Misc Pharm

Question 1

What are the two classes of antineoplastic agents?

Answer 1

cell cycle-specific (CCS) AND cell cycle-nonspecific (CCNS)

Question 2

Why are antineoplastics given over short intervals?

Answer 2

so good cells don’t die, less immunosuppression, work on actively dividing DNA

Question 3

When are CCS antineoplastics used?

Answer 3

hematologic malignancies or tumors that have a large portion of cells in proliferation

Question 4

What are some examples of CCS antineoplastics?

Answer 4

methotrexate, bleomycin, vincristine

Question 5

When are CCNS antineoplastics used?

Answer 5

more effective in tumors that are slower to proliferate

Question 6

What are some examples of CCNS antineoplastics?

Answer 6

cyclophosphamide, doxorubicin, cisplatin

Question 7

What chemo drugs are alkylating agents?

Answer 7

cyclophosphamide, cisplatin

Question 8

What chemo drugs are antimetabolites?

Answer 8

methotrexate

Question 9

What chemo drugs are natural products?

Answer 9

vincristine

Question 10

What chemo drugs are antitumor antibiotics?

Answer 10

bleomycin, doxorubicin

Question 11

What is an uncommon but fatal side effect of bleomycin?

Answer 11

pulmonary fibrosis, particularly in older patients.

Question 12

What is a consideration if a patient has had bleo in the last year?

Answer 12

use as low as possible FiO2 to prevent damage

Question 13

What is an adverse effect of doxorubicin?

Answer 13

bone marrow suppression and CARDIAC TOXICITY d/t excessive intracellular production of free radicals within the myocardium

Question 14

What are the 3 main types of hormones/steroids created in the adrenal cortex?

Answer 14

Mineralocorticoids (aldosterone), Glucocorticoids (cortisol), and androgenic hormones (sex hormones)

Question 15

What’s the MOA of steroids?

Answer 15

bind to corticosteroid binding globulin in the plasma, unbind and reach a cell, cross through cellular membrane and bind to intracellular receptor

Question 16

What do steroids do?

Answer 16

alter gene transcription and create tissue specific responses

Question 17

What effects do steroids have on the tissues?

Answer 17

stimulate gluconeogenesis, muscle protein breakdown, stimulate insulin secretion, increase lipolysis, lipogenesis, osteoporosis, immunosuppression, anti-inflammatory, behavioral changes

Question 18

What is acute adrenal crisis?

Answer 18

sudden onset/exacerbation of severe adrenal insufficiency, can happen in preop phase d/t stress of surgery in a patient with inadequate adrenal reserves. considered medical EMERGENCY b/c leads to CV collapse if not treated

Question 19

What are the S/S of acute adrenal crisis?

Answer 19

weakness, nausea, hypotension (refractory/transient), fever, CNS changes

Question 20

What is the treatment of Acute adrenal crisis?

Answer 20

steroids, electrolyte correction, fluids, inotropic support

Question 21

Who needs perioperative steroid replacement?

Answer 21

patients at risk for adrenal insufficiency, prednisone 5mg/day, >2-3 weeks, during last 12 months

Question 22

How do you perioperatively replace steroids?

Answer 22

mixed glucocorticoid/mineralocorticoid (hydrocortisone) so you can hit both systems. 0.8glucocorticoid/1.0mineralocorticoid.
Dose 25-150mg depending on type of surgery

Question 23

True/false. You cannot give ancef if someone is allergic to PCN.

Answer 23

False, there is a cross sensitivity but important to know what the allergy actually is to PCN. If its rash/fever, ancef probably ok.

Question 24

What is the weight based dosing of Ancef?

Answer 24

<80kg 1gm, 80-120kg 2gm, >120kg 3gm

Question 25

What is the severe side effect of beta-lactams?

Answer 25

severe allergic reaction, seizures

Question 26

What is the MOA of beta-lactams?

Answer 26

target cell wall, bactericidal (kill), partially bacterialstatic (inhibit), effective against gram + and -

Question 27

What are examples of beta lactams?

Answer 27

PCN, cephalosporins, carbapenem, monobactam

Question 28

What is ancef used for?

Answer 28

mostly gram - but does have some gram + effects, used in surgery to kill skin flora

Question 29

How is ancef eliminated?

Answer 29

renal excretion, adjust dose for renal function

Question 30

When should ancef be given?

Answer 30

within 60 min of surgical incision and redosed q3h

Question 31

What are examples of beta-lactamase inhibitors?

Answer 31

vancomycin, bacitracin

Question 32

What is the MOA of beta-lactamase inhibitors?

Answer 32

bind irreversibly to B-lactamase

Question 33

What are some s/e of vanco?

Answer 33

red man's syndrome, hypotension--infuse slowly

Question 34

Describe vanco.

Answer 34

Bactericidal, widely distributed, body weight used for dosing, renal dependent--adjust dose

Question 35

What are aminoglycosides for?

Answer 35

treat gram -, bactericidal

Question 36

What are some examples of aminoglycosides?

Answer 36

streptomycin, gentamycin

Question 37

What are the s/e of aminoglycosides?

Answer 37

ototoxicity, nephrotoxicity, prolong action of NMBD

Question 38

What abx do you give for cardiac/thoracic/gi/gyn/neuro?

Answer 38

ancef

Question 39

What abx do you give for GI obstruction?

Answer 39

flagyl + ancef

Question 40

What abx do you give for cystoscopy?

Answer 40

ciprofloxacin PO before the come back to OR, add more in OR

Question 41

What are considerations in an asthmatic patient?

Answer 41

what inhalers do they take, how often, when was the last time they took it, have they had any ED visits in last 6 months, lung sounds, have albuterol out and ready with filter for vent tubing. (remove CO2 line before use.

Question 42

What is the goal of nitric oxide and how does it work?

Answer 42

goal improved perfusion to lung by direct pulmonary arterioles vasodilator, decreases intrapulmonary shunt.

Question 43

What is the FDA approved use of Nitric?

Answer 43

infants with respiratory distress syndrome

Question 44

What should you monitor if you use nitric over 24hours?

Answer 44

methemoglobin levels

Question 45

What are the inhaled adrenergic agonists?

Answer 45

albuterol (short acting) and saleterol/formoterol. (long acting)

Question 46

When do they recommend a long acting inhaler?

Answer 46

when short acting is used more than 2x/week. always used in combination therapy

Question 47

What are the side effects of albuterol & saleterol/formoterol?

Answer 47

tremors, tachycardia...albuterol for hyperkalemia

Question 48

What is an inhaled cholinergic antagonist and how does it work?

Answer 48

ipatropium (short acting), acts on muscarinic receptors in airway to reduce tone.

Question 49

What is ipatropium used for?

Answer 49

maintenance therapy for COPD and rescue therapy for asthma and COPD

Question 50

What are the side effects of ipatropium?

Answer 50

poor systemic absorption so few SE: dry mouth, urinary retention, pupillary dilation, blurred vision

Question 51

Which anesthetics have a beneficial effect on bronchomotor tone?

Answer 51

Volatiles: sevo/iso. IV: propofol, midazolam, ketamine

Question 52

What is HPV?

Answer 52

Hypoxic Pulmonary Vasoconstriction: an intrinsic response within the lungs that occurs with hypoxia, vasculature in a hypoxic area will constrict to direct more BF to hypoxic area.

Question 53

What medications inhibit HPV?

Answer 53

all volatiles in dose dependent fashion, systemic vasodilators: nitroglycerine/nipride