question

A preoperative anesthesia evaluation is performed on ____ surgical ______ and is conducted by the anesthesia provider.

answer

all, patients

question

The preoperative anesthesia evaluation is used to confirm the patient's surgical _____ and to assess concurrent _____ _____ that might increase the risk of anesthesia-related complications. It also identifies any medications the patient may be taking (including herbal or OTC medications) and any allergies the patient may have.

answer

Diagnosis, medical condition

question

The pre-anesthesia physical examination is a complete assessment of the patient's _____ _____.

answer

Physical status

question

The _____ is evaluated for all patients, even when a local or regional anesthesia plan is intended.

answer

Airway

question

A _____ level is assessed for patient's taking diuretics and a ____ _____ level is determined for patients with diabetes.

answer

Potassium, blood glucose

question

______ are given to relieve anxiety, which is common in surgical patients, these drugs produce a mild drowsiness, and they may have _____ (pertaining to amnesia) and antiemetic effects.

answer

Sedatives, amnestic

question

The most common sedatives used preoperatively are the _____, a chemical classification of drugs used to control anxiety.

answer

Benzodiazepines

question

In low doses, benzodiazepines produce ______ (relief of anxiety).

answer

Anxiolysis

question

In high doses, benzodiazepines produce _______ amnesia.

answer

Anterograde

question

The prefix "anter/o means ____ ____ ___, so patients with anterograde amnesia don't remember events that occur from a point forward in time.

answer

In front of

question

One characteristic of benzodiazepines is high lipid solubility, which means that the chemicals are absorbed quickly and completely and are easily able to cross the ____ ____ ____ to exert their effects.

answer

Blood brain barrier

question

The benzodiazepine family of drugs includes D_____ (_____).

answer

Diazepam, Valium (trade name):

question

The benzodiazepine family of drugs includes L_____ (_____).

answer

Lorazepam, Ativan (trade name):

question

The benzodiazepine family of drugs includes M____ (_____).

answer

Midazolam, Versed (trade name):

question

An adverse side effect of benzodiazepines is _____ _____.

answer

respiratory depression

question

Benzodiazepines are administered intravenously in weight-dependent dosages (mg/kg) for preoperative ______.

answer

Sedation

question

______ is the most common benzodiazepine administered preoperatively.

answer

Midazolam

question

Some patients may require ____ (pain relief; literally "without pain") preoperatively. Examples include trauma patients.

answer

Analgesia

question

When indicated for analgesis, _____ may be administered preoperatively. The term ______ (same as first blank) refers to all drugs, natural, semisynthetic, having morphine-like actions.

answer

Opioids

question

Opioids cause ____ and mild sedation in usual doses and may reduce the amount of anesthesia needed for the surgical procedure.

answer

Analgesia

question

Preoperative use of opioids may be ______ for outpatient surgery because of the prohibitively intense patient monitoring required.

answer

Contraindicated

question

_____ (Astramorph, Duramorph) is a natural opioid that may be used preoperatively.

answer

Morphine

question

Morphine is given via IV in doses of 5 to 15mg for average adults, depending on the patients ability to tolerate drugs. Onset of action is expected in ___ to ____ minutes, with peak in ___ to ___ minutes, and effects often last ___ to ___ hours or more.

answer

2, 5, 10, 15, 2, 4

question

The most common synthetic opioids are m______ (______) and f_____ (_____).

answer

meperidine, Demerol, fentanyl, Sublimaze

question

Onset of action for Meperidine occurs in ___ to ___ minutes, peaks at 5 to 20 minutes, and provides analgesia for ___ to ___ hours.

answer

1, 3, 2, 4

question

Fentanyl is 75 to 125 times more potent than morphine; it is characterized by rapid onset of ____ seconds and short duration, ___ to ____ minutes.

answer

30, 30, 60

question

_______are agents that block the action of the neurotransmitter acetylcholine, inhibiting the transmission of parasympathetic nerve impulses. Acetylcholine (Ach) is a key neurotransmitter in the autonomic nervous system, so these agents exert systemic effects.

answer

Anticholinergics

question

Anticholinergics are not routinely used, but may be indicated for specific instances to inhibit ____ _____ of the respiratory and digestive tract (antisialagogue effect).

answer

Mucous secretions

question

Anticholinergic medications may also be administered preoperatively to block certain receptors on the vagus nerve, _______.

answer

Vagolysis

question

When indicated, anticholinergics most frequently used preoperatively are _____, _______ and _____.

answer

Atropine, glycopyrrolate, scopolamine

question

______ is twice as potent an antisialagogue as atropine and has a longer duration.

answer

Glycopyrrolate

question

______ is 3 times more potent an antisialagogue than atropine and is given when both antisialagogue effect and sedation are desired.

answer

Scopolamine

question

Atropine is administered via IV in doses of 0.4 to 0.6mg; onset is almost ______ and duration is ___ to ___ minutes.

answer

Immediate, 15, 30

question

Glycopyrrolate is administered via IV in doses of 0.1 to 2mg, onset occurring within ___ minute and lasting ___ to ___ hours.

answer

1, 2, 3

question

Scopalamine is given via IV in doses of 0.3 to 0.6mg; onset is _____ and effects are seen for ____ to ____ minutes. Scopalamine is classified as an antisialagogue, a sedative, and an antiemetic.

answer

Immediate, 30, 60

question

_____ may also be used intraoperatively to block the vagal response (called reflex bradycardia) to certain stimuli such as stretching the peritoneum during open abdominal procedures, bowel manipulation, cervical traction in gynecologic cases, carotid artery dissection, or stretching eye muscles during retinal procedures.

answer

Anticholinergics

question

Anxiety and fear, so often seen in surgical patients, initiates a stress response mediated by the sympathetic nervous system, which may slow down or stop the _____ process.

answer

Digestive

question

If the patient vomits or gastric reflux occurs during induction of anesthesia, gastric contents can enter the lungs, causing mild to severe damage. This complication is called _____, which may result in aspiration pneumonitis.

answer

Aspiration

question

The mechanical process of digestion is due to the ______ motions of the muscles and folds of the stomach, which mix food with gastric secretions. This mixture becomes a thin liquid called ______, which is propelled in small amounts through the pylorus into the duodenum.

answer

Peristaltic, chyme

question

Hydrochloric acid is produced by the ________ cells of the stomach and is the chemical responsible for the acidic nature of gastric contents.

answer

parietal

question

If the patient vomits or gastric reflux occurs during induction of anesthesia, gastric contents can enter the lungs, causing mild to severe damage. This complication is called ________.

answer

aspiration

question

Even though elective patients are NPO (nothing by mouth), gastric secretions are still present.When the lungs are damaged by ______, it is implicated in 10% to 30% of anesthesia deaths.

answer

aspiration

question

______ are used to chemically neutralize gastric acid already present in the stomach. Preoperative administration of these drugs is intended to minimize damage to the lungs from gastric acid should aspiration occur.

answer

Antacids

question

_______ ______ with citric acid (________) is a nonparticulate liquid antacid that may be administered preoperatively to neutralize the acidity of stomach contents.

answer

Sodium citrate, Bicitra

question

Sodium citrate is metabolized to ________ ________ a base that chemically neutralizes gastric acid.

answer

sodium bicarbonate

question

When indicated, sodium citrate is given orally in a dose of 15 to 30 mL. Effects are _______ and the duration is approximately ____ hours.

answer

immediate, 2

question

_______ _________ ______ (H2) area antacids names for their physiologic action on the receptors found on parietal cells in the stomach. By blocking H2 receptors, these agents temporarily interfere with the production of gastric acid by parietal cels. These agents are not used in emergency surgery because they do not change the acid already present in the stomach.

answer

Histamine receptor antagonists

question

A common H2 blockers given preoperatively is c______ (______).

answer

cimetidine, Tagamet

question

A common H2 blockers given preoperatively is f______ (______).

answer

famotidine, Pepcid

question

A common H2 blockers given preoperatively is r______ (______).

answer

ranitidine, Zantac

question

Cimetidine (H2 blocker) is given in 2 to 4 mg/kg doses. Effects occur _____ to ____ minutes and last _____ hours.

answer

4, 5, 4

question

Famotidine (H2 blocker) is given orally in 20 to 40 mg doses the night before surgery. Onset of effects is _____ to ____ minutes and last _____to ____ hours.

answer

20, 45, 7, 9

question

Ranitidine (H2 blocker) is given in a 50 mg dose. Onset of action is within ______minutes and last _____to ____ hours.

answer

15, 6, 8

question

_______ ________ ______ are medications that bind irreversibly with the acid pump of parietal cells and prevent the release of hydrochloric acid (gastric acid).

answer

Proton pump inhibitors

question

What does PPI stand for?

answer

Proton pump inhibitors

question

Proton pump inhibitors are an example of _________ because they are administered in an inactive form and are converted by the body into active drug molecules.

answer

prodrugs

question

Proton pump inhibitors (PPI) are unique in that they are not converted to active drugs in the liver, but in the ________ ____ ____. These drugs prevent the final step of gastric acid production by interfering with hydrogen and potassium ion exchanges.

answer

parietal cell canaliculus

question

The prototype drug in this category (Proton pump inhibitors) is _________ (_______), bit it is not commonly used preoperatively because it takes days to become fully effective.

answer

omeprazole, Prilosec

question

The proton inhibitor medications _________ (______) is administered via IV and given in 40mg doses and will reduce gastric acid in 20 minutes.

answer

pantoprazole, Protonix IV

question

___________ are agents administered preoperatively to reduce nausea and minimize the possibility of postoperative nausea and vomiting (PONV) in at risk patients.

answer

Antiemetics

question

The types of patients most at risk for PONV (postoperative nausea & vomiming) are _______; those patients who have or will receive opioids, babiturates, or etomidate; and ______ patients. Also, obesity has been assumed to be associated with increased risk of PONV.

answer

Pediatric, female

question

Types of procedures associated with a greater risk of PONV include ______ procedures and procedures usually performed on children, such as strabismus correction, tonsillectomy and adenoidectomy, orchiopexy, and middle ear procedures.

answer

Abdominal

question

A category of medications used to prevent PONV G_______ (______).

answer

GI prokinetics, metoclopramide

question

A category of medications used to prevent PONV N_______ (______).

answer

Neuroleptics, droperidol

question

A category of medications used to prevent PONV S_______ _______ (______).

answer

Serotonin antagonists, ondansetron

question

______ (_____) is classified as a GI prokinetic agent and reduces the risk of postoperative nausea because it also works as a peripheral and central dopamine receptor antagonist.

answer

Metoclopramide, Raglan

question

Metoclopramide (Raglan) is used to reduce gastric fluid volume and is administered via IV with onset expected in ___ to ___ minutes and duration of ___ to ____ hours.

answer

1, 3, 1, 2

question

_____ (_____) is an antiemetic drug with sedative properties that is less frequently used in current practice. The FDA requires a "Black box" warning on this medication.

answer

Droperidol, Inapsine

question

The most commonly used antiemetic agent used preoperatively is _____ (_____). It is classified as a serotonin antagonist, also known as a 5-HT3 receptor antagonist.

answer

Ondansetron, Zofran

question

Ondansetron (Zofran) is given intravenously in dose of 4mg over a period ____ to ___ minutes immediately before induction. Its effects last from ____ to _____ hours, and it has been very effective in reducing the incidence of PONV, especially in patients undergoing ambulatory gynecologic or middle ear procedures.

answer

2, 5, 12, 24

question

______ can also be given to prevent PONV. It is usually administered by dermal patch, which may be applied the night before or just before surgery. Side effects include visual disturbances, dizziness, and dry mouth. The patch contains 1.5mg of the medication, which is absorbed at a rate of 5mcg per hour for approximately ____ hours.

answer

Scopolamine, 72

Pharmacology – Chapter 13 – Preoperative Medications – Flashcards

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