Pharmacology Flashcards
(211 cards)
1
Q
A
2
Q
Heparin
[half-life elimination time]
A
1 -2 hours
3
Q
2-Chloroprocaine
[rapid onset]
A
able to use high concentrations due to its low systemic toxicitiy
- unlike normally, does not depend on PKa, which is about 9 and thus more pronated (less likely to cross cell membrane) at physiologic pH
4
Q
5-HT3
[receptor]
A
serotonin on platelets and GI tract
5
Q
Adrenergic Agonists
[which 2 have the greatest increase on CO]
A
isoproterenol and dobutamien
6
Q
Adrengergic Agonists
[which 2 cause a large decrease in renal blood flow]
A
phenylephrine and norepinephrine
7
Q
Agents
[effect on SA node]
A
depresses SA node automaticity
- only modest effects on AV node; explains the occurrence of junctional tachycardia when administering an anticholinergic during inhalation anesthesia
8
Q
Agents
[effects on blood pressure]
A
decrease
- Des, Sevo, and Iso decrease blood pressure due to a decrease in systemic vascular resistance
- halothane depression is due to decreases in myocardial contractility and cardiac output
9
Q
Agents
[effects on cardiac output]
A
minimal decrease
10
Q
Agents
[effects on CVP]
A
slight increase except for Sevoflurane
- However, around 1.5 MAC, sevo will show an increase in CVP, then drop again
11
Q
Agents
[effects on heart rate]
A
increase heart rate
- Sevoflurane only increases HR when MAC > 1.5
- halothane has no effect on heart rate
12
Q
Agents
[effects on minute ventilation]
A
decrease
- increase respiratory rate while decreasing tidal volume
- except for Isoflurane
13
Q
Agents
[effects on pulmonary vascular resistance]
A
little to no effect
14
Q
Agents
[effects on systemic vascular resistance]
A
decrease SVR
15
Q
Agents
[ventilatory response]
A
decrease response to incrasing PaCO2
- Desflurane above 1 MAC has the greatest effect
16
Q
Agents
[best for ablative procedures]
A
Sevoflurane
- no effect on AV conduction
- Isoflurane increases the refractoriness of accessory pathways
17
Q
Alpha Blockers
[examples]
A
prazosin
phentolamine
phenoxybenzamine
18
Q
Alpha-1 Agonists
[cardiovascular effects]
A
vasoconstriction
leading to an increase in peripheral vascular resistance, left ventricular afterload, and atrial blood pressure
19
Q
Alpha-1 Agonist
[mechanism of action]
A
increase intracellular [Ca2+] leading to contraction of smooth muscles
20
Q
Alpha-2 Agonists
[cardiovascular effects]
A
reduction of sympathetic outflow
peripheral vasodilation and lower blood pressure
21
Q
Alpha-2 Agonists
[mechanism of action]
A
inhibits adenylate cyclase activity
- decreases the entry of calcium ions into neuronal terminal, which limits exit of norepinephrine
22
Q
anesthetic agent with low potency and poor blood solubility
A
Desflurane
(and N2O)
23
Q
Anti-Arrhythmic Agents
[Class I - type]
A
Na+ channel blocker
- blocks voltage-gated Na+ channels and decreases the slope of phase 0 (Vmax)
24
Q
Anti-Arrhytmic Agents
[Class III - examples]
A
amiodarone and sotalol
25
**Anti-Arrhytmic Agents**
[largest increase in QT interval]
amiodarone
26
**Anti-Arrhytmic Agents**
[best for supraventricular arrhythmias]
adenosine
27
**Anti-Arrhytmic Agents**
[class I - examples]
quinidine
lidocaine
phenytoin
flecainide
28
**Anti-Arrhytmic Agents**
[Class II - examples]
esmolol and metoprolol
29
**Anti-Arrhytmic Agents**
[class II - type]
beta blocker
30
**Anti-Arrhytmic Agents**
[class III - type]
K+ channel blocker
* prolongs repolarization
31
**Anti-Arrhytmic Agents**
[Class IV - examples]
verapamil and diltiazem
32
**Anti-Arrhytmic Agents**
[class IV - type]
Ca2+ channel blocker
* blocks slow calcium channels
33
**Anticholinergics**
[effects on cardiovascular system]
tachycardia
* blockade of muscarinic receptors in the SA node
34
**Anticholinergics**
[respiratory effects]
decrease secretions
bronchodilation
35
**Anticholinesterase**
[muscarinic effects on gastrointestinal system]
increased spasm and salvation
36
**Anticholinesterase**
[muscarinic side effects on cardiovascular system]
decreased heart rate and bradyarrhythmias
37
**Anticholinesterase**
[muscarinic side effets on pulmonary system]
bronchospasm
38
**Antimuscarinics**
[3 examples]
atropine
scopolamine
glycopyrrolate
39
**Atracurium**
[metabolism]
ester hydrolysis and hofmann elimination
40
**Atracurium**
[side effects]
histamine release
* avoid in severe asthmatics
41
**Atropine**
[anti-sialagogue IM dose]
0.01 - 0.02 mg/kg
42
**Barbiturates**
[effect on ICP]
greatest decrease in ICP
43
**Barbiturates**
[effect on seizure threshold]
lowers seizure threshold
44
**Barbiturates**
[effects on cerebral physiology]
decrease CMR, CBF, and ICP
45
**Benzodiazepines**
[effects on cerebral physiology]
slightly decreases CMR, CBF, and ICP
46
**Benzodiazepines**
[mechanism of action]
enhance GABA receptor affinity, but do not directly activate
47
**Benzodiazepines**
[pregnancy and labor]
crosses placenta and may lead to CNS depression
* may increase risk of cleft lip/palate when given during first trimester
48
**Bleomycin**
[adverse effects]
pulmonary fibrosis
49
**Bronchodilators**
[order of effectiveness]
Beta agonists
glucocorticoids
leukotriene blockers
mast-cell stabilizers
theophyllines
anticholinergics
50
**Bupivacaine**
(marcaine)
[duration of action]
5 - 15 hours (anesthesia)
* epinephrine is less effective in prolonging anesthesia because *duration of action is independent of local blood flow*
51
**Calcium Channel Blockers**
[greatest risk of SVT]
verapamil and diltiazem
52
**Cerebral Vasospasm**
[treatment]
Nimodipine
53
**Cisatracurium**
[metabolism]
Hofmann elimination
54
**Cisplatin**
[adverse effects]
renal impairment
55
**Clomipramine**
[drug class]
tricyclic anti-depressant
56
**Clomipramine**
[treatment]
obsessive-compulsive disorder
57
**Clonidine**
## Footnote
(catapres)
[mechanism of action]
alpha-2 agonist
* less selective and longer acting than dexmedetomidine (precedex)
58
**Context Sensitive Half-Time**
[definition]
time necessary for the plasma drug concentration to decrease 50% after discontinuing a continuous infusion
59
Coronary Steal Syndrome
theory that coronary vasodilators that target smaller coronary vessels would redistribute blood from ischemic to nonischemic areas
* Examples: Isoflurane, adenosine, dipyridamole, and nitroprusside
* not clinically proven
60
**Creatinine Clearance**
[equation estimate]
[140 - age] x kg
divided by
72 x [creatinine%]
* multiply by 85% for women
* "Cockroft and Gault" equation
61
**Cryoprecipitate**
[components]
von willebrands
fibrinogen
factor VIII and XIII
62
**Cyclosporine**
[mechanism of action]
calcineurin inhibitor
63
**Cyclosporine**
[treatment]
immunosuppression for organ transplant
64
Anesthetic implications of decreased SVR
* excess perfusion relative to oxygen needs
* loss of body heat due to increase cutaneous blood flow
* enhanced delivery of drugs to NMJ
65
**Desflurane**
[vaporizer]
desflurane is heated to 39oC to *raise* its partial pressure to 1,500 mmHg
* ensures a constant concentration despite changes in barometric pressure or temperature
66
**Desflurane**
[Blood:Gas]
0.42
67
**Desflurane**
[Brand name]
Suprane
68
**Desflurane**
[MAC]
6.0
69
**Desflurane**
[vapor pressure]
660
70
**Dexmedetomidine**
## Footnote
(precedex)
[adverse effects]
antimuscarinic effects
* dry mouth and blurred vision
71
**Dexmedetomidine**
(precedex)
[mechanism of action]
alpha-2 agonist
72
**Dexmedetomidine**
[receptor selectivity]
alpha-2 \> alpha-1
73
**Dextrose 5%**
[osmolarity]
252
74
Diffusion Hypoxia
occurs with abrubtly ending inhalation of N2O
75
**Diuretics**
[3 K+-Sparing Examples]
Spironolactone (*aldactone*)
Triamterene (*dyrenium*)
amiloride (*midamor*)
76
**Diuretics**
[4 Loop Examples]
Furosemide (*lasix*)
Bumetanide (*bumex*)
Torasemide (*demadex*)
Ethacrynic acid (*edecrin*)
77
**Dobutamine**
[effects]
enhances cardiac output without changing blood pressure
78
**Dobutamine**
[receptor selectivity]
Beta-1 \>\> beta-2
79
**Droperidol**
[mechanism of action]
D2 Antagonist
80
**Droperidol**
[side effets]
dystonia
QT prolongation
decreased seizure threshold
81
Drugs causing decreased renal perfusion
NSAIDS
ACE inhibitors
IV contrast
cyclosporines
82
drugs causing direct tubular injury
aminoglycosides
IV contrast
heavy metals
myoglobin and hemoglobin
HIV protease
83
**Edrophonium**
[reversal dose of Atropine]
0.014 mg per mg of anti-cholinesterase
84
**Effect on MAC**
[hypernatremia]
increase
85
**Effect on MAC**
[alpha-2 agonists]
decrease
86
**Effect on MAC**
[Cyclosporine]
increase
87
**Effect on MAC**
[hyperthermia]
increases
88
**Effect on MAC**
[hyponatremia]
decrease
89
**Effect on MAC**
[Lidocaine]
decrease
90
**Epinephrine**
[receptor selectivity]
Beta-1 \> alpha-1 = alpha-2 = beta-2
91
**Esmolol**
[cardiovascular effects]
lowers heart rate and, to a lesser extent, blood pressure
92
**Etomidate**
[Adrenocortical Suppression]
inhibits converstion of cholesterol to cortisol through 11-beta-hydroxylase
* avoid in septic or hemorrhaging patients
* usually only seen in infusions or repeated doses
93
**Etomidate**
[drug interactions]
fentanyl prolongs half-life
opioids decrease myoclonus
94
**Etomidate**
[mechanism of action]
GABAA agonist
95
First Pass **Hepatic** Effect
[which route of administration?]
oral
96
**First Pass Hepatic Effect**
GI tract to portal venous blood to liver before entering systemic circulation
* greatly reduces available drug
97
**Flumazenil**
(imidazobenzodiazepine)
[contraindications]
tricyclic anti-depressants
patients taking benzos for control of seizures
98
**Flumazenil**
## Footnote
(imidazobenzodiazepine)
[mechanism of action]
competitive antagonist of benzodiazepine binding site on GABAA receptors
99
**H1 Antagonists**
[2 examples]
diphenhydramine (benadryl)
promethazine (phenergan)
100
**H2 antagonist**
[gastrointestinal effects]
decreases gastric acid secretion from parietal cells
101
**Halothane Hepatitis**
[risk factors]
female, obese, middle aged, and multiple halothane exposures
102
**Halothane**
[cardiac risks]
slows conduction through SA node
* predisoposes patients to junctional arrhythmias and bradycardia
103
**Histamine**
[cardiovascular effects]
lowers blood pressure
increases HR and contractility
104
**Ionized Drugs**
[characteristics]
inactive
water soluble
cannot cross BBB or undergo hepatic metabolism
can be excreted renally
105
**Isoflurane**
[Blood:Gas]
1.5
106
**Isoflurane**
[brand name]
Florane
107
**Isoflurane**
[MAC]
1.2
108
**Isoflurane**
[vapor pressure]
238
109
**Isoflurane**
[why is emergence quicker than induction?]
agent continues to be absorbed by peripheral tissues dueing emergence
110
**Ketamine**
[adverse effects]
increased oral secretions
myoclonic movements
increased ICP
ocular effects
difficulty to assess anesthetic depth
111
**Ketamine**
[cardiovascular effects]
increases BP, HR, and CO
* when administered with a smalld ose of benzodiazepine or Propofol, sympathetic stimulation can be blunted or eliminated
112
**Ketamine**
[effects on cerebral physiology]
increase CBF and ICP
113
**Ketamine**
[mechanism of action]
NMDA antagonist
114
**Ketamine**
[ocular effects]
diplopia
mydriasis
nystagmus
blepharospasm
increased intraocular pressure
115
**Ketorolac**
[contraindications]
kidney failure and allergy to NSAIDs
* relative contraindications:
* asthma, risk of hemorrhage
116
**Ketorolac**
[equivalence to morphine]
standard dose of Ketorolac equals 6-12 mg of morphine
117
**Ketorolac**
[mechanism of action]
NSAID that inhibits prostaglandin synthesis
118
**Labetalol**
[cardiovascular effects]
lowers blood pressure without increasing heart rate
119
**Lactated Ringer**
[components]
Na+, Cl-, K+, Ca2+, and lactate
120
**Lactated Ringer**
[osmolarity]
273
121
**Lidocaine**
[effects on cerebral physiology]
decrease CMR, CBF, and ICP
122
**Local Anesthetics**
[cardiovascular effects]
depress myocardial automaticity
(*spontaneous phase IV depolarization*)
* can decrease contractility and conduction velocity at high concentrations
* inhibit nitric oxide, causing vasoconstriction
123
**local anesthetics**
[sodium bicarb]
shortens onset time
* alkinalizes drug
124
**Loop Diuretics**
[adverse effects]
* Hypo-
* K+, Ca2+, Mg2+
* Hyperglycemia
* metabolic alkalosis
125
**Mannitol**
[contraindications]
intracranial aneurysm
arteriovenous malformations
intracranial hemorrhage until open
126
**Mannitol**
[dose]
0.25 - 1 g/kg
127
**Meperidine**
## Footnote
(demerol)
[drug interactions]
monoamine oxidase inhibitors
* delirium or fatal hyperthermia
128
**Metabolism**
[4 basic pathways of metabolism]
oxidation
reduction
hydrolysis
conjugation
129
**Metabolism**
[phase I reactions]
reduction
hydrolysis
oxidation
130
**Metoclopromide**
[drug interactions]
blocked by anti-muscarinic drugs
increased side effects with *droperidol*
131
**Metoclopromide**
[black box warnings]
tardive dyskinesia
132
**Metoclopromide**
[contraindications]
GI obstruction
Parkinson's
Pheochromocytoma
133
**Metoclopromide**
[drug class]
dopamine-2 antagonist
134
**Minimal Alveolar Concentration**
[definition]
concentration at 1 atm that prevents skeletal muscle movement in response to supramaximal stimulus in 50% of patients
135
**muscle relaxants**
[effect of respiratory acidosis]
potentiates blockade of NDMR and antagonizes reversal
* may prevent recovery in hypoventilating post-operative patients
136
**Muscle Relaxants**
[effects of Magnesium]
potentiates blockade
* competes with calcium at motor end-plate
137
**Naloxone**
[adverse effects]
may precipitate *pulmonary edema* and *cardiac arrest*
(rare)
138
**Naloxone**
[mechanism of action]
opioid antagonist
139
**Cerebral Palsy**
[response to NDMR]
resistance
140
**Neostigmine**
[onset and peak]
will see effects in 5 minutes
peaks at 10 min
141
**Nitrates**
[vascular effects]
venodilator \> arterial dilator
* decrease preload
142
**Nitroglycerin**
[vascular effects]
venous dilation \> arterial dilation
143
Nitrous can safely be administered in retinal reattachment surgeries as long as it is discontinued ____ minutes prior to bubble injection
15 minutes
144
**Nitrous Oxide**
[Blood:Gas]
0.47
145
**Nitrous Oxide**
[contraindictations]
COPD with blebs
venous air embolism
pneumothorax and pneumocephalus
acut intestinal obstruction
tympanic membrane
intraocular procedures
146
**Nitrous Oxide**
[duration of analgesic effects]
20 minutes
147
**Nitrous Oxide**
[effect on pulmonary vascular resistance]
increase PVR
* especially in patients with pre-existing pulmonary hypertension
148
**Nitrous Oxide**
[effect on vitamin B12]
inhibits vitamin B12 synthesis
* use with caution in pregnant patients and those deficient of the vitamin
149
**Nitrous Oxide**
[effects on right-to-left intracardiac shunt]
may increase shunting of blood and further jeapordize arterial oxygenation
150
**Nitrous Oxide**
[MAC]
104
151
**NMDA Antagonists**
[reason for neuroprotection]
during ischemia, [K+]i decreases and [Na+]i increases causing [Ca2+]i to increase
leads to release of glutamate which acts on the NMDA receptor, enhancing Ca2+ entry
152
**Norepinephrine**
[receptor selectivity]
alpha-1 = alpha-2 = beta-1
153
**Norepinephrine**
[cardiovascular effects]
arterial and venous vasoconstriction
* increased myocardial contractility
* rise in systolic and diastolic pressures
* However, increased afterload and reflex bradycardia prevent rise in cardiac output
154
**Normal Saline**
[osmolarity]
308
155
**Normal Saline**
[components]
Na+ and Cl-
156
**Normothermic Shivering**
[treatment]
meperidine (25-50mg)
clorpromazine (10-25mg)
butorphanol (1-2mg)
157
**Ondanesetron**
[mechanism of action]
5-HT3 antagonist
158
**Ondanestron**
[side effects]
dizziness, headache, QT prolongation
159
**Ondansetron**
[brand name]
Zofran
160
**Opioids**
[allergic reactions]
rare, although some anaphylactoid reactions may occur
* secondary to histamine release following morphine or meperidine
161
**Opioids**
[gastrointestinal effets]
decrease gastric emptying
increase biliary pressure
sphincter of Oddi spasms
162
**Pancuronium**
[allergic reactions]
patients who are hypersensitive to bromides may exhibit allergic reactions
163
**Pancuronium**
[arrhythmias]
predisposition to ventricular dysrhythmias
* increased atrioventricular conduction and catacholamine release
* avoid in combination with tricyclic anti-depressants and halothane
164
**Pancuronium**
[side effects]
hypertension and tachycardia via vagal response
arrhythmias
165
**Phenelzine**
[adverse effects]
decreases plasma cholinesterase activity
166
**Phenylephrine**
[receptor selectivity]
alpha-1 \>\> alpha-2
167
**Phenytoin**
[mechanism of action]
voltage-gated Na+ channel blocker
168
**Physostigmine**
[treatment]
anti-cholinergic toxicity
169
**Plasmalyte**
[osmolarity]
294
170
**Plasmalyte**
[components]
Na+, Cl-, K+, Mg2+, gluconate, and acetate
171
Propofol Infusion Syndrome
Prolonged high-dose infusions of Propofol that can lead to cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure
172
**Propofol**
[effects on cerebral physiology]
decreases CMR, CBF, and ICP
173
**Propofol**
[lipid disorders]
due to its lipid emulsion, should be used cautiously in patients with disorders of lipid metabolism
* examples: hyperlipidemia and pancreatitis
174
**Propofol**
[mechanism of action]
GABAA agonist
* increased chloride conductance, resulting in hyperpolarization of the post-synaptic cell membrane and functional inhibition
175
**Prostaglandin Inhibitors**
[patent ductus arteriosus]
promote closure of persistent PDA
* specifically Ibuprofen and indomethacin
176
Most acidic drugs bind to \_\_\_\_\_, whereas basic drugs bind to \_\_\_\_\_.
albumin (acidic)
alpha-1 glycoprotein (basic)
177
**Proton Pump Inhibitors**
[mechanism of action]
bind to proton-pump on parietal cells in the gastric mucosa and inhibit H+ secretion
178
**Pseudocholinesterase Deficiency**
[drugs known to decrease activity]
Echothiophate
neostigmine
phenelzine
metoclopromide
esmolol
pancuronium
oral contraceptives
179
**Pulmonary Hypertension**
[treatment]
nitric oxide
180
"The speed in an inhalation induction is slowed by right-to-left shunting. The change in the rate of induction is LEAST pronounced when using \_\_\_\_\_"
Isoflurane
* right-to-left shunting more pronounced with high blood:gas solubilities
181
Which inhalational agent is most likely associated with a junctional rhythm?
halothane
182
The rate of _____ determines the rate of induction with volatile agents
FA/FI
183
Which of the following is most responsible
for maintenance of cardiac output during isoflurane
administration?
increased heart rate
* results in maintenance of cardiac output due to preserved carotid baroreceptor reflex
184
"Desflurane vaporizer dial must be set ______ at higher elevations"
## Footnote
(higher or lower)
higher
185
"For intermediate-acting NDMR, a palpable post-tetanic twtich appears about _____ before spontaneous recovery of the first TOF twitch"
10 minutes
186
"Time to recovery is prolonged in proportion to the duration of anesthesia for which agents?"
soluble anesthetics
| (isoflourane and halothane)
187
**Rocuronium**
[metabolism and excretion]
no metabolism
eliminated mostly by liver
188
**Second Gas Effect**
high-volume uptake of one gas accelerates the rate of increase of the alveolar pressure of a concurrently administered "second" gas
189
**Seizure**
[treatment]
Propofol (50-100mg)
phenytoin (500-1000 mg slowly)
midazolam (1-5mg)
190
**Sevoflurane**
[brand name]
Ultane
191
**Sevoflurane**
[Blood:Gas]
0.65
192
Sevoflurane
[MAC]
2.4
193
**Sevoflurane**
[vapor pressure]
160
194
**Sodium Nitroprusside**
[adverse effects]
cyanide toxicity
* metabolic acidosis, cardiac arrhythmias, and increased venous oxygen content
195
**Speed of Induction**
[effects of right-to-left shunt]
slow induction
196
**Speed of Induction**
[relationship to Cardiac Output]
inverse relationship
* an increased cardiac output results in a rapid uptake and therefore a slower induction
* CO mostly influeces soluble anesthetics
* Example: Isoflurane
197
**St. John's Wort**
[adverse drug interactions]
MAO inhibitors and Meperidine
* increased risk of serotonin syndrome
198
**Amyotrophic Lateral Sclerosis**
[response to Succinylcholine]
contractures
199
**Myasthenia Gravis**
[response to Succinylcholine]
resistant
200
**Autoimmune disorders**
[response to Succinylcholine]
hypersensitivity
201
**Sulfonamides**
[risks in neonates]
displaces uconjugated bilirubin from binding sites on albumin, leading to bilirubin encephalopathy
202
**Thiazide Diuretics**
[adverse effects]
* Hypo-
* K+, Na+, Mg2+
* Hyper-
* glycemia, uricemia, lipidemia, Ca2+
203
**Tricyclic Anti-depressants**
[drugs to avoid]
indirect-acting vasopressors and those with sympathetic stimulation
* pancuronium, ketamine, meperidine, and local with epi
204
**Valproic Acid**
## Footnote
(depakote)
[drug interactions]
benzodiazepines
* may precipitate a psychotic episode
205
**Valproic Acid**
[mechanism of action]
increases GABA and inhibitis NMDA
206
**Valproic Acid**
(depakote or valproate)
[treatment]
seizures and bipolar disorder
207
**Vecuronium**
[metabolism]
biliary excretion
| (some renal)
208
**Vincristine**
[adverse effects]
neuropathy
209
**volatile agents**
[effect on dead space]
increase
* due to the decrease in tidal volume
210
**volatile agents**
[effects on cerebral physiology]
decrease CMR, but increase CBF and ICP
211
**volatile agents**
[effects on PaCO2]
increase
