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Pharm Final Exam > final > Flashcards

final Flashcards

1
Q

SUX dose

A

20 mg/ml

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2
Q

Epi CPR dose

A

1 mg IV/IO every 3-5 min

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3
Q

Epi adult and peds dose

A

adult= 2-10 mcg bolus PRN to effect
1-10 mcg/min infusion PRN to effect

Ped=0.05-10 mcg/kg bolus
0.05-0.5 mcg/kg/min infusion

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4
Q

Norepi dose

A

0.5-12 mcg/min titrated to effect

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5
Q

dopamine low

A

1.2

vasodilation of kidneys brain and viscera

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6
Q

dopamine medium

A

2-10 mcg/kg/min

incresed CO

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7
Q

dopamine high

A

over 10 mcg/kg/min

alpha activity predominates with profound arterial and venous vasoconstriction

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8
Q

dobutamine adult and peds dose

A

adult=2-10 mcg/kg/min titrated

ped=2.5-10 mcg/kg/min titrated

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9
Q

Phenylephrine (neo) adult and peds dose

A 
adult= 50-200 mcg
ped= 0.05-0.5 mcg/kg/min
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10
Q

hydralazine dose

A

2.5-5 mg every 15 min (max is 20-40 mg)

for severe HTN give 10-20 mg slow IV push

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11
Q

Furosemide dose

A

2.5-5 mg

for chronic therapy give 20-40 mg

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12
Q

Nitroprusside dose

A

0.5-10 mcg/kg/min (peds get low end)

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13
Q

Thiazides dose

A

500 mg

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14
Q

Mannitol dose

A

12.5-25 grams

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15
Q

methylene blue dose

A

1-2 mg/kg (up to 50 mg) IV push over 3-5min

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16
Q

dantolene dose

A

2.5 mg/kg IV push

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17
Q

adenosine dose

A

6 mg fast IV push

if SVT sill there then give 12mg fast IV push

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18
Q

how many mg of heparin is in 1 unit

A

0.0002mg

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19
Q

warafrin dose

A

5-7 mg/day

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20
Q

aspirin dose for complete platelet inactivation

A

160mg

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21
Q

hespan max dose

A

20 ml/kg

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22
Q

FFP dose for warfarin over activity

A

15 ml/kg

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23
Q

FFP dose for AT3 deficiency

A

20 ml/kg

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24
Q

cryo dose

A

1 unit= 15 ml and 15ml= 250-350 mg of fibrinogen

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25
Q

general anesthesia characteristics

A

unconsciousness
immobility
muscle relaxation
loss of sensation

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26
Q

anesthetics work by inhibiting the release of what

A

excitatory afferent neurotransmitters

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27
Q

opiod agonists do what

A

bind to and stimulate mu and kappa

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28
Q

opiod agonists/antagonists do what

A

bind to delta, mu and kappa but only stimulate kappa

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29
Q

opiod antagonists do what

A

bind to delta, mu and kappa but doesn’t stimulate any of them

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30
Q

opiod effects on the heart

A

bradycardia (except mepiridine which causes tachy)

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31
Q

opiod effects on the lungs

A

decrease resp rate and tidal volume. cough suppresant

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32
Q

opiod effects on the eyes

A

miosis and increased intraocular pressure

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33
Q

opiod effects on the GI

A

salivation and vomiting from chemoreceptor trigger zone (CTZ) being stimulated

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34
Q

opiod effects on the head

A

increased intracranial pressure

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35
Q

opiod effects on histamine

A

releases histamine so avoid asthmatics

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36
Q

nerurpletpanalgesia=

A

mix opiods and tranquilizers for a dream like state

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37
Q

endogenous opiods are

A

B-endorphins, dynorphins, and enkephalins

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38
Q

most opiods are water soluble except

A

diazapam (valium)

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39
Q

opiods treat what

A

acute pulmonary edema as seen in CHF

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40
Q

pharmacokinetics of barbs

A

binds to proteins but free/unbound drug enters the brain. HYPOproteinemia causes more free drug so more goes in the brain so a normal dose can cause prolonged unconsciousness or death

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41
Q

main use for barbs

A

rapid anesthetic induction (always intubate)

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42
Q

1 drug for induction is

A

propofol

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43
Q

how is propofol terminated

A

metabolized by the liver, excreted by the kidneys but terminated through redistribution

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44
Q

propofols onset of action and duration of action

A

onset- 30-60 seconds

duration- 5-10 min

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45
Q

propofols appearance

A

milky

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46
Q

propofol inhibits what

A

GABA

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47
Q

propofol has what side effect on the lungs

A

potent respiratory depressant so administer slowly

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48
Q

propofol has what side effect on the liver

A

causes increased hepatic enzyme activity so prolonged use (epileptics) metabolize it in the liver much faster

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49
Q

dissociative anestheics

A

phencyclidine

ketamine

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50
Q

disocciative anesthetics effect on the heart

A

increase HR, CO, and BP so they make sick hearts work harder

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51
Q

disocciative anesthetics effect on the lungs

A

stable resp rate and tital vol. Apneustic at high doses

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52
Q

benzodiazepines (MDL)

A

midazolam (versed)
diazapam (valium)
lorazapam (ativan)

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53
Q

benzdoazapines block what

A

GABA

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54
Q

benzdoazapines reversal agent

A

flumazenil (anexate)

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55
Q

Inhaled halogenated anesthetics (DISH)

A

desflurane (suprane)
isoflurane (forane)
sevoflurane (Ultane)
halothane

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56
Q

Inhaled halogenated anesthetics effects on the heart and lungs

A 
heart= decreased BP
lungs= CO2 retention and acidosis (met and resp)
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57
Q

which Inhaled halogenated anesthetics causes coronary steal syndrome

A

forane

- when dilation steals blood flow from stenotic aresa

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58
Q

high vapor pressure

low vapor pressure

A 
high= volatile with precision vaporizer
low= non volatile with a non precision vaporizer
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59
Q

high blood gas partition coefiecient

low blood gas partition coefiecient

A 
high= more soluble in blood so SLOW induciton/recovery
low= less soluble in blood so FAST induction /revovery
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60
Q

high MAC

low MAC

A 
high= LESS potent so increase setting
low= MORE potent so increase setting
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61
Q

deflurane (suprane) MAC=

A

7.2- 9.8 (LESS POTENT)

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62
Q

isoflurane (forane) MAC=

A

1.3-1.63 (MOST POTENT)

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63
Q

sevoflurane (ultane) MAC=

A

2.34-2.58

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64
Q

which halogenated anethestic has the lowest blood gas partition coefiecient

A

desflurane (one breath anesthetic)

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65
Q

most effective tool for changing BP on bypass is

A

the anesthetic vaporizer

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66
Q

max nitrous oxide you can give

A

80%

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67
Q

Beta cells secrete

A

insulin which decreased blood glucose

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68
Q

Alpha cells secrete

A

glucagon which increased blood glucose

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69
Q

Delta cells secrete

A

somatosatin

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70
Q

diabetes insipidus=

A

doesnt respond to ADH so you have dilute urine

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71
Q

diabetes mellitus type 1

A

insulin dependent= absolute insulin deficiency

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72
Q

diabetes mellitus type 2

A

non insulin dependent= relative insulin deficiency

73
Q

diabetes mellitus type 3

A

other= side effects of drugs, infection, genetics

74
Q

diabetes mellitus type 4

A

gestational= 3rd trimester

75
Q

insulin and c-proteins half life

A

insulin 3-5 min

c-protein 30 min

76
Q

what kind of effect does insulin exhibit on target tissures

A

ANAbolic

77
Q

insulin is commonly used to treat what on bypass

A

hyperkalemia (drives K intracellularly)

78
Q

rapid onset/short action insulin

A 
regular insulin (humulin R, novolin R)
insulun lispro (humulog)
insulin aspart (novolog)
insulin glulisine (aprida)
79
Q

intermediate onset and acting insulin

A

neural protamine hagedorn (humulin N, novolin N)

80
Q

long actin insulin

A 
insulin glargine (lantus)
insuline detemire (levemir)
81
Q

MIC=

MBC=

A 
MIC= min INHIBITORY conc that prevents growth
MBC= min BACTERIOCIDAL conc that kills 99%
82
Q

Antistaphylococcal (DON)

A

docloxacillin (dynapen)
oxacillin
Nafcillin (nallpen)

83
Q

Broad Spectrum (AA)

A

ampicillin

amoxicillin

84
Q

Antipseudomonal (PTC)

A

piperacillin (piperacil)
ticarcillin (ticar)
carbencillin (geocillin)

85
Q

B-lactaminase inhibitors

A

amoxicillin + CA= Augmentin

ticarcillin + CA= Timentin

86
Q

Aminoglycosides (STAGN)

A 
streptomycin
tobramycin (nebcin)
amikacin (amikin)
gentamicin
neomycin
87
Q

vancomysin treats what

A

MRSA, MRSE, gram pos

88
Q

antistaphylococcal drugs treat what

A

gram pos- break down peptidoglycan bonds

89
Q

DOC for precardiac surgery dental prophyllaxis

A

amoxicillin

90
Q

antipseuomonal drugs treat what

A

gram neg

91
Q

what does clavulanic acid (CA) do

A

suicide inhibitor for B-lactaminase

92
Q

aminoglycosides treat what

A

gram neg

93
Q

which aminoglycoside in the most/least resistane

A 
most= streptomycin
least= amikacin
94
Q

mycin means=

A

streptomyses sp

95
Q

micin=

A

micromonospora sp

96
Q

how to aminoglycosides interact with pens, cephs, and vanco

A

synergistic reaction

97
Q

which type of antimicrobial crosses the blood/placenta barrier and concentrates in the fetal tissue

A

aminoglysocsides

98
Q

what so glucocorticoids cause

A
  • -vasoconstriction and insulin release so its a STRONG insulin antagonists
  • -decease WBS # and functionality so its an immunosupressive even at a single dose
  • -supress T cells
99
Q

glucocorticoids are what type of sterois

A

CATabolic

100
Q

side effects from glucocorticoids are seen what

A

high doses long term

101
Q

glucocorticoid drugs

A 
prednisone
prednisolone
hydrocortisone (solu-cortef)
dexamethasone (decadron)
methylpredisolone (medrol)
102
Q

calcineurin inhibitors

A

cyclosporin (sandimmune)

tacrolimus (prograf)

103
Q

mTOR inhibitor

A

Sirolimus (rapamune)

104
Q

Antiproliferative agents (MAM)

A 
mycophenolate mofetil (cellcept)
azathioprine (imuran)
mycophenolate sodium (myfortic)
105
Q

malignant hyperthermia treatment

A

stop volatile anesthetic and sux
hyperventilate with 100% 02
give 1-2mg bicarb
give 2.5 mg/kg IV push of Dantrolene and repeat PRN
cool patient
treat arrhythmias (dont use Ca++ channel blockers)
monitor coagulation and electrolytes

106
Q

malignant hyperthermia is caused by what mutation

A

RYR1

107
Q

Norepi (levophed) effects

A

increased SVR

decreased HR

108
Q

what is the rate limiting step in the synthesis of Ach

A

uptake of choline

109
Q

what is the rate limiting step in the synthesis of Norepi

A

tyrosine getting transported intracellularly and getting hydroxylated in to DOPA

110
Q

after Ach is released by the presynaptic nerve is is rapidly hydrolyzed by what

A

acetylcholinesterase

111
Q

difference between depolarizing and nondepolarizing NMB

A

depolarizing= agonist of Ach (sux)

nondepolarizing=antagonists of Ach

112
Q

suz has side effects in what communities

A

persian jewish

indian hindu

113
Q

after norepi is released by the presynaptic nerve- left overs get metabolized by COMT or MOA- but what happens most commonly

A

it gets reabsorbed in presynaptic nerve

114
Q

alpha 1 effects

A

smooth muscle- non cardiac

115
Q

alpha 2 effects

A

prejunctional neg feed back loops

116
Q

beta 1 effects

A

heart, lipolysis and renin)

117
Q

beta 2 effects

A

lungs, skeletal muscle and insulin

118
Q

epi effects on the heart

A

increase systolic

decrease diastolic

119
Q

dopamine is the DOC for

A

cargiogenic or septic shock

120
Q

dobutamine is DOC for

A

short term CHF as seen in pts struggling to separate from CPB

121
Q

phenylephrine (neo) is DOC for

A

increase SVR and BP on bypass

122
Q

what are ace inhibitors rate limiting side effect

A

bad coudh

123
Q

loop diuretics DOC

A

emergency edema

124
Q

what is special about thiazides

A

promote reabsorption of Ca++ (decrease bone density by 1/3)

125
Q

mannitol test dose

A

give 12.5 grams IV and if UOP is less than 50ml/hr for 3 hours then avoid

126
Q

1 rule when giving mannitol

A

check for precipitates

127
Q

how do you treat methemoglobinemia

A

give 1-2 mg of methylene blue (up to 50mg) IV over 3-5 minutes, give ascorbic acid and 100% O2

128
Q

when is the gold standard for giving ace inhibitors

A

after a AMI

129
Q

Na+ channel blockers are known as

A

membrane stabilizers

130
Q

lidocaine is DOC for

A

ventricular arrhythmia’s especially post-MI

131
Q

amiodarone is DOC for

A

A-fib

132
Q

what can K+channel blockers cause

A

torsades de pointed

133
Q

adenosine is DOC for

A

SVT

134
Q

magnesium sulfate is DOC for

A

digoxin induced arrhythmias

135
Q

unfactionated heparin and LMWH half life

A

unfactionated heparin= 1-2 hours

LMWH= 3-7 hours

136
Q

what enzyme does warfain block

A

vitamin K epoxide reductase

137
Q

how do you reverse lepirudin

A

you cant- no reversal agent

138
Q

how do you reverse bivalirudun

A

hemoconcentrator

139
Q

MOA of aspirin

A

irreversibly binds to COX 1 and modifies COX 2 (once modified- COX 2 produces lipoxins)

140
Q

1 gram of dextran binds to how many mls of water

A

20-25 ml

141
Q

perfusion trend of moving toward atyrn and away from

A

thromabte

142
Q

protamine is a mild anticoagulant by inhibiting what factor

A

5

143
Q

protamine only partially reverses

A

LMWH

144
Q

protamine has noe effect on what drug

A

fondaparinux

145
Q

how do you minimize protamine reaction

A

administer slowly. administer through intra-aortic. administer with steroids and antihistamines

146
Q

vitamine k has to be given slowly or what will happen

A

anaphylaxis

147
Q

FFP contains

A

AT3, PC, PS and all factors BUT 3, 4, 8, 12

148
Q

% of t1/2 with 1 half life
% of t1/2 with 3.3 half life
% of t1/2 with 4.3 half life

A

1 half life= 50%

  1. 3 half life= 90%
  2. 3 half life= 95%
149
Q

DOC for exercise induced angina

A

b-blockers

150
Q

long term angina DOC

short term angina DOC

A

long- b-blockers

short- nitrates

151
Q

DOC for variant angina

A

nifedipine (procardia)

152
Q

DOC for liver failure/edema

A

spironolactone (aldactone)

153
Q

midazolam

A

(versed)

154
Q

diazapam

A

(valium)

155
Q

lorazapam

A

(ativan)

156
Q

desflurane

A

(suprane)

157
Q

isoflurane

A

(forane)

158
Q

sevoflurane

A

(Ultane)

159
Q

regular insulin

A

(humulin R, novolin R)

160
Q

insulun lispro

A

(humulog)

161
Q

insulin aspart

A

(novolog)

162
Q

insulin glulisine

A

(aprida)

163
Q

neural protamine hagedorn

A

(humulin N, novolin N)

164
Q

insulin glargine

A

(lantus)

165
Q

insuline detemire

A

(levemir)

166
Q

amoxicillin + CA=

A

Augmentin

167
Q

ticarcillin + CA=

A

Timentin

168
Q

tobramycin

A

(nebcin)

169
Q

amikacin

A

(amikin)

170
Q

hydrocortisone

A

(solu-cortef)

171
Q

dexamethasone

A

(decadron)

172
Q

methylpredisolone

A

(medrol)

173
Q

cyclosporin

A

(sandimmune)

174
Q

tacrolimus

A

(prograf)

175
Q

Sirolimus

A

(rapamune)

176
Q

mycophenolate mofetil

A

(cellcept)

177
Q

azathioprine

A

(imuran)

178
Q

mycophenolate sodium

A

(myfortic)

Pharm Final Exam (8 decks)

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