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Flashcards in Pharm Deck (16)
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which medication do you use to treat alcoholic withdrawal in a patient with normal hepatic function?


what about an alcoholic with POOR hepatic function?

Benzodiazepines are first-line therapy for the psychomotor agitation associated with alcohol withdrawal and to prevent progression to seizures and delirium. Long-acting benzodiazepines  such as diazepam and chlordiazepoxide,  are processed by the liver into active metabolites, and prevent symptoms of alcohol withdrawal: autonomicinstability, seizures, and delerium tremens. Long-acting benzos are preferred in the majority of patients due to their self-tapering effects, resulting in a smoother course of withdrawal. 

In patients with cirrhosis or alcoholic hepatitis, these active metabolites accumulate, leading to oversedation. Therefore, in patients with hepatic insufficiency such as from advance cirrhosis, short-acting benzodiazepines that are more rapidly inactivated and habe no active metabolites are preferred. Lorazepam, Oxazepam, Temazepam used for those who drink a LOT. Ok for Terrible Livers. 


which of the following signs is an indication that a patient has begun to develop a physical dependence on benzodiazepines?

The patient begins to experience anxiety and irritability when medication dose is decreased.

explanation: Patients who develop physical dependence to a drug will experience withdrawal symptoms when the drug dose is decreased or terminated. Chronic use of sedative benzodiazepines can cause downregulation of the inhibitory GABA-A receptor complex and upregulation of excitatory NMDA and AMPA receptors. As a result, when the regular dose of benzodiazepines is reduced, patients with physical dependence to benzodiazepines experience anxiety, irritability, weight loss, tremor, poor sleep due to the increased levels of NMDA and AMPA receptors. 


what are the short acting benzodiazepines?


  • Alprazolam
  • Triazolam
  • Oxazepam
  • Midazolam


Sevoflurane may result in all the follwoing respiratory effects EXCEPT:

  • hypercapnia
  • decreased tidal volume
  • increased minute ventilation
    • postoperative atelectasis

minute ventilation decreases with the used of volatile anesthetics such as sevoflurane. Volatile anesthetics such as sevoflurane are respiratory depressants that decrease tidal volume (TV) and induce a compensatory increase in respiratory rate (RR). However, the increase in respiratory rate is not adequate to compensate for the decrease in tifal voume and thus minute ventilation  (MV= TV * RR) decreases. The breathing pattern seen in patients under general anesthesia with volatile anesthetics is rapid and shallow. 


Minimal alveolar concetration is influlenced by which of the following patient characteristics?

height, weight, age, sex


MAC does vary with age. Older patients will typically require a lower concentration of drug to achieve a comparable anesthetic effect, meaning that the MAC decreasees with advancing age. 


What symptoms can help you differentiate between serotonin syndrome  and neuroleptic malignant syndrome (NMS)?

serotonin syndrome= hyperreflexia and clonus

NMS= rigidity and hyporeflexia


CYP450 inducers

Most chronic alcoholics steal Phen-Phen and Never Refuse Greasy Carbs

  • Modafinil
  • Chronic alcohol use
  • St. Johns wort
  • Phenytoin
  • Phenobarbital
  • Nevirapine
  • Rifampin
  • Griseofulvin
  • Carbamazepine


CYP450 substrates

Always Think When Outdoors

  • Anti-epileptics
  • Theophylline
  • Warfarin
  • Oral contraceptive pills


CYP450 Inhibitors

SICKFACES.COM (when I am drinking grapefruit juice)

  • sodium valproate
  • Isoniazid
  • Cimetidine
  • Ketoconazole
  • Fluconazole
  • Acute alcohol abuse
  • Chloramphenicol
  • Erythromycin/clarithromycin
  • Sulfonamides
  • Ciprofloxacin
  • Omeprazole
  • Metronidazole
  • Amiodarone
  • Grapefruit juice


Which antiarrythmic class would be inneffective in treating an ECG reading with a widened QRS with delta waves?

Class II (beta blockers)

A widened QRS with a delta wave is suggestive of Wolff–Parkinson–White, a condition where an accessory pathway allows impulses to pass from the atria to the ventricles without passing through the AV node. Because Class II antiarrhythmics primarily influence calcium-dependent depolarization in the SA and AV nodes, they are less effective in arrhythmias driven by accessory pathways.



A 55-year-old woman is started on metoprolol for her atrial flutter. Excited by the prospect of terminating her palpitations, she takes three times the prescribed dose. Which of the following ECG changes are least likely to occur following initiation of a Class II antiarrhythmic?

  1. bradycardia
  2. prolonged PR interval
  3. Prolonged QRS
  4. Junctional rhythm

(3) Class II antiarrhythmics (beta blockers) are least likely to affect QRS duration; these drugs primarily decrease sympathetic input to the SA and AV nodes. QRS duration is driven by the action of potassium channels in the His-Purkinje system and ventricular myocytes.


Where in the heart are beta 1 adrenergic receptors located?

Which part of the heart recieves most benefit from beta blockers (class II antiarrythmics)?

  • Beta-1 receptors are located throughout the heart, and all cardiac tissue is responsive to adrenergic stimulation.
  • In the SA and AV nodes agonism of beta receptors increases heart rate, while in the myocytes beta agonism increases contractility.


Which drugs can cause gingival hyperplasia?


calcium channel blockers, phenytoin, cyclosporine


which drugs can cause drug-induced lupus/SLE?

hydralazine, procainamide, isoniazid


which drug classes can cause orthostatic htn as an adverse effect?

alpha 1 blockers and ACE inhibitors (esp when on a diuretic)


What is reflex tachycardia and what drugs can cause it?

  • vasodilation--> decreased BP--> activation of the sympathetic NS
  • reflex response: increase HR
  • Can be caused by vasodilators:
    • hydralazine
    • alpha 1 blockers
    • dihydropyridine calcium channel blockers
    • nitroglycerine