Pharmacology Flashcards
1
Q
FFP
A
- Fresh frozen plasma
- 1 unit is the plasma from 1 unit of whole blood
- Approximate volume is 250-300ml
- Contains proteins / clotting factors
- Used for coagulation factor deficiencies, rapid warfarin reversal, massive transfusion protocols.
- Must be ABO compatible
- AB+ is the universal plasma donor (no antibodies against A, B, or RhD)
2
Q
Slowing Ostomy Output
A
- Imodium (Loperamide)
- mu opioid agonist in the myenteric plexus.
- Decreases tone of intestinal smooth muscles
- Lomotil (Diphenoxylate/Atropine)
- Diphenoxylate is an opioid agonist
- Decreases smooth muscle tone
- Diphenoxylate is an opioid agonist
- Tincture of Opium (Laudanum)
- 10% powdered opium by weight
- Decrease smooth muscle tone
3
Q
What is the risk of severe side effects from pelvic radiation?
A
- 7-8%
4
Q
DVT Prophylaxis
A
- Heparin
- Lovanox
- Fondaparinix - used for patients with history of HITT
- SCD’s
5
Q
Heparin
A
- Anticoagulant
- Binds antithrombin III and activates it –> ATIII inhibits clotting factors, especially Thrombin and Xa
- Effects measured by aPTT
- Peak effect: IV = instant, SQ = 30min.
- Dosing for DVT PPX is 5,000 units SQ 2h pre-op and then 5,000 units BID or TID.
6
Q
Lovenox (Enoxaparin)
A
- Anticoagulant - Low molecular weight heparin
- Binds antithrombin III and activates it –> ATIII inhibits clotting factors, especially Thrombin and Xa
- Effects measured by aPTT (Intrinsic / Combined pathway)
- Peak effect 3-5h after administration
- DVT PPX: 30mg BID or 40mg QD. May increase up to 60mg BID for morbid obesity
- Therapeutic: 1mg/kg BID or 1.5mg/kg QD
- Dosing may need to be adjusted for Cr clearance <30 [renal dosing]
7
Q
Fondaparinux (Arixtra)
A
- Anticoagulant - Antithrombin III mediated inhibition of factor Xa
- Effects measured by aPTT (Intrinsic / Combined pathway)
- Peak effect 2-3h after administration
- DVT PPX: 2.5mg SQ QD. Prophylactic dosing CI in patients <50kg
- Therapeutic:
- <50kg = 5mg SQ QD
- 50-100kg = 7.5mg SQ QD
- >100kg = 10mg SQ QD
8
Q
Treatment of Neutropenic Fever
A
- Empiric antibiotics
- At Loyola - Mirapenam
- add Vancomycin if history of MRSA or if patient not improving on Mirapenam alone
- Neupogen
9
Q
Neupogen (Filgrastim)
A
- Granulocyte colony stimulating factor (G-CSF)
- Stimulates production, maturation, and stimulation of Neutrophils
- Start dosing at 5mcg/kg/day SQ or IV
- Do not give within 24h of the chemo
- Maximum ANC 3-5d after administration
10
Q
Meropenam
A
- Antibiotic
- Inhibits cell wall synthesis by binding penicillin binding proteins
- Off label for neutropenic fever - 1g IV TID
- Penetrates body fluids very well (peritoneal fluid, CSF)
- Spectrum of activity includes some Gram+, Gram- including Pseudomonas, and anaerobes
11
Q
Albumin
A
- Usually comes as 5% solution = .05g/ml
- 1 unit of albumin is approximately 250ml (12.5g)
- Colloid given
12
Q
Hespan (Hetastarch)
A
- Plant colloidal starch
- One unit is 500ml and 6% starch = 30g
- Used for plasma volume expansion
- Maximum daily dose 1-1.5L, which is limited by interference with platelet function.
13
Q
Perioperative Anti-Hypertensives in Chronic Hypertension
A
- Beta blockers are the only hypertensives that have to be continued in the perioperative period.
14
Q
WBC Nadir Following Chemotherapy
A
- 5-7 days
15
Q
NSAIDs and Anticoagulants
A
- NSAIDs should not be used in patients on therapeutic doses of anticoagulants.
- NSAID use likely OK in patients on prophylactic doses of anticoagulants.
