Ready to Mingle
Food or drink that should be avoided while taking simvistatin
Grapefruit and grapefruit juice
There's an increased risk of ___ and ___ after narcotic use in infant population.
Apnea and hypoventilation
Recommended hours of fasting prior to an elective sedation for a patient that had a full meal vs infant formula (or light meal w/o fat) vs breast milk vs clear liquids
8hrs
6hrs
4hrs
2hrs
Name 2 tools used for pain assessment in children
Face, Legs, Activity, Cry, and Consolability (FLACC) tool
FACES Pain Scale (FPS)
The process by which drug gains access to the bloodstream from the site of drug administration (bioavailability)
Absorption
Classify this reaction--nonimmune hemolytic anemia in a patient with G6PD after taking oral primaquine
Idiosyncratic adverse drug reaction
List at least 3 risk factors for sedation-related adverse effects
Airway obstruction history
Obstructive sleep apnea
Inability to properly handle airway secretions
Craniofacial anomalies
Chronic lung disease
Myocardial dysfunction
Mental status changes
Poorly controlled seizures
Hydrocephalus (and other causes of increased intracranial pressure)
Acute illness (upper respiratory infection, cough, GI symptoms)
These 2 sedation agents reduce ICP, which is useful to consider for patients with head trauma
Propofol
Etomidate
According to 2012 WHO guidelines, treat mild pain with either ____ or ____, before adding a weak ____ for moderate-to-severe pain.
Acetaminophen
Ibuprofen
Opioid
Pharmaceutical ____ have the same therapeutic moiety, though not necessarily the same quantity or dosage form
Alternatives
Pharmaceutical equivalents have the exact amounts of the active drug ingredient in the same dosage form and routine of administration and meet applicable standards of purity, quality, strength, and identity
List at least 2 inducers and inhibitors of cytochrome P450
Inducers: phenytoin, phenobarbitol, carbamazepine, griseofulvin, rifampin
Inhibitors: erythromycin, clarithromycin, azole antifungals, protease inhibitors
____ precedes ____, which is why relying solely on oxygen saturations via pulse oximetry is dangerous
Hypoxia
If you have these two food allergies, propofol is absolutely contraindicated
egg allergy or soy allergy
Most potent opioid
IV Fentanyl (opioid equianalgesic dose 0.2mg)
The number of half-lives necessary to reach a steady state for a medication with first-order drug elimination
4 to 5 (94% of steady state vs 97%)
____ order elimination kinetics has a drug clearance rate that is dependent on and proportional to the drug concentration, whereas ____ order elimination kinetics is not
First (linear progression)
Zero (saturable kinetics, has flat rate)
List at least 3 potential adverse events of sedation
Airway obstruction (laryngospasm)
Hypoventilation and apnea (central or obstructive)
Aspiration
Cardiac depression
Absolute contraindication for Etomidate
adrenal insufficiency (inhibits 11-beta-hydroxylase)
Least potent opioid
PO Codeine (opioid equianalgesic dose 180-200mg)
Composition of magic mouthwash
1:1:1 mixture of 2% viscous lidocaine, aluminum and magnesium hydroxides, and diphenhydramine suspension liquid
True or False: the loading dose in a patient with renal failure is the same as that in a healthy patient
TRUE
(and if the drug is cleared by the kidney the subsequent maintenance dose differs)
Describe the ASA Class types for assessment of sedation suitability
Class 1: normal healthy patient; excellent sedation suitability
Class 2: mild systemic disease without functional limitation; good sedation suitability
Class 3: severe systemic disease with definite functional limitation; intermediate-to-poor sedation suitability
Class 4: severe systemic disease with a constant threat to life; poor sedation suitability (benefits rarely outweigh the risks)
Class 5: a very ill patient not expected to survive without operative intervention
Class 6: declared brain dead whose organs are being removed for donor purposes
Name the 4 degrees of sedation and level of monitoring required
Minimal sedation: anxiolysis; Monitoring: observing via intermittent assessment by a supervising practitioner
Moderate sedation: light sleep; Monitoring: continuous pulse oximetry, continuous HR, and intermittent RR and BP
Deep sedation: deep sleep; Monitoring: continuous pulse oximetry, continuous HR, and intermittent RR and BP
General anesthesia: loss of consciousness; Monitoring: anesthesiology fellowship
Which local topical analgesic (LET or EMLA) has quicker onset, and by how much?
LET (onset 30min)
EMLA (onset 1hr)
What is the equation for volume of distribution (VD)?
VD = DT/CP
Volume of distribution (VD) = total amount of drug in the body (DT) divided by the plasma concentration (CP)