Surgery and General Anesthesia Pharm Flashcards Preview

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Flashcards in Surgery and General Anesthesia Pharm Deck (25)
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1
Q

Opioids

A

Most widely used med for post-op pain

Bolus injection dosing most common, continuous infusions are dangerous

All are hepatically metabolized to active and inactive metabolites

  • these are eliminated in urine

Need dosing adjustments with severe liver disease

2
Q

Morphine

A

Rapid onset, duration of action 4-5 hours

IV 1-3 mg q5min

Neurotoxicities w/ renal insufficiency

-Myoclonus, confusion, coma, death

Relative CI w/ severe renal disease

Erratic GI absorption - have to give higher oral dose than IV

3
Q

Hydromorphone (Dilaudid)

A

Peak onset 30 mints

1/2 life: 2.4 hours

4-6X more potent than morphine

4
Q

Fentanyl

A

Synthetic morphine derivative - 100X more potent

No histamine release (no itchy); preferred w/ hemodynamic instability or bronchospams

Often used for procedural sedation - colonoscopy

IV for acute pain management

Transdermal is never for acute

5
Q

Meperidine

A

Short-term management of acute pain

CI w/ MAOI - lower seizure threshold

Dysphoric effect, less effective opioid

Slower metabolism rate in elderly or liver/renal failure

CI w/ PCA pump - risk for active metabolite accumulation

6
Q

Opioid Side Effects

A

Somnolence

Brainstem depression - respiratory drive

Hypotension

Urinary retention

N/V

GI slowing - constipation, ileus

Histamine release - MC after morphine; don’t get w/ fentanyl

7
Q

Transition from IV to oral

A

Switch to oral once patient can tolerate PO

Calculate 24 hour opioid consumption - use equianalgesic chart

PO analgesic effect in 30-60 minutes

Switch to Oxycodone, hydrocodone (2 MC); Hydromorphone and morphine

8
Q

Oxycodone Oral Combinations

A

Oxycodone/acetaminophen (Percocet)

Oxycodone/ibuprofen (Combunox)

Schedule II drug

9
Q

Hydrocodone Oral Combinations

A

Hydrocodone/acetaminophen (Lortab, Vicodin)

Hydrocodone/ibuprofen (Vicoprofen)

10
Q

Opioids to use in impaired renal function

A

Hydromorphone and oxycodone = inactive metabolites

Fentanyl - inpatient only

11
Q

Opioid Reversal

A

Naloxone (Narcan)

Reverse respiratory depression

IV, IM, subQ, endotracheally

0.04-0.4 mg initially, repeat until response or 0.8 total

12
Q

NSAIDs

A

Can reduce needed opioid dose

Caution with kidney impairment

IV Nonselective have higher incident rate of GI bleed

13
Q

Nonselective NSAIDs - IV and PO

A

IV: Ketorolac, ibuprofen

PO/PR: ibuprofen, Diclofenac, Ketoprofen

14
Q

Selective NSAIDS

A

No IV formulation selective

PO/PR: Celecoxib (Celebrex)

15
Q

Other non-opioid adjunctive medications

A

Ketamine - NMDA receptor inhibitor, causes hallucinations

Acetaminophen - CI hepatic failure, can give + NSAIDs

Lidocaine - Class 1 antiarrhythmic - most effective for major abdominal surgery

Magnesium sulfate - NMDA receptor antagonist, rarely used despite effectiveness

16
Q

Anesthesia Induction Drugs

A

Propofol - MC used; causes BP and cardiac output drop

-has antiemetic properties

Etomidate: no vasodilation or antiemetic effects, increased risk of death and cortisol biosynthesis inhibitor

Ketamine: used w/ hemodynamic instability - cardiac stimulation

-get hallucinations

17
Q

Anesthesia Maintenance Drugs

A

Inhaled: volatile (seroflurane/desfluane), nitrix oxide (in combo w/ volatile, never alone)

IV anesthetics: propofol, remfentanil

18
Q

Anesthesia Emergence Drugs

A

To blunt autonomic hyper-response (tachycardia, HTN, bronchospasm, laryngospasm)

Short term narcotics

Beta blocker

Lidocaine

19
Q

Propofol (Diprivan)

A

Nonbarbiturate

Rapidly metabolized in liver and excreted in urine

Good for long duration surgery due to rapid onset, clearance, and reversibility (shut off drip)

40 second onset, 1-3 hour duration

Versed is a more potent amnesiac

SE: rapid microorganism growth, HOTN, hypertonia/movement, respiratory depression

20
Q

Ketamine

A

Dissociative anesthesia - patient appears awake but is unresponsive to sensory stimuli

Commonly used in pediatric surgery, high risk geriatrics, and shock

Can give IM (peds), and provides cardiac stimulation

Use limited due to hallucinations

30 second onset, 5-10 minute duration

21
Q

Anesthetic Gas Keys

A

Reversibility matters here

The more soluble the gas, the longer the elimination period

NO and desflurane are the shortest acting

Disrupt normal synaptic transmission by altering neurotransmitter release, re-uptake, and binding to post-synaptic sites

22
Q

Minimum Alveolar Concentration (MAC)

A

Inhaled concentration where 50% of patients move in response to midline abdominal incision

Decreases with age

23
Q

Isoflurane

Desflurane

Sevoflurane

Nitrous Oxide

A

Isoflurane: Higher solubility, airway irritation, vasodilation and tachycardia

Desflurane: Lest well tolerated in airway - not for mask induction

Sevoflurane: Well-tolerated, no tachycardia

Nitrous Oxide:MAC 105% - never monotherapy

-No malignant hypothermia risk

24
Q

-curonium, Cisatracurium

A

Nondepolarizing Neuromuscular Blocking Drugs

Reversible ACh binding

Pancuronium longest acting with vagolytic effect

Mivacurium shortest acting

Train of four to monitor

25
Q

NMBD Reversal

A

Acetylcholine esterase inhibitor - neostigmine, edrophonium

  • get ACh accumulation @ neuromuscular junction

Sugammadex - no anticholinergic effect

-Reverses vecuronium and rocuronium