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Pharm_spring > Spring Exam 1 > Flashcards

Spring Exam 1 Flashcards

1
Q

nitrous oxide

A 
inhaled general anesthetic
maintenance
weak anesthetic
rapid induction/emergence --> poorly soluble in blood
blood/gas partition coefficient = 0.47
low lipid solubility --> low potency
SE: air pockets may expand, can change bp, depress vent response to hypoxia
does NOT trigger malignant hyperthermia
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2
Q

isoflurane

A 
inhaled general anesthetic
rapidly reversible
blood:gas partition coeff = 1.4
eliminated unchanged via lungs
SE: decr bp, vasodilation, decr vent rate, muscle relaxation, decr renal blood flow, decr brain metabolic rate 
CO maintained
*preferred GA for neurosurgery
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3
Q

enflurane

A 
inhaled general anesthetic
rapidly reversible
blood: gas partition coeff = 1.8
SE: decr bp, decr contractility, vasodilate, decr vent rate, *produce electrical seizure activity
no change in HR
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4
Q

desflurane

A 
inhaled general anesthetic
rapidly reversible; very fast acting
blood:gas partition coeff = 0.45
irritating gas - *must use IV to induce anesthesia
eliminated unchanged via lungs
SE: decr bp, decr vent rate
CO maintained
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5
Q

sevoflurane

A 
inhaled general anesthetic
rapidly reversible
blood:gas partition coeff = 0.65
*eliminated unchanged via lungs
no change in CO -- *preferred if prone to MI
SE: decr bp, vasodilation, renal effects
*potential short term renal damage*
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6
Q

propofol

A 
IV general anesthetic - "go to"
fast-acting
induction *most common*
not water soluble
- may be dissolved in vegetable oil -- very fatty; *caution with high triglycerides
enhance GABAa
SE: *decr vent rate*, decr bp, vasodilate, decr contractility, pain with injection, anti-emetic
does NOT cross placenta
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7
Q

etomidate

A 
IV general anesthetic
induction and maintenance
used for pts at risk for hypotension
enhance GABAa
activate GABAa without GABA present
SE: myoclonic movements, *N/V*, inhib adrenal gland synthetic enzymes
*NO decr bp or CO*
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8
Q

ketamine

A

IV general anesthetic
water soluble
profound analgesic - don’t need to add opioids
competitive antagonist at NMDA receptor
inhibit voltage sensitive Na, K channels
SE: incr cerebral blood flow, emergence delirium, incr bp, CO, HR, slight decr vent rate, bronchodilator
useful for pts at risk for hypotension
abuse –> deterioration of urinary bladder

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9
Q

midazolam

A 
general anesthetic adjunct
benzodiazepine
pre-op sedation
rapid onset, rapid recovery
water soluble
SE: decr brain metabolic rate, decr blood flow, decr bp, decr vent rate
NO pain with injection
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10
Q

fentanyl

A

general anesthetic adjunct - “go to”
opioid
may be given at induction for later intubation, initial incision
SE: decr vent rate

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11
Q

dexmedetomidine

A 
general anesthetic adjunct
alpha 2 adrenergic agonist
- decr catecholamine release
sedation (long-term)
no amnesia
SE: decr bp, bradycardia
NO change in vent rate!
*useful in non-intubated patients*
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12
Q

dantrolene

A

ryanodine receptor inhibitor
used to treat spasms
treat malignant hyperthermia
SE: muscle weakness, hepatotoxicity

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13
Q

halothane

A

general anesthetic
blood/gas coefficient = 2.3
slowest induction/recovery –> high water (blood) solubility
lipid soluble –> high potency
SE: decr bp, vasodilate, decr CO, bradycardia, decr GFR, decr vent rate, halothane hepatitis, musc relaxation

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14
Q

atracurium

A

non-depolarizing NMJ blocker
intermediate duration of action (30-90min)
degraded by temp
not metabolized by enzymes
– useful for pts with liver and/or renal failure

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15
Q

mivacurium

A 
non-depolarizing NMJ blocker
short duration of action (12-18 min)
metabolized by plasma cholinesterase
SE: flushing of face and neck
caution with liver disease or nutritional deficiencies
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16
Q

rocuronium

A 
non-depolarizing NMJ blocker
steroidal structure
liver metabolism
intermediate duration of action (30-90min)
very rapid onset
used for tracheal intubation
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17
Q

succinylcholine

A

depolarizing NMJ blocker
very rapid onset, short duration of action
used for very short procedures (ex. intubation)
initial fasciculations in chest and abdomen
no antidote
degraded by plasma cholinesterase (butyrylcholinesterase)
excessive opening of nicotinic ACh receptors –> –> less muscle response to motor neuron activity

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18
Q

bupivacaine

A 
local anesthetic
amide - metab in liver, long acting
used for infiltration, nerve block, spinal, epidural
more sensory than motor block
*analgesia during labor*
**NO IV because cardiotoxic**
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19
Q

lidocaine

A 
local anesthetic 
amide - metab in liver, long acting
most widely used
used for infiltration, nerve block, spinal, epidural, topical, IV
good diffusion, penetration
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20
Q

ropivacaine

A 
local anesthetic
amide - metab in liver, long acting
*use for procedures where motor block is undesirable
**ex. labor anesthesia**
reduced CNS and cardiac toxicity
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21
Q

articaine

A

local anesthetic
amide - metab in liver, long acting
rapidly metabolized to inactive metabolite by plasma carboxyesterase
*SE: prolonged numbness

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22
Q

benzocaine

A

local anesthetic
ester - metab in blood, short acting
topically for surface anesthesia
SE: methemoglobin production (at high doses)

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23
Q

cocaine hydrochloride

A

local anesthetic
ester - metab in blood, short acting
topical only
only local anesthetic with inherent vasoconstrictive properties
SE: nervousness, convulsions, cardiac failure
admin with epi may incr cardiac toxicity

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24
Q

“___curium”

A

benzylisoquinonlines
histamine release
few vagal/ganglionic blocking effects
SE: histamine release

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25
Q

“___curonium”

A

steroidal
block ganglionic muscarinic receptors
SE: –> tachy (except vecuronium and rocuronium)

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26
Q

SE of non-depolarizing (competitive) NMJ blockers

A

prolonged apnea

histamine release –> bronchospasm, hypotension

27
Q

amphetamine

A

psychomotor stimulant

28
Q

d-amphetamine

A

psychomotor stimulant

29
Q

lisdexamfetamine

A

psychomotor stimulant

prodrug - linked to lysine

30
Q

methamphetamine

A

psychomotor stimulant
“speed,” “crank,” “ice”
methyl groups –> resistant to metabolism by MAO, increase lipid solubility
longer acting than cocaine

31
Q

methylphenidate

A

psychomotor stimulant
paradoxical effect
stimulate locus ceruleus (NE producing neurons) –> focus

32
Q

cathinone

A

psychomotor stimulant

“bath salts”

33
Q

ephedrine

A

psychomotor stimulant

sympathomimetic

34
Q

modafanil

A

psychomotor stimulant
“non-amphetamine stimulant”
used for narcolepsy, shift work disorders

35
Q

armodafanil

A

psychomotor stimulant
“non-amphetamine stimulant”
used for narcolepsy, shift work disorders

36
Q

cocaine

A

psychomotor stimulant
powdered (HCl) - H2O soluble (absorb through mucous membranes); snorted, ingested, IV
crack (free base) - fat soluble; smoked

local anesthetic with vasoconstriction
similar effects to amphetamines
metabolized by plasma esterase

37
Q

caffeine

A

methylated xanthine
may be used to treat apnea in preterm infants
cortical stimulation, increased mental alertness
respiratory stimulation
cardiac stimulation - incr rate and contractility
periph dilation
renal dilation - diuretic
cerebral - constriction
relax bronchioles
stimulate gastric secretion - AVOID with peptic ulcer

38
Q

theophylline

A

methylated xanthine
treat asthma
may be used to treat apnea in preterm infants
respiratory stimulation
cardiac stimulation - incr rate and contractility
periph dilation
renal dilation - diuretic
cerebral - constriction
relax bronchioles
stimulate gastric secretion - AVOID with peptic ulcer

39
Q

aminophylline

A 
methylated xanthine
treat severe asthma
respiratory stimulation
cardiac stimulation - incr rate and contractility
periph dilation
renal dilation - diuretic
cerebral - constriction
relax bronchioles
stimulate gastric secretion - AVOID with peptic ulcer
40
Q

strychnine

A 
spinal cord stimulant
convulsant
rat poison
antagonist at glycine receptors
- remove post-synaptic inhibitor influences 
--> severe toxic seizures
Tx: diazepam to control seizures
41
Q

tetanus toxin

A

spinal cord stimulant
generalized tetanus, tonic convulsions
inhibit release of glycine from Renshaw cels
Tx: diazepam to control seizures, antimicrobial

42
Q

CNS effects of amphetamines

A 
stimulate reticular activating system
- incr arousal, wakefullness
euphoria (some dysphoria)
delay of "fatigue induced decline" in performance
rebound effects
psychological and physical tolerance and dependence
amphetamine psychosis
suppress appetite (hypothalamus)
43
Q

peripheral effects of amphetamines

A

sympathomimetic
hypertension, tachy, arrhythmia, mydriasis
decreased food intake, malnutrition

44
Q

toxicity of amphetamines

A

sympathomimetic
excessive stimulation, hostility, aggression, psychotic reactions
tactile hallucinations - formication
potential irreversible degen of DA, SE pathways in brain

45
Q

MOA amphetamines

A

acute - incr NE, DA release and inhibit reuptake
chronic - decr DA in reward centers
direct stim alpha receptors in reward centers

46
Q

amphetamines uses

A 
ADD, "hyperkinetic syndrome" in children
narcolepsy
obesity and weight reduction -- tolerance develops
stimulants
abuse
47
Q

cocaine effects

A 
stimulation
euphoria/dysphoria
increased confidence
powerful reinforcer
suppress appetite
paranoia, hallucinations, psychosis
teratogenic, deterioration nasal septum, lung damage, IV infections
48
Q

cocaine MOA

A

acute - block synaptic reuptake dopamine –> euphoria, reinforcing effects
chronic - can’t replenish lost DA –> craving, tolerance/dependence
periphery - block synaptic reuptake NE –> sympathomimetic

49
Q

caffeine, theophylline MOA

A

inhibition phosphodiesterase
blockade adenosine receptors
release of Ca

50
Q 
high water (blood) solubility --> \_\_\_\_\_\_\_ induction
low water (blood) solubility --> \_\_\_\_\_\_\_\_ induction
A

high solubility –> SLOW induction

low solubility –> FAST induction

51
Q

high ____ solubility –> high potency

A

LIPID solubility

52
Q

induction _____ related to water (blood) solubility

potency ______ related to lipid solubility

A

inversely

proportionally

53
Q

IV general anesthetics

A

fast acting
induce anesthesia
highly lipophilic –> high potency
go to CNS and spinal cord first

54
Q

benzodiazepine

A

GA adjunct
pre-op sedation
SE: decr brain metabolic rate, blood flow, decr bp, decr vent rate
monitor closely b/c drug interactions

55
Q

opioids

A

potent analgesics
minimize vascular reflex to noxious, painful stimuli
u-opioid receptor agonist
SE: N/V, decr vent rate, decr HR, decr bp

56
Q

Succinylcholine Phase 1

A

single dose
fast onset
excessive opening nicotinic ACh channels
neostigmine AUGMENT SCh blocking

57
Q

Succinylcholine Phase 2

A

prolonged or 10x normal dose
slow onset
normal muscle membrane potential; nicotinic ACh channels become less sensitive
neostigmine ANTAGONIZE SCh blocking

58
Q

amide local anesthetics

A

metabolized in liver
long acting
taken up by fat, brain, kidney, liver, muscle, gut
highly bound to plasma proteins (a1-acid glycoprotein)

59
Q

ester local anesthetics

A

metabolized by plasma cholinesterase (blood)
short acting
SE: allergic reactions more common

60
Q

epinephrine

A

given with local anesthetics (except cocaine)
co-administered for vasoconstriction
decrease rate of absorption and prolong anesthesia
– reduces amount needed to reach effect
DO NOT inject at peripheral sites
SE: vasodilate skeletal muscle beds –> may incr toxicity

61
Q

local anesthetic CNS side effects

A

initial stimulatory, then depression
low conc
- sleepiness, dizziness, restlessness
high conc
- nystagmus, shivering, CNS depression, resp failure
- restlessness, tremor –> tonic clonic convulsions

62
Q

local anesthetic CV side effects

A

changes in excitability, conduction rate, force of contraction

high, toxic levels
- depression cardiac excitability

63
Q

local anesthetic PNS, etc side effects

A

sensory, motor deficits

cross placenta

64
Q

cocaethylene

A

active metabolite

created when cocaine used in combustion with alcohol

Pharm_spring (3 decks)

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