Mm Chapter 15. Adjuncts To Anesthesia

Front 1

Diphenhydramine competitively blocks

Back 1

H1-receptors.

Front 2

Many drugs with H1-receptor antagonist properties have considerable ___________________________ activity

Back 2

Many drugs with H1-receptor antagonist
properties have considerable antimuscarinic, or atropine-like, activity (eg, dry
mouth), or antiserotonergic activity (antiemetic).

Front 3

H2-blockers reduce the perioperative risk of aspiration pneumonia by 2X

Back 3

by decreasing gastric fluid volume and raising the pH of gastric contents.

Front 4

Metoclopramide works 3 ways

Back 4

increases lower esophageal sphincter tone,

speeds gastric emptying,

and lowers gastric fluid volume by enhancing the stimulatory effects of
acetylcholine on intestinal smooth muscle.

Front 5

Ondansetron, granisetron, and dolasetron selectively block

Back 5

Ondansetron, granisetron, and dolasetron selectively block serotonin 5-HT3
receptors, with little or no effect on dopamine receptors.

Front 6

5-HT3 receptors play an important role in

Back 6

the initiation of the vomiting reflex.

Front 7

Ketorolac is

works by

Back 7

Ketorolac is a parenterally administered nonsteroidal antiinflammatory drug
that provides analgesia by inhibiting prostaglandin synthesis.

Front 8

Clonidine useful in management of patients with

Back 8

neuropathic pain who become increasingly
resistant to epidural opioid infusions.

Front 9

Dexmedetomidine is a

Back 9

parenteral selective a2-agonist with sedative
properties. It appears to be more selective for the a2-receptor than clonidine.

Front 10

Naloxone reverses

Back 10

the agonist activity associated with endogenous or
exogenous opioid compounds.

Front 11

useful in the reversal of benzodiazepine sedation and the treatment of benzodiazepine overdose.

Back 11

Flumazenil

Front 12

Aspiration does not necessarily result in aspiration pneumonia. The
seriousness of the lung damage depends on

Back 12

the volume and composition of the aspirate.

Front 13

Patients are at risk for aspiration pneumonia if 2X

Back 13

their gastric volume is greater than 25 mL (0.4 mL/
kg) and their gastric pH is less than 2.5.

Front 14

Histamine is found in 3X

Back 14

the central nervous system, in the gastric mucosa, and in
other peripheral tissues.

Front 15

Histaminergic neurons are primarily located in

Back 15

the posterior hypothalamus but have wide
projections in the brain.

Front 16

Histamine also normally plays a major role in the secretion of

Back 16

hydrochloric acid by parietal cells in the stomach

Front 17

The highest concentrations of histamine are found in

Back 17

the storage granules of circulating basophils and
mast cells throughout the body.

Front 18

Mast cells tend to be concentrated in

Back 18

connective tissue
just beneath epithelial (mucosal) surfaces.

Front 19

Histamine release (degranulation) from mast cells can be triggered by 3X

Back 19

chemical, mechanical, or immunological stimulation

Front 20

Secretion of hydrochloric acid is normally mediated by

Back 20

gastrin-induced histamine release from
enterochromaffin-like cells in the stomach.

Front 21

Two receptors, _____ ans _____ mediate the effects of histamine.

Back 21

H1 and H2,

Front 22

The H1-receptor
activates

Back 22

phospholipase C,

Front 23

H2-receptor activates

Back 23

increases intracellular cyclic
adenosine monophosphate (cAMP).

Front 24

An H3-receptor is primarily located on

Back 24

histaminesecreting
cells and mediates negative feedback, inhibiting the synthesis and release of
additional histamine.

Front 25

Cardiovascular
Histamine

Back 25

reduces arterial blood pressure but increases heart rate and myocardial
contractility

Front 26

Cardiovascular
H1-Receptor stimulation increases

Back 26

capillary permeability and enhances
ventricular irritability,

Front 27

Cardiovascular
H2-receptor stimulation

Back 27

increases heart rate and increases contractility.

Front 28

Respiratory
Histamine

Back 28

constricts bronchiolar smooth muscle via the H1-receptor. H2-Receptor
stimulation may produce mild bronchodilation.

Front 29

Respiratory
Histamine

H1-receptor

Back 29

appears to mediate some pulmonary
vasodilation

Front 30

Respiratory
Histamine

H2-receptor

Back 30

histamine-mediated
pulmonary vasoconstriction.

Front 31

Gastrointestinal

Activation of H2-receptors

Back 31

parietal cells increases gastric acid secretion

Front 32

Gastrointestinal
Stimulation of H1-receptors

Back 32

leads to contraction of intestinal smooth muscle

Front 33

histamine Dermal

Back 33

The classic wheal-and-flare response of the skin to histamine results from
increased capillary permeability and vasodilation and is primarily via H1-receptor
activation.

Front 34

Immunological
Histamine

Back 34

is a major mediator of type 1 hypersensitivity reactions (see Chapter
46). H1-Receptor stimulation attracts leukocytes and induces synthesis of prostaglandin.
In contrast, the H2-receptor appears to activate suppressor T lymphocytes.

Front 35

diphenhydramine blocks

Back 35

competitively blocks H1-receptors

Front 36

Promethazine is a

blocking properties 2x

Back 36

phenothiazine derivative with H1-
receptor antagonist activity as well as antidopaminergic and -adrenergic–blocking
properties.

Front 37

Antacids neutralize the acidity of gastric fluid by

Back 37

providing a base (usually
hydroxide, carbonate, bicarbonate, citrate, or trisilicate) that reacts with hydrogen ions to
form water.

Front 38

Metoclopramide acts peripherally as

centrally as

Back 38

acts peripherally as a cholinomimetic (ie, facilitates acetylcholine
transmission at selective muscarinic receptors) and centrally as a dopamine antagonist.

Front 39

Metoclopramide produces an antiemetic effect by

Back 39

blocking dopamine receptors in
the chemoreceptor trigger zone of the central nervous system

Front 40

metoclopramide is
contraindicated in

Back 40

patients with complete intestinal obstruction

Front 41

(Prilosec), lansoprazole (Prevacid), rabeprazole
(Aciphex), and pantoprazole (Protonix)

work by

Back 41

bind to the proton pump of parietal cells in the
gastric mucosa and inhibit secretion of hydrogen ions.

Front 42

Ondansetron (Zofran), granisetron (Kytril), and dolasetron (Anzemet) selectively
block serotonin

Back 42

5-HT3 receptors, with little or no effect on dopamine receptors

Front 43

Ketorolac is a parenterally administered nonsteroidal antiinflammatory drug (NSAID) that provides analgesia by

Back 43

by inhibiting prostaglandin synthesis

Front 44

ketorolac has a duration of action

Back 44

duration of action (6–8 h).

Front 45

ketorolac

heme wise

Back 45

ketorolac inhibits platelet aggregation and prolongs bleeding time

Front 46

ketorolac elimination

Back 46

ketorolac depends on elimination by the kidneys, it should not be given to patients in renal failure. Ketorolac is contraindicated in patients allergic to aspirin or NSAIDs.

Front 47

Mechanism of Action

Clonidine

Back 47

imidazoline derivative with predominantly a2-adrenergic agonist activity

penetrates the blood–brain barrier

activates inhibitory neurons.
The overall effect is to decrease sympathetic activity, enhance parasympathetic tone, and reduce circulating catecholamines

Front 48

clonidine

diabetic patients

Back 48

Lastly, clonidine can mask the symptoms of hypoglycemia in diabetic patients

Front 49

Mechanism of Action

Dexmedetomidine (Precedex)

Back 49

Dexmedetomidine (Precedex) is a parenteral selective 2-agonist with sedative properties

Front 50

Dexmedetomidine

principal side effects

Back 50

bradycardia, heart block, and hypotension

Front 51

Dexmedetomidine

recommended initial loading dose

Back 51

1 mcg/kg intravenously over 10 min with a maintenance infusion rate of 0.2–0.7 mcg/kg/h. Dexmedetomidine has a rapid onset and terminal half-life of 2 h.

Front 52

Mechanism of Action

Naloxone

Back 52

competitive antagonist at opioid receptors.

Naloxone has no significant agonist activity.

Front 53

Naloxone reverses

Back 53

the agonist activity associated with endogenous (enkephalins, endorphins) or exogenous opioid compounds.

Front 54

narcan
Abrupt reversal of opioid analgesia can result in

Back 54

sympathetic stimulation (tachycardia, ventricular irritability, hypertension, pulmonary edema) caused by pain perception, an acute withdrawal syndrome in patients who are opioid dependent or vomiting. The extent of these side effects is proportional to the amount of opioid being reversed and the speed of the reversal.