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NURS 575 (Pharm) > FINAL: Exam 3 > Flashcards

FINAL: Exam 3 Flashcards

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1
Q

Local anesthetics produce _______ conduction blockade of impulses along central and peripheral nerve pathways

A

reversible

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2
Q

Local anesthetics consist of a _________ and ________ portion separated by a connecting ________ chain

OUTLINE hydrophilic portion (on very right side) N-C2H3-C2H5

A

lipophilic
hydrophilic
hydrocarbon

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3
Q

Mepivacaine, bupivacaine, and ropivacaine are chircal because they possess an ________ carbon atom

A

asymmetric

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4
Q

Drugs such as lidocaine, tetracaine, and bupicavcaine have been incorporated into liposomes

This _______ the duration of action and __________ toxicity

A

prolongs

decreases

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5
Q

Local anesthetics prevent transmission of nerve impulses (conduction blockade) by inhibiting passage of _______ ______ through ion-selective sodium channels in nerve membranes

This slows the rate of ________, therefore threshold potential is not reached and no action potential is propagated

A

sodium ions

depolarization

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6
Q

Local anesthetics

The Cm (minimum effective concentration) of motor fibers is approximately ______ that of sensory fibers

Therefore, _______ anesthesia may not always be accompanied by ________ _______ paralysis

A

twice

sensory
skeletal muscle

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7
Q

Local anesthetics are ______ ______ that have pK values somewhat above physiologic pH

A

weak bases

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8
Q

Water-soluble metabolites of local anesthetics, such as _____ -_________ _____ (_____) resulting from metabolism of ester local anesthetics are readily excreted in urine

A

para-aminobenzoic acid (PABA)

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9
Q

Ester local anesthetics undergo hydrolysis by ___________ enzyme principally in the plasma

A

cholinesterase

(Plasma cholinesterase)

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10
Q

S/S of LAST include: ________, ________

A

Hypotension, seizures

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11
Q

Treatment of LAST
-____________
-_____________ to suppress local anesthetic-induced seizures
-Early use of _______ _______

A

Ventilation
Benzodiazepine
Lipid emulsion

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12
Q

LA

Methemoglobinemia: Rare life-threatening complication (decreased oxygen-carrying capacity) that causes ________ of hemoglobin to methemoglobin more rapidly than methemoglobin is _________ to hemoglobin

A

oxidation
reduced

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13
Q

Dosages of local anesthetics used for spinal anesthesia vary according to the :
- ________ of the patient, which determines the ________ of the subarachnoid space
-________ level of anesthesia desired
-__________ of anesthesia desired

A

Height, volume
Segmental
Duration

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14
Q

LA

Risk factors for hypotension include sensory anesthesia above:

A

T5

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15
Q

LA

________ ________ _________ associated with 5% lidocaine, 25 g needle

A

Cauda equina syndrome

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16
Q

Alkalinization of LA

Adding ________ ________ will speed the onset of peripheral nerve block and epidural block by ____ to ____ minutes

A

sodium bicarbonate
3 to 5

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17
Q

LA

Laboratory evaluation of patients suspected of having atypical pseudocholinesterase is facilitated by measurement of the degree of enzyme suppression by _________, a test termed the ___________ ________

A

dibucaine

dibucaine number

(n = 80)

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18
Q

Cardiovascular sympathomimetic and sympatholytic agents

_____________ has the most significant effect on metabolism of all the catecholamines

A

Epinephrine

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19
Q

Cardiovascular sympathomimetic and sympatholytic agents

Coagulation is __________ by epinephrine = a ___________ state

A

accelerated
hypercoagulable

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20
Q

Cardiovascular sympathomimetic and sympatholytic agents

_________ is a first-line agent in the treatment of refractory hypotension during severe sepsis

A

Norepinephrine

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21
Q

Cardiovascular sympathomimetic and sympatholytic agents

___________ is used clinically to increase cardiac output in patients with decreased contractility, low systemic blood pressure, and low urine output as may be present after cardiopulmonary bypass or with chronic heart failure

A

Dopamine

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22
Q

Cardiovascular sympathomimetic and sympatholytic agents

When dopamine is used in the chronic phase of illness, it further suppresses the circulating concentrations of __________ hormones

A

pituitary

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23
Q

Cardiovascular sympathomimetic and sympatholytic agents

__________ is the most potent activator of all the sympathomimetics with beta-1 and beta-2 receptor activity ____ to ____ times more potent than epinephrine and at least ____ times more active than norepinephrine

A

Isoproterenol
two to three
100

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24
Q

Cardiovascular sympathomimetic and sympatholytic agents

__________ is used to improve cardiac output in patients with congestive heart failure and is also useful for weaning from cardiopulmonary bypass

A

Dobumatine

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25
Cardiovascular sympathomimetic and sympatholytic agents Ephedrine is an _______ and ________ acting sympathomimetic -Stimulation of release of endogenous norepinephrine = _____ -Stimulates alpha and beta adrenergic receptors = ________
indirect, direct indirect direct
26
Cardiovascular sympathomimetic and sympatholytic agents A continuous infusion of __________ during acute potassium loading interferes with the movement of potassium ions across celL membranes into cells
phenylephrine
27
Cardiovascular sympathomimetic and sympatholytic agents __________ is the preferred selective _______ adrenergic agonist for the treatment of acute bronchospasm due to asthma
Albuterol beta-2
28
Cardiovascular sympathomimetic and sympatholytic agents The effects of albuterol and volatile anesthetics on bronchomotor tone are __________
additive
29
Cardiovascular sympathomimetic and sympatholytic agents __________ is a predominantly beta-2 adrenergic agonist that may be administered orally, subcutaneously, or by inhalation to treat asthma
Terbutaline
30
Cardiovascular sympathomimetic and sympatholytic agents The subcutaneous administration of terbutaline is ___ mg
0.25
31
Milrinone is associated with _____ (more/less) vasodilation and ______ (fewer/greater) decreases in systemic vascular resistance and blood pressure than dobutamine True or false question
more greater
32
Cardiovascular sympathomimetic and sympatholytic agents Acidosis ________ ionized calcium, whereas alkalosis ________ ionized calcium
increases reduced
33
Cardiovascular sympathomimetic and sympatholytic agents Prazosin is a selective __________ alpha-1 receptor antagonist
postsynaptic
34
Cardiovascular sympathomimetic and sympatholytic agents Beta-antagonist therapy should be _________ thoughout the perioperative period to maintain desirable drug effects and to avoid risk of sympathetic nervous system _________ associated with abrupt discontinuation of these drugs
continued hyperactivity
35
Cardiovascular sympathomimetic and sympatholytic agents Chronic administration of beta-adrenergic antagonists is associated with an ________ in the number of beta-adrenergic receptors
increase
36
Cardiovascular sympathomimetic and sympatholytic agents The principle difference in pharmacokinetics between all the beta-adrenergic receptor antagonists is the ________ ____ - _______
elimination half-time
37
Cardiovascular sympathomimetic and sympatholytic agents __________ was the first beta-adrenergic antagonist introduced clinically and is the standard drug to which all beta-adrenergic antagonists are compared
Propranolol
38
Cardiovascular sympathomimetic and sympatholytic agents _______ = administered as eyedrops, systemic absorption may be sufficient to cause resting bradycardia and airway resistance = DC in perioperative period
Timolol
39
Cardiovascular sympathomimetic and sympatholytic agents __________ __________ responsible for the hydrolysis of esmolol are distinct from plasma cholinesterase, and the duration of action of succinylcholine is NOT predictably prolonged in patients treated with esmolol
Plasma esterases
40
Cardiovascular sympathomimetic and sympatholytic agents Patients treated with ___________ in whom profound bradycardia has been observed in the presence of inhaled anesthetics =. beta adrenergic antagonist that should not be maintained during perioperative period
timolol
41
Cardiovascular sympathomimetic and sympatholytic agents The beta to alpha blocking potency ration is __:___ for oral labetalol and ___: ___ for IV labetalol
3:1 7:1
42
Cardiovascular sympathomimetic and sympatholytic agents ACE inhibitors first line for: -systemic __________ -________ ________ ________ -________ ___________
systemic hypertension congestive heart failure mitral regurgitation
43
Cardiovascular sympathomimetic and sympatholytic agents ACE inhibitors should be DC'd ___-___ hours before anesthesia and surgery d/t exaggerated hypotension
12-24
44
Cardiovascular sympathomimetic and sympatholytic agents The most common side effects of clonidine are: -____________ -____________
sedation xerostoma
45
Cardiovascular sympathomimetic and sympatholytic agents Do beta-adrenergic antagonists cross the placenta?
Yes
46
Cardiovascular sympathomimetic and sympatholytic agents\ Fetal effects of beta blockers -___________ -__________ -___________
Hypotension Hypoglycemia Bradycardia
47
Vasodilators Calcium channel blocking drugs used as hypertensives inhibit _____ influx through the voltage-sensitive L-type calcium channels in vascular _____ muscle
calcium smooth
48
Vasodilators Hydralazine is an effective _____ reducing agent
afterload
49
Vasodilators Inhaled _____ ______, 10-20 ppm has been used for therapy of persistent pulmonary HTN in the newborn
nitric oxide
50
Nitrovasodilators Nitrodilators work through the generation of NO, which then augments ______ in vascular smooth muscle, both arteries and veins, leading to vasodilation (Sodium nitroprusside, nitroglycerin)
cGMP
51
Nitrovasodilators Sodium nitroprusside (SNP) interacts with oxyhemoglobin, disassociating immediately and forming _________, while releasing _____ and _____ (NO = direct vasodilating effect)
methemoglobin cyanide NO
52
Nitrates The most common clinical use of ___________ is sublingual or IV administration for the treatment of angina pectoris
nitroglycerin
53
Nitrates Nitroglycerine is NOT RECOMMENDED in patients with ___________ __________ __________ or in the presence of severe ________ _______
hypertrophic obstructive cardiomyopathy aortic stenosis
54
Drugs administered for the chronic suppression of cardiac arrhythmias pose little threat to the uneventful course of anesthesia and should be _________ up to the time of induction of anesthesia
continued
55
Antiarrhythmic drugs produce pharmacologic effects by blocking passage of ions across ion channels present in the heart: -__________ ion -_________ ion -_________ ion
sodium potassium calcium
56
Classes of antiarrhythmic drugs: ClassI: _________ Class II: _________ Class III: ________ Class IV: _________
sodium beta blocker potassium calcium
57
The two major physiologic mechanisms that cause ectopic cardiac arrhythmias are ________ and enhanced _________
reentry automaticity
58
The effectiveness of lidocaine in suppressing premature ventricular contractions reflects its ability to decrease the rate of spontaneous phase ____ _________
4 depolarization
59
Anti-arrhythmics Oral absorption of ________ is excellent, and a prolonged elimination hall-time (about 20 hours) makes a twice daily dose of 10-200 mg acceptable
flecainide
60
Anti-arrhythmics Flecainide _________ the capture thresholds of pacemakers
increases
61
beta-adrenergic agonists _________, __________, and _________ are approved for prevention of sudden death following myocardial infarction
Acebutolol Propranolol Metoprolol
62
Anti-arrhythmics _____ mg IV of amiodarone is recommended for ventricular tachycardia or fibrillation resistant to electrical defibrillation
300
63
Anti-arrhythmics Amiodarone has a prolonged elimination half-time (____ days) and is minimally dependent on renal excretion
29
64
Anti-arrhythmics Verapamil has a substantial depressant effect on the _________ node and a negative chronotropic effect on the __________ node
atrioventricular sinoatrial
65
The most frequent case of digitalis toxicity in the absence of renal dysfunction is the concurrent administration of _______ that cause _______ depletion
diuretics potassium
66
In approximately ____% of patients with WPW syndrome, digitalis decreases refractoriness in the accessory conduction pathway
30
67
___________ is an endogenous nucleoside that slows conduction of cardiac impulses through the ________node
Adenosine AV
68
Adenosine can be used in patients with Wolff-Parkinson-White syndrome True or false
True
69
Diuretics Most diuretics produce their clinical effect by blocking sodium (Na+) reabsorption in different locations in the _______, resulting in increased sodium ion delivery to the distal tubles
nephron
70
Diuretics Torsemide is _______ as potent as furosemide and has a _____ duration of action
twice longer
71
Diuretics The sustained antihypertensive effect of thiazide diuretics is due to __________ ___________, which requires several weeks to develop
peripheral vasodilation
72
Diuretics Structurally, mannitol is a ____- carbon sugar alcohol that does NOT undergo metabolism
six
73
The prothrombin time (PT) is used to evaluate the _______ coagulation cascade The activated partial thromboplastin time (aPTT) is used to evaluate the _______ pathway of the classic coagulation system
extrinsic intrinsic
74
FFP is transfused to replace ______ and ________ ________ during massive transfusion
volume coagulation factors
75
Cryoprecipitate contains: -__________ -Factor ____ -Factor ____ -_____
Fibrinogen VIII (8) XIII (13) vWF
76
For surgery or following trauma, expert recommendations suggest a platelet count of greater than or equal to ________ mico L
50,000
77
Tranexemic acid (TXA) is not prothrombotic but rather a ____ __________
clot stabilizer
78
Patients at increased risk for adverse Protamine reaction: -_____ _________ -____________ -______ _______ _______ -______ _______ _________
NPH insulin vasectomy Multiple drug allergies Prior protamine exposure
79
Andexanet alfa is an anticoagulant reversal for _______ and ____________ ( ____ _____ inhibitors)
Apixaban Rivaroxaban Factor Xa
80
_________ is a factor Xa inhibitor that can be administered IV or subcutaneously
Fondaparinux
81
Which statements are true regarding heparin: -The antagonist to heparin is _________ -The onset of action is __________
protamine immediate
82
Delay surgery ___ hours after the last dose of LMWH in patients with normal renal function and longer with renal dysfunction
12
83
Does protamine neutralize LMWH?
No
84
Which statements regarding warfarin are true a. The elimination half-time is ____ hours b. It is 33% protein bound c. Peak concentration in __ hour d. Onset of action = delayed for __-__ h e. Crosses _______, exaggerated effects on fetus
a. 24 b. FALSE (97% protein bound) c. 1 d. 8-12 e. placenta
85
What class of anticoagulants that high-risk surgery patients at risk for or history of HIT may receive ________ __________ inhibitors ________ and ________
Direct thrombin Bivalirudin (Angiomax) Argatroban
86
What is true about ACCP's guidelinesa for Aspirin? a. Stop ___ -____ days before surgery b. Resume about ___ hours after surgery c. Effect is ______ and last for lifetime of platelet (___-___ days) d. Treatment with aspirin reduced incidence of occlusive _____ vascular events
a. 7-10 b. 24 c. irreversible, 7-10 d. arterial

NURS 575 (Pharm) (25 decks)

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