3) Meds, Pre-Op Eval, IV Placement, Premedication

define pharmacokinetics

what the body does to the drug

what word describes the process of a substance entering systemic circulation?

absorption

absorption is governed by…

route of delivery

order routes of delivery from slow to fast

oral, tissues (IM/subq), inhaled, transdermal (prolonged)

oral medications can be slow acting because of the first pass effect. what does this mean?

drug is metabolized before circulating

what word describes how a drug moves from blood to tissues

distribution

what’s the volume of distribution equation?

Vd = drug total (dose) / drug in plasma

does a drug need to be protein-bound or free (unbound) to cross capillaries to target tissue/cells?

free (unbound)

why do drugs bind to proteins in the blood?

temporary reservoir

define clearance

volume of plasma cleared of drug

what are 3 ways a drug can be cleared?

liver, kidneys, tissues

how does the liver make inactive metabolites?

oxidation/reduction and hydrolysis/conjugation

what is oxidation/reduction?

transfer of electrons

what is hydrolysis/conjugation?

molecule becomes hydrophilic and splits apart

how does plasma and tissues clear drugs?

ester hydrolysis

what drugs are cleared in the plasma and tissues by ester hydrolysis?

remifentanil, succinylcholine, esmolol

how do the kidneys remove drugs from plasma?

glomerulus filtration and direct transfer to tubules

half-life is the time is takes to reach ____% decrease in plasma concentration.

50

define pharmacodynamics

what the drug does to the body

what are objective pharmacodynamics?

changes in BP or HR

what are subjective pharmacodynamics?

changes in pain or anxiety

in what kind of antagonism can an agonist with increasing concentration outcompete the antagonist?

competitive (compete for same binding site)

in what kind of antagonism does high concentrations of agonist not overcome the antagonist?

noncompetitive (irreversibly bind or render receptor inactive via allosteric site)

2 examples of competitive antagonists

NDMRs and beta blockers

2 examples of non-competitive antagonists

aspirin and ketamine

when drugs have an additive effect, their summation is ________ an algebraic summation. what’s an example of drugs that have an additive effect?

equal to, inhaled anesthetics

when drugs have a synergistic effect, their summation is ________ the algebraic summation. what’s an example of drugs that have a synergistic effect?

greater than, alcohol and narcotics

if a patient has high/low severity of disease & high surgical invasiveness, when should the chart review, pt interview, and physical exam take place?

before day surgery

if a patient has low severity of disease & med/low surgical invasiveness, when should chart review, pt interview, and physical exam take place?

day of or before surgery

in a minimal assessment, the ASA taskforce recommends reviewing…

airway, lungs, heart, vitals, height, weight

during chart review, what’s the 3 important things to review?

medical history, labs, consents

specific testing avoids what?

false positives

sensitive testing avoids what?

false negatives

should preoperative testing be ordered routinely?

no, patient unlikely to benefit

when is preoperative testing necessary?

no history or physical

what is the most important factor in preventing malpractice claims?

good relationship between patient and provider

what is the rule of 5 vowels for interviewing?

audition, evaluation, inquiry, observation, understanding

what drugs should be continued before a surgery?

anti-depressants, asthma meds, GERD meds, statins, thyroid meds

what medications should be discontinued before a surgery?

herbals, supplements, NSAIDS, ACE inhibitors

why should you stop NSAIDS 1 week before a surgery?

they deactivate platelets so higher risk of bleeding

what are major complications from anesthesia?

malignant hyperthermia, pseudocholinesterase deficiency, difficult airway, PONV

how many hours before surgery can a patient have food and fluids as desired?

8

how many hours before surgery can a patient have a light meal (ex: toast, clear liquids)

6

how many hours before surgery can a patient have infant formula or nonhuman milk?

6

how many hours before surgery can a patient have breast milk?

4

how many hours before surgery can a patient have clear liquids (no solids or foods containing fat in any form)?

2

what drinks count as clear liquids?

water, carbonated drinks, sports drinks, coffee or tea without milk

if a patient is chewing gum, should the surgery be cancelled?

no

how can the anesthesia team advise the patient to minimize the risk that their GLP-1 causes delayed stomach emptying?

have patient follow liquid only diet 24 hours before surgery

what increases risk for aspiration?

emergency surgeries, pregnancy, obesity, diabetes

define ASA I

normal healthy patient

define ASA II

mild systemic disease

define ASA III

severe systemic disease

define ASA IV

severe systemic disease constantly threatening life

define ASA V

patient won’t survive without surgery

define ASA VI

brain-dead patient donating organs

sodium

potassium

chloride

bicarbonate

blood urea nitrogen

creatinine

glucose

hemoglobin

platelets

hematocrit

white blood cell

what gauge is an orange IV catheter?

14

what gauge is a grey IV catheter?

16

what gauge is a green IV catheter?

18

what gauge is a pink IV catheter?

20

what gauge is a blue IV catheter?

22

what gauge is a yellow IV catheter?

24

what are 2 methods of GERD prophylaxis?

increase gastric fluid pH or decrease gastric fluid volume

what drug can help with post-operative shivering?

promethazine (Phenergan)

what anti-emetic can delay patient waking up?

diphenhydramine (Benadryl)

name things that increase risk of PONV

female, young, non-smoker, gyn/breast/ENT/laparoscopic surgery