Fall'20 Pharmacology III > Spring 2020 - pharm exam 3 > Flashcards

Spring 2020 - pharm exam 3 Flashcards

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1
Q

CCB may increase the plasma concentration of:

A

Digoxin

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2
Q

Digoxin plasma concentration may be increased by:

A

CCB’s

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3
Q

Which effects of propranolol are most important?

A
  • Decreased HR

- Decreased contractility

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4
Q

If a patient is saying their ears are ringing; what might you anticipate their plasma concentration of Lidocaine to be?

A

5MCG/ml

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5
Q

what medication would you avoid with Raynaud’s Syndrome?

A

Propranolol

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6
Q

What drug decreases the plasma CLEARANCE of lidocaine and bupivacaine?

A

Propranolol

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7
Q

Q: Which of the following is Ture:

Answers are: (finish them)

  • Epinephrine is…
  • Phenylephrine is…
  • Dobutamine is…
A
  • Epi (Direct general agonist)
  • Neo (pure alpha agonist), A1>A2)
  • Dobutamine (Beta 1 > beta 2)
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8
Q

Drug with greatest potential to produce ventricular arrhythmias:

A

Dopamine

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9
Q

Which is associated with active metabolites? (beta blockers)

A

Propranolol

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10
Q

LA prevent the transmission of nerve impulses by inhibiting what specific voltage gated channels?

A

sodium

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11
Q

Large IV bolus of Precedex leads to:

A

HTN

Bradycardia

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12
Q

What LA has the greatest protein binding?

A

Levobupivacaine

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13
Q

Is tetany a SE of CCB?

A

No

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14
Q

What are SE of CCBs?

A 
hypotension
H/A
Flushing
Edema
Constipation?
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15
Q

What drug can cause reflex bradycardia?

A

Phenylephrine

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16
Q

What is the regional dose of lidocaine with epinephrine?

A

7mg/kg

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17
Q

Name two things that are true regarding Diltiazem?

A
  1. First line tx for SVT
  2. Minimal vasodilating properties; intermediate b/w verapamil and dihydrophyridines
  3. ) Diltiazem has minimal cardiodepressant effects and Is unlikely to interact with beta blocking drugs
    - tx WPW
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18
Q

Ephedrine indirectly or directly stimulates…. (receptors)

A

indirectly

alpha and beta

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19
Q

What amide LA undergoes the slowest metabolism:

A

bupivacaine

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20
Q

List CCB least to greatest for AV/SA node effect & Vasodilation properties

A

verapamil , diltiazem, dihydrophyridines (nicardipine, etc)

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21
Q

List the amides in order of slowest to fastest metabolism:

A

fastest -to slowest : Prilocaine, Lido/mepiv, etio, bupivacaine=ropivacaine

SLOWEST
-ropivacaine
-bupivacaine
-mepivacaine
-Lidocaine
-Prilocaine
FASTEST
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22
Q

Which of the sympatholytics can be administered orally?

A

Ephedrine

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23
Q

Which of the following has very little beta stimulation?

A

phenylephrine

*epi, norepi, ephedrine and dobutamine definitely do

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24
Q

Name a rapid onset selective beta 1 antagonist:

A

Esmolol

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25
Which LA is 35 times more lipid soluble and has a potency and DOA 3-4 times that of mepivacaine:
bupivicaine
26
Principle difference in pharmacokinetecs b/w all the beta blockers is:
elimination Half-time
27
Dobutamine leads to an increase in
cAMP
28
Clearance comparison between Ropivacaine and bupivacaine:
Bupivacaine half time is LONGER *ropivacaine lipid solubility is less than bupivicaine; and has a shorter half time
29
what pharmacological effects of propranolol are most important? (2)
- decreased HR | - decreased contractility
30
Protein binding of Beta Blockers from greatest to least:
Propranolol > Metoprolol > atenolol ``` ** add "PENAMA" Propranolol esmolol nadolol acebutolol Metoprolol Atenolol ```
31
Which LA class is likely to cause an allergic reaction?
Esters | *Tetracaine
32
Prazosin is a (2):
- sympatholytic | - vasodilator
33
What type of patients will have a marked decrease in psudocholinesterase activity but normal enzyme?
- Hep C | - 30 Yo late stage of pregnancy
34
What LA are extracted by the lungs?
Lidocaine Prilocaine Bupivacaine *all amides so Tetracaine is not!
35
What are significant applications of Verapamil?
- Negative chronotropy on SA node | - moderate vasodilating effect on CA and systemic arteries
36
BB with highest protein binding:
Propanolol
37
Which drug has an alpha 2 preference of 1600:1
dexmedetomidine | precedex
38
Labatelol therapy includes: | all of the following
- selective alpha 1 antagonist - direct vasodilation *(also beta 1and 2)
39
Which of the following is not a beta blocker:
isoproterenol
40
What BB has: - less lipid solubility - decreased entrance into the CNS
Atenolol
41
during pregnancy there is a faster onset of
LA blockade
42
Principle contraindication of administration of esmolol is: (2)
- AV Block | - HF not induced by tachycardia
43
Dibucaine is an amide that inhibits: (2)
- Typical plasmacholinesterase | - Typical P CH E
44
Lidocaine, diazepam, and propranolol can increase the pharmacologicallya ctive, unbound portion of which drug?
Verapamil
45
high dose IV push Metoprolol does: (2)
- antagonize Beta 2 | - antagonize receptor Beta 1 selectively
46
PDI produce:
- increased contractility and | - dilates arteries and veins
47
Chiral LA drugs that have S&R:
Bupivacaine | Mepivacaine
48
Elimination half time of Esmolol is due to :
hydrolysis
49
Which drug(s) should be used with caution when given with Dantrolene?
Verapamil & Nifedipine | *CCB's
50
due to Verapamil's dextroisomer , it has:
no slow calcium channel activity
51
Benzocaine is unique because:
it is a weak acid
52
Most alph 2 receptors are found in:
locus cerelus
53
Timolol is effective for glaucoma tx b/c it decreases production of:
aqueous humor
54
L-type channel antagonized by CCB works on which receptor:
Alpha 1
55
What drug should be avoided in asthmatic patients?
Labetalol
56
Initiation of labetalol does what action through Alpha 1 blockade and Beta blockade:
- decreases SVR by A1 blockade | - attenuates tachy by beta blockade
57
what is stored in postganglionic sympathetic nerve endings?
Norepi
58
Prototype of sympathomimetics:
epinephrine
59
What LA's are racemic mixtures?
mepivacaine | bupivacaine
60
CCB should be used with caution in patient with:
- hypovolemia | - LV dysfunction
61
Amide metabolism from Rapid to slow:
Prilocaine>Mepivicaine > Etido = Ropivacaine
62
Which of the following LA is 10xmore potent and more lipid soluble (than procaine)
Tetracaine
63
Unique aspect of nadolol:
daily administration d/t long elimination half tie
64
Drug you would use with caution in RV failure:
Norepi | and dopamine "DN.R"
65
Drug that has the greatest effect on metabolim:
epinephrine
66
Potent activator of alpha, but also activates beta 1 and 2:
epinephrine
67
Which drug does not produce an interaction with digoxin:
Clonidine
68
Drug of choice for prehospital managment of pheochromocytoma is:
Phenoxybenzamine
69
What can be added to LA to increase DOA?
epinephrine
70
Verapamil is given for all of the following situations except:
acute myocardial ischemia
71
is verapamil (CCB's) given for management of acute MI?
no
72
Dibucaine number that inhibits succinlchoine?
30
73
Physiological effects of Calcium is seen in:
freely diffusible ionized Ca
74
Substituting a butyl group for the amine group on the benzene ring of procaine results in
tetracaine
75
Labetalol lowers systemic bp by
decreasing SVR and reflex tachycardia triggered by vasodilation is attenuated by simulatneous beta blockade
76
reflex tachycardia triggered by vasodilation is attenuated by
``` beta blockade (labetalol would do this) ```
77
What describes best how the action potential and relationship b/w locals
Failure of sodium channel permeability to increase slows the rate of depolarization such that threshold potential is not reached and thus an action potential is not propagated.
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