Drugs

Question 1

What is amiloride

Answer 1

Potassium conserving drug that is given w loop or thiazide to prevent potassium lossless

Question 2

What precipitates dig tox

Answer 2

Hyokalemia

Question 3

Half life of a drug and clearence

Answer 3

Inversely proportional

However directly proportional to volume of dostribution

Question 4

Alfentanil rapid affect

Answer 4

2:2 90% unionized fraction while fentanyl is 9%

Question 5

Morphine active metabolite

Answer 5

Morphine 6 glucouronide, mainly renally excreted and becomes accumulated in renal failure

Question 6

Fentanyl duration

Answer 6

30 mins due to redistribution however termination 3-4 hours

Question 7

Dose response curve

Answer 7

Is a graph that shows how much drug is needed to create a response on a slope
Steeper the graph, the less drug that is required

Question 8

Opoid receptor activation leads to

Answer 8

By increasing potassium conductance and decreasing calcium conductance the neuornal pain pathways become hyper polorized which decreases the release of neurotransmitters

Question 9

Mu 1 receptor

Answer 9

Mediate suprasspinal (brain) anagesia and kappa anelgesia.

Also causes muscle rigidty

Question 10

Mu2

Answer 10

Causes resp depression

Question 11

Meperidine and how its diffirent from other opiates

Answer 11

Decreases contractiliry, inc hr and mydriasis. Acts like atropine anti chol

Question 12

Opiates blunt co2 chemoreceptors in medulla causing whay

Answer 12

Increase tidal volume and dec resp to maintain ventilkation

Question 13

Chest wall rigidty with opiate

Answer 13

Central acting can be inhibitted by muscle relaxant

Question 14

Meperidine inhibits shivering via

Answer 14

Kappa receptors

Question 15

Properties of opiates that are resistant to tolerance

Answer 15

Constipation is resistant to tolerance meaning everyone gets it

Also miosis is resistant

Question 16

Maoi and meperidine

Answer 16

Can precipitate seretonin syndrom

Question 17

Sufentanil vs fentanyl in infusions

Answer 17

Fentanyl redistributes from periphery to central compartment after infusion is stopped

Sufentanil contiues to go into periphery even when drip is stopped

Means context sensative halflife is much longer in fenanyl

Question 18

Remifenil and dibucaine number

Answer 18

No affect. Remi is non spec esterases. Dibucaine interprets pseudocholinesterase

Question 19

Benzodiazipine moa

Answer 19

Binds to gaba-a in cns and leads to inc binding of receptor to gaba molecule.
This then causes hyperpolorization and dec post synaptic excitability

Question 20

Baclofen vs benzo teceptor

Answer 20

Baclofen gaba b, benzo gaba-a

Question 21

How long after surgery must pt come back if not voided

Answer 21

12 hrs

Question 22

Max dec of mac w high dose opiods

Answer 22

60%

Question 23

Longest half life termination

Answer 23

Methadone

Question 24

Chronic opiod affect

Answer 24

Dec in opiate receptors and glutimate receptors

Also leads to increased nmda receptors even tho glutumate binds to nmda

So ketamine a nmda antag is good for chronic pain patients

Question 25

Benzo binding to gaba causes what

Answer 25

A change in postsynaptic! Chloride and changes the nernst potential Nernst means the difference in membrane potential

Question 26

Mu 2

Answer 26

Resp depression and constipation

Question 27

Kappa

Answer 27

Sedation and miosis

Question 28

Mu 1

Answer 28

Euphoria moosis and bradycardia

Question 29

Local anesthetic + fentanyl

Answer 29

Decrease intraoperative nausea then just bupivicaine or morphine because they lead to a denser block from visceral pain to dec nv

Question 30

Neseritide

Answer 30

Works via cgmp to cause vascular smooth muscle relaxation simolar to no Dec map and pcwo but increases renal blood flow

Question 31

Digoxin

Answer 31

Works via inhibiting na/k pump leading to increased intracellular calcium. It decreases chronotroph via dec conduction jn av node and purkinje fibrrs Used in heartfailure and atrial fib/flutter

Question 32

Nicotinic vs muscarinic

Answer 32

Nicotinic : stimulates autonomic ganglia and skeletal muscle Muscarinic: activates end organ effector crlls in bronchial smooth muscle, salivary glands and sa node Nicotinix is blocked my nmb Muscarnic is blocked by anticholenrgics Makes sense nicotnic is for muscl Muscarinic is for heart sa node

Question 33

Meperidine

Answer 33

Decreased contractility, increased he, increased mydriasis

Question 34

Morphine vs fentanyl half life

Answer 34

Morphine is less protein bound and less lipid soluble so its half life is less

Question 35

Prolonged use of opiods

Answer 35

Leads to down regulation and internalization kof opiod rexeltors leading to less membrane hyperpolorization. Opiod receptors are g protien with secondary messaging mechanism and decoupling. In orher words there are fewer receptors

Question 36

Most likely to be removed in lungs

Answer 36

Nor epi Serotonin also removed

Question 37

All volatile anesthics

Answer 37

Dec tv inc rr dev mv and cause airway irritation

Question 38

Ketamine

Answer 38

Inhibits nmda

Question 39

Induction agent with greatest myocardial depression

Answer 39

Thiopental greater then propofol most like to cause a dose dependent negative effect from dec of caclium influx