Final Review Flashcards
(182 cards)
1
Q
Tachyphylaxis is described as?
A. The magnitude of a response seen with respect to the given dose of drug.
B. The rapid appearance of progressive decrease in response to a given dose of a drug after continuous or repetitive administration.
C. The number and activity of a receptor population may increase or decrease in response to chronic drug administration.
D. The effect of a drug increase with additional doses, and an increase in adverse effects is noted.
A
B. The rapid appearance of progressive decrease in response to a given dose of a drug after continuous or repetitive administration
2
Q
- Alignment of a drug with its receptor is aided by various bonding forces, which two bonding forces play a prominent role in this alignment?
A. Van der Waals
B. Hydrophobic
C. Hydrogen
D. Ionic
A
A. Van der Waals
D. Ionic
3
Q
- When choosing the best drug dose for a patient, which of the following factors should be taken into consideration (PATA)
A. Age
B. Gender
C. Weight
D. Ethic Background
A
All. A. B. C. D.
4
Q
- Neuraxial opioids undergo uptake into epidural fat, systemic absorption, or diffusion across dura into cerebrospinal fluid.
A. True
B. False
A
A. True
5
Q
- The first-pass hepatic metabolism can alter bioavailability of some drugs. Pick two drugs that undergo substantial first-pass elimination.
A. Morphine
B. Propofol
C. Sevoflurane
D. Lidocaine
A
A. Morphine
D. Lidocaine
6
Q
- Opioids work as agonists on opioid receptors at pre and postsynaptic sites in the (Pick 2)
A. Frontal Lobe
B. Brainstem
C. Spinal cord
D. Peripheral extremities
A
B. Brainstem
C. Spinal cord
7
Q
- You are developing an anesthesia care plan for a 20kg child undergoing surgery. You wish to administer fentanyl as an induction adjunct. How many mcg of fentanyl would you administer based on current dosing guidelines?
A. 2mcg
B. 20mcg (1 mcg/kg)
C. 200mcg
D. 2000mcg
A
B. 20mcg (1 mcg/kg)
8
Q
- Which opioid agonists are known for being especially good at suppressing the cough centers in the medulla? (Pick 2)
A. Morphine
B. Codeine
C. Remifentanil
D. Heroin
A
B. Codeine
D. Heroin
9
Q
- Which opioid receptor is primarily responsible for ventilatory depression?
A. Mu1
B. Mu2
C. Kappa
D. Delta
A
B. Mu2
10
Q
- What are the most common psychologic responses to pain? (PATA)
A. Anger
B. Discomfort
C. Depression
D. Fear
E. Anxiety
A
D. Fear
E. Anxiety
11
Q
- ____________ has also shown efficacy in the management of neuropathic pain.
A. Ketamine
B. Dexmedetomidine
C. Clonidine
D. Depakote
A
A. Ketamine
12
Q
- _____________ acts as a selective partial a2-receptor agonist and is sometimes added to local anesthetics to prolong duration of action.
A
Clonidine (partial agonist)
or
Dexmedetomidine (highly selective agonist)
13
Q
- NSAIDS are associated with a spectrum of upper gastrointestinal complications. Serious ulcer complications have been noted to occur in ____ of patients, including perforation and bleeding.
A. 1-2%
B. 3-4%
C. 5-6%
D. 7-8%
A
A. 1-2%
14
Q
- Which opioid receptors are responsible for urinary retention?
A
Mu1 and delta
15
Q
- Dose for epidural/intrathecal buprenorphine?
A
300 mcg (epidural), 150 mcg (intrathecal)
16
Q
- A substance that binds to a specific receptor and triggers a response in the cell is categorized as an?
A
Agonist
17
Q
- Protamine is a positive charged protein that forms ionic bond with heparin this type of antagonism is referred as:
A
Chemical antagonism
18
Q
- A drug is regarded as being fully eliminated when_______% has been eliminated from the body.
A
95%
19
Q
- How many half-lives elapse before a drug is considered as being fully eliminated from the body?
A
4-5 half lives
20
Q
- 1:10000 concentration of epinephrine has how many mcg/ml?
A
100 mcg/mL
(1,000,000 / 10,000)
one million divided by dilute value
21
Q
- _____________ is a molecule that is able to bind and form a complex with a receptor to produce biologic response.
A
Ligand
22
Q
- The equation 1+1 =3 is a mathematic representation of which form of drug interaction?
A
Synergism
23
Q
- ________is the process by which a cell increases the number of receptors to a given drug
A
Upregulation
24
Q
- The dosage range of a drug that provides safe effective therapy with the minimal adverse effect is___________?
A
Therapeutic window
25
25. Volume of distribution of a mathematical calculation equal?
Dose of drug/plasma concentration of drug
26
When administering morphine IV, analgesia is produced followed by sedation. T/F
False (sedation comes first)
27
What would be a safe dose of epidural morphine to administer as an adjunct?
4 mg (bolus is 2-6mg)
28
28. Which IV anesthetic is highly specific for alpha 2 vs alpha1 at a ratio of 1600:1?
Dexmedetomidine
29
29. Which opioid agonist causes the least increase in biliary duct pressure and sphincter of oddi tone:
meperidine
30
You are ordering meperidine for post op shivering what dosage range will you
order?
12.5-25mg
31
31. Oxycodone is considered to be_________as potent as oral morphine.
Twice
32
Ketamine is a non-competitive antagonist at the _______ receptor.
NMDA
33
What are mu receptors principally responsible for?
Supra spinal analgesia and spinal analgesia
34
What would be a safe dose of subarachnoid fentanyl to administer in an adult patient?
20 mcg (safe is 10-25 mcg)
35
Ketamine enhances opioid-induced analgesia and prevents hyperalgesia. T/F
True (prevents wind-up)
36
Clinically __________rate of breathing and ______ tidal volume is observed when administering opioid agonist to patients
37
State two true statements regarding clinical effects of opioids on neuromuscular junctions and cough suppression
Opioids do not affect nerve conduction at the neuromuscular junction.
Opiates can produce cough suppression
38
Introduced in the 1940’s, methadone is a powerful natural occurring opioid
agonist. T / F
False (synthetic)
39
Hypersensitivity reactions to NSAIDs rarely occur, and they are more common in
individuals with?
Nasal polyps and asthma
40
There is evidence supporting the use of________in multimodal analgesia
protocols to contribute to the post-operative recovery of the patient by minimizing
opioid doses and therefore side effects. This group of drugs also prolong local
and regional anesthesia.
Corticosteroids
41
NSAID's decrease the clearance of _______, which increases serum concentrations.
Lithium
42
________ irreversibly inactivates COX leading to prolonged inhibition of platelet aggregation.
Acetylsalicylic acid (Aspirin)
43
_______ is the leading cause of acute liver failure in the US
Acetaminophen
44
NSAID'S and aspirin inhibit thromboxane production, which leads to alterations in plt
function. The inhibition of thromboxane production is an effect on what____________
COX-1
45
Cox enzyme exists as ________ and _________isoenzymes.
COX-1 and COX-2
46
NSAID's inhibit biosynthesis of prostaglandins by preventing the substrate
arachidonic acid from binding to the_______enzyme active site.
COX
47
The opioid______ does NOT sensitize to cardiac catecholamines or cause cardiac dysrhythmias
Morphine
48
Remifentanil has these increased incidence of ___, ___, and ___ when bolus dosing/repeat dosing
Bradycardia
Respiratory depression
Myoclonus
49
Opioid induced bradycardia by ___ nuclei and depresses the SA node
Vagal
50
Most common side effects of opioids? Select all that applies
a. local histamine release
b. orthostatic hypotension
c. nausea & vomiting
a. local histamine release
b. orthostatic hypotension
c. nausea & vomiting
51
Which induction agent is considered to be the agent of choice in patients with active Asthma?
Ketamine
52
Which statement is true of benzodiazepines and their max effects?
Are known to have ceiling effect (allosteric binding to GABA).
53
Rapid redistribution of propofol from central to peripheral compartments causing brain concentrations to fall accounts for _____
Rapid reawakening in 5-15 mins
54
T/F: Etomidates rapid redistribution accounts for short duration of action
True
55
Which adverse effects can be seen following administration of etomidate? (SATA)
A. adrenocortical suppression
B. Myoclonia
C. Thrombophlebitis
D. nausea/vomiting
A. adrenocortical suppression
B. Myoclonia
C. Thrombophlebitis
D. nausea/vomiting
56
Which agent produces a catatonic state where patients often describe falling separate from the environment?
Ketamine
57
In patients with known liver disease which benzodiazepine would be preferred?
Lorazepam
58
Ketamine is known to____________myocardial oxygen consumption
INcrease
59
Commonly used non-barbiturate iv anesthetics include?
Propofol, ketamine, etomidate
60
Propofol does not cross the placenta. T/F
False (highly lipid soluble and does cross the placenta)
61
Pick two other pharmacological actions that make propofol administration beneficial in select patient populations
Anti emetic & antipruritic effects.
62
Which agents can be administered to reduce the incidence of myoclonus?
Dexmedetomidine, rocuronium, lidocaine (midazolam too, but not an option)
63
13. Which selection is a pharmacologic effect of benzodiazepines?
Anterograde amnesia
64
Remimazolam has a rapid onset and DOA by what mechanism
Organ independent metabolism
65
Benzodiazepines and opioids decrease the MAC for volatile anesthetics. T/F
True
66
Respiratory depression by propofol is considered:
Transient
67
Propofol producing myoclonia is seizure activity and its excitation in the brain T/F
False, this is not true seizure activity
68
Substitutions on various positions of the benzene and seven-member diazepine rings affect __________ and ____________
potency and biotransformation
69
Preservative in propofol?
0.005% disodium edetate (EDTA [ethylenediaminetetraacetic acid])
70
What medication can reduce emergence delirium/agitation in children?
Dexmedetomidine
71
Which inhaled anesthetic is a good bronchodilator?
Sevo
71
____ is concentration required to produce anesthesia in 50% of population upon surgical stimulation
MAC. Minimal Alveolar Concentration
72
MAC requirements are age dependent and peaks at 6 months, then gradually decreases?
At 40yo, MAC decreases 6% every 10 years
73
Diffusion of N2O into closed spaces can occur in medical devices such as:
LMA and ETT
74
What percent of sevo is metabolized?
5-8%
75
What hemodynamic does Sevo have a minimal effect on?
HR
76
When ___ is maintained, the cardiac steel phenomenon is abated
Normotension
77
_________ evoked potential is most sensitive to volatile agents, while ________ evoked potentials are most resistant.
Visual
brainstem
78
Morbidities related to PONV?
Dehydration, electrolyte abnormalities, wound dehiscence, bleeding, esophageal rupture, airway compromise.
79
PONV does not cause hyperalgesia. T/F
True
80
Patient factors that increase risk of PONV?
Women, nonsmoker, history of motion sickness, previous PONV.
81
Surgical factors that increase risk of PONV?
Long procedure, gynecologic, laparoscopic, ENT, breast, plastic, and ortho surgery.
82
Anesthetic factors that increase risk of PONV?
Inhaled anesthetics, nitrous, neostigmine, opioids.
(also etomidate)
83
What medication should not be given to those with gastric obstruction?
Metoclopramide (Reglan)
84
Dexamethasone- periop hyperglycemia risk in which patients?
Obese and Diabetic
85
What medication significantly reduces the risk of vomiting after strabismus surgery in children?
Dimenhydrinate (marketed as Dramamine)
86
Sodium citrate, ____-_____ mL administered ___-____ minutes before the induction of anesthesia, is effective in reliably increasing gastric fluid pH in pregnant and nonpregnant patients.
15-30mL
15-30min
(Nonparticulate (clear) antacids such as sodium citrate are less likely to cause a foreign body reaction if aspirated, and their mixing with gastric fluid is more complete than is that of particulate antacids. Onset of effect is more rapid with sodium citrate than with particulate antacids that require a longer time for adequate mixing with gastric fluid.)
87
_____________ can increase lower esophageal sphincter tone and promotes gastric emptying in those with gastroparesis.
Erythromycin (macrolides)
88
Describe how ED95 values relate to potency and onset of action. Explain WHY
1. Drugs with HIGHER ED95 are less potent and tend to be faster onset times.
*A higher ED95 means more drug is needed, indicating lower potency.
*Drugs with lower potency often have faster onset because they are administered at higher concentrations, which may cross barriers (e.g., blood-brain barrier) more rapidly.
2. Drugs with LOWER ED95 have higher potency require lower doses and having longer durations due to slower clearance
*Lower ED95 means the drug is more potent (requires a smaller dose to achieve the same effect).
*More potent opioids (e.g., fentanyl) are often used in microgram doses vs. milligram doses for less potent drugs (e.g., morphine).
[onset of action is also influenced by lipophilicity, pKa, and formulation, so not all high-potency drugs are slow-onset, and not all low-potency drugs are fast-onset. It’s a general trend, not a strict rule.]
89
MAC of Sevo, Iso, Des, and Nitrous Oxide
Sevo = 2
Des= 6
Iso = 1.1
N2O = 104
90
Blood/Gas Partition Coefficient (@37 Celsius) of Sevo, Iso, Des, and Nitrous Oxide
Sevo = 0.6
Iso = 1.4
N2O = 0.47
Des = 0.42
91
Oil/Gas Partition Coefficient (@37 Celsius) of Sevo, Iso, Des, and Nitrous Oxide
Sevo = 50
Iso = 99
Des = 18.7
N2O = 18.7
92
Factors that increase MAC requirements
93
Factors the decrease MAC requirements
94
Childbearing women need backup birth control for how many days after being sugammadex?
7 days
95
What is a risk of using Neostigmine in patients with pround NMB?
Incomplete reversal, postop residual paralysis
96
What nerve is most sensitive for detecting residual NMB?
Ulnar Nerve - Adductor Pollicis Nerve of Thumb
97
What nerve is most sensitive for detecting onset NMB?
Facial Nerve - Orbicularis Oculi
or
Corrugator Supercili (eyebrow)
98
What and Where: Acetylcholine Metabolized?
Acetylcholinesterase
(Genuine, Type I, True, Specific Cholinesterase)
Primary Location: Neuromuscular Junction
99
What and Where: Succinylcholine, Mivacurium, and Ester LAs Metabolized?
Pseudocholinesterase aka Plasma Cholinesterase (aka Butyryl, Type II, False Cholinesterase)
100
What and Where is Esmolol metabolized?
RBC esterases in the RBC
101
What antibiotics affect NMBs?
102
Which NMB has a metabolite that can produce seizures?
Atracurium, active metabolite Laudanosine
103
During CardioPulmonary Bypass, will you need more or less volatile anesthetic?
More
104
When are MAC requirements highest?
at 6 months of age, MAC 1.5-1.8 times higher than that of a 40 yr old
105
How does hypothermia influence induction and emergence of volatile anesthetics?
slower induction, with slower emergence due to increased tissue capacity and slower perfusion, as temp falls solubility and potency increase
106
what is MAC-Bar
It represents the mean alveolar concentration at which 50% of patients will not exhibit an adrenergic response to surgical stimulation
107
What is MAC-Awake
108
What antibiotics can prolong NMBs?
Aminoglycosides (Gentamicin), polymyxins, clindamycin, lincomycin, tetracyclines
109
What diuretic can prolong NMB?
Furosemide
110
Albuterol and volatile anesthetics effects on bronchomotor tone are?
Additive
111
LA liposomal delivery systems are used to:
Prolong the duration of local anesthetics
Decrease toxicity of LA
Allow a consistent release of LA into the tissue
112
The minimum concentration of LA necessary to produce conduction blockade of nerve impulse is termed:
Minimum effective concentration (Cm)
113
LA act by:
Binding to specific sites in the voltage-gated sodium channels, blocking sodium ion current.
114
LA produces ___ blockade on both CNS and PNS
Reversible
114
Goal of spinal anesthesia is:
For sensory anesthesia
Muscle relaxation/paralysis
114
Pipecoloxylidide (mepivacaine, bupivacaine, ropivacaine) are chiral because their molecules possess an ___ carbon atom.
Asymmetric
115
Chemical structure of LA:
Ester or amide carbon group link together a hydrophilic hydrocarbon chain to a lipophilic aromatic ring.
116
LA are weak bases with a pka slightly ___ physiologic pH.
Above
117
The Minimum effective concentration (Cm) of motor fibers is twice that of sensory fibers, therefore:
Sensory anesthesia may not always be accompanied by skeletal muscle paralysis.
118
Order of loss of sensation:
Early: vasomotor, superficial pain, touch, and temperature
Intermediate: pressure, touch, pain, cold, muscle tone
Last: proprioception, motor
119
True or False: There may be clinically significant transplacental transfer of LA between mom and fetus
True - ion trapping
120
T or F: Acidic environments (infection) increase ionized fraction which will decrease the effectiveness of LA.
True
121
Absorption of LA is influenced by what?
Site of injection, dose, use of epi, and pharmacologic characteristics
122
If the pka is close to physiological pH, you will have a ___ onset.
faster
123
Esters have a metabolite, ___, which can cause allergic reactions.
Paraaminobenzoic, PABA
124
Prilocaine metabolizes to orthotoluidine which oxidizes hemoglobin to methemoglobin resulting in what?
Methemoglobinemia
125
What syndrome is commonly associated with intrathecal injection of 5% lidocaine?
Cauda equina
126
Site of action for an epidural?
Diffuses across the dura to act on nerve roots and spinal cord
127
What do you need to calculate the dose for a spinal?
Height, segmental level of desired anesthesia, and duration desired.
128
Risk factors for hypotension and bradycardia include sensory anesthesia above ___ and baseline SBP <120 mmHg.
T4
129
What does epinephrine do to B2 receptors?
Activation of B2 receptors causes smooth muscle relaxation in bronchioles.
And in skeletal muscle vasodilates to facilitate blood flow during times of stress
130
Coagulation is ___ by epinephrine.
Accelerated
131
Which pressor is used to increase CO in patients with low contractility, low BP, low UO, and may be used after bypass or in CHF pt?
Dopamine
132
When using dopamine in a chronic phase of illness, it can further suppress circulating levels of which hormones?
Pituitary hormones.
133
In what patients will dobutamine increase CO?
CHF and is useful for weaning cardiopulmonary bypass. Not good for pt with low SVR because it causes modest peripheral vasodilation.
134
Is ephedrine a direct or indirect acting agent?
Both
135
Ephedrine is not as effective in what patient group?
Those who are catecholamine depleted: HF, excessive HTN, neurodegenerative, any state of stress (sepsis).
136
Which pressor has the most effect on metabolism?
epinephrine
137
First line pressor for sepsis?
Norepinephrine
138
What drug is 2-3 times more potent than epinephrine and at least 100 times more active than norepinephrine?
Isoproterenol
139
Continuous infusion of which pressor during a potassium infusion interferes with K movement across the membrane into the cell causing hyperkalemia?
Phenylephrine
140
T or F: Phenylephrine mimics the action of norepinephrine but is less potent and longer lasting.
True
141
Dose for subcutaneous terbutaline?
0.25 mg SQ
142
In ___% of Wolff-Parkinson White pt, digitalis decreases refractoriness in the accessory conduction pathway to the point where rapid atrial impulses can cause Vfib.
30%
143
The most common reason for digitalis toxicity in the absence of renal disease is?
Concurrent administration of diuretics (causes K depletion)
144
Milirnone is associated with more vasodilation and greater decrease in SVR and BP than dobutamine. Unlike dobutamine, it rarely causes _______
tachycardia
145
What does acidosis do to ionized calcium?
Increases calcium levels (H ions kick off Ca from proteins)
146
What is Prazosin?
Selective post-synaptic a1-receptor antagonist
147
Most common side effects of clonidine?
Sedation and xerostomia
148
T or F: Beta antagonists should be continued throughout periop period to maintain desired effects and avoid sympathetic NS hyperactivity.
True
149
True or False: The principal difference in pharmacokinetics between all B-antagonists is the elimination half time ranging from brief for esmolol (10 mins) to hours.
True
150
What is the standard BB to which all others are compared?
Propranolol
151
True or False: Plasma esterases responsible for hydrolysis of esmolol are distinct from plasma cholinesterase and duration of action of succinylcholine is not predictable prolonged.
True (Esmolol is metabolized by RBC esterases, not plasma)
152
What medication used as eye drops may have systemic absorption and can cause bradycardia and increased airway resistance?
Timolol
153
Beta antagonists can cross the placenta and cause:
bradycardia, hypotension, and hypoglycemia in newborns
154
Blocking potency ratio (B to alpha) of labetalol?
3:1 for PO and 7:1 for IV
155
B antagonist prophylaxis after acute MI is one of the best preventative treatments.
acebutolol, propranolol, and metoprolol are approved for prevention of sudden death following MI)
156
Verapamil binds to calcium channels, decreasing Ca influx, therefore decreasing rate of spontaneous phase 4 depolarization. Effects of this include:
Substantial depressant effects on AV node and negative chronotropic effects on SA node.
157
MOA of Hydralazine
Direct systemic arterial vasodilation
158
What is used for therapy of persistent pulmonary HTN in newborns?
Nitric oxide- decreases incidence of death and chronic lung disease
159
MOA of sodium nitroprusside
Generates NO, which augments cyclic cGMP in smooth muscle, leading to vasodilation. Interacts with oxyhemoglobin, dissociating into NO and methemoglobin releasing cyanide.
160
The most common clinical use of nitroglycerin is sublingual or IV administration for treatment of angina pectoris. True or False
True
161
Nitro is not recommended for patients with hypertrophic obstructive cardiomyopathy or severe aortic stenosis. T or False
162
What is a commonly administered oral nitrate for prophylaxis of angina pectoris and preload reduction in HF patients?
Isosorbide
163
The two major physiologic mechanisms that cause ectopic arrhythmias are:
Reentry and enhanced automaticity
164
Antiarrhythmic drugs produce effects by blocking what ion channels in the heart?
Sodium, potassium, calcium
165
What electrolytes or receptors are blocked in each 4 antiarrythymic classes
No Body Knows Cardiac
Class I: Na “No”
Class II: BB “Body”
Class III: K “Knows”
Class IV: Ca “Cardiac”
166
What antiarrythymic drug has excellent oral absorption and a prolonged elimination half life of 20 hours?
Flecainide
167
Most dangerous side effect of sotalol is:
Torsades
167
Amiodarone has a recommended loading dose of 300 mg IV and a prolonged elimination half life of?
29 days
168
What is an endogenous nucleoside that slows cardiac impulses through the AV node?
Adenosine
169
Torsamide is _____ as potent as furosemide.
twice
170
Which diuretic can have antihypertensive effects after several weeks of use?
Thiazide
171
Structurally, mannitol is a ______ sugar alcohol that does not undergo metabolism
six-carbon
172
Which lab values for which coagulation pathway?
Extrinsic- prothrombin time (PT)
Intrinsic- activated partial thromboplastin time (PTT)
173
____ is used to replace all clotting factors and volume
FFP
174
______ does not reverse low-molecular weight heparin
Protamine
175
Which patients are at risk for protamine reaction?
NPH insulin users, vasectomy, multiple drug allergies, prior protamine exposure.
175
High risk surgery patients at risk for or history of HIT may receive:
Bivalirudin or argatroban
176
Delay surgery for _____ hours after the last dose of LMWH in pt with normal renal function.
12
177
Subcut or IV factor Xa antagonist
Fondaparinux
