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Anaesthesiology > Pharmacology in Anaesthesia > Flashcards

Pharmacology in Anaesthesia Flashcards

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1
Q

Name selective beta-1 antagonists

A

atenolol
metoprolol
bisoprolol
betaxolol
esmolol

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2
Q

Which drugs are safe to use in acute porphyrias

A

propofol
all neuromuscular blockers
all volatiles
opioids
local anaesthetics

?etomidate

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3
Q

Why do some anaesthetists avoid regional anaesthesia acute porphyrias?

A

In order to avoid confusion if neurological changes occur

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4
Q

Name dopamine antagonists

A

droperidol
promethazine
thiethylperazine
metoclopramide

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5
Q

Which disease causes increased resistance to depolarising neuromuscular blockers

A

myasthenia gravis

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6
Q

What is diazepam mixed with, and what is the result

A

Propylene glycol
Painful IV injection

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7
Q

What are the safe submucosal adrenaline doses for patients under anaesthesia

A

Anaesthesia with halothane: <2mcg/kg.
Arrhythmias occur in 50% of patients at doses >2.1mcg/kg

Anaesthesia with sevo/iso up to 1.2 MAC: 5mcg/kg
Arrhythmias occur in 33% of patients at doses 5-15mcg/kg

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8
Q

Side effects of propranolol

A

[propranolol is a non-selective B-blocker]
- blunted response to hypoglycaemia
- suppressed insulin secretion
- bronchoconstriction
- fatigue
- excessive myocardial suppression
- AV block
- rebound tachycardia after discontinuation
- accentuated response to potassium infusions

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9
Q

Effects of atropine

A
  1. reduced gastric acid secretion
  2. inhibition of salivary secretions
  3. tachycardia
  4. mydriasis
  5. decreased lower oesophageal sphincter tone
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10
Q

Which anticholinesterases can, and cannot, cross the blood brain barrier

A

Cannot cross:
neostigmine
pyridostigmine
edrophonium

Can cross:
physostigmine

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11
Q

Tell me about meperidine:
What is it,
What is important about its structure,
Metabolite,
Side effects

A

Opioid receptor agonist;
structurally similar to atropine;
metabolite normeperidine is renally excreted, causes delirium and seizures especially in patients with renal failure;
has local anaesthetic-like properties,
can impair myocardial contractility

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12
Q

Neuromuscular blockers that can cause histamine releast

A
  1. atracurium
  2. d-tubocurarine
  3. succinylcholine
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13
Q

Metoclopramide effects

A
  1. decreased secretions
  2. raised lower oesophageal tone
  3. increased gastric motility
  4. increased upper intestinal motility
  5. sedation
  6. dysphoria/agitation
  7. EPSEs
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14
Q

Causes of reduced sensitivity to non-depolarising neuromuscular blockers

A

hypercalcaemia
hyperparathyroidism

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15
Q

Drugs that enhance the effect of non-depolarising neuromuscular blockers

A
  1. aminoglycosides
  2. IV lignocaine
  3. magnesium
  4. volatiles
  5. dantrolene
  6. lithium
  7. furosemide
  8. calcium channel blockers
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16
Q

Laudanosine:
what is it,
how is it excreted,
what is its structure,
effect on CNS

A

Metabolite of atracurium and cisatracurium due to the effect of plasma cholinesterases;
renal and hepatic excretion;
tertiary amine;
crosses BBB and stimulates CNS

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17
Q

What are possible mechanisms for the cardiovascular effects of neuromuscular blockers

A

a. histamine release
b. effect on cardiac muscarinic receptors
c. effect on autonomic ganglia nicotinic receptors

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18
Q

Pre-curarisation attenuates which effects of succinylcholine

A

raised intraoccular pressure,
raised intracranial pressure,
myalgia,
bradycardia

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19
Q

What is the pH of thiopental and what is the relevance thereof

A

10.5
Highly alkaline, so high risk of tissue damage if injected arterial or subcutaneously;
bacteriostasis - stays sterile for 6 days at 22C;
is incompatible with most opioids, catecholamines, and neuromuscular blockers

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20
Q

Conditions where succinylcholine causes severe hyperkalaemia (only after a few days)

A
  1. severe burns
  2. severe abdominal infections
  3. stroke
  4. spinal cord transection
  5. myopathies
  6. muscular atrophy due to disease or disuse
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21
Q

Flumazenil:
what is it,
what are its side effects

A

specific antagonist to benzodiazepines;
nausea and vomiting
dizziness
tremors
hypertension

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22
Q

Triggers of acute intermittent porphyrias

A
  1. starvation
  2. dehydration
  3. stress
  4. sepsis
  5. certain drugs
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23
Q

Drugs that may trigger acute intermittent porphyrias

A

barbiturates
ketorolac
pentazocine
diazepam
phenytoin

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24
Q

Drugs that increase CSF production

A

enflurane
desflurane (only in setting of hypocapnoea)

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25
Drugs that inhibit CSF production
halothane furosemide acetazolamide (and hypothermia)
26
Drugs that can enhance conduction via accessory atrial pathways (and are thus contraindicated in WPW syndrome)
pancuronium ketamine verapamil meperidine
27
What does pseudocholinesterase metabolise
acetylcholine succinylcholine mivacurium ester-type local anaesthetics
28
Ageing affects the recovery index of which non-depolarising muscle relaxants
1. vecuronium 2. d-tubocurarine 3. pancuronium 4. rocuronium
29
Side-effects of cyclosporine therapy
1. limb parasthesias (50%) 2. nephrotoxicity (25-38%) 3. hypertension 4. headache 5. seizures 6. somnolence/confusion 7. elevated liver enzymes 8. allergy 9. gum hyperplasia 10. hirsutism 11. hyperglycaemia
30
Indications for cyclosporine therapy
1. anti-rejection after organ transplant 2. Crohn's disease 3. uveitis 4. psoriasis 5. rheumatoid arthritis
31
Side effects of dexmedetomidine
1. hypertension initially, then hypotension after an hour 2. bradycardia 3. sinus arrest 4. respiratory arrest
32
Tolerance develops eventually to which effects of morphine
1. euphoria 2. analgesia 3. nausea 4. respiratory depression
33
Tolerance DOES NOT develop to which effects of morphine
constipation miosis
34
Cimetidine: side effects
1. confusion/delayed emergence 2. bradycardia 3. elevated aminotransaminases 4. CYP inhibition therefore impaired metabolism of: diazepam, lignocaine, propranolol
35
Post anaesthetic shivering: causes
1. hypothermia 2. pain 3. anaesthetic 4. transfusion reaction
36
Post-anaesthetic shivering: drug treatment
1. narcotics 2. tramadol 3. meperidine 4. propofol 5. cimetidine 6. magnesium sulphate 7. physostigmine 8. dexmedetomidine 9. ketanserin (5HT2-antagonist, anti-hypertensive)
37
Treatment for accidental intra-arterial injection of thiopental
1. blocks: stellate ganglion, brachial plexus 2. antithrombotics: heparin, urokinase 3. intra-arterial agents: lignocaine, papaverine
38
Chlorpromazine: What is it; What are its effects/side-effects
D2-antagonist; anti-emetic and antipsychotic; potentiates narcotics; interacts with guanethidine; ECG changes; lowers seizure threshold and causes EPSEs; cholestatic jaundice; impotence; photosensitivity
39
Chlorpromazine ECG changes
QT prolongation PR prolongation blunted T-waves ST depression PVCs Torsades de pointes
40
Drugs used in beta-blocker overdose
1. GLUCAGON 2. atropine 3. dobutamine 4. isoprotenerol (non-selective B-agonist, analog of adrenaline) 5. aminophylline 6. calcium chloride
41
Signs and symptoms of opioid withdrawal
hyperthermia raised blood pressure and heart rate abdominal cramps jerking legs other signs of sympathetic stimulation
42
Minoxidil: effects
1. reduced blood pressure 2. stimulates hair growth 3. pericardial effusion 4. cardiac tamponade 5. pulmonary hypertension
43
Thiocyanate: what is it; signs of toxicity
products of metabolism of sodium nitroprusside especially in renal failure; tinnitus abdominal pain muscle weakness confusion, seizures, coma
44
Signs of cyanide toxicity
metabolic acidosis resistance to antihypertensive effects of sodium nitroprusside raised mixed venous partial pressure of oxygen
45
Examples of monoamine neurotransmitters
1. dopamine 2. noradrenaline 3. adrenaline 4. histamine 5. serotonin 6. melatonin
46
Primary precursor proteins of opioids
pro-opiomelanocortin pro-enkephalin pro-dynorphin
47
Examples of 1. excitatory 2. inhibitory amino acid neurotransmitters
1. glutamate, aspartate 2. glycine, GABA
48
Acid drugs bind to: Basic drugs bind to:
1. albumin 2. a1 acid glycoprotein (AGP)
49
Examples of peptide neurotransmitters
1. encephalins 2. orexins 3. substance P
50
Name the neurotransmitter groups
1. peptides 2. excitatory amino acids 3. inhibitory amino acids 4. cholinergics 5. monoamines 6. nitric oxide
51
Define: neurotransmitter
A substance that transmits physiologic information in the nervous system
52
Which major channels do opioids affect, and how
1. Calcium channels: inhibition, therefore inhibits release of substance P and glutamate 2. Potassium channels: opens postsynaptic channels, causing hyperpolarisation and inhibiting the post-synaptic response
53
Name locations of opioid receptors
1. presynaptic terminals 2. primary afferent neurons 3. post-synaptic second-order pain transmission neurons
54
Name the pain pathways
1. Ascending peripheral nerves dorsal horn of spinal cord thalamus 2. Descending midbrain periaqueductal grey matter rostral ventromedial medulla locus coeruleus
55
Main effects of Substance P
1. pain 2. nausea and vomiting
56
What is aprepitant, and what does it act on
1. antiemetic for chemotherapy and post-operative nausea and vomiting 2. Neurokinin-1 receptor antagonist
57
NMDA receptor antagonists
1. ketamine 2. dextromethorphan 3. magnesium 4. nitrous oxide 5. xenon
58
Receptors affected by ketamine
1. NMDA 2. AMPA 3. opioid 4. acetylcholine (nicotinic and muscarinic) 5. GABA 6. Monoaminergic
59
Receptors in the cys-loop family
1. GABA-A 2. Glycine 3. 5-HT 4. Acetylcholine: nicotinic
60
Agonists of GABA-A
1. barbiturates 2. etomidate 3. propofol 4. benzodiazepines 5. volatile agents
61
For gabapentin/pregabalin: 1. effect site 2. uses
1. voltage-dependent calcium channels; post-synaptic dorsal horn 2. relieving allodynia and hyperalgesia
62
On what three segments of the kidney nephron do osmotic agents such as mannitol exert their diuretic effects?
proximal convoluted tubule thin descending loop of Henle collecting duct
63
On what segment of the kidney nephron do loop agents such as furosemide exert their diuretic effects?
Ascending limb of loop of Henle
64
On what segment of the kidney nephron do thiazides exert their diuretic effects?
distal convoluted tubule
65
On what segment of the kidney nephron do potassium-sparing agents exert their diuretic effects?
collecting tubule
66
On what segment of the kidney nephron do antidiuretic hormone antagonists exert their effects?
collecting duct
67
In the proximal convoluted tubule, the filtrate is _____ (hypotonic/isotonic/hypertonic) to blood plasma.
isotonic
68
In the thin descending limb of the loop of Henle, the filtrate is _____ (hypotonic/isotonic/hypertonic) to blood plasma.
hypertonic
69
In the thick ascending limb of the loop of Henle and the distal convoluted tubule, the filtrate is _____ (hypotonic/isotonic/hypertonic) to blood plasma.
hypotonic
70
On what segment of the kidney nephron does the diuretic acetazolamide exert its effects?
proximal convoluted tubule
71
What are the clinical uses of mannitol?
treating: shock drug overdose raised ICP/IOP
72
What is the mechanism of action of mannitol?
osmotic diuretic increasing osmolarity in the renal tubules; producing increasing urine volume
73
What side-effects are associated with mannitol?
pulmonary oedema dehydration
74
In what two conditions is mannitol contraindicated?
anuric renal failure congestive cardiac failure
75
What four side-effects are associated with acetazolamide?
hyperchloraemic metabolic acidosis; neuropathy; ammonia toxicity; sulpha-like allergic reactions
76
What is the mechanism of action of acetazolamide?
carbonic anhydrase inhibitor; self-limited sodium bicarbonate diuresis; reduction of total body bicarbonate stores
77
What are the four clinical uses of acetazolamide?
Treating: glaucoma; altitude sickness; metabolic alkalosis; urinary alkalisation
78
What are three (general) the clinical uses of furosemide?
Treating: oedematous states; hypertension; hypercalcaemia
79
What is the mechanism of action of furosemide?
inhibits sodium-potassium-chloride co-transport in thick ascending limb of loop of Henle; abolishes hypertonic environment of renal medulla; prevents ability to concentrate urine.
80
What is the effect of the diuretic furosemide on calcium handling in the kidney nephron?
increases calcium excretion (loops lose calcium)
81
Name six toxicities associated with use of loop diuretics
ototoxicity; hypokalaemia; dehydration; allergy (sulpha-like); nephritis (interstitial); gout (OH DANG!)
82
Ethacrynic acid has a mechanism of action similar to which other drug?
furosemide
83
Which loop diuretic is used to diurese patients who are allergic to sulfa drugs?
ethacrynic acid
84
Serum levels of which substances are increased as a result of the effects of hydrochlorothiazide?
hyperglycaemia; hyperlipidaemia; hyperuricaemia; hypercalcaemia

Anaesthesiology (12 decks)

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