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Premedication
Pharm (Test 3)
| Question | Answer |
|---|---|
| What are some goals for premedication? | reduce anxiety, amnesia, pain relief, sedation, dec. risk of aspiration, n/v prophylaxis, antisialagogue, dec. MAC, prophylaxis of allergic rxn |
| What causes sedation from benzo's? What causes anxiolysis? | sedation=intensifying of GABA effects; anxiolysis=glycine-mediated inhibitory effect on neuronal pathways in the brain |
| What are some advantages to benzo's? | sedation, anxiolysis, amnesia, minimal effects on resp/CV, raise seizure threshold, dec. MAC |
| What are some disadvantages to benzo's? | no analgesia, possible paradoxical rxn (confusion, agitation), teratogenic during 1st trimester (cleft-lip) |
| True or False: Benzo's have replaced barb's as premedication of choice. | True |
| What is an example of a butyrophenone? | droperidol/inapsine |
| What is the mechanism of action of droperidol/inapsine? | antagonizes the activation of dopamine receptors, also alpha blocker |
| What are some advantages to droperidol/inapsine? | outward appearance of calm, antiemetic |
| What are some disadvantages to droperidol/inapsine? | dysphoria, restlessness, fear of death, hypotension, prolonged QT |
| What are some advantages to opioids? | no direct myocardial depression, pre-emptive analgesia, analgesia in pre-existing pain, dec. incidence of inc. HR during surgical procedures |
| What receptors do opioids act on? | mu, kappa, delta, sigma |
| What are some disadvantages to opioids? | depresses ventilation (esp. RR), inc. apneic CO2 threshold, dec. hypoxic drive, orthostatic hypotension, n/v, no amnestic effect, sphincter of oddi spasm, dysphoria in pts w/o pain, histamine release |
| What is the most commonly used opioid in anesthesia? | fentanyl |
| What is a typical dose of fentanyl? | 1-2mcg/kg |
| What are some advantages to NSAID's? | reduces amount of opioid required, pre-emptive analgesia |
| What are some disadvantages to NSAID's? | dec. platelet aggregation d/t prostaglandin inhibition, avoid in elderly/gastric ulcer pts/renal impairment/hepatic impairment |
| What is the most common NSAID used in anesthesia? | Ketoralac/Toradol |
| What should be given for anaphylaxis prophylaxis? | Benadryl (H1), Pepcid or Ranitidine (H2), prednisone |
| What is an example of an alpha 2 agonist given as a pre-medication? | clonidine |
| What are the advantages to giving clonidine as a premedication? | blunts autonomic nervous sys reflex responses to surgical stim (such as inc HR and BP), can dec. anesthetic requirement |
| What is the premedication dose of clonidine? | 5mcg/kg PO (takes 90 min to work) |
| What are some advantages to giving anticholinergics as premedication? | vagolytic effect, antisialagogue, sedation, amnesia |
| What are some disadvantages to giving anticholinergics as premedication? | central anticholinergic syndrome, mydriasis, cycloplegia, tachycardia, arrhythmias |
| In preventing aspiration, our goal is a gastric pH >______, and gastric volume < _______? | pH>2.5, gastric volume <25mL |
| How do H2 receptor blockers reduce risk of aspiration? | changes pH of contents produced/excreted after admin; doesn't change pH of current gastric contents |
| What are some examples of H2 receptor blockers? | Cimetidine/Tagamet, Ranitidine/Zantac, Famotidine/Pepcid |
| What is a therapeutic dose of Ranitidine/Zantac? PO? IV? Onset? Duration? | PO=150-300mg; IV=50mg; onset=60-90min; duration=9 hrs |
| What is a therapeutic dose of Famotidine/Pepcid? PO? IV? Onset? Duration? | PO=20-40mg; IV=20mg; onset=60-90min; duration=10-12 hrs |
| What is an example of a gastrokinetic agent? How does it prevent aspiration? | metoclopramide/reglan; lowers gastric volume (inc. gastric emptying, inc. lower esophageal sphincter tone, relaxes pylorus and duodenum |
| True or False: Reglan lowers gastric pH. | False |
| What is a therapeutic dose of metoclopraminde/reglan? PO? IV? Onset? | PO=10-15mg (30-60min); IV=10mg (15-30min) |
| What are some contraindications for giving metoclopramide/reglan? | intestinal obstruction, parkinson's |
| How do antacids reduce risk of aspiration? | raises gastric pH of fluid already present in stomach by neutralizing H+ ions w/ a base |
| What is a disadvantage to use of antacids to reduce risk of aspiration? | increases volume |
| True or False: Particulate antacids are more effective, but can cause pulmonary damage if aspirated, so use non-particulate antacids in anesthesia. | True |
| What is an example of a non-particulate antacid? | Sodium citrate/Bicitra |
| What is a therapeutic PO dose of bicitra? Onset? | 15-30mL; 15-30min |
| How can proton pump inhibitors reduce risk of aspiration? | dec. gastric acidity AND gastric volume |
| What is a disadvantage to PPI? Why don't we use in anesthesia? | takes daily admin. over 5 days to inhibit secretion 66% |
| What are some side effects of PPI? | headache, agitation, confusion (crosses BBB), abdominal pain, flatulence, n/v |
| What meds are used for anxiolysis in peds? | Versed (PO), Brevital (PR), Ketamine (IM) |
| What makes for an ideal pt preop? | anxiety-free, sedated, easily arousable, cooperative, gastric volume <25mL, gastric pH>2.5, minimal airway secretions, pain-free, medically tuned-up |
Created by:
lindseymontgomery
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