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PHARMACOLOGY STUDY GUIDE FOR LESSON 3 QUIZ. #2

NOTE: THE TABLES and INFORMATION IN THE MANDATORY READING ON "MEDICATIONS USED IN TRACHEAL INTUBATION" and "RAPID SEQUENCE INTUBATION" ARE VERY IMPORTANT FOR THE QUIZ THIS WEEK!! Note: some of the numbers below are information and definitions

THE REVERSAL AGENT STUDY GUIDE WILL BE USED FOR A SHORT BONUS QUIZ!

1) Know the reason why preoxygenation is important for patients undergoing RSI anesthesia

2) Know what causes a pressor response.

3) Know the names of the drugs that decrease (attenuate) the pressor response:

4) What is lidocaine? 5) What is fentanyl? 6) Know the order of rapid onset/short duration for the following opioid drugs from fastest to slowest: Alfentanil (=fastest), Sufentanil, Fentanyl(=slowest)

7) In neuro cases the following formula and information is very important:

Cerebral oxygenation (oxygenation of the brain) is determined by:

Cerebral Perfusion Pressure (CPP), which is defined as CPP = MAP (mean arterial pressure) - ICP (intracranial pressure).

Normal CPP is 80-100 mm Hg and must be maintained above 50 mm Hg to maintain normal cerebral autoregulatory functions. Normal ICP is less than 10 mm Hg.

MAP is a term used to describe an average arterial blood pressure during a single cardiac cycle (from the beginning of one heartbeat to the beginning of the next) in an individual.

In patients with brain injuries: coughing, gagging, pressor responses, and stimulation due to endotracheal suction and laryngeal manipulation (intubation) can increase the ICP. 2

Any significant increase in ICP or decrease in MAP may result in a critical decrease in CPP---which means further injury and damage to the brain of the neuro patient!!!

8) Know the advantages of atropine. 9) Know the advantages of Norcuron. 10) Know the advantages of Zemuron. 11) Know examples of pretreatment (before induction) medications. 12) When are pretreatment medications given or administered? 13) Know the 2 classes of neuromuscular blocking agents: 14) What is the action of depolarizing agents? 15) What is the action of nondepolarizing agents?

16) Know the following definitions: Agonist- a drug that can combine with a receptor on a cell to produce a physiological reaction Antagonist- a drug that neutralizes or counteracts the effects of another drug

17) What is the paralytic of choice in almost all cases of rapid sequence induction (RSI) in adults?

18) What type of agent is succinylcholine? 19) What is the rare disorder associated with succinylcholine use? 20) What is the electrolyte imbalance that succinylcholine can cause?

21) Know the following information (from wisegeek.com):

Electrolyte: In human health, electrolytes aid in a number of vital bodily processes. Many heart and nerve functions, muscle control and coordination, and the body's ability to absorb fluids all depend on a healthy balance of electrolytes. The most common electrolytes found in the human body are sodium (Na+), potassium (k+), magnesium (Mg++), chloride (Cl-) and calcium (2+). LR (lactated ringers) have lots of electrolytes in them.

Various hormones in the body help regulate intake of these electrolytes, and the kidneys filter electrolytes which reach excessive levels. Unhealthy levels of consumption of any or all of the body's necessary electrolytes can cause serious health issues. The most common imbalances are: hyper- and hypo-natremia (Na+), or excessive and insufficient levels of sodium, and hyper- and hypo-kalemia (k+), or excessive and insufficient levels of potassium.

Many sports drinks contain added potassium and sodium to help restore the body's proper electrolyte balance after intense physical exertion. After exercising heavily, it can be dangerous to ingest large quantities of water, as it may dilute existing electrolyte levels and cause physical problems. Additionally, a number of electrolyte enhanced drinks exist specifically for children and may be helpful for regular use, particularly to restore electrolyte balance after sickness which has included vomiting or diarrhea. 3

Electrolytes conducts electricity. This is why sterile water instead of LR is used in many Cystoscopy procedures, especially if the use of a bovie is needed during the procedure; the proper amount and distribution of electrolytes in the body is essential for health; examples: calcium and sodium and potassium; An electrolyte solution is full of ions, which are atoms that have some sort of net electric charge, either positive or negative. A dilute electrolyte solution has a relatively small amount of ions for its volume, while a concentrated electrolyte solution has a high amount of ions.

22) What is the safe alternative to succinylcholine? 23) What other nondepolarizing agent is rocuronium similar to?

24) Know the following: Atracurium and Mivacurium are also nondepolarizing neuromuscular blocking agents.

25) From the Rapid Sequence Intubation article, Know the following:

 Pretreatment medications are typically administered 2-3 minutes prior to induction and paralysis. These medications can be remembered by using the mnemonic LOAD (ie, Lidocaine, Opioid analgesic, Atropine, Defasciculating agents).