CNOR Pharmacology Practice Questions (90 Flashcards)

Per 2024-2026 ASA and AORN consensus, GLP-1 receptor agonists must be held to minimize the risk of intraoperative aspiration due to delayed gastric emptying. For weekly dosing, hold the medication for 1 week prior to surgery. For daily dosing, hold the day of surgery. On the day of procedure, if GI symptoms (nausea, vomiting, fullness) are present, consider delaying surgery or treating as a full stomach with rapid sequence induction (RSI). Exam Tip: CCI focuses on patient safety; aspiration is the primary concern here, not just glycemic control. Even if the patient followed NPO guidelines, the stomach may still contain solids.

Both should be discontinued 7 to 10 days prior to surgery. This allows for the turnover of the platelet population, as both drugs irreversibly inhibit platelet function for the life of the platelet (approx. 7-10 days). However, for many cardiac or vascular procedures, Aspirin may be continued to prevent stent thrombosis. CCI Strategy: Always clarify if the procedure is low risk (continue aspirin) or closed-space/high risk like neurosurgery (stop aspirin).

Ephedra is a sympathomimetic that increases heart rate and BP by stimulating alpha and beta-adrenergic receptors. It can cause intraoperative hypertension, tachyarrhythmias, myocardial ischemia, and stroke. It also depletes endogenous catecholamines with chronic use, potentially leading to refractory hypotension during induction. Exam Tip: CCI focuses on hemodynamic instability. This supplement is banned in many regions but still found in some natural or pre-workout products.

This is caused by the blockade of the cardioaccelerator fibers located at the T1 to T4 spinal levels. When the sympathetic block reaches these levels, the compensatory tachycardia usually seen with hypotension is inhibited, and the parasympathetic (vagal) tone dominates. Exam Strategy: CCI expects you to distinguish between simple vasodilation (T5-L2) and cardioaccelerator block (T1-T4). Treatment includes aggressive fluid resuscitation and sympathomimetics like ephedrine or, in severe cases, epinephrine.

The most critical risk is the precipitation of seizures. Flumazenil acutely reverses the effects of benzodiazepines, which can trigger withdrawal seizures in patients with physical dependence or those using benzos for seizure control. Clinical Pearl: Flumazenil has a shorter half-life (approx. 40-80 minutes) than many benzodiazepines; therefore, the RN must monitor for re-sedation as the reversal agent wears off. CCI focuses on the half-life mismatch between agonists and antagonists.