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NUAN 700- Nurse Anesthesia Pharm I > Test 2 Study Guide > Flashcards

Test 2 Study Guide Flashcards

1
Q

What is the Law of energy conservation?

A

Energy is neither created nor destroyed; rather, it is converted to other kinds of energy.

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2
Q

List the following from smallest to largest: atoms, elements, compounds.

A
  • Atoms
  • Elements
  • Compounds
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3
Q

What is an atom?

A

The basic unit of a chemical element.

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4
Q

What phase of matter is compressible?

A

Gas

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5
Q

What is the purpose of the periodic table?

A

To provide atomic number and functional abilities.

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6
Q

What has the highest electronegativity?

A

Fluorine

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7
Q

Are covalent bonds stronger or weaker than ionic bonds?

A

Stronger

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8
Q

What are cations?

A

Molecules that lose an electron and become positively charged.

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9
Q

What are anions?

A

Molecules that gain an electron and become negatively charged.

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10
Q

what are synonymous terms for Lipid Soluble?

A

lipophilic
hydrophobic
nonpolar
unionized
ACTIVE

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11
Q

what are synonymous terms for water soluble

A

hydrophilic
lipophobic
polar
ionized = excretable
INACTIVE

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12
Q

how do you calculate the 02 dissolved in blood

A

To calculate the amount of oxygen dissolved in blood, you use Henry’s Law, which tells us that the amount of a gas dissolved in a liquid is proportional to its partial pressure.

Here’s the basic formula:

Dissolved O₂ (mL O₂/dL blood) = PaO₂ × 0.003

Explanation:
PaO₂ = arterial partial pressure of oxygen (in mmHg)

0.003 = solubility coefficient of oxygen in plasma at 37°C (in mL O₂/dL/mmHg)

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13
Q

calculated 02 dissolved in blood with a Pa02 of 100%

A

If a patient has a PaO₂ of 100 mmHg, then:

Dissolved O₂ = 100 × 0.003 = 0.3 mL O₂/100mL of blood

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14
Q

What is hgb constant?

A

1 g Hgb = 1.34 ml O2

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15
Q

How many osmoles are in NaCl?

A

2

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16
Q

What does Graham’s law pertain to?

A

Density

The rate of diffusion of a gas is inversely proportional to the square root of either the density or the molar mass of the gas.

Molecular weight of water = 18
Molecular weight of alcohol = 56
Therefore, water would diffuse faster than alcohol.

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17
Q

What does Poiseuille’s law pertain to? what’s the formula

A

Viscosity

Rate of Flow(Q)= (pie[3.14] x r^4P) / 8nL

r=radius of tube, P=dif in pressure, L=length of tube, n=viscosity

small changes matter!

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18
Q

Is diffusion reversible?

A

No

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19
Q

Select ways to improve flow in an IV infusion

A

Raise the bag, increase diameter IV, etc.

poiseuilles law

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20
Q

What is the exponent for turbulent flow in Poiseuille’s law?

A

5th power

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21
Q

What is the exponent for laminar flow in Poiseuille’s law?

A

4th power

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22
Q

What is Dalton’s partial pressure calculation?

A

the total pressure exertede by any mix of gases is = to the sum of all the partial pressures in the mixture. (760mmHg)

P= P1 + P2 + P3………..Pn

An example could be oxygen gas at atmospheric pressure (760 mmHg) in which oxygen corresponds to 21% of all gas molecules present in a sample. Therefore, the partial pressure of Oxygen would be 21% x 760 mmHg or about 160 mmHg.

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23
Q

What is the typical humidity range in an operating room?

A

50-60%

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24
Q

What model is glycopyrrolate best shown as?

A

One compartment model

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25
How does a hemorrhagic patient affect metabolism?
It affects perfusion dependent metabolism
26
What is Avogadro's number?
6.022 x 10^23
27
What is the definition of Henry's law?
Relates to gas solubility in liquids
28
In most cases, what must a drug do before reaching its site of action?
Enter the plasma first
29
True or False: A drug must go back to the central compartment before it is metabolized and excreted.
True
30
What law describes the passive flux of molecules down a concentration gradient?
Fick's law
31
Why does propofol wear off on a patient?
Redistribution of drug moving from vessel rich to vessel poor group
32
Q: What law describes passive flux of molecules down a concentration gradient?
Ficks Law Law of passive flux
33
why does propofol wear off so quickly
redistribution vessel rich to vessel poor compartments
34
What are the two types of compartment models in pharmacokinetics?
Vessel-rich: Brain, heart Vessel-poor: Fat, skin
35
How many half-lives does it take to eliminate 96% of a drug?
5 half-lives
36
What should you do if the effect of a slow onset antifibrinolytic takes long?
Give a loading dose
37
What is the relationship between longer infusion and context-sensitive half-time?
Longer infusion = longer context-sensitive half-time (except remifentanil); relates to duration after stopping infusion.
38
What is the purpose of Phase 1 metabolism?
Make drug more hydrophilic and often inactivate it.
39
What element is involved in Phase 1 metabolism?
Oxygen (via CYP450 oxidation)
40
What does Phase 2 metabolism involve?
Conjugation (e.g., glucuronidation, sulfation)
41
What is hydrolysis?
Water breaks ester/amide bond (e.g., esmolol, remifentanil) ++
42
Why is Nimbex considered good for liver failure?
Hoffman elimination (organ-independent)
43
What is the effect of enzyme inhibition on drug metabolism?
↓ metabolism → ↑ drug effect
44
What is the effect of enzyme induction on drug metabolism?
↑ metabolism → ↓ drug effect increased enzyme activity shortens effect
45
True/False: Prodrugs are inactive and activated in the liver.
True
46
What are examples of zero order kinetics?
Ethanol, phenytoin, aspirin
47
What is the difference between first order and zero order kinetics?
First order: Constant fraction eliminated Zero order: Constant amount eliminated
48
What factors affect renal drug entry?
GFR, protein binding, renal blood flow
49
What is the difference between capacity-limited and perfusion-limited elimination?
Capacity-limited: Depends on enzyme function Perfusion-limited: Depends on liver blood flow
50
What is a common variant of polymorphism?
Single base pair change (SNP)
51
What is the effect of an ultrarapid metabolizer on drug activation?
↓ drug effect if drug needs activation; ↑ toxicity if prodrug (e.g., codeine → morphine) eats through all the meds/inhaleds faster than every day peeps
52
What happens to drug effect or toxicity in poor metabolizers?
↑ drug effect or toxicity if drug is active form
53
What does G6PD deficiency cause?
Hemolytic anemia (esp. with oxidative stress)
54
What are the characteristics of AIP?
Autosomal dominant; defect in heme synthesis
55
What is the treatment for AIP?
Avoid triggers (barbiturates, etomidate); give glucose/hemin
56
What are the treatments for Long QT Syndrome (LQTS)?
Beta blockers, avoid QT-prolonging drugs, Mg for torsades
57
Which is NOT a treatment for LQTS?
Class I antiarrhythmics
58
What should be done preoperatively for LQTS?
Consult cardiology, avoid QT-prolonging agents, correct electrolytes
59
What to do in case of succinylcholine and atypical PChE?
Intubate, mechanically ventilate, start propofol gtt; wait 4–8 hrs
60
How is atypical PChE diagnosed?
Dibucaine number (low = atypical variant)
61
What are the essentials for malignant hyperthermia (MH)?
Know triggers (volatile agents, succs), dantrolene dose, genetic link (RYR1), temp/rhabdo/hyperK signs
62
What are the interventions for MH?
TIVA only Flush anesthesia machine 15+ min Use charcoal filters Remove succinylcholine
63
What is the treatment for MH?
Dantrolene 2.5 mg/kg Cool patient Treat hyperkalemia
64
What does brain partial pressure reflect?
Alveolar partial pressure (PA ≈ Pbrain over time)
65
What is the N₂O partial pressure when using 2L N₂O and 1L O₂?
N₂O = 2/3 or ~66%
66
Why can't an O₂ flowmeter reliably measure N₂O?
Due to differences in viscosity/density; N₂O must be independently regulated
67
What is the definition of prolonged QT in males and females?
> 450 ms in males, > 460 ms in females ## Footnote Prolonged QT is a measure of the time it takes for the heart to repolarize after each heartbeat, which can indicate potential heart issues.
68
What are polymorphic ventricular tachyarrhythmias associated with prolonged QT?
Torsades de pointes ## Footnote Torsades de pointes is a specific type of abnormal heart rhythm that can lead to syncope (fainting) and sudden death.
69
What are the two main types of Long QT Syndrome?
Congenital and Acquired ## Footnote Congenital LQTS is inherited, while acquired LQTS can develop due to various factors such as medications or health conditions.
70
What types of mutations are involved in Long QT Syndrome?
Mutations to potassium, sodium, or calcium channels ## Footnote These mutations affect the ion channels that regulate heart electrical activity, leading to prolonged QT intervals.
71
What are some treatments for Long QT Syndrome?
Β-blockers, Limited exercise, AIC ## Footnote AIC refers to an Automatic Implantable Cardioverter-Defibrillator, which may be used in severe cases to prevent life-threatening arrhythmias.
72
What medications should be avoided in patients with Long QT Syndrome (LQTS)?
QT-prolonging medications such as: * Dexamethasone * Epinephrine * Ketamine * Succinylcholine * Anticholinergics * Anticholinesterases * Ondansetron ## Footnote These medications can exacerbate the condition by prolonging the QT interval.
73
Which anesthetics should be used with caution in patients with Long QT Syndrome (LQTS)?
Caution is advised with: * Propofol * Etomidate * Volatile anesthetics ## Footnote The use of volatile anesthetics is controversial due to their potential to prolong the QT interval.
74
What pre-operative measures should be taken for a patient with Long QT Syndrome (LQTS)?
Pre-operative measures include: * Correcting low K+ * Correcting low Mg²⁺ * Correcting low Ca²⁺ * Maintaining normothermia ## Footnote Ensuring electrolyte balance and normothermia helps reduce the risk of arrhythmias.
75
How can sympathetic tone be reduced in patients with Long QT Syndrome (LQTS)?
To reduce sympathetic tone, use: * Anxiolytics * Pain control * Lidocaine ## Footnote These measures help mitigate stress responses that may exacerbate the condition.
76
What is the treatment for torsades de pointes in patients with Long QT Syndrome (LQTS)?
For torsades de pointes, administer: * Magnesium 2 g IV * Cardiovert if unstable ## Footnote Magnesium is effective in terminating torsades de pointes, and electrical cardioversion may be necessary for unstable patients.
77
What treatment options are available for acquired Long QT Syndrome (LQTS)?
Treatment options for acquired LQTS include: * Overdrive pacing * Isoproterenol ## Footnote These interventions can help stabilize the heart rhythm and mitigate symptoms.
78
Name drugs that are weak acids
barbituates propofol acetaminophen aspirin | **b**utt **p**lugs or** a**spirin in the **a**ss
79
Name drugs that are weak bases
Local Anesthetics Opioids Benzos Vasopressors | **L**et **O**ur **B**odies **V**ibrate (lol)
80
What is ion trapping, and how does pH differences across compartments (e.g., fetus vs. mother, stomach vs. intestine) affect drug absorption and reabsorption?
Ion trapping occurs when a molecule crosses a membrane in its nonionized (lipid-soluble) form, then becomes ionized in a compartment with a different pH—trapping it there. Examples: * Fetal blood is more acidic than maternal blood * Cytosol is more acidic than extracellular fluid * Stomach is more acidic than the intestine This affects drug absorption/reabsorption (e.g., in kidneys) because ionized molecules can't easily cross membranes.
81
what's distribution and what are 3 things it is dependent upon
Movement of drug from the central compartment (blood/plasma) to the peripheral compartment (tissues) and redistribution back into the central compartment * Cardiac output * Regional blood flow * Protein binding - Lipid solubility, Degree of ionization, Molecular weight
82
calculation for VD
* Vd = Total amount of drug in the body / Amount of drug in the plasma * Apparent volume/theoretical space vs. physical volume * High volume of distribution = ↑ extravascular vs. vascular Compartment Models * Most distribution to tissues * Higher dose of drug is needed to maintain plasma concentrations * Low volume of distribution = ↑ vascular vs. extravascula
83
T/F- a drug with a higher VD it will have a shorter Half life than a drug with a lower VD
FALSE large vd= unbound an lipid soluble- it has a low plasma concentration therefore a slower elimination | ex- prop, fent, iso
84
Age Related changes that effect pharmacokinetic variability
decreased Cardiac Output decreased protein binding decreased enzyme activity increased fat content = increased VD = stuff sticks around longer Reduced TBW Reduced Renal FXN
85
Q: What is Acute Intermittent Porphyria (AIP), and what are key anesthesia considerations?
AIP is an autosomal dominant metabolic disorder caused by defects in heme synthesis, leading to accumulation of toxic precursors. Symptoms: Neurologic (seizures, psychosis, weakness), GI (severe abdominal pain, emesis), autonomic instability (HTN, tachycardia), anxiety, confusion. Triggers: Stress, fasting, dehydration, sepsis, certain drugs. Avoid: Barbiturates, diazepam, ketorolac, phenytoin, sulfa drugs, OCPs. Controversial: Ketamine, etomidate, regional anesthesia. Safe: Propofol, midazolam, fentanyl, NMBs, glycopyrrolate, atropine, sevoflurane, N₂O.
86

NUAN 700- Nurse Anesthesia Pharm I (6 decks)

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