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Epsilon-Aminocaproic Acid (Amicar)

Uses EACA is a hemostatic agent used in the treatment of hyperfibrinolysis associated with excessive bleeding. Indications: Fibrinolytic bleeding associated with surgical complications following heart surgery (with or without CPB) and portacaval shunt; surgical hematuria (following prostatectomy and nephrectomy) or nonsurgical hematuria (accompanying polycystic or neoplastic diseases of the GU system); acute and life-threatening abruptio placentae; hepatic cirrhosis; neoplastic disease such as carcinoma of the prostate,…

Diuretics

Uses Prescribed for pts with Htn, CHF, elevated ICP, edema, hemoglobinuria, low intraop UO, hyperkalemia, volume overload, and rhabdomyolysis. Mannitol may function as a renal preservative by free radical scavenging and toxin dilution. Fenoldopam is a selective dopamine-1 agonist. As a vasodilator, it lowers blood pressure and augments renal blood flow, which improves UO and glomerular filtration rate. It may also serve as a renal protectant.…

Dipyridamole

Uses Rx as adjunctive therapy for prophylaxis of thromboembolism with cardiac valve replacement. Used for secondary stroke prevention (often combined with aspirin). Used in stress tests to evaluate for presence of coronary artery disease. Perioperative Risks Headache Plt dysfunction Hemorrhage Exacerbation of angina pectoris Worry About Potentiation of anticoagulants Thrombosis secondary to dipyridamole discontinuation You’re Reading a Preview Become a Clinical Tree membership for Full access…

Digitalis (Digoxin)

Uses Treatment of CHF, atrial fibrillation, and flutter. Prevention of supraventricular arrhythmias following thoracotomy (controversial). Cardiac side effects: Arrhythmias and conduction disturbances. Noncardiac side effects: GI—anorexia, N/V, and abdominal pain; CNS—visual disturbances, headache, drowsiness, and confusion. Perioperative Risks Recent systematic review and meta-analysis suggest that use of digoxin is associated with increased mortality risk, especially in pts with atrial fibrillation. Cardiac arrhythmia (toxicity) can be precipitated…

Dabigatran

Uses Stroke prevention in nonvalvular AFIB Thromboembolism prophylaxis after total hip and knee replacement Treatment and prevention of DVT and PE not related to surgery Worry About Contraindicated in pts with creatinine clearance less than 30 mL Use with other anticoagulants will increase the risk of bleeding and is not recommended. Use with strong inhibitors of p-glycoprotein (e.g., ketoconazole, itraconazole, cyclosporine) is contraindicated as they increase…

Cromolyn Sodium

Uses Approved by the FDA in 1973 as the first prophylactic nonsteroidal drug available for treatment of chronic asthma. Alternative initial maintenance therapy for mild persistent and moderate persistent asthma. Preventative only; not effective during acute episodes of bronchospasm. Beneficial for allergic-component and exercise-induced asthma. May be beneficial in allergic rhinitis and atopic ocular diseases. Oral formulations for the management of mastocytosis, ulcerative colitis, and food…

Colchicine

Uses Specifically indicated for treatment and relief of pain in acute attacks of gouty arthritis. Often effective in aborting an attack when taken at initial sign of discomfort. Not an analgesic and should not be used for other causes of pain. Recommended for prophylaxis of gouty attacks with regular use between attacks. Well documented use in familial Mediterranean fever. Also used in other conditions such as…

Cocaine

Uses Cocaine (benzoylmethylecgonine) is a commonly abused stimulant drug isolated from leaves of the coca plant ( Erythroxylon coca ). Administered IV, to mucosa, “snorted,” or smoked (“crack”); lipophilic and crosses BBB. Extremely addictive; 5 million Americans are regular users and 30 million have tried it at least once (2012 National Survey on Drug Use and Health). Drug that is most commonly associated with mortality. Perioperative…

Cilostazol

Uses Phosphodiesterase inhibitor with antiplatelet aggregation and arteriolar vasodilator properties. Prescribed for intermittent claudication in pts with peripheral arterial disease. Lowers restenosis rates after peripheral endovascular procedures in Asian populations. Secondary prevention of cerebral infarction with less hemorrhagic conversion than aspirin in Asian populations. Use has been limited by tolerability due to high incidence of side effects. Perioperative Risks Plt dysfunction Unknown effect on periop blood…

Chemotherapeutic Agents

Risk Cancer is the second most common cause of death in USA. In 2016, about 1,685,210 pts will be diagnosed with cancer and 595,690 will die of it. More than two-thirds of all cancers are diagnosed in people 50 y of age or older. Prostate cancer is the most common among men, while breast cancer is the most frequent in women. In both genders, lung cancer…

Carbamazepine–Oxcarbazepine

Uses Synthesized in 1953, introduced for trigeminal pain in 1962 and for epilepsy in 1965; approved by the USA FDA since 1976 for the following: Epilepsy: Generalized tonic-clonic seizures, partial seizures with complex pathology (psychomotor, temporal), partial seizures with or without generalization, mixed generalized and partial seizures Chronic pain: Pain associated to trigeminal and/or glossopharyngeal neuralgia CNS disorders: Acute or mixed episodes associated with bipolar I…

Capsaicin

Uses Topical analgesic treatment for diabetic polyneuropathy, postherpetic neuralgia, and other peripheral neuropathic pain; also for osteoarthritis, rheumatoid arthritis, and other painful disorders Spray used as nonlethal force by law enforcement Perioperative Risks None reported. After exposure to aerosolized capsaicin (e.g., in a trauma pt restrained by police), airway irritability, coughing, and bronchospasm may occur. You’re Reading a Preview Become a Clinical Tree membership for Full…

Calcium-Channel Blockers

Uses Prescribed to treat Htn, angina, supraventricular arrhythmias, cerebral vasospasm, and HCM. Perioperative Risks CCBs are used chronically in a significant proportion of the surgical population. CCBs are utilized in the treatment of Htn, CAD, or supraventricular arrhythmias and syndromes associated with vascular spasm. CCBs are recommended in combination with ACE inhibitors for diabetic pts with Htn. This class of drug effectively decreases myocardial O 2…

Buprenorphine

Uses Management of opioid addiction Management of chronic pain (“off-label” use for SL buprenorphine and buprenorphine TD patch) Perioperative Risks Challenges in pain management throughout periop period Respiratory depression Can cause neonatal abstinence syndrome You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Bleomycin

Uses Treatment of squamous cell carcinoma Treatment of melanomas and sarcomas Treatment of testicular carcinoma Treatment of Hodgkin and non-Hodgkin lymphoma Sclerosing agent for malignant pleural effusion Perioperative Risks Adverse effects >10%. Acute febrile reactions (25 -50%). Dermatologic: Skin thickening, diffuse scleroderma, onycholysis, pruritus. 50% of pts develop erythema, rash, striae, indu hyperkeratosis, vesiculation, and peeling of the skin; predominantly seen on the palmar and plantar…

Bisphosphonates

Uses Oral bisphosphonates: Alendronate (Fosamax), risedronate (Actonel): Prevention and treatment of postmenopausal osteoporosis, prevention and treatment of glucocorticoid-induced osteoporosis, treatment of osteoporosis in men, and Paget disease of bone Etidronate (Didronel): Prevention and treatment of postmenopausal osteoporosis and Paget disease of bone Ibandronate (Boniva) administered PO and IV: Prevention and treatment of postmenopausal osteoporosis IV bisphosphonates: Pamidronate (Aredia): Treatment of hypercalcemia of malignancy, osteolysis secondary to…

Beta-Adrenergic Receptor Antagonists (Blockers)

Uses Available PO and IV. Prescribed long term for stable angina, systolic CHF, MI (secondary prevention), Htn, and AFIB (for control of heart rate). No longer considered first-line Rx for essential Htn, especially in elderly pts. Long-term Rx must be continued periop (Class I ACC/AHA recommendation). Risk-benefit balance of periop (prophylactic) beta-blocker Rx is unclear. Periop Rx prevents MI after surgery, but increases risks of CVA…

Benzodiazepines

Uses Prescribed for the treatment of anxiety Used for premedication and procedural (moderate and deep) sedation Perioperative Risks High levels associated with hypnosis, unconsciousness, apnea/respiratory depression Worry About Combination (synergy) with opioids and other CNS depressants may result in severe respiratory depression, apnea, hypotension. Overview/Pharmacology Anxiolysis, sedation, hypnosis, muscle relaxation, anterograde amnesia, anticonvulsant Midazolam: Short-elimination half-life (2.5 h) Lorazepam: Intermediate-elimination half-life (15 h) Diazepam: Long-elimination half-life…

Aspirin (Acetylsalicylic Acid)

Uses People in USA consume 10,000–20,000 tons annually. Rx for mild and/or moderate pain, fever, arthritis, and prevention of MI. Perioperative Risks Peptic ulcer disease Plt dysfunction Increased bleeding risk Stroke Interstitial nephritis Reye syndrome Worry About Displacement of protein-bound drugs (e.g., warfarin, sulfonylureas, thiopental, methotrexate) Potentiation of anticoagulants. Thrombosis secondary to aspirin withdrawal. You’re Reading a Preview Become a Clinical Tree membership for Full access…

Antipsychotics

Uses/Risk In a given year, 26.2% of Americans 18 y or older have some form of mental disorder. Schizophrenia has a community prevalence rate of 1%. Psychiatric disorders such as schizophrenia, bipolar disorder, major depression, and disorders with psychotic features are treated with this class of drugs. Perioperative Risks Cardiovascular instability, including hypotension and arrhythmia Cardiomyopathy/myocarditis Extrapyramidal effects Drug-drug interaction Postop psychosis Worry About Antipsychotics act…