Test #2 Herbal and illicit drug PPt-Josh Flashcards Preview

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Flashcards in Test #2 Herbal and illicit drug PPt-Josh Deck (116):
1

Herbal Supplements:

are they regulated by FDA?


NOpe

2


Herbal Supplements:

is there rigorus testing such as with Rx meds?


nope

3


Herbal Supplements:

are the adverse effects all know?


nope

4


Herbal Supplements:

should be stoped how long prior to Sx


2 weeks

5


Herbal Supplements:

what is the most popular herbal remedy in currently in the US


Echinacea

6


Herbal Supplements: Echinacea

is beleived to improve immune system by how?


modulation of cytokine signaling

7


Herbal Supplements: Echinacea

is used for tx of what?


viral, bacterial, and fungal infections (especially URI)

8


Herbal Supplements: Echinacea

Chronic use can resut in what?


immunosupression and hepatic faiuler

9


Herbal Supplements: Echinacea

what are some periop considerations?


avaoid hepatotoxic drugs

avoid in immunosupressed pts (transplant)

10


Herbal Supplements: Echinacea

other names


purple coneflower

coneflower

American coneflower

11


Herbal Supplements: Ephedra

other names?


ma Huang

Herbal ecstasy

Cloud 9

(sounds bad ass)

12


Herbal Supplements: Ephedra

Sale is restricted in the US to Chinese Herbal Medicine only d/t adverse effects r/t dietary suppliments. what are some of those SE

 

  • Palpatations
  • HTN
  • Tacjycardia
  • Stroke
  • Seizures
  • Cardiomyopathy
  • MI
  • Dysrhythmias
  • Acute hepatitis
  • psychosis
  • death

13


Herbal Supplements: Ephedra

it contains what alkaloids?

 

  •  ephedrine
  • pseudoephedrine
  • methylephredrine
  • nor-pseudo-ephedrine

14


Herbal Supplements: Ephedra

has direct effect on ____ and ___ receptors and can indirectly increase the release of norepi for presynaptic neurons


alpha

beta

15


Herbal Supplements: Ephedra

Used for what 3 things

 


Weight loss

CNS stimulant

Asthma

16


Herbal Supplements: Ephedra

periop considerations

 

  • when combined with other sympathomimetics can cause
  • HTN
  • Dysrhythmias
  • Hyperthermia
  • CV instability

17


Herbal Supplements: Garlic

also called what?

Allium sativum

18

Herbal Supplements: Garlic

has been used for centuries to treat what?


CV disease

DM

Infections

Tumors

19


Herbal Supplements: Garlic

the _____ in garlic is beleived to decrease thromboxane formation and alter arachidonic metabolism


Cysteine

20


Herbal Supplements: Garlic

since it decreases thromboxane formation it can inhibit what?


platelet aggregation

21


Herbal Supplements: Garlic

can potentiate the anti-platelet effects of what drugs (2)?

Aspirin

NSAIDs

22


Herbal Supplements: Garlic

preop considerations

 

  • Assess bleeding risk
  • D?C 7 days b4 sx

23


Herbal Supplements: Ginger

also called what?


Ziingiber officinale

24


Herbal Supplements: Ginger

used to treat what?


Arthritis

GI d/o

Vertigo

antiemetic

 

25


Herbal Supplements: Ginger

the active component ______ is thought to inhibit prostaglandin and leukotriene sysnthesis


Gingerol

26

Herbal Supplements: Ginger

is also thought to inhibit ________ synthatase, thus decreasing platelet agregation


thromboxane

27


Herbal Supplements: Ginger

may ________ the effect of medications with anticoagulation properties

potentiate

28


Herbal Supplements: Ginger

periop considerations

 

  • assess for bleeding
  • Avoid in combination w/ other anticoagulants

29


Herbal Supplements: Gingko Biloba

is thought to do what?


protect vascular walls and nerve cells

30


Herbal Supplements: Gingko Biloba

is thought to protect vascular walls and nerve cells by acting as a _____-___ scavengers and ________ platelet activating factor

  • free-radical scavenger
  • inhibiting

31


Herbal Supplements: Gingko Biloba

was approved in Germany for the tx of ______


dementia

32


Herbal Supplements: Gingko Biloba

is also beleived to decrease blood viscosity and improve blood flow to tissues and is used to treat _____


PVD

33


Herbal Supplements: Gingko Biloba

periop considerations

 

  • Assess bleeding
  • Avoid w/ NSAIDs, Aspirin, Warfarin
  • D/C 36 hours prior to sx

34


Herbal Supplements: Ginseng

used in traditional Chinese medicine for what? (3 main things)


immunomodulation

Mood enhancement

aphrodisiac

35



Herbal Supplements: Ginseng

has mild sympathomimetic effect and may interact with what enzyme? tremors and mania have beenreported


Monoamine Oxidase Enzyme (MAO)

36



Herbal Supplements: Ginseng

does what to BGL


Hypoglycemia

37



Herbal Supplements: Ginseng

does what to platelet aggregation

interferes

38



Herbal Supplements: Ginseng

periop considerations

 

  • Monitor BGL
  • May increase bleeding (Assess)
  • D/c 7 days prior to sx

39



Herbal Supplements: Herbal Diuretics

what are 5 types

 

  • Dandelion
  • Green tea
  • Goldenseal
  • Saw Palmetto Berries
  • Spearmint

40


Herbal Supplements: Herbal Diuretics

the MOA is uncertain but it is thought to interfers with the _____ system

RAAS

41


Herbal Supplements: Herbal Diuretics

do to the diuretic effects significant ____ and _____ disturbances are associated with their use?


fluid and electrolyte

42

Herbal Supplements: Herbal Diuretics

periop considerations


monitor fluid and electrolytes

correct prior to sx

43


Herbal Supplements: KAVA

another name


Piper methysticum

44



Herbal Supplements: KAVA

derived for the dried root of the ___ plant family


pepper

45



Herbal Supplements: KAVA

what is it used for


anxiolytic and Sedative effects

46



Herbal Supplements: KAVA

the anxiolytic and seditive effect are mediated by potentiation of what?


GABA

Gamma-aminobutyric acid

47



Herbal Supplements: KAVA

potentiated effects of what drugs


barbs

Benzos

48



Herbal Supplements: KAVA

SE are seen in what organ


hepatotoxicity

(LIVER)

49



Herbal Supplements: KAVA

Perioperative considerations


may reduce MAC

Avaoid hepatotoxic drugs

D/C 24hrs prior to sx

50



Herbal Supplements: St. John's Wort

Another name


Hypericum perforatum

51


Herbal Supplements: St. John's Wort

is widely used in western societies as what?


antidepressant for mood disorders

52

Herbal Supplements: St. John's Wort

similar to more convential antidepressents , and it's effects are thought to be b/c of thr inhibition of _______, ______, and _______ re-uptake by neurons


Serotonin

Noorepinephrine

Dopamine

53


Herbal Supplements: St. John's Wort

found to be equal to _______antidepressants (drug class) in the treatment of mild to moderate depressive d/o


tricyclic

54


Herbal Supplements: St. John's Wort

periop considerations

 

  • can lead to serotonergic syndrome
  • may increase metabolism of Drugs (d/t potent inducer of CYP450)
  • reduces anticoagulation effect of drugs
  • Sedative properties may prolong anesthestic drugs
  • D/C 5 days b4 sx

55

Herbal Supplements: Valerian

another name?

Valeriana Officnialis

56


Herbal Supplements: Valerian

has been used as what?


Anxiolytic sedative

57


Herbal Supplements: Valerian

produces dose dependent sedation and hypnosis, possiably d/t inhibition of _____ breakdown and re-uptake


GABA

58


Herbal Supplements: Valerian

acutly stopping will cause what?


withdrawl

59


Herbal Supplements: Valerian

periop considerations

 

  • Decrease MAC
  • Benzo like withdrawl if sudden stop

60

Illicit Drug Use:

what are signs that indicate illicit drug use?

Track marks

thrombotic veins

Phlebitis

Tattoos

ablation of venous return (unilateral edema)

Sub Q abcess

61


Illicit Drug Use: Opthalmologic Changes

opiods


constriction (miosis)

62


Illicit Drug Use: Opthalmologic Changes

Amphetamines


Dilation (Mydriasis)

63


Illicit Drug Use: Opthalmologic Changes

PCP


Nystagmus

64


Illicit Drug Use:

malnourishment is usually seen in what obusers opiod or amphetamines?


Amphetamines

65



Illicit Drug Use:

Poor dentation is usually associated with abusers of what drugs


Amphetamines

66



Illicit Drug Use:

nasal perforation is isually from what drug abuse


Cocaine

67



Illicit Drug Use:

S/S of withdrawl (abstinence)

HTN

Tachycardia

Abdominal pain Cramping

Diahrrea

Tremors anxiety

irritability

Lacrimation

Mydriasis

algid sweating

yawning

68


Illicit Drug Use:

suspection of Drug abuse should be followed up with what?


urine drug screen

69



Illicit Drug Use: Marijuana
other names


pot

hash

grass

weed

THC

70


Illicit Drug Use: Marijuana

obtained from what plant


Cannabis Sativa

71


Illicit Drug Use: Marijuana

What is the active ingrediant


Delta-9-tetrahydrocannabinol (THC)

72


Illicit Drug Use: Marijuana

effects


possible antiemetic

analgesia

anticonvulsant

appatite stimulant

73


Illicit Drug Use: Marijuana

1/2 life


56 hours for occasional users

28 hrs for chronic users

74


Illicit Drug Use: Marijuana

why is the tissue half life so long? (1 weeks)


d/t sequestering in adipose tissue

75


Illicit Drug Use: Marijuana

complete elimination of a single dose may take up to how many days


30 days

76


Illicit Drug Use: Marijuana

metabolized by the _____ into more than 20 metabolites (most w/ psychoactive properties)


Liver

77


Illicit Drug Use: Marijuana

frequent use can lead to what?

 

  • cognative impairment
  • Shorted memory span
  • Confusion
  • altered time perception
  • Dulled reflexes
  • diff with ADLs

78


Illicit Drug Use: Marijuana

low or moderate doses _______ sympathetic activity and ________ parasympathetic activity. which results in what?

 

  1. increases
  2. decreases
  3. tachycardia and increased CO

79


Illicit Drug Use: Marijuana

High doses ______ sympathetic activity but not parasympathetic activity, leading to  what

 

  • inhibit
  • Hypotension & bradycardia

80


Illicit Drug Use: Marijuana

combination with other sedatives (ETOH, Benzo) may enhance _____ Depression


CNS

81


Illicit Drug Use: Marijuana

effects on CV

  • Myocaridal depression and and HR
  • BP and HR drugs
  • What drugs should you avoid

 

  • increased Myocadial depression and tachycardia
  • Potentiates BP and HR drugs
  • Avoid drugs that increase HR (ketamine, panc, atropine, ephedrine)

82


Illicit Drug Use: Marijuana

respiratory effects

 

  • Upper airway irritability
  • Cough/bronchitits/ COPD/ bronchospasm
  • Upper airway edema

83


Illicit Drug Use: Marijuana

some reccomend administration of what drug as prophylaxis from airway edema and irritation prior to GA


Dexamethasone

84


Illicit Drug Use: Opioids

S/S of opioid craving

 


lacrimation

Rhinorrhea

yawning

Piloerection

 

85


Illicit Drug Use: Opioids

S/S of opiod overdose

 

  • Slow RR
  • Increased TV
  • Miotic pupils

86


Illicit Drug Use: Opioids

s/s of withdrawl

 

  • restlessness
  • insomnia
  • mydriasis
  • tachycardia
  • tachypnea
  • HTN
  • Dysphoria
  • Unconciousness
  •  

87


Illicit Drug Use: Opioids

when does withdrawl occur? when does it peak?


4-6 hours post last intake

peaks 48-72 hours

88


Illicit Drug Use: Opioids

treatment for withdrawl


Opioids

Methadone

Clonidine

 

89


Illicit Drug Use: Opioids

what drugs do you want to avoid, bc they can cause withdrawl


Nubain

Narcan

90


Illicit Drug Use: Opioids Anesthestic considerations

Acute opiiod intoxication does what to MAC


decreases

91


Illicit Drug Use: Opioids Anesthestic considerations

Chronic opioid abuse does what to MAC


increases it

92


Illicit Drug Use: Opioids Anesthestic considerations

why do abusers usually have exaggerated pain post op?

 

  • decreased pain tolerance
  • decreased productionof endogenous opioids (endorphins, Enkephalins)
  • increased post op Opioid requirement

93


Illicit Drug Use: Cocaine

extracted from the leaves of what plant?


Erythroxylon coca

94



Illicit Drug Use: Cocaine

available in what hydrochloride forms


powder

granules

crystals

 

95



Illicit Drug Use: Cocaine

alkalinizide form (highly addictive) is called what


Crack

rock

free base

 

96



Illicit Drug Use: Cocaine

When Smoked injected, snorted or ingested orally inhibits _________ uptake of sympathomimetic NT (AKA NE, Serotonin, Dopamine)


Presynaptic

97



Illicit Drug Use: Cocaine

produces a pwerful euphoria lasting ____-___ min as a result of free catecholamines stimulation


5-30 min

98



Illicit Drug Use: Cocaine

blood flow to arteries in areas like the ___ & ____may be compromised as the vessels vasoconstrict or vasospasm temporarily, severly compromising oxygenation and supply; this may lead to irreversable brain damage, stroke, and MI


Heart and brain

99



Illicit Drug Use: Cocaine metabolism

_____ _____ across lipid membranes d/t low molecular weight and High lipid solubility


Easilly diffused

100


Illicit Drug Use: Cocaine metabolism

metabolised to water soluble metabolites abd excreted in _____


urine

101


Illicit Drug Use: Cocaine metabolism

biological 1/2 life?


0.5-1.5 hr

102


Illicit Drug Use: Cocaine metabolism

______ cholenesterases metabolizes 75-90% of cocaine into ____ INACTIVE metabolites, which can be detected 15-60 min after intacke!

Also name the metabolites

  • Plasma
  • 2
  • ecgonine methyl ester & Benzolecgonine

103


Illicit Drug Use: Cocaine metabolism

_____ cholinesterase metabolizes 10% of cocaine into ______, an ACTIVE metabolite that produce similar actions as cocaine

LIver

norcocaine

104


Illicit Drug Use: Cocaine metabolism
Plasma cholinesterase deficiences results in greater liver cholinesterase metabolism whch can ______ the effects of cocaine and increase the risk of complications


Prolong

105


Illicit Drug Use: Cocaine metabolism

only 1-1.5% is cleared unmetabolized in the urine allowing ots detection only ___ hours after its use

3-6

106

Illicit Drug Use: Cocaine Anesthesia considerations:

although rare acute aortic dissection can occur, perhaps a consequence of abrupt, sever HTN, from ______ release


catecholamine

107


Illicit Drug Use: Cocaine Anesthesia considerations:

Why must you be careful with regional


Cocain induced thrombocytopenia can occur form cocaine use

108


Illicit Drug Use: Cocaine Anesthesia considerations:

why may HTN occur with regional


peripheral vasoconstriction

109


Illicit Drug Use: Cocaine Anesthesia considerations:

Regional

Ephdrine resitant Hypotension may occur. what drug may correct this


Phenylephrine

110


Illicit Drug Use: Cocaine GETA

What drugs are contraindicated to treat Severe HTN an dCardiac arrhythmias

 

  • BBs
  •  

111


Illicit Drug Use: Cocaine GETA

why is hydralazine good for HTN in these ots?


vasodilation effects and decreased SVR

(watch for tachycardia relfex)

112


Illicit Drug Use: Cocaine GETA

VAAs and especially _______ may produce arrhythmias


Halothane

113

Illicit Drug Use: Cocaine GETA

why is ketamine avoided


CNS stimulat effects- increases catecholamines

114


Illicit Drug Use: Cocaine GETA

why shoud etomidate be avoided


myoclonus

seizures

hyperreflexia

115


Illicit Drug Use: Cocaine GETA

what may happen to SCh duration and why?


prologation

d/t depletion of cholinesterase by cocaine metabolism

 

116


Illicit Drug Use: Cocaine GETA

what drug may delay cocain induced seizure activity and increase the cumulative doses of cocaine necessary to produce seizures


Dexmedetomidine