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47 Cards in this Set
- Front
- Back
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True or False: Not all patients require pre-operative medications.
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True: requirements are driven partially by medical conditions
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What conditions require preoperative medications?
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Asthma
Diabetes Hypertension |
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What determines which drugs a patient requires preoperatively?
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Type of surgery
Current medical condition Pharmacologic effect of the medication Interaction with anesthetics |
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What are some typical classes of chronic medications under consideration for preoperative requirements?
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Antihypertensives
Bronchodilators TCA's SSRI's Thryoid Corticosteroids Anxiolytics Anticonvulsants NSAIDS, Plavix, ASA, Coumadin |
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Should corticosteroids be continued preoperatively? And why/why not?
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Yes. Withdrawing the steroids could cause the HPA to shut down.
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Can Coumadin be used preoperatively?
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No. Stop it 7-10 days prior to begin therapy with heparin or heparin-like medication.
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What are the goals of preoperative medications?
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Reduce anxiety
Produce sedation Prevent autonomic response intraoperatively Reduce salivation and other secretions |
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True or False: The use of clonidine perioperatively can increase the need for anesthetics and opiods.
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False: Clonidine can reduce the need.
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When is a patient at increased risk for aspiration pneumonia?
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if gastric pH <2.5 or gastric volume >25mL
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In regards to aspiration pneumonia, what two conditions need to be considered for increased risk?
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Diabetics - gastroparesis
Late term pregnancy - hormonal changes delay gastric emptying |
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What are the advantages and disadvantages for using antacids pre-operatively?
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Advantage: they act instantly
Disadvantage: they are short-acting, taste bad, and add volume to the stomach |
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What is important to remember when preparing antacids pre-operatively?
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Must be non-particulate (particles can add to damage if aspirated.)
Non-particulate means solution, not suspension. |
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Do prokinetics have any effect on gastric pH or acid secretion?
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No.
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What drugs can offset the affect of prokinetics?
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Opioids or anticholinergics
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True or False: IV pantoprazole used preoperatively has shown better efficacy than IV ranitidine.
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False: IV pantoprazole is good, but studies show no difference from IV ranitidine
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What is the purpose of anesthetics?
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unconsciousness, analgesia, amnesia, immobility, attenuation of autonomic response
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By what mechanism do most anesthetics work?
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GABA: medication binds to receptor, which reduces rate of GABA dissociation which produces hyperpolarization which inhibits nerve transmission which leads to hypnosis.
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How does Ketamine work?
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it dissociates cortex and thalamus within the limbic system.
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What drugs are used for induction of anesthesia?
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Thiopental and methohexatol.
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What signs/symptoms would you see in ARDs?
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tachycardia, hypertension
hiccups, seizures, hallucinations |
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What are examples of volatile inhalation agents?
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Desflurane
Sevoflurane Isoflurane |
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What are the advantages of using volatile inhalation agents?
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Can produce all components of anesthetic state to varying degrees
Administered through lungs, which gives excellent control |
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When using volatile inhalation agents, how do you get a balanced sequence?
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Combine with other agents
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What is the mechanism of action for volatile inhalation agents?
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it's not well understood: it may inhibit or excite.
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Regarding solubility, what is the advantage of volatile inhalation agentings?
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the decreased solubility is increased lipophilicity which leads to a quicker response and quicker emergence.
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How do neuromuscular blocking agents work?
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Depolarizing: succinylcholine acts like ACh but remains on the receptor longer, not allowing it to repolarize.
Nondepolarizing: competitively block receptor |
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What drugs interact with neuromuscular blocking agents?
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aminoglycoside, furosemide, mag sulfate potentiate
- nondepolarizing agents may be reversed with cholinesterase inhibitors |
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What are the two types of local and regonal anesthesias?
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Amides and Esters
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What is novocaine? What is lidocaine?
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Ester
Amide |
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How do esters and amides work?
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they block sodium channels, so there is no depolarization.
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What causes the allergy to esters?
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the metabolite PABA
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If a patient is allergic to esters, what do you use instead?
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An amide that is preservative and Epi free.
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What are the side effects of local and regional anesthesia?
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CNS, Cardiovascular, metallic taste, hypotension, tremor, seizure, arrhythmia.
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What is the metabolism of amides? Esters?
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Amides - p40
Esters - plasma cholinesterase |
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True or False: As protein binding increases, duration increases.
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True.
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True or False: The higher the pKa, the faster the onset.
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False: the lower pKa, the faster the onset.
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When using droperidol for post op nausea and vomit, what do you have to monitor?
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EKG monitoring before and during.
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When do you give metoclopromide for post op nausea?
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at the end of surgery to be effective
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When do you give ondansetron (Zofran) for nausea and vomiting?
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At the end of surgery
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When do you use dexamethasone for vomiting?
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For highly emetogenic procedures; its given at the beginning of the surgery
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How do you use prochlorperazine (Compazine)?
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It's short duration, so you must give multiple doses.
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True or False: Prochlorperazine is better than Zofran for PONV.
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True.
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How long is the onset for the scopolalmine patch?
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Four hour onset
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When do you use dexamethasone for vomiting?
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For highly emetogenic procedures; its given at the beginning of the surgery
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How do you use prochlorperazine (Compazine)?
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It's short duration, so you must give multiple doses.
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True or False: Prochlorperazine is better than Zofran for PONV.
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True.
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How long is the onset for the scopolalmine patch?
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Four hour onset
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