases conduction through the AV node
* IV onset 10-30 minutes
* inhibits Na+/K+ ATPase
* increases CO, SV, renal perfusion
* decreases LVEDP
* can co-administer with beta blockers
39
(5) Causes of Digoxin Toxicity
* renal dysfunction
* hypoxemia
* hypokalemia
* hypercalcemia
* hypermagnesemia
40
EKG changes in Digoxin
scaphoid effect
41
Diagnosis of Digoxin Toxicity
anorexia, nausea, and plasma concentration
* will also see EKG changes
* arrhythmias
* long PR and heart block
42
Treatment of Digoxin Toxicity
* correct the causes
* treat cardiac dysrhythmias
* phenytoin, lidocaine, or atropine
* temporary pacemaker
* if complete heart block
43
Contraindications for Digoxin
HOCM and WPW
44
Hypertrophic Obstructive Cardiomyopathies (HOCM)
idiopathic LVH and subaortic stenosis
* leading cause of death in young athletes
* Digoxin contraindicated
45
Wolff-Parkinson-White Syndrome (WPW)
pre-excitation syndrome due to secondary accessory AV pathway (bundle of Kent)
* EKG shows delta wave and short PR interval
* "circus rhythm"
46
(5) Adverse Drug Interactions with Digoxin
* Quinidine
* Succinylcholine
* Sympathomimetics with B-agonist effects
* IV calcium
* some diuretics
47
Effects of Phosphodiesterase Inhibitors
positive inotropic effects with vasodilation
* act independently of B-receptors; therefore, effective in B-blocked patients
* enhance actions of catecholamines
* improves location of Starling curve
48
(2) Types of Phosphodiesterase Inhibitors
Amrinone and Milrinone
49
Total serum calcium includes:
Ca2+ bound to albumin, complexed with citrate and phosphate, and free (ionized) Ca2+
* free calcium is the active ion that can be measured
50
Events needing Calcium
* massive transfusion
* calcium binds to the citrate in PRBCs
* CP bypass
* due to multiple units of blood
* parathyroidectomy
* if hyperparathyroidism
51
How is Calcium Chloride administered?
through a central line
* has a very low pH
* always aspirate line first
52
Another term for the Sympathetic system
thoraco-lumbar
53
Another name for the Parasympathetic System
Cranio-Sacral
54
Major tissues affected by Alpha-1
Smooth muscle and sphincters
55
Major tissues affected by Alpha-2
nerve endings
56
Major tissues effected by Beta-1
Cardiac and Kidney muscle
57
Major tissues effected by Beta-2
smooth muscle, bronchi, liver, and skeletal muscle
58
Major tissue effected by Beta-3
Adipose
59
Major tissue effected by DA-1
Smooth muscle, renal, mesenteric, and cardiac
60
Major functions of Alpha-1
contraction and constriction
61
Major function of Alpha-2
decrease transmitter release
62
Major function of Beta-1
increase HR, contractility, and renal secretion
63
Major function of Beta-2
relax smooth muscle
increases gluconeogenesis, glycogenolysis, and potassium uptake
64
Major function of Beta-3
increase lipolysis
65
Major function of DA-1
relax renal vascular smooth muscle
(higher doses activates Beta-1 and alpha-1)
66
What two enzymes inactivate catecholamines?
MAO and COMT
67
Dose of Epinephrine for Cardiac Arrest
0.1 mL/kg of 1:1000 via ETT
or
0.1 mL/kg of 1:10,000 via IV/IO
68
Epinephrine dose for Status Asthmaticus
0.01 mg/kg of 1:1000 sq
69
(2) Non-Selective Alpha Antagonists
Phentolamine and Phenoxybenzamine
70
(4) Alpha-1 Antagonist
Prazosin, Doxazosin, Terazosin, and Tamulosin
## Footnote
**-osin**
71
(2) Alpha-2 Agonists
Clonidine and Dexmedetomidine
72
(2) Combined Alpha and Beta Antagonists
Lavetolol and Carvedilol
73
Which part of the nervous system uses Norepinephrine (rather than acetylcholine)?
sympathetic post-ganglionic
74
Alpha-2 (CNS) agonist acts like an ______ antagonist
Alpha-1
75
Phentolamine
| (regitine)
non-selective alpha antagonist
* peripheral vasodilation and decrease BP
76
Phentolamine Clinical Uses
treatment for acute hypertensive emergencies
* pheochromocytoma
* autonomic hyperreflexia
77
Phenoxybenzamine
| (dibenzyline)
non-reversible and non-selective Alpha Antagonist
* used preoperatively for Pheochromocytoma
* Raynauds
* preferentially dilates cutaneous arteries
78
Pheochromocytoma
tumor of the adrenal medulla
* secretes excessive amounts of Epi and NE
* Malignant hypertension
79
Pheochromocytoma
| (preoperative preparation)
* alpha blockade
* phenoxybenzamine
* add CCB if needed
* Beta blocker for tachycardia
* fluid replacement
80
In a patient treated with propranolol and phenoxybenzamine prior to resection of a solitary pheochromocytoma, would you expect postoperative hypotension or hypertension?
Hypotension
* hypovolemia
* residual BB and alpha blockade
* adrenal insufficiency
81
Doxazosin
| (cardura)
Alpha-1 Antagonist
* treatment for hypertension and BPH
* relaxes prostatic and vascular smooth muscle
82
Prazosin
| (minipres)
alpha-1 Antagonist
* used for HTN and CHF
* dilates arterioles and veins
83
Terazosin
| (hytrin)
Alpha-1 Antagonist
* used for BPH
* relaxes prostatic smooth muscle
84
Tamulosin
| (flomax)
Alpha-1 Antagonist
* used for BPH
* may cause orthostatic hypotension and syncope
85
Alpha-2 Receptor Agonists
bind pre-synaptically and reduce NE release
* mostly in CNS
* uses a negative feedback mechanism
86
Clonidine
centrally-acting Alpha Agonist
* decreases HR and BP
* added to regional anesthetics
87
Dexmedetomidine
Alpha-2 Agonist
* sedative and analgesic
* central sympatholytic effects
* avoid in liver failure
88
(3) Non-selective Beta Antagonists
Propranolol, Labetalol, and Sotalol
89
Blockade of Beta-1 in the kidney
decreases renin
* vasodilation and decreased BP
* decreased aldosterone
* salt and water retention
* decreased NE release
90
Best drug for controlling Torsades de Pointess in patients with prolonged QTc
Propranolol
91
Best drugs to give patients with CHF
Metoprolol and Carvedilol
92
Labetalol
| (normodyne and trandate)
Alpha-1 and non-selective Beta Antagonist
* used for hypertension and controlled hypotension
* 1 - 5 min onset
93
Treatment for Beta Blocker Toxicity
* Atropine
* Isoproterenol
* Dobutamine
* Glucagon
* Calcium Chloride
94
Blockade of Beta-2 receptors in the bronchi will cause \_\_\_\_\_
bronchoconstriction
95
Why should Beta-1 blockers be used with caution in diabetic patients?
can impair receovery from hypogylcemia and mask symptoms of hyperglycemia
96
Which beta blocker does not cross the placenta?
esmolol
97
Contraindications to Beta Blockers
* heart blocks and sinus arrest
* hypovolemic patients with compensatory tachycardia
* COPD (relative)
* conditions that would result in unopposed alpha stimulation
* cocaine and pheochromocytoma
98
Propranolol decreases the clearance of _____ local anesthetics
amide
* increased LA toxicity
* especially bupivicaine
99
Esmolol
| (brevibloc)
short-acting Beta-1 Antagonist
* fast onset and half-life
* hydrolysis by plasma esterases
100
Metoprolol
| (lopressor)
Beta-1 Antagonist
* large doses become non-selective
101
Atenolol
| (tenormin)
most selective Beta-1 Antagonist
* used in CAD patients at high risk of MI
102
Timolol
Beta Antagonist
* eyedrops used for Glaucoma
* systemic absorption can cause bradycardia and increase airway resistance
103
Carvedilol
| (coreg)
Alpha-1 and non-selective Beta Antagonist
* weak vasodilator
* treats mild CHF and hypertension
104
Which types of CCB are selective for the AV node?
Benzothiazepines and Phenylalkylamines
105
Which type of CCB is selective for arteriolar beds?
Dihydropyridines
106
Calcium Channel Blockers
decrease HR by decreasing the speed of conduction through the SA and AV node
* reduce contractility and relax vascular smooth muscle
* treats coronary spasms, angina, and SVT
107
(1) Benzothiazepine example
Diltiazem
108
(1) Phenylalkylamine example
Verapamil
109
Verapamil
CCB
(phenylalkylamine)
* slows conduction through AV node
* negative chronotropic effect on SA node
* avoid in WPW
110
Nifedipie
CCB
(dihydropyridines)
* coronary and peripheral arterial vasodilation
* no AV or SA node depression
111
Which CCB has the greatest vasodilating effects?
Nicardipine
112
Nimodipine
CCB
(dihydropyridine)
* CNS vasodilation of large cerebral arteries
* good for cerebral vasospasm following sub-arachnoid hemorrhage
113
What causes cerebral vasospasms?
influx of Ca2+ ions causing contraction of smooth muscle cells in large cerebral arteries
114
Diltiazem
| (cardizem)
CCB
* selective for AV node
* used for SVT and angina
| (benzothiazepine)
115
Which (2) CCB increase risk of LA toxicity
Verapamil and Diltiazem
116
(4) ACE inhibitor examples
Captopril, Enalopril, Lisinopril, and Ramipril
## Footnote
**-pril**
117
ACE Inhibitors
treat hypertension secondary to increases renin production
* may delay onset of renal disease in DM
* no bronchospasm or bradycardia
118
ACE Inhibitor side effects
cough and hypotension
119
(4) ARB examples
candesartan, losartan, valsartan, and telmisartan
## Footnote
**-sartan**
120
Angiotensin Receptor Blockers (ARB)
blocks vasoconstrictive action of Angiotensin II
* no cough or allergy symptoms
121
Aliskiren
| (teckturna)
direct renin inhibitor
122
Nitric Oxide
pulmonary arterial dilator used for primary pulmonary hypertension
* improves V/Q mismatch
* administered via inhalation
123
Nitric Oxide Complications
* Methemoglobinemia
* treat with IV methylene blue
* withdrawal symptoms
* Silo-Filler's disease
124
Sodium Nitroprusside (SNP)
direct-acting peripheral vasodilator
* relaxes arterial and venous smooth muscle
* immediate onset and short duration
* requires A-line
125
Nitroprusside and Cyanide Toxicity
tachyphylaxis, metabolic acidosis, and increased mixed venous PO2
* 2 mcg/kg/min
* children at greater risk
126
Cyanide Toxicity Treatment
* 100% oxygen
* sodium thiosulfate
* sodium nitrate
* methylene blue
127
Nitroglycerin
venodilator and large coronary artery dilator
* used for cardiac ischemia, reduce preload in CHF, and controlled hypotension
128
Nicardipine
cerebral and coronary vasodilator
* IV infusion for control of BP
129
Hydralazine
direct arterial vasodilator
* good for CHF
* not indicated in ischemia or coronary disease
* reflex tachycardia and increased contractility
130
Fenoldopam
Dopamine-1 agonist
* systemic arterial dilation
* increases renal and splanchnic blood flow
* increases urine output
131
Carbonic Anhydrase Inhibitors
diuretic used for altitude sickness and glaucoma
* proximal convoluted tubule and collecting duct
* decreases reabsorption of Na+, HCO3, and water
132
Acetazolamide
| (diamox)
carbonic anhydrase inhibitor
* treats altitude sickness and glaucoma
133
Carbonic Anhydrase side effects
metabolic acidosis
134
Loop Diuretics
most potent diuretic
* acts on thick ascending Loop of Henle
* inhibits reabsorption of Na+, K+, and Cl-
* Treats CHF
135
(2) Loop Diuretic examples
Furosemide and Bumetanide
136
Loop Diuretic side effects
ototoxicity, alkalosis, and hypokalemia
* nephrotoxicity
* aminoglycoside antibiotics
* cephalosporin
* increased lithium levels
137
Thiazide Diuretics
used for long-term treatment of hypertension
* acts on cortical ascending Loop of Henle
* inhibits Na2+ reabsorption
* increases excretion of Na+, K+, and Cl-
138
Thiazide Diuretic side effects
hypokalemia, hypochloremia, metabolic alkalosis, and diabetes
139
Osmotic diuretic
inert substances that cause osmotic diuresis in the proximal renal tubules and Loop of Henle
* example: mannitol
* used for increased ICP
140
Mannitol
osmotic diuretic
* draws fluid from intracellular to extracellular space
* increases renal blood flow
* may protect transplanted kidneys
* lowers ICP
141
Mannitol side effects
rebound intracranial hypertension and hyperosmolarity
142
Potassium-Sparing Diuretics
adjunct to other diuretics
* two categories
* pteridine and aldosterone receptor blockers
* Na+ excretion without K+ excretion
143
Pteridine analogs
Triamterene (dyazide) and Amiloride
* prevent Na+ reabsorption in the cortical collecting duct
* blocks ENa+ channels
144
Spironolactone
Aldosterone receptor blocker
* prevents the synthesis and activation of aldosterone via Na-K-ATPase pump
145
Atrial Natriuretic Peptide
endogenous substance produced in response to myocardial wall stretch
* acts on collecting duct
* Nesiritide
* synthetic ANP for CHF
146
PNS and the respiratory system
* regulates airway caliber and glandular activity via the Vagus nerve
* Ach activates muscarinic receptors
* bronchoconstriction
* anticholinergics produce vasodilation
147
Nonadrenergic-Noncholinergic system (NANC)
ANS derived influences on the bronchomotor tone through excitatory and inhibitory peptides
148
(2) Short-Acting inhaled adrenergic agonists
**albuterol** and metaproterenol
149
(2) Long-Acting adrenergic agonists
salmeterol and formoterol
150
example of short-acting inhaled cholinergic antagonist
ipratropium
151
Long-acting inhaled cholinergic antagonist
tiotropium
152
Ipratropium
| (atrovent)
inhaled cholinergic antagonist
* short acting
* used for COPD maintenance and asthma rescue
153
Tiotropium
| (spiriva)
inhaled cholinergic antagonist
* long acting
* maintenance of COPD
154
COPD and Asthma involve which similar cells in inflammation?
macrophages, lymphocytes, and eosinophils
Asthma: mast cell
COPD: neutrophils
155
example of inhaled corticosteroid
| (monotherapy)
fluticasone
## Footnote
**-nide or -sone**
156
Inhaled Corticosteroids
reduce inflammation
* combine with long-acting Beta-2 agonist
157
(2) Leukotriene Antagonists
Montelukast and Zafirlukast
158
(1) Leuketriene inhibitor
Zileuton
159
Cromolyn
mast cell stabilizer
* prevents the release of histamine
160
(2) Methylxanthines
Theophylline and Aminophylline
161
IV anesthetic bronchodilators
propofol, ketamine, and midazolam
162
(3) major causes of right heart failure
COPD, primary pulmonary hypertension, and OSA
163
Four classes of Pulmonary Hypertension
I - normal
IV - right heart failure
164
Ketamine
NMDA antagonist
* stimulates release and inhibits uptake of catecholamines
* maintains SVR
* prevents right-to-left shunting
* maintains coronary perfusion pressure
165
Propofol
GABA agonist
* decreases SVR
* increases right-to-left shunt
* may lead to right heart failure
166
Etomidate
GABA agonist
* no change in SVR
* coronary perfusion pressure maintained
* no change in R-to-L shunt
167
Which neuromuscular blocker increases PVR?
pancuronium
168
sympathetic stimulation ______ PVR
increases
169
all volatile agents ____ HPV
inhibit
(although modern agents are very weak dilators)
170
Management of PHTN
reduce right ventricular afterload while preserving coronary perfusion
171
(4) phases of clot formation
initiation, amplification, propagation, and stabilization
172
Thrombin
converts fibrinogen to fibrin
173
Factor XIII
promotes cross-linking of fibrin polymers to form a stable clot
174
(3) Anti-Coagulation agents
NO, prostacyclin, and anti-thrombin
175
Thrombomodulin
activates Protein-C and keeps thrombin at site of injury
176
Tissue Plasminogen Activator
| (t-PA)
activates plasmin from plasminogen
177
Protein C
inhibits factors Va and VIIIIa
178
VII is part of the _____ system of the coagulation cascade
Extrinsic
179
Prothrombin Time (PT)
evaluates the extrinsic and common pathways
* affected by reductions in prothrombin, V, VII, and X
180
International Normalized Ratio (INR)
standard measurement of PT
## Footnote
**0.08 - 1.2**
181
Partial Thromboplastin Time (PTT)
assess intrinsic pathway
## Footnote
**Heparin**
182
Activated Clotting Time (ACT)
used to measure high doses of **Heparin**
## Footnote
**90-150 seconds**
183
Bleeding Time
general measure of platelet function
## Footnote
**3 - 10 minutes**
184
Laboratory findings in Warfarin
| (or Vitamin K deficiency)
prolonged PT and slightly prolonged PTT
185
Laboratory findings in Von Willebrand's disease
prolonged PTT and bleeding time
186
Laboratory findings in Aspirin
prolonged bleeding time
187
Laboratory findings in Factor V deficiency
prolonged PT and PTT
188
DIC
Disseminated Intravascular Coagulation
189
Disseminated Intravascular Coagulation (DIC)
consumption of platelets and an inability to prevent thrombin formation
* coagulopathy and bleeding
* 10-50% mortality
* caused by a pathological activation of the hemostatic system
190
DIC diagnosis
* continued bleeding, petechiae
* low fibrinogen
* D-dimer levels (fibrin split products)
191
Hemophilia A
factor VIII deficiency
192
Hemophilia B
factor IX deficiency
193
TRALI
Transfusion Related Acute Lung Injury
194
Type A Blood
contains A antigens
| (anti-B antibodies)
195
When would you use FFP?
urgernt reversal of warfarn
196
"unit" of blood
10% of patient's estimated blood volume
197
Cryoprecipitate
precipitate of frozen plasma
* contains factor VIII, XIII, fibrinogen, and vonWillebrand
198
Leukoreduction
reduces white blood cells
* used in PRBC and platelets
* decreases exposure to non-ABO antigens and CMV
199
Which blood transfusions have the greatest risk of TRALI?
plasma \> platelets \> RBCs
200
Transfusion-Related Acute Lung Injury (TRALI)
hypoxia and pulmonary edema within 6 hours of transfusion
201
Which factors catalyze the transformation of Prothrombin to thrombin?
(II and IIa)
Factor Xa and Va
202
Heparin
binds to anti-thrombin to enhance coagulation
* highly charged acidic molecule
* poorly lipid soluble with a high molecular weight
203
Heparin Administration
IV (immediate onset)
Subcutaneous (1-2 hours)
204
Heparin side effects
hemorrhage, spinal hematoma, and allergic reactions
205
aPTT
| (activated plasma thromboplastin time)
30 - 35 seconds
## Footnote
**Heparin**
206
Enoxaparin
| (lovenox)
low-MW Heparin
* anti-factor Xa
* no PTT necessary
207
HIT
Heparin Induced Thrombocytopenia
208
Heparin Induced Thrombocytopenia
* Type I
* drug induced platelet aggregation
* 3-5 days after therapy
* Type II
* immune mediated response to prior exposure to Heparin
* severe thrombocytopenia
* 6-10 days after therapy
209
HIT treatment
Argatroban or Lepirudin
* warfarin is contraindicated
* discontinue heparin, substitute with LMWH
210
Protamine
reverses heparin-induced anticoagulation
* strongly alkaline
* 1.3 mg protamine per 100 units Heparin
* administer slowly
211
Protamine side effets
* hypotension
* pulmonary hypertension and vasoconstriction
* bronchoconstriction
212
Protamine allergic reactions
fish allergies, NPH insulin, and vasectomy
* pretreat with histamine antagonist (H2 blockers)
213
Warfarin
| (coumadin)
inhibits vitamin K
(alters prothrombin, factors II, VII, IX, and X)
* crosses the placenta
* measured by PT and INR
* does NOT alter platelet activity
214
Reversal of Warfarin Therapy
Vitamin K or FFP
215
How long should you wait before having surgery when using LMWH?
12 hours
216
How long should you wait before having surgery with unfractionated Heparin?
4 - 6 hours
217
How long should you wait before having surgery while using Warfarin?
5 days
| (INR \< 1.5)
218
Aspirin
ADP inhibitor that stops thromboxane synthesis
* irreversible effect
* **COX inhibitor**
219
Plavix
| (clopidogrel)
blocks ADP on surface of platelets
* blocks platelet activation
* irreversible
220
(3) GIIB/IIIA antagonists
**Ab**ciximab, Tirofi**ba**n, and Eptifi**ba**tide
221
Bivalirudin
| (angiomax)
direct thrombin inhibitor
* used in patients at risk for HIT
* monitor with ACT
222
(2) Direct Xa inhibitor
Rivaroxaban (xarelto)
Apixaban (eliquis)
223
Epsilon Aminocaproic Acid (EACA)
lysine analog that prevents lysis of clots
(anti-fibrinolytic)
224
Tranexamic Acid
anti-fibrinolytic
225
Massive Blood Transfusion
Definition
* \>10 RBC units
* transfusion of \>4 RBC in 1 hour
* replacement of \>50% of TBV within 3 hours
* transfusion support to loss of blood \> 150mL/min
226
TEG
| (picture)
227
Lepirudin
| (Refludan)
used for HIT and prevention of further VTE
* monitor with aPTT
* stop 24 hours before surgery
* irreversible thrombin inhibitor
228
Dabigatran
| (pradaxa)
used for total hip/knee, VTE, and a-fib
* monitor with thrombin times and aPTT
* stop 48 hours before surgery if normal renal function
229
(6) Pro-Hemostatic Agents
* anti-fibrinolytic agents
* aprotinin, tranexamic acid
* DDAVP
* Protamine
* factor concentrates
* recombinant factors
* thrombin
230
(6) Anticoagulants
* heparin
* warfarin
* LMWH
* direct thrombin inhibitors
* platelet inhibitors
* aspirin, plavix
* platelet glycoprotein IIB/IIIA
231
vomiting center
medulla oblongata
* sends signals through CN X to vagal parasympathetic fibers and sympathetic chain to muscles
232
Apfel scoring system
cateogorizes risk of PONV
233
Scopolamine
transdermal anticholinergic
* blocks transmission of impulses to the medulla
234
Metoclopromide
| (reglan)
Dopamine Antagonist used for PONV
* increases gastric motility and contracts esophageal sphincter
* readily crosses BBB
* benzamide
235
Midazolam in PONV
| (versed)
benzodiazepine
* decrease synthesis and release of dopamine in CRTZ
* 2 mg
236
Droperidol in PONV
Butyrophenone
* 0.625 - 1.25 mg
* concern for cardiac arrhythmias secondary to prolonged QT interval
237
Dexamethasone
Glucocorticoid for PONV
* relatively contraindicated in diabetics and obese patients
* administer slowly or burning genitals
238
Serotonin
5-HT3
* endogenous vasoactive substance and inhibitor neurotransmitter of CNS
* 90% present in enterochromaffin cells of the GI tract
239
(3) 5-HT3 Antagonists
Ondansetron (zofran)
Graniestron (kytril)
Dolasetron (anzemet)
240
Neurokinin-1 Antagonists
treatment for PONV
* aprepitant and fosaprepitant
* more effective when combined with dexamethasone
241
Sodium Citrate
| (bicitra)
non-particulate antacid
* commonly used in parturients
242
H1 Antagonists
anti-emetic
* may cause sedation, urinary retention, and QT interval changes
* **contraindicated in patients with glaucoma or taking MAO inhibitors**
* examples
* Benadryl and Phenergan
243
Dimenhydrinate
| (dramamine)
H1 Antagonist
* used for motion sickness and strabismus surgery
244
H1 Antagonist side effects
somnolence, dry mouth, urinary retention and QT prolongation
245
H2 Antagonists
inhibits histamine binding to gastric parietal cells
* examples:
* rantidine (zantac), Famotadine (pepcid)
246
Omeprazole
| (prilosec)
proton-pump inhibitor
* increases pH and decreases volume
* crosses the BBB
247
Metoclopromide side effects and contraindications
* do not administer to:
* Parkinson disease
* restless leg
* MAO inhibitors
* tricyclic anti-depressants
* may cause hypotension, tachycardia, bradycardia,
* inhibitory effect on plasma cholinesterase activity
248
Insulin secretion
pancreatic islets of Langerhans
249
Insulin
| (effects on cells)
* facilitates glucose diffusion into cells
* shifts intracellular glucose metabolism towards glyocogen storage
* stimulates K+ uptake and protein synthesis
250
Azotemia
Increased production and excretion of urea and ammonia
251
Type I Diabetes
auto-immune destruction of pancreatic Beta cells
* do not produce insulin
252
A1C
reflects glucose control over 3 months
* should be less than 7%
253
(2) very rapid Insulin
Humalog and NovoLog
254
(1) rapid-acting insulin
Humulin
| (regular insulin)
255
(2) Long-Acting Insulin
Lantus and Levemir
256
Degludec
| (Tresiba)
longest acting insulin
257
What is the only insulin that can be given IV
regular insulin
258
Insulin
site of injection
abdomen \> arm \> buttocks \> thigh
259
Rule of 1800
calculates insulin sensitivity
* 1800/total daily dose of insulin (units)
* = reduction of glucose/unit
Assuming 60 units per day, each unit of insulin should lower blood sugar by 30 mg/dL
260
\_\_\_\_\_ results in a hyperadrenergic state
hypoglycemia
* tachycardia, sweating, anxiety
261
Glucagon
works opposite of insulin
* synthesized in pancreatic islet A cells
* reduced secretion by BB
* can cause hypoglycemia
262
SAMBA
glycemic control for the perioperative period
263
(4) types of Hypoglycemic agents
* sulfonylureas
* meglitinides
* biguanides
* thiazolidinediones
264
Pioglitazone
| (actos)
oral hypoglycemic agent
* thiazolidinedinones
265
Rosiglitazone
| (avandia)
oral hypoglycemic agent
* thiazolidinediones
266
Sulfonylureas
stimulate the release of insulin from pancreatic Beta cells
* may cause hypoglycemia
267
Meglitinides
stimulates insulin secretion
* fast acting and short duration
* example: Repaglinide (prandin)
268
Biguanides
inhibits glucose production by the liver
* example: Metformin (glucophage)
* possible lactic acidosis
269
Thiazolidinediones
increase sensitivity to insulin for glucose uptake by skeletal muscle
* not a risk for hypoglycemia
* Examples: avandia and actos
270
Levothyroxine
T4
* easily overlooked in post-op orders, may present as "failure to thrive"
271
Treatment of Mineralcorticoid deficiency
Fludrocortisone
| (florinef)
272
Addison's disease
adrenal failure where the body does not produce enough steroid hormones
* low blood pressure, nausea, vitiligo
273
Cushing's Syndrome
exccess steroids
* weight gain, slow healing, fatigue, gluocse intolerance
274
Vasopressin
anti-diuretic hormone
* secreted by posterior pituitary
* arterial vasoconstrictor and reabsorbs water
275
Vasopressin side effects
* vasoconstriction and increased BP
* increased pulmonary artery pressure
* coronary ischemia
* increased peristalsis
276
Oxytocin
| (pitocin)
indirect stimulation of uterine muscle to induce labor and reduce uterine atony
* secreted by posterior pituitary
277
Ocetreotide
| (sandostatin)
somatostatin that inhibits release of growth hormone
* used to treat acromegaly and acute carcinoid crisis
278
SBE
subacute bacterial endocarditis
279
\_\_\_\_ do not need to distinguish between positive and negative
anaerobes
280
Redose of antibiotics
2 1/2 half lives
281
Cefazolin
| (ancef)
1st generation cephalosporin
* gram positive and negative
* cross-reacts with PCN allergy
282
Cefoxitin
| (mefoxin)
gram positive and negative aerones AND anaerobes
283
Clindamycin
| (cleocin)
Lincosamides
* gram positive aerobes AND anaerobes
* may prolong NMD
* may cause superinfection with C.diff
284
recommended antibiotic for Urologic surgery
Fluroquinolones
285
Ciprofloxacin
| (cipro)
fluoroquinolones
* gram positive and negative
* pseudomonas
* increases serum level of Theophylline
286
Vancomycin
primary treatment for MRSA
* infuse over 60 minutes
* redman syndrome
287
Redman Syndrome
hypersensitivity to Vancomycin
* degranulation of mast cells and basophils
* flushing, red skin, hypotension
288
Fluoroquinolones side effects
tendonopathies
289
Levofloxacin
| (levaquin)
Fluroquinolones
avoid in patients with Myasthenia gravis
290
Gentamicin
Aminoglycoside
* may cause ototoxicity, nephrotoxicity, and potentiation of NMB
* give over 60 minutes
291
Metronidazole
| (flagyl)
treats C. diff and H. pylori
* give over 60 minutes
292
antibiotics contraindicated in pregnancy
fluroquinolones
293
