exam 3 Flashcards
(81 cards)
1
Q
CCB may increase the plasma concentrations of what drug?
A
digoxin
2
Q
If you create beta 1 blockade what does that make happen? (give me two)
A
slow sinus rate
negative inotropy
3
Q
lidocaine drip and the patient has tinnitus, what is the plasma concentration?
A
5mcg/ml (not MG)
4
Q
Raynaud’s syndrome, what medication will you avoid?
A
Propranolol
5
Q
What decreases plasma clearance of lidocaine and bupivacaine?
A
Propranolol
6
Q
epi has what kind of action (direct or indirect?)
A
direct general agonist
7
Q
what receptors does phenylephrine work on?
A
pure alpha, a1>a2 (some beta 2 honestly)
8
Q
dobutamine what receptors does it activate?
A
beta 1 > beta 2
9
Q
which catecholamine is known to produce ventricular arrythmias?
A
dopamine
10
Q
which beta blocker has active metabolites?
A
propranolol
11
Q
large IV bolus of Precedex leads to?
A
hypertension and bradycardia
12
Q
LA with the greatest protein binding?
A
Levobupivacaine is MOST then,
bupi, robiv, mepiv, tetra, lido, prilo, procaine
13
Q
What is the regional dose of lidocaine with epinephrine?
A
7mg/kg
14
Q
What drug is described: minimal vasodilating properties, intermediate btwn verapamil and dihydropyridines. One of the “first” line treatments for SVT, minimal cardiodepressant effects and is unlikely to interact with b-adrenergic blocking drugs to decrease myocardial contractility.
A
diltiazem
15
Q
indirectly stimulates alpha and beta describes which drug?
A
ephedrine
16
Q
Amide with slowest metabolism?
A
Bupivacaine
Extra: also in the slowest group would be etidocaine and ropivacaine.
17
Q
very little beta stimulation out of the catecholamines would be?
A
phenylephrine
18
Q
beta 1 antagonist with RAPID onset?
A
esmolol (can be given IV, quick on and quick off)
19
Q
Which of the LA is 35 times more lipid soluble and potency and DOA 3-4 times that of mepivacaine?
A
Bupivicaine
20
Q
Principle difference in pharmacokinetics between all the beta adrenergic receptor antagonists is the?
A
elimination half-time range
21
Q
Dobutamine leads to an increase in?
A
cAMP
22
Q
Clearance comparison between Ropivacaine and Bupivacaine
A
Bupivacaine half time is LONGER, thus ropivacaine would be shorter half-time.
extra: overall clearance of ropivacaine is higher than that determined for bupivacaine, and it’s elimination half-time is shorter.
23
Q
What pharmacological effects of propranolol is most important? (two answers)
A
DECREASES HR and Decreases myocardial contractility.
24
Q
CCB do not cause what side effect?
A
tetany
25
Protein binding from greatest to least (Beta blockers)?
propranolol is MOST
atenolol is LEAST
on the exam metoprolol was in the middle
26
which are most likely to cause an allergic reaction esters or amides?
ESTERS (thus if all LA are given the ester will be the answer)
27
what type of drug is Prasozin and what does it do to the vessels?
sympatholytic (anti SNS) and it is a vasodilator of vessels.
28
Which LA are extracted via the lungs?
lidocaine, bupivicaine, and prilociane.
On the exam it asked which one was NOT extracted by the lungs and the answer was tetracaine.
29
Considered a negative chronotropic drug and moderate vasodilator?
Verapamil
30
which drug has alpha 2 preference of 1600:1?
dexmedatomidine
31
which beta blocker does this describe, selective alpha 1 antagonist, direct vasodilation?
labatelol
32
what do beta blockers end in?
-elol or -olol
33
of the beta blockers, which one has less lipid solubility and decreased entrance into the CNS?
atenelol
34
What bodily process creates a faster onset of LA blockade? (not a dz)
Pregnancy
35
Principle contraindication of administration of esmolol is?
AV block
| Heart failure NOT induced by tachycardia
36
pseudocholinesterase activity is normal in early pregnancy, when is it decreased?
late pregnancy
cirrhosis
kidney dz
Extra: on the exam it gave you four normal abnormal situations above and then asked for the EXCEPT, thus the answer on the exam was 20 year old lady 18 weeks pregnant.
37
Class IA, and class III, class IV, what are those classifications called and give me some ex. of drugs in each one.
```
Class IA (inhibit fast sodium ion channels)
Quiniidine and Procainamide
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Class III (inhibit potassium ion channels)
Amiodarone, Sotalol, and Bretylium
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Class IV (inhibit slow calcium channels)
Verapamil and Diltiazem
```
38
What drug does this describe: does not have a depressant effect on accessory tracts and thus will not slow the ventricular response rate in patients with WPW syndrome?
Verapamil
39
Propafenone, what patients would you NOT want to use this drug with? Flood pg 525
Patients with poor left ventricular function and sustained ventricular tachycardia bc it may be proarrhythmic in these patients.
extra: if you have liver disease the availability of this drug in your system becomes more.
40
Which vasodilator can cause cyanide toxicity?
Sodium Nitroprusside.
41
What drug is described: causes vascular smooth muscle relaxation and positive inotropy?
PDE III
42
Dibucaine is an amide that inhibits? (2 answers)
Typical plasmacholinsterase
Typical P CH E (technically its 70% typical and 20%)
43
Lidocaine, diazepam, and propranolol can increase the pharmacologically active, unbound portion of which drug?
Verapamil
44
High doses IV push of Metoprolol (choose 2)
Antagonize Beta 2
| Antagonize receptor Beta 1 Selectively
45
PDI produce?
increased contractility and dilates arteries and veins
46
Chiral LA drugs that have S&R?
Mepivacaine and Bupivacaine
47
Elimination half time of esmolol is due to?
Hydrolysis
48
Which of the following drug should be used with caution when given with Dantrolene?
Our class review said Verapamil and Nifedipine (i do not know if this was a select two?) if it is a select one the answer is verapamil, and if it is a select two and verapamil and dilt. are both available I would go with that. See below for book information.
"The ability of both verapamil and dantrolene to inhibit intracellular calcium ion flux and excitation-contraction coupling would suggest this combination might be useful in the treatment of malignant hyperthermia. In swine, however, the administration of dantrolene in the presence of verapamil or diltiazem results in hyperkalemia and cardiovascular collapse. A patient receiving verapamil developed hyperkalemia and myocardial depression within 1.5 hours of being treated with dantrolene administered IV. Ths same patient did not experience hyperkalemia when nifedipine was substituted for verapamil before pretreatment with dantrolene.
Whenever calcium channel blockers, especially verapamil or diltiazem, and dantrolene must be administered concurrently, invasive hemodynamic monitoring and frequent measurement of the plasma potassium concentration are recommended. It is speculated that verapamil alters normal homeostatic mechanisms for regulation of plasma potassium concentrations and may result in hyperkalemia from dantrolene-induced potassium release. Furthermore, there is evidence that verapamil does not influence the ability of known triggering drugs to evoke malignant hyperthermia in susceptible animals.
49
drug described: has no slow calcium channel activity with its dextroisomer?
Verapamil
50
Why is benzocaine unique?
it is a weak acid when the rest of the LA are weak bases
51
Most alpha 2 receptors are found in?
Locus cerelus
52
Which beta blocker decreases aqueous humor production?
Timolol
53
49. L- type channel antagonised by calcium channel blocker works on which receptor?
alpha 1
54
Which beta blocker should be avoided in asthmatic patients?
The answer on the exam was labetalol bc it is a non selective beta blocker. Thus if he has all selective beta blockers and one non selective, that will be the answer.
(other non selective: carvedilol, nadolol, propranolol)
55
By what receptor does labetalol decrease SVR?
ALPHA 1 blockade
56
By what receptor does labetalol attnuate tachycardia?
Beta blockade (specifically beta 1)
57
initiation of labetalol? (select two on exam)
Decreases SVR by alpha 1 blockade
| Attenuates Tachy by beta blockade
58
Where is norepi stored?
postganglionic sympathetic nerve endings
59
Prototype of sympathomimetics
EPI
60
Which LA are racemic mixture of enantiomers?
Mepivacaine and Bupivacaine
| on exam the only one listed was bupivacaine but both are correct
61
List all four chiral LA?
mepivacaine, bupivicaine, ropivacaine, and levobupivacaine
62
CCB should be used with caution in patients with? (2 answers)
hypovolemia
| LV dysfunction
63
tell me most rapid to to slowest amide metabolism?
most rapid = prilocaine
intermediate = lidocaine and mepivacaine
Slowest = etiodcaine, bupivacaine, ropivacaine
On exam answer was prilocaine > mepiviaine > etido = ropi
64
57. Which of the following LA is 10x more potent and more lipid soluble that procaine?
Tetracaine
65
What is unique about nadolol?
daily administration due to long elimination half time.
66
What drug would you use with CAUTION in RV failure?
Norepinephrine
67
which catecholamine has the greatest effect on metabolism?
Epinephrine
68
what all does epinephrine activate receptor wise?
potent activator of alpha receptors and also activates B1 and B2 receptors.
69
Does digoxin and clonidine produce a drug interaction?
No, clonidine has NO drug interaction with digoxin.
70
Drug of choice for pre-hospital management of pheochromocytoma is?
Phenoxybenzamine
(pre hospital is the clue here bc the above med can be given orally, Phentolamine is also used for pheochromocytoma but is an IV drug)
71
What can you add to a LA to increase duration of action?
Epinephrine
72
Would you use Verapamil with acute myocardial ischemia?
NO! no increase in mortality has been seen with verapamil and acute myocardial ischemia so we do not use it!
73
Tell me about dibucaine number?
exam question stated: dibucaine number that inhibits succinylcholine?
above 70 is normal
40-60 means hetero gene present
below 30 homo gene present
On exam the answer was 30 to inhibit sux.
From the book: if you have usual butyrylcholinesterase genotype D# will be 70 or higher, if you are homo atypical gene you will be below 30, if you are heterozygous atypical variant D# will range 40-60.
If you have Homozygous atypical then sux or mivacurium will be prolonged to 4-8 hours. (takes longer to clear out)
74
Physiological effects of calcium?
exam answer was: freely diffusible ionized calcium
75
68. Substituting a butyl group for the amine group on the benzene ring of procaine results in?
Tetracaine
76
What do LA cause in relation to the sodium channel and action potential?
failure of the sodium channels permeability to increase
77
what medication impairs bupivacaine extraction by the lungs?
Propranolol
78
Ester LA metabolism, list most rapid to slowest?
most rapid = chloroprocaine
intermediate = procaine
slowest = tetracaine
79
Which LA is more likely to release allergic metabolites?
BUT what are most adverse reactions to LA actually from (not actually allergic reaction but something else)?
Esters are more likely to produce metabolites related to paraaminobenzoic acid thus creating an allergic reaction.
Most adverse reactions to LA are actually due to excessive plasma concentration of the LA and not a ture allergic reaction.
extra: more often its the preservatives causing a reaction and not even real metabolites.
80
If you have given someone lidocaine and they have a seizure or go unconscious, what plasma concentration level would be present?
10-15 mcg/ml
81
What drug class potentiates the effects of depolorizing and non depolorizing NMB?
CCB
