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What are the general side effects of narcotics?
Hypotension, respiratory depression, nausea, urinary retention and constipation
What is a contraindication to narcotics?
Name 6 narcotics
- Hydromorphone (Dilaudid)
- Morphine sulfate (MS contin)
- Meperidine (demerol
You are rounding on post op patient who is being managed with dilaudid due to post op pain. You notice pulse ox is 42%. Blood pressure has dropped to 75/50. What would you do?
*hint: you notice dilaudid perscription was scribed 12 mg instead of 1.2 mg.
Supliment with O2 and give patient Naloxone. Pt has opiod toxicity. Pt is experiencing respiratory depression and hypotention (side effects of opiods). Naloxone (opiod antagonist).
Give an example of a schedule I, II, II, IV, and V drug.
- Schedule I: heroin, LSD
- Schedule II: Most potent opiates, intermediate acting barbituates, cocaine
- Schedule III: Codeine, some barbituates
- Schedule IV: Diazepam
- Schedule V: Rx not required
Pt is on aspirin, lasix, metformin, and simvastatin. Pt has history of gout and presents with an acute gouty attack. Would you consider holding any medications above to help with his gout?
*Obviously you would first consult PCP to see what patient is on medications for and also if they can be temporarily held.
- 1. Aspirin inhibits excretion of uric acid
- 2. Loop diuretics can cause increased uric acid
Pt needs NSAID but has history of GERD and allergy to sulfa drugs. If you were to choose two NSAIDS which would you choose?
- Diclofenac (arthrotec): Arthrotec tablets are combined with misoprostol which is a GI protector.
- Rofecoxib (vioxx): Cox 2 inhibitor, not contraindicated in patients with stomach problems or anticoagulants
Celebrex or Bextra which are both COX 2 inhibitors because they are contraindicated with Sulfa allergy.
A 7 year old has tendonitis and you would like to perscribe an NSAID to help with inflammation. Which two would you choose?
ASA or Tolmentin (both approved for children).
Patient has history of positive U/S for DVT. You are a first year resident and asked to put the patient on the approapriate therapy. What do you do?
- First get baseline PTT
- 5,000-10,000u IV bolus, then 750-1500u/hr IV
- Monitor PTT q8h (maintain PTT at 1.5-2 above control).
Anesthesiologists gives pt ketamine, however pt has "emergence reaction" of hallucinations. What class of drug can you give that will reverse hallucinations?
Pt is on diuretic. You check pre-op labs and notice potassium levels are below baseline. What diuretic might the patient be on? And what would you treat the patient with?
- Thiazides may cause hypokalemia.
- Infuse KCL at rate 10mEq/hr. Dont want to infuse too fast because can get ventricular tachycardias.
Patient has been on Amitriptyline for 2 weeks however hasn't seen any results. Should patient d/c taking the medication?
Continue taking for a few more weeks because tricyclics usually take several weeks before therapeutic response develops.
Pt wife complains pt has been making tics (random and sudden, repetitive movements). And yelling obscene remarks randomly. Pt was diagnosed with Tourettes syndrome. What is DOC?
Prior to administering this drug the anesthesioligist asked the pt if he had egg allergy
Pt is on amitriptyline for neuropathy and terazosin for BPH and HTN. Pt blood pressure hasn't improved. What might be a reason?
Tricyclic antidepressents may block the antihypertensive effects of antiadrenergic agents.
Pt had rise of body temperature to 105 degrees fast. Pt was diagnosed with malignant hyperthermia. What drug give continuous rapid IV can be used?
Pt has been occassionally having a sudden blank stare with impairment of consiousness. What is the DOC for absense seizures?
What is DOC for Grand Mal seizures?
Pt is experiencing nausea post-op, what do you perscribe?
Phenergan (also given as an adjuct to analgesics, potentiates demerol).
Name to antidote to the following poisenings:
- Heparin=Protamine sulfate
- Tricyclic antidepressants=Physostigmine
- Warfarin=Vit K
Pt presents with wound and has history of tetanus immunization and his last booster was 12 years ago, what do you give?
- Give 0.5 cc of tetanus toxoid
- *booster is needed every 10 years
Pt has wound and doesn't remember if he's been immunized or if he's had a booster
- Give 0.5 cc of tetanus toxoid IM
- And give 250 U of tetanus immunoglobin IM