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pharm Flashcards

1
Q

how is remifentanyl metabolized

A

ester hydrolysis

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2
Q

how is a bolus dose of thiopental terminated

A

redistribution from brain to periphery

this is the same for propofol, fentanyl, methohexital

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3
Q

doxyrubicin

does it have a dose dependnt effect on cardiotoxicity?
what are the EKG changes seen with acute toxicity
what are the other systems that it can effect?

A
  • yes dose dependent effect during and mnths after therapy
  • ST segment changes
  • hepatic, renal, GI, plum, myelotoxicity can also occur
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4
Q

what local anesthetics can cause methemeglobinemia?

A

prilocaine and benzocaine

treated by methlylene blue

think i take PRIde when i roll up to the MET in my BENZ

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5
Q

which anticholinergic agents are best paired wth AcHesterase inhbiitors of neostigmine, pyridostigmine, edrophonium, when revering neuromuscular blockade

A

edrophonium –> atropine

neostigmine/pyridostigmine –> glyco

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6
Q

what procedure is methohexital usually used for and whalso what class of drugs is it

A

its a short acting barbituate

used for ECT, can trigger seizures

think you are HEXED with methohexital aka seizure activity

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7
Q

what is the preferred method to reverse INR

when patient needs surgery or if theres hella bleeding

A

prothrombin complex concentrate +vitamine K

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8
Q

relative contracindiations to ketamine use

A

ischemic heart disease (as sole agent)
vascular anuersym (as sole agent)
increased ICP / brain mass w spontaneous ventilation
open eye opthalmic injury (increased IOP)
schizophrenia

mostly bc ketamine will cause tachycardia and htn

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9
Q

what 2 benzos will not undergo phase 1 meabolism

A

lorazepam + oxazepam

phase 1 = dealkalation or alphatic hydoxylation
phase 2 = glucuronidatio + actylation

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10
Q

what drugs are metabolized by psuedocholinesterase in the plasma

A

succinylcholine
mivacurium
2 chloroprocaine

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11
Q

what drugs are metabolized by nonspecific ester in intestine and muscles

A

remifentanil

atracurium

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12
Q

what drug is metabolized by hoffman degrdation in the plasma

A

atracurium

cisatracurium

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13
Q

zero order vs first order kinetics

A

zero order is that the same amount of of drug is removed per a period of time, linear relationship

first order is dose dependent and removes a percentage of drug per unit time, this is dependent on liver blood flow

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14
Q

what drugs do NOT undergo anny lung metabolism

A

dopamine
isoproterenal
epinephrine

think if the lung touches these drugs u DIE

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15
Q

how to volatile anesthetics affect CBF and CMRO2

A 
CMRO2 decreases 
CBF increases (vasodiation)

NO DOES NOT HAVE this uncoupling effect

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16
Q

from greatest to least wahts the vapor pressure of volatile anesthetics

A

desflurane > iso > sevo

DIS

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17
Q

whats the mechanism of milrinone

A

pde III inhibitor which decreases hydrolysis (breakdown) of cAMP

this drug will increse contractility, decrease afterload

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18
Q

how does introducing ccb to a patient that hasnt had it before affect paralytic agents

A

mild augmentation of both depolarizing and nondepolarizing agents

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19
Q

time of onset of oral vs IV famotadine

A

oral takes 1 hour

IV takes 30 min

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20
Q

what drugs will decrease the changes of K hole symptoms when using ketamine

A

benzos (versed) think u forget about the nightmates
barbituates
propofol

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21
Q

fluride ion production from greatest to least of the volatile gases

A

methoxyflurane > sevo > enflurane > isoflurane > desflurane

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22
Q

recurrence of hypoapnea can happen when narcan is given after what two opioids

A

morphine
dilaudid

think the longer acting ones because narcan only has a 30 min ish duration
narcan = nolaxone

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23
Q

testing for HIT

A

antiplatlet factor 4 has high sensitivity

serotonin release assay has high specficity

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24
Q

what are the hemodynamic effects of high doses of meperidine and why

A

hypotension bc histamine

tachycardia bc atropine like effect

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25
Q

If patient has hypercalcemia how should u change ur nondepolarization muscular blocking agent dose

A

increase dose of paralytic bc ca can antagonize it

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26
Q

how do paralytics affect MG patients

A

they are resistent to succ

and very sensitive to non depolarizating agents

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27
Q

chlorprocaine’s rapid onset of action is due to what property?

A

its high concentration

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28
Q

what is the mechanism of action of IV regional anesthesia

A

blockade of nerves with LA thorugh vasciualr beds reading peripheral nerves and nerve trunks

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29
Q

how does lithium affect depolarizing and non depolarizing muscle blockers

A

it prolongs the effects of depolarizing and non depolarizing muscle paralytics

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30
Q

what patients should you not use succ in

A

any pathology that causes an increase in ach receptors, denervating disorders etc.

you CAN use succ in MG and lambort eaton bc this will not cuase life threatening hyper k since there are less receptors available bc of the antibodies

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31
Q

what two things will increase metabolism of cisatricurium

A

its hoffman elimination and increased temp and increased pH will increase hoffman elimination

32
Q

most common side effect of fospropofol

A

paresthesias and genital itching

its water soluble whereas propofol is lipid soluble (lipid soluble is more like to lead to bacteria growth)

33
Q

what pressor should u not give IM

A
34
Q

by what mechanism does glucagon help cardiac muscle

A

increases cAMP so increases chronotropy and ionotropy via nonadrenergic receptor

35
Q

what agent should you avoid using alone in thyrotoxicosis

A

radioactive iodine, it can initally worsen thyrotoxicosis

36
Q

at a MAC of 1 what volatiles preserve total hepatic blood flow the least

A

from greatest preservation to lease

sevo > iso > halothane

37
Q

two issues with using NO for abdominal insufflation

A
  1. surgical issue if surgery is prolonged

2. PONV risk is higher if surgery > 1 hour

38
Q

what substance is used to measure potency of inhaled anesthetic gases

A

olive oil

Meyer-overton correlation

39
Q

what benzo induction agent is NOT Assocaited w myoclonus

A

midazolam

40
Q

most effective method to reduce propofol pain

A

injecting it into the AC

mixing lido and prop decreases the stability of propofol

41
Q

what eye drug that causes dilation can cause CNS toxicity and convulsions

A

cyclopentolate

42
Q

mechanism of nalbuphine

A

mu antagoinst

kappa agonist

43
Q

flumazenil has a short half so u may need to do what when administering it?

A

redose it, could have recrudescence of sedation after since its so short

44
Q

how does succ affect LES tone and intragastric pressure

A

increases LES and intragastric pressure but it increases LES more

45
Q

4 herbal supplements related to increased bleeding

A

ginger
ginko
garlic
vitamin E

46
Q

what is the median time to peak plasma concentration for fentanyl patch

A

30 hours

onset happens in about 6-8 hours

47
Q

whats the onset of action of chlorprocaine

A

6-12 minutes

48
Q

what is normeperdidine

A

metabolite of meperidine from the liver that can cause CNS stimulation aka seizures

49
Q

what two drugs are metabolized by psuedocholinesterase

A

mivacurium

succinylcholine

50
Q

injecting into the corcobrachilias muscle will ensure what nerve is also blocked

A

musculocutaneous

if this is not properly blocked you will have sensation of the lateral forearm

51
Q

what protects patient from respiratory depression when using buphreorphine

A

ceiling affect for respiratory depression at high doses more than analgesoa

way stronger potency than

52
Q

what eyedrop drug inhibits psuedocholinesrterase and will potentiate succ // miva

A

echothiophase

think drug increases the ECHO “effect” of succ

53
Q

what respiratory effect do benzos have

A

decreased minute ventilaiton mostly by decreasesing tidal volume

54
Q

what does metoclompromide to to LES tone

A

it increaeses LES tone

think its a prokinetic and wants things to move fowrard

no affect on pH

55
Q

do calcium channel blockers affect acH release?

A

no

CCB work on L type channels not P channels

56
Q

which gas will cause megaloblastic anemia

A

NO

57
Q

what enzyme does etomidate suppress that reduces cortisol and aldosterone

A

11 beta hydroxylase

58
Q

what LA has the highest potency for cardiac toxicity

A

bupivicaine
and has the lowest cardiac:CNS toxicity ratio

think bupi will BUMP the HEART too hard that it stops

59
Q

does nicardipine act more on reducing preload or afterload

A

reduces afterload so its easier to titrate

60
Q

after stopping of antiplatlet agent how much platelets are restored each day

A

10-14% daily

61
Q

how is vecuronium cleared

A

liver metabolism

62
Q

what is the clinical correlation with volatile gas metabolism

A

more metabolism increases fluoride and can cause fluoride toxicity

sevo > enflurane > iso > des

enflurane is the only one that causes fluroide nephropathy

63
Q

how long before surgery should u apply scop patch and what are the common side effects of it

A

should be administered 4 hours before surgery

its antimuscarininc side effects = blurry vision, dry mouth agitation

64
Q

what two paralytics will have accumulation of active metabolites in renal failure patients

A

pancuronium

vecuronium

65
Q

what opioid does not have any activity on NMDA receptor

A

oxymorphone

66
Q

which enzyme is induced by st john wart

A

450 3A4

67
Q

how does liver disease affect nicardipine metabolism

A

prolonged half life in liver disese

68
Q

what two drugs are metaboliszed by non specific esterases and would not be effected by psuedocholinesterase deficiency

A

esmolol and remi

succ, mivacurium, ester locals (chloroprocaine) ,cocaine and heroin are metabolized by psuedocholinesterase

69
Q

what is the mechanism of action of eptifibitide and tirofiban

A

IIb-IIIA receptor inhibitors

70
Q

if patient has allergy to cyclodextrins what drug is contraindicated

A

suggamadex

thing the GAME incudes a CYCLE

71
Q

most potent clinically used opioids

A

sulfentanil > fentanyl, remfentanil > alfentanil > morhpine

72
Q

which synthetic opioid does not have biliary spasm

A

butorphanol

73
Q

what drug can be used to treate scopolamine realted delirum

A

physostigmine

74
Q

wha

A
75
Q

how long before surgery should ticlodipine be stopped

A

2 weeks

76
Q

what is dibucaine

A

LA that inhibits normal psuedocholinesterase by 80% in normal person, so dib number is 8-

77
Q

bioavailabilit of midazolam based on route of admin greater to least

A

IV > IM > intranasal > rectal > oral

Basic (8 decks)

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