Drugs

Question 1

SEs of Succinylcholine

Answer 1

Malignant hyperthermia, hyperkalemia

Question 2

SEs Ketamine

Answer 2

Tachycardia/increased secretions (sympathetic stimulatory effect), Hallucinations

Question 3

SEs Propofol

Answer 3

Hypotension (peripheral vasodilation and myocardial depression), propofol-related infusion syndrome (Brady -> systole, acidosis, rhabdo; MC in kids with high doses)

Question 4

SEs etomidate

Answer 4

Adrenal insufficiency

Question 5

SEs meperidine

Answer 5

Seizures

Question 6

SEs morphine

Answer 6

Histamine release, hypotension

Question 7

MOA ketamine

Answer 7

Phencyclidine derivative

Dissociation of thalamus and limbic systems.

Amnesia, analgesia

Sympathetic stimulatory effect therefore CI in pts w/ ischemic heart disease

Question 8

propofol infusion syndrome

Answer 8

RFs: longer use (>48 hr), doses > 4mg/kg/h, concomitant steroid and pressor use, presence of neurons injury or pathology

metabolic acidosis, rhabdo, renal insufficiency, refractory bradycardia, hyperlipidemia, transaminitis

tx: d/c, cardiopulmonary support, HD

Question 9

Amphotericin B MOA

Answer 9

binds fungal cell wall sterols, causing cell death via lysis

Question 10

Amphotericin B SEs

Answer 10

nephrotoxicity, electrolyte abnormality (hypokalemia, hypomagnesemia)

Question 11

-Azole agents MOA

Answer 11

inhibit fungal sterol synthesis (needed for cell wall growth)

Question 12

caspofungin

Answer 12

inhibits fungal cell wall synthesis

Question 13

Sevoflurane

Answer 13

MC inhalation induction agent
Fast, minimal laryngospasm
Mask induction

Question 14

Desflurane

Answer 14

Most rapid onset/offset
pungent odor
Not used for induction; used for maintenance anesthesia

Question 15

Nitrous oxide

Answer 15

fast, minimal myocardial depression

Diffuses into closed spaces - not used in pts with SBO or PTX

Question 16

Volatile anesthetic hepatitis

Answer 16

fever, eosinophilia, jaundice, increased LFTs

Question 17

Propofol

Answer 17

MC IV induction agent
Not analgesic
SEs: hypotension (MC), resp depression

Question 18

Propofol infusion syndrome

Answer 18

metabolic acidosis, renal failure, cardiac failure, death

MC in long-term use; MC in children

Question 19

Etomidate

Answer 19

Used in RSI
Not analgesic
Fewest cardiac effects
SEs: adrenocortical suppression

Question 20

Dexmedetomidine (Precedex)

Answer 20

\+Analgesia
Doesn't blunt respiratory drive
Used for early extubation protocols
CNS alpha-2 rec agonist
SEs: BP lability

Question 21

Ketamine

Answer 21

Mech: NMDA rec antagonist; dissociation of thalamic and limbic systems
+analgesia
Good in kids
SEs: hallucinations, catecholamine release, increased airway secretions, increased cerebral blood flow
CI: head injury

Question 22

Meperidine (Demerol)

Answer 22

acts on mu-opioid agonist
Toxic metabolite = normeperidine (analgesic activity, longer half-life)

Accumulates in pts w/ renal failure.

Toxic doses –> seizures and CNS irritability

Question 23

Varenicline

Answer 23

selective nicotinic receptor partial agonist for a4b2 receptors

most effective adjunctive measure in aiding smoking cessation - superior to both nicotine replacement therapy and bupropion

Question 24

MOA Norepi

Answer 24

Mixed alpha > beta adrenergic

1st-line for septic shock

May cause tachycardia

Question 25

MOA Vaso

Answer 25

V1 receptors -> vasoconstrictor V2 receptors on kidney -> water resorption (decreases UOP) 2nd-line for septic shock May cause decreased stroke volume & CO in pts w/ myocardial dysfunction or cause ischemia in pts w/ CAD

Question 26

MOA Epi

Answer 26

Mixed beta > alpha adrenergic 1st-line for anaphylactic shock 2nd/3rd-line for septic shock May induce tachyarrythmias and ischemia. Decreases mesenteric perfusion

Question 27

MOA Neo (Phenylephrine)

Answer 27

Pure alpha1 agonist -> vasoconstrictor Added for hypotension in pts w/ preserved cardiac output May decrease stroke volume & CO in pts w/ cardiac dysfunction

Question 28

MOA Milrinone

Answer 28

PDE-3 inhibitor Short-term cardiac output augmentation in cardiogenic shock refractory to other agents. Renal cleared. May cause peripheral vasodilation, hypotension, ventricular arrhythmia

Question 29

MOA Dobutamine

Answer 29

Beta-1 & Beta-2 adrenergic 1st-line for cardiogenic shock Added to norepinephrine in septic shock in pts w/ decreased cardiac output Augments CO in pts w/ myocardial dysfunction or ongoing hypo perfusion despite adequate intravascular volume Increases contractility and HR. May cause hypotension

Question 30

MOA Dopamine

Answer 30

Dose-dependent Low (0.5-3mcg/kg/min): dopamine recs. increases mesenteric and renal blood flow --> diuresis Mod (3-5mcg/kg/min): beta-adrenergic. increases contractility High (>5mcg/kg/min): alpha-adrenergic. vasoconstrictor

Question 31

Warfarin reversal

Answer 31

Vit K | PCC

Question 32

Dabigatran reversal

Answer 32

Praxbind - idarucizumab direct thrombin inhibitor

Question 33

Argatroban

Answer 33

Reversible direct thrombin inhibitor Often used in pts with HIT No reversal agent Short half-life (45 min), stopping med and supportive care is enough for reversal

Question 34

Rivaroxaban (Xarelto), Apixaban (Eliquis) & reversal agent

Answer 34

Inhibits factor Xa Andexanet alfa (Andexxa)

Question 35

Protamine

Answer 35

Cationic. Binds anionic heparin. Forms stable salt with no anticoagulant activity. Also reverse anti factor Xa activity in LMWH. Partial reversal activity (~60%). Administer slowly. Rapid infusion can cause hypotension and CV collapse. Component of insulin aspart protamine and NPH insulin. DM pts can have hypersensitivity reactions. Dosage depends on amount of heparin given. 1mg for 100u. Also adjusted depending on duration of time since heparin given b/c heparin half-life is 60-90min. Cleared by reticuloendothelial system (not renal or hepatic). Dose doesn't need to be adjusted for renal for hepatic insufficiency.

Question 36

Neostigmine

Answer 36

Parasympathomimetic Tx acute colonic pseudo-obstruction (2.5mg IV over 3 min) Successful decompression in ~90% of pts w/in 10 min Recurrence rate of 5% SEs: brady, hypotension, dizziness. Excreted by kidneys

Question 37

Mafenide acetate

Answer 37

Eschar penetration for severe burns. Gram neg coverage (Pseudomonas) CI: TBSA >40%, allergy to sulfonamides

Question 38

Aminoglycosides

Answer 38

``` Inhibit 30S ribosome. stop protein synthesis Aerobic GNR coverage (Pseudomonas) Bactericidal Resistance: decreased active transport SEs: ototoxicity, nephrotoxicity ```

Question 39

Silver alginate

Answer 39

Used in wounds like burns, pressure ulcers, leg ulcers Reduces bacterial load Silver has antimicrobial properties: ribosomal toxicity, intercalates into DNA, denaturation of proteins, disruption of bacterial cell membrane

Question 40

Acetaminophen toxicity

Answer 40

Acetylcysteine

Question 41

Black widow spider antidote

Answer 41

Antivenum (latrodectus mactans)

Question 42

Ca Channel Blocker toxicity antidote

Answer 42

Ca Gluconate

Question 43

Malignant hypothermia, neuroleptic malignant syndrome antidotes

Answer 43

Dantrolene

Question 44

Iron toxicity antidote

Answer 44

Deferoxamine mesylate

Question 45

Benzo toxicity antidote

Answer 45

Flumazenil

Question 46

Cyanide toxicity antidote

Answer 46

Amyl nitrate, hydroxycobalamin, sodium nitrite, sodium thiosulfate

Question 47

Methotrexate toxicity antidote

Answer 47

Leucovorin calcium

Question 48

Methemoglobinemia tx

Answer 48

Methylene blue

Question 49

Anticholinergic toxicity antidote

Answer 49

Physostigmine

Question 50

Heparin reversal

Answer 50

protamine

Question 51

Lithium toxicity

Answer 51

Normal pharmakokinetics: absorbed in GI tract, excreted in kidneys. After gastric bypass surgery, increases gastric pH, increases deprotonated form of lithium -> increased absorption 2/2 decreased GFR, significant wt loss Increased calc & mag reabsorption in LOH. Elevates PTH

Question 52

Effects on Gastric bypass on drugs

Answer 52

Decreases absorption: Phenytoin, erythromycin, warfarin, ampicillin, tamoxifen, cyclosporine, levonorgestrel, imatinib, tacrolimus Increases absorption: Digoxin, lithium, PCN, atorvastatin

Question 53

SEs silver sulfadiazine

Answer 53

transient neutropenia and thrombocytopenia

Question 54

Vancomycin infusion reaction

Answer 54

Hypersensitivity reaction to rapid infusion of Vanc Degranulation of mast cells and basophils --> increased histamine Tx: antihistamine

Question 55

Meds that cause histamine release

Answer 55

Opioids (morphine, dilaudid, oxycodone) Ketamine Cipro Rifampin

Question 56

What meds can chelate fluoroquinolone?

Answer 56

Calcium Iron Mag Aluminum

Question 57

Anastrazole

Answer 57

``` Aromatase inhibitor (reversible binding of aromatase enzyme through competitive inhibition) Blocks conversion of androgens to estrogens in peripheral (extra-gonadal) tissue ```

Question 58

Tamoxifen

Answer 58

Selective estrogen receptor modulator | Partial agonist of estrogen receptors

Question 59

Trastuzumab

Answer 59

Monoclonal Ab binding of domain IV of extracellular segment of Her2/neu receptor Makes cells undergo arrest during G1 phase Reduced proliferation Down-regulates activation of serine/threonine kinase Act Suppresses angiogenesis by induction of antiangiogenic factors & repression of proangiogenic factors SEs: cardiotoxicity (need echo)

Question 60

Taxanes (paclitaxel, docetaxel)

Answer 60

impair cell division through inhibition of microtubule disassembly during mitosis

Question 61

Doxorubicin (adriamycin)

Answer 61

impair DNA repair by inhibiting topoisomerase II

Question 62

Bacitracin

Answer 62

bacteriostatic and bactericidal inhibits bacterial cell wall synthesis & bacterial replication nephrotoxic - tubular and glomerular necrosis -> oliguria and edema

Question 63

cyclosporine

Answer 63

Calcineurin inhibitor, inhibit expression of IL-2, stops propagation of immune response used for maintenance therapy in heart transplant patients assoc with formation of gallstones, renal arterial constriction -> renal toxicity, hirsutism, gingival hyperplasia, thrombocytopenia

Question 64

Tacrolimus

Answer 64

binds immunophilin FKBP12 inhibits calcineurin, dephosphorylates of nuclear factor of activated T cells, inhibits T cell activation SEs: nephrotoxic, seizures, tremors, H/A, new onset T2DM, hyperlipidemia, HTN, alopecia

Question 65

Dabigatran

Answer 65

non-vit-K oral anticoagulant (NOAC) Direct thrombin inhibitor for VTE tx/prevention Check creatinine clearance prior to deciding when to discontinue meds for surgery (cleared renally). If CrCl <50mL/min -> d/c 3-5 days before surgery If CrCl >50mL/min -> d/c 2 days before surgery don't need to bridge with heparin

Question 66

tamoxifen med interactions

Answer 66

affected by SSRIs (fluoxetine, paroxetine) - decreases formation of active metabolites of tamoxifen -> decreases efficacy

Question 67

Isoproterenol action

Answer 67

Pure beta-adrenergic agonist Inotrope and chronotrope Increases heart rate and cardiac contractility, peripheral vasodilation Poor side effect profile to induce arrhythmias and increase cardiac demand (used solely for diagnostic procedures to provoke arrhythmias)