FINAL: Exam 1

Question 1

A protein or other substance that binds to an endogenous chemical or a drug is a ____________

Answer 1

receptor

Question 2

Which drugs experience high levels of first pass metabolism?

Stoelting (3)

Nagelhout (12)

Answer 2

Propranolol
Lidocaine
Nitroglycerin (po)

Aspirin
Lidocaine
Morphine
Midazolam

Hydralazine
Metoprolol
Verapamil

Glyceryl trinitrate
Levodopa
Cimetidine
Felodipine
Neostigmine

Question 3

Alignment of a drug with its receptor is aided by various bonding forces, which bonding forces play a prominent role in this alignment? (there are 5, which 2 most prominent?)

Answer 3

Van der Waals ()
Hydrophobic
Hydrogen
Ionic ()
Covalent

Question 4

The dosage range of a drug that provides safe effective therapy with minimal adverse effects is?

Answer 4

Therapeutic window

Question 5

Volume of distribution of a mathematical calculation which equals _____/ ______

Answer 5

Dose of drug/Plasma concentration of drug

Question 6

______ ________ are similar in molecular structure to their corresponding agonist drugs; they have receptor affinity, but lack intrinsic activity or efficacy

Answer 6

Pure antagonists

(Sits on receptor site but nothing happens)

Question 7

_______ _________ occurs when a drug’s action is blocked and no receptor activity is involved

Answer 7

Chemical antagonism

(ex: protamine, sugammadex)

Question 8

Drug is regarded as fully eliminated when approximately ___% has been eliminated

Usually occurs in ___ -___ half-lives

Answer 8

95

4-5

Question 9

1:10,000 epinephrine = ____ mcg?

Answer 9

100 mcg

Question 10

Opioids work as agonists on opioid receptors at pre and post synaptic sites in the central nervous system:
_________
_________

Answer 10

Brain stem
Spinal cord

Question 11

Mu receptors principally responsible for:
________ analgesia
________ analgesia

Answer 11

supraspinal
spinal

Question 12

Respiratory depression characteristic of ____ receptor activation

and ____ and ____

Answer 12

mu

mu2, delta

Question 13

Respiratory depression less prominent with ____ receptor activation

Answer 13

kappa

Question 14

Opioid receptors normally activated by endogenous peptide opioid receptor ligands (3)

Answer 14

Enkephalins (Delta)
Endorphins (Mu)
Dynorphins (Kappa)

Question 15

Most common side effects of opioid allergy (3)

Answer 15

Localized histamine release
Orthostatic hypotension
Nausea and vomiting

Question 16

________ is not an indication of pain control

Answer 16

Sedation

Question 17

Morphine produces a histamine release from tissue mast cells, which can cause _______ _____, ________, and _______

Answer 17

decreased SVR
hypotension
tachycardia

Question 18

Morphine Epidural dosing
Bolus: __ - __ mg q__-___h
Infusion: ___-___ mg/h

Answer 18

2-6 mg q8-24h
0.2-1mg/h

Question 19

Dose of meperidine for adult postoperative shivering

Answer 19

12.5-25 mg IV

Question 20

Fentanyl intrathecal dose

Answer 20

10-25 mcg

Question 21

Bolusing remifentanil can cause: (3)

Answer 21

Bradycardia/hypotension
Ventilatory depression
Muscle rigidity

Question 22

Methadone is a ________ opioid

Answer 22

synthetic

Question 23

Oxycodone is ______ as potent as oral morphine

Answer 23

twice

Question 24

Codeine has good ________ activity

2 drugs that suppress cough:

Answer 24

antitussive

codeine, heroin (?), dextromethorphan (?)

Question 25

Buprenorphine Epidural dose: ____ Buprenorphine Intrathecal dose: ____

Answer 25

0.3 mg 0.15 mg

Question 26

_______ _____-_______ ______ (______) are among the most commonly prescribed drugs in the world

Answer 26

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Question 27

NSAIDs inhibit the biosynthesis of __________ by preventing the substrate _________ _____ from binding _________ (_____) enzyme active site

Answer 27

prostaglandins arachidonic acid cyclooxygenase (COX)

Question 28

The COX enzyme exists as: (2)

Answer 28

COX-1 isoenzyme COX-2 isoenzyme

Question 29

COX-1 isoenzyme functions: -Maintenance of normal ______ function in the _______ -________ protection in the _______ tract -Production of proaggregatory ________ ___ in the __________

Answer 29

renal, kidneys Mucosal, gastrointestinal thromboxane A2, platelets

Question 30

Hypersensitivity reactions to NSAIDs _____ occur, and they are more common in individuals with _________ or __________

Answer 30

rarely nasal polyps asthma

Question 31

_________ is the leading cause of acute liver failure in the United States, and nearly half of _________ - associated cases are due to ________ overdose

Answer 31

Acetaminophen Acetaminophen unintentional

Question 32

There is evidence supporting the use of _________ in the multimodal analgesia protocols to contribute to postoperative recovery of patients by minimizing opioid doses and, therefore, side effects

Answer 32

corticosteroids

Question 33

Lidocaine produces analgesia by suppressing the activity of ______ channels in neurons that respond to noxious stimuli, thereby preventing _______ conduction and ______ transmission

Answer 33

sodium nerve pain

Question 34

__________ acts as a selective partial alpha2-receptor agonist

Answer 34

Clonidine (Ex: neuraxially) (Precedex also selective alpha2-receptor agonist = more selective than clonidine)

Question 35

In patients taking NSAIDs, GI perforation exists in what % of people?

Answer 35

1%-2%

Question 36

__________ does not increase catecholamines (opioid)

Answer 36

Morphine

Question 37

Opioid induced bradycardia/hypotension occurs through stimulation of :

Answer 37

vagal stimulation

Question 38

__________ is the acute tolerance; rapid appearance of a progressive decrease in response to a given dose of a drug after continuous or repetitive administration

Answer 38

Tachyphylaxis

Question 39

Drugs that cause least amount of biliary pressure increase

Answer 39

Meperidine Naloxone (reverses pressure)

Question 40

Which opioid receptors are responsible for urinary retention?

Answer 40

Mu1 Delta

Question 41

NSAIDs decrease clearance of _______, leading to toxicity

Answer 41

lithium

Question 42

What irreversibly inactivates COX1, leading to prolonged inhibition of platelet aggregation?

Answer 42

Acetylsalicylic acid (Aspirin)

Question 43

This drug has been shown to be beneficial in neurologic pain

Answer 43

Methadone (d/t NMDA receptor antagonism) or Ketamine (NMDA antagonist) or Magnesium (NMDA antagonist)

Question 44

Two drugs that undergo extensive first-pass metabolism

Answer 44

Lidocaine Morphine

Question 45

Things to consider when prescribing a drug (4)

Answer 45

Age Gender Weight Ethnicity

Question 46

*1+1 = 3: _______* 1+ 0 = 3: _______ 1+1 = 0: ________ 1+1 = 2: ________

Answer 46

*Synergism* Potentiation Antagonism Addition

Question 47

___-_______ is the process by which a cell increases the number of receptors to a given drug __- _______ is the process by which a cell decreases the number of receptors for a given drug in response to chronic stimulation

Answer 47

Up-regulation (beta-adrenergic receptors up-regulate in presence of antagonists) Down-regulation (beta-adrenergic receptors down-regulate in presence of agonists)