Drugs (s/e, dosing, MOA, onset, peak, etc) & some cardiac Flashcards Preview

Board Review CRNA (Sweat Book) > Drugs (s/e, dosing, MOA, onset, peak, etc) & some cardiac > Flashcards

Flashcards in Drugs (s/e, dosing, MOA, onset, peak, etc) & some cardiac Deck (93):
1

Trade name for Succinylcholine?

Anectine

2

Trade name for Mivacurium?

Mivacron

3

Trade name for Atracurium?

Tracurium

4

Trade name for Cisatracurium?

Nimbex

5

Trade name for Vecuronium?

Norcuron

6

Trade name for Rocuronium?

Zemuron

7

Trade name for d-Tubocurarine?

Tubarine

8

Trade name for Pancuronium?

Pavulon

9

Name the following (ultrashort, short, intermediate, or long):
1) Succinylcholine
2) Pancuronium
3) Mivacurium
4) Cisatracurium
5) d-Tubocurarine
6) Rocuronium
7) Atracurium
8) Vecuronium

1) Succinylcholine: ultra short
2) Pancuronium: long
3) Mivacurium: short
4) Cisatracurium: intermediate
5) d-Tubocurarine: long
6) Rocuronium: intermediate
7) Atracurium: intermediate
8) Vecuronium: intermediate

10

Name the onset time for the following:
1) Succinylcholine: ultra short
2) Pancuronium: long
3) Mivacurium: short
4) Cisatracurium: intermediate
5) d-Tubocurarine: long
6) Rocuronium: intermediate
7) Atracurium: intermediate
8) Vecuronium: intermediate

1) Succinylcholine: 0.5-1.5 min
2) Pancuronium: 2-4 min
3) Mivacurium: 3-4 min
4) Cisatracurium: 5-7 min
5) d-Tubocurarine: 2-4 min
6) Rocuronium: 1-1.5 min
7) Atracurium: 3-4 min
8) Vecuronium: 3-4 min

11

Name the duration to 25 % recovery for the following:
1) Succinylcholine: ultra short
2) Pancuronium: long
3) Mivacurium: short
4) Cisatracurium: intermediate
5) d-Tubocurarine: long
6) Rocuronium: intermediate
7) Atracurium: intermediate
8) Vecuronium: intermediate

1) Succinylcholine: 6-8 min
2) Pancuronium: 60-120 min
3) Mivacurium: 15-20 min
4) Cisatracurium: 35-45 min
5) d-Tubocurarine: 60-120 min
6) Rocuronium: 30-40 min
7) Atracurium: 35-45 min
8) Vecuronium: 35-45 min

12

Name the ED95 for the following:
1) Succinylcholine: ultra short
2) Pancuronium: long
3) Mivacurium: short
4) Cisatracurium: intermediate
5) d-Tubocurarine: long
6) Rocuronium: intermediate
7) Atracurium: intermediate
8) Vecuronium: intermediate

1) Succinylcholine: 0.30 mg/kg
2) Pancuronium: 0.06 mg/kg
3) Mivacurium: 0.08 mg/kg
4) Cisatracurium: 0.05 mg/kg
5) d-Tubocurarine: 0.50 mg/kg
6) Rocuronium: 0.30 mg/kg
7) Atracurium: 0.20 mg/kg
8) Vecuronium: 0.05 mg/kg

13

Name the primary route of elimination of the following:
1) Succinylcholine
2) Pancuronium
3) Mivacurium
4) Cisatracurium
5) d-Tubocurarine
6) Rocuronium
7) Atracurium
8) Vecuronium

1) Succinylcholine: metabolism (plasma cholinesterases)
2) Pancuronium: 85% RENAL/ 15% BILIARY
3) Mivacurium: metabolism
4) Cisatracurium: metabolism (HOFFMAN ONLY)--> nonspecific esterases are NOT involved
5) d-Tubocurarine: primary renal, secondary biliary
6) Rocuronium: 80% Biliary/ 20% renal
7) Atracurium: metabolism (2/3 by hydrolysis--> nonspecific esrterases, 1/3 by Hoffman elimination)
8) Vecuronium: 60% BILIARY/ 40% RENAL/ some metabolism
**the termination of atracurium, cisatricurium, vec, and roc is by redistribution

14

Place the following NMB's into the appropriate category:
vec, roc, pancuronium, atracurium, cisatracurium
1) monoquaternary aminosteroids
2) bisquaternary aminosteroids
3) bisquaternary benzylisoquinolines

1) monoquaternary aminosteroids: vec, roc
2) bisquaternary aminosteroids: panc
3) bisquaternary benzylisoquinolines: atrac, cisatra
**aminosteroids= "curonium"
**benzylisoquinolines= "curium"
**ALL are quaternary ammonium compounds

15

Which NMB's produce autonomic ganglionic blockade? (2)

d-tubocurarine and metocurine block nicotinic receptors at the autonomic ganglia

16

Which NMB's elicit the release of histamine? (5)

sux, mivacurium, atracurium, d-tubocurarine, and metocurarine

17

Which NMB's produce bradycardia and why? (1)

succinylcholine mimics the action of acetylcholine and directly stimulates muscarinic receptors of the sinoatrial node

18

Which NMB's produce tachycardia and why? (5)

-atracurium, d-tubocurarine, metocurine produce reflex tachycardia
-pancuronium and gallamine competitively antagonize acetylcholine, which are referred to as direct vagolytic, or more specifically antimuscarinic, actions

19

Which NMB's produce significant hypotension? (3)

succinylcholine, d-tubocurarine, metocurarine

20

Which NMB's produce significant hypertension? (2)

pancuronium and gallamine

21

The acronym "M-SAC" is my way to remember NMB's that are primarily eliminated by METABOLISM. What does it stand for?

M- mivacurium
S- succinylcholine
** BOTH of the above are by plasma cholinesterase
A- atracurium
2/3 hydrolysis, 1/3 Hoffman
C- cisatricurium
ALL by Hoffman

22

I am a long acting non-selective alpha adrenergic antagonist used to control blood pressure in patients with pheochromocytoma.

phenoxybenzamine
* another non-selective alpha adrenergic antagonist is phentolamine

23

I am a selective alpha 2 adrenergic antagonist used to treat impotence.

yohimbine

24

How is prazosin different from other alpha adrenergic antagonists?

unlike non-selective alpha blockers, prazosin (a selective alpha 1 adrenergic antagonist) lowers BP without increasing release of NE from postganglionic sympathetic nerve terminals b/c it doesn't block alpha 2

25

Name one of the primary non-selective beta antagonists, and why it isn't usually used for with irritable airways.

propanolol--> beta 2 adrenergic receptor blockade can induce bronchoconstriction

26

I am a competitive antagonist of beta 1 adrenergic receptors. I am also very short acting and am metabolized in the _______ by __________ of the red blood cell.

Esmolol. in the plasma by non-selective esterases of the red blood cells

27

What are some uses of esmolol?

1) treat intraop SVT
2) treat intraop HTN
3) blunt reflex cardiovascular responses to DL and produce controlled hypotension

28

What receptors does labetalol competitively antagonize?

alpha 1, beta 1, beta 2

29

Name 2 uses of labetalol?

1) treat HTN emergencies
2) produce controlled hypotension
*decreases HR, myocardial contractility, and SVR

30

What is the alpha to beta ratio of the block produced by labetalol?

7:1 beta to alpha (so stronger beta than alpha)

31

What drugs can be used to treat excess myocardial depression induced by beta antagonists?

1) Atropine (incremental doses of 7mcg/kg)
2) Dobutamine (selective beta 1)
3) Calcium Chloride (250 to 1000mg IV)
4) Glucagon (1-10 mg IV, followed by 5 mg/hr IV)
5) transvenous artificial cardiac pacer
*Isoproterenol not good d\t its beta 1 and beta 2 effects, could cause vasodilation
*Dopamine NOT recommended

32

Why is Ketamine not normally recommended for use with beta blockers?

b\c it promotes SNS stimulation and with beta blockade it promotes increased SVR--> not able to be compensated by increased myocardial contractility (b\c the heart is beta blocked)--> heart failure may ensue
*same thing can happen with pheochromocytoma if beta blockade is produced prior to alpha blockade

33

What alpha adrenergic blocker could you use to control HTN during a pheo case?

phentolamine (regitine)

34

What drugs should you avoid in the asthmatic patient?

1) beta 2 blockers like propanolol and labetalol
2) drugs that stimulate histamine release (trimethaphan, d-tubocurarine, atracurium, and mivacurium)

35

Order MOST to LEAST on sedation: atropine, scopolamine, robinul.

scopolamine, atropine, glyco

36

Order MOST to LEAST on antisialogogue: atropine, scopolamine, robinul.

scopolamine, glyco, atropine

37

Order MOST to LEAST on increased HR: atropine, scopolamine, robinul.

atropine, glyco, scop

38

Order MOST to LEAST on relax smooth muscle: atropine, scopolamine, robinul.

atropine and glyco, scop

39

Order MOST to LEAST on mydriasis: atropine, scopolamine, robinul.

scop, atropine, glyco

40

Order MOST to LEAST on motion sickness prevention: atropine, scopolamine, robinul.

scopolamine, atropine, glyco

41

What antimuscarinic LEAST crosses the BBB?

glyco, b\c it has a charged quaternary ammonium group (ions DO NOT like to cross lipid membranes)

42

What is the treatment for anticholinergic syndrome?

physostigmine (an acetylcholinesterase inhibitor) 15-60mcg/kg IV

43

T/F? Decreased tone of the lower esophageal sphincter is a disadvantageous feature of antimuscarinics.

TRUE

44

What is the action of milrinone?

well... cAMP is normally cleaned up by phosphodiesterase...... so, milrinone is a PDA blocker--> causing a buildup of cAMP

45

When administering terbutaline... what receptor does it agonize? Is it metabotropic or ionotropic? Why?

works on beta 2--> terbutaline is a 1st messenger (Gs protein)--> the substrate ATP combines with enzyme adenylyl cyclase to activate 2nd messenger cAMP (the product)--> activates protein kinase--> bronchodilation

46

When looking at bronchiole smooth muscle, the presence of Ca+ indicates _______.

constricition.... absence of Ca+ = dilation

47

How does nitric oxide (NO) work?

it is a 1st messenger that crosses the lipid membrane (lipid soluble, so no receptor needed)--> acts with GTP--> cGMP (2nd messenger inside the cell)--> bronchodilation

48

What is the 2nd messenger of terbutaline in bronchiole smooth muscle?

cAMP

49

What is the 2nd messenger of nitric oxide in bronchiole smooth muscle?

cGMP

50

What is the 2nd messenger of atropine and ipratroprium in bronchiole smooth muscle?

IP3 and Ca+; AcH binds to muscarinic receptor--> phospholipase C cuts the head off... that is IP3--> IP3 helps release Ca+--> both are second messengers--> bronchoconstriction

51

cAMP and cGMP are "cleaned up" by _________.

phosphodiesterase; but different kind called isoform

52

Name the phosphodiesterase isoform for: cAMP

PDE III

53

Name the phosphodiesterase isoform for: cGMP

PDE V

54

What is aminophylline?

a phosphodiesterase inhibitor--> so causes buildup of cAMP--> promote bronchodilation as cAMP accumulates

55

How does nitroglycerin and nitroprusside (nitric oxide donors) promote bronchodilation?

by increasing the concentration of cGMP

56

How do atropine and ipratropium (atrovent-- an inhaled antimuscarinic) promote bronchodilation?

competitively inhibit muscarinic 3 receptors

57

What 4 second messengers are at work in bronchial smooth muscle cells?

1) cAMP
2) cGMP
3) IP3
4) Ca+

58

In bronchial smooth muscle, which first messenger does NOT bing to a cell membrane receptor?

nitric oxide (NO)

59

Name two common xanthines.

aminophylline and theophylline--> competitively antagonize adenosine receptors
CNS: nervousness, anxiety, n/v
RESP: bronchodilation

60

Does aminophylline readily cross the placenta?

YES

61

How do antimuscarinics cause bronchodilation?

atropine & ipratropium (atrovent); they antagonize AcH--> cause bronchodilation because less inositol triphosphate IP3 is produced, so less calcium is available for contractile proteins

62

What second messenger promotes bronchoconstriction?

Ca+ and IP3

63

Anti HTN: Name the trade name and action: hydralazine

Apresoline--> arterial vasodilator

64

Anti HTN: Name the trade name and action: diazoxide

Hyperstat--> arterial dilator (can cause hypoglycemic coma)

65

Anti HTN: Name the trade name and action: nitroglycerin

venodilator

66

Anti HTN: Name the trade name and action: nitroprusside

Nipride--> arterial and venous dilator

67

CCB: Name the trade name and action: verapamil

Calan, Isoptin--> arterial dilator and decreased HR

68

CCB: Name the trade name and action: diltiazem

arterial dilator and decreased HR

69

CCB: Name the trade name and action: nifedipine

Procardia--> arterial dilator (causes reflex increase in HR)

70

ACE INH: Name the trade name and action: captopril

Capoten--> arterial dilator

71

ACE INH: Name the trade name and action: enalapril

Vasotec--> arterial dilator

72

PDE INH: Name the trade name and action: inamrinone

Inocor--> block breakdown of cAMP= inc. myocardial contractility= dec. SVR (relaxes vascular smooth muscle)

73

PDE INH: Name the trade name and action: milrinone

Primacor--> block breakdown of cAMP= inc. myocardial contractility= dec. SVR (relaxes vascular smooth muscle)

74

What is the action of Adenosine?

it is an endogenous nucleotide occurring in all cells of the body.... can be administered to:
1) slow conduction of impulses through the AV node
2) interrupt reentry pathways through AV node
3) restore NSR in pt's with paroxysmal SVT, including the associated WPW syndrome

75

What is the dose of Adenosine?

6-12 mg IV as rapid injection

76

What is the elimination half time of Adenosine?

< 10 seconds owing to rapid metabolism

77

"Fast, Full, and Forward" applies to ______.

regurgitation; you want a faster HR so you spend LESS time in systole

78

What is the mneumonic to remember what will increase or decrease an outflow obstruction?

Old Cats Pee Alot
Obstruction: up down (increased or decreased)
-------------------------------------------
Contractility: up down
Preload: down up
Afterload: down up

79

Is ephedrine good to give a patient with a valve obstruction?

No! increases HR (you want to maintain)

80

Is digitalis good to give a patient with a valve obstruction?

No! increases contractility and worsens obstruction

81

Is increasing PEEP good for a patient with a valve obstruction?

No! decreases venous return= Not good, worsens obstruction

82

Aortic regurgitation can either be congenital or from ______.

rheumatic fever--> causes valvular problems

83

Aortic annulus dilation can cause regurgitation. What are causes of aortic annulus dilation?

syphilis, rheumatoid and psoriatic arthritis, ankylosing spondylitis, cystic medial necrosis, annuloaortic ectasia

84

What happens when there is aortic regurgitation and eccentric LV hypertrophy?

ventricles experience a large increase in volume with a small increase in pressure... left ventricular compliance is large--> fluid backs up into LV and starts to dilate it

85

Where is the coronary "take-off" located?

right after the aortic arch

86

Patients with acute aortic regurgitation present with the sudden onset of _______ and _______.

pulmonary edema and HTN
typically the 3 things seen are:
1) severe dyspnea
2) hypotension
3) weakness

87

Chronic aortic regurgitation normally presents as _______. Symptoms are minimal when the regurgitant volume are < _____, and severe if > ______ of SV.

CHF; 60%
Can remembers rule of 1/2's:
1/2 SV= severe

88

Chronic aortic regurgitation can be heard as a ______ murmur, best heard at the _______.

diastolic murmur, best heard at the left sternal border (b\c blood is flowing anterograde
* other manifestations: widened pulse pressure, bounding peripheral pulses, mitral regurg

89

Arterial waveform of a pt with IHSS may be ____.

bifid.... bisferiens pulse

90

What is the pressor of choice with aortic and mitral regurgitation?

Ephedrine... keep it fast full and forward.. phenylephrine would increase the afterload

91

Chronic mitral regurgitation is usually d\t _______. (3)

rheumatic fever, incompetent valve, or destruction of mitral valve annulus

92

What is the rule to remember when comparing the symptomatic progression of mitral regurgitation?

rule of 1/3rds
60= severe

93

Chronic mitral regurgitation is heard as a ________ murmur, best heard at the _____.

holosystolic murmur best heard at the apex