ACE Review - Pharm Flashcards
Moa clopidogrel and ticlopidine
Inhibit adenosine diphosphate receptors.
Moa aspirin
Stops cox1 from changing arach to thromboxane.
Moa tirofibran and abciximab.
Irrev binder of g3p2 receptors.
Moa of Gabapentin.
L type calcium channels on the alpha 2 delta subunit.
Does Gabapentin work on GABA receptors?
no
common triggers for malig hypertherm
volatiles and succ
what gene mutation is prone to malignant hyperthem
ryr1 gene in chrom 19
malignant hyperthermia moa
irregular release of intracell calcium…intracell contraction, atp, depletion, acidosis, cell death
dose if dantrolene
2.5mg/kg
does nitrous oxide cause MH
no
does intravenous anesthestics cause MH
no
how to treat hyperkalemia in MH
bicarb, glucose/insulin, calcium chloride
is cacl or ca gluconate adding to hypercalemic state of MH
no, the hypercalcemic state occurs intracell, not extracell, main goal is to treat arrythmia
what is not a treatment drug for MH assoc arrythmia
calcium channel blockers because they work against dantrolene
goal urine output in MH
2cc/kg/min
goal temp of MH
36-38, not higher or lower
is 2.5mg/kg dantrolene enough
no sometimes titrated up to 10mg/kg
what kind of mm relaxant is roc
monoquaternary aminosteriod
what is likely to decrease when given atropine
decrease in bronchopulmonary tone
what happens to body temp when given atropine
it increases body temp because there is a decrease in sweat gland secretions
what happens to the urine when given atropine
decrease urine output because it prevents urethral relaxation
what happens to the gi tract when given atropine
constipation, decrease acid secretion, decrease LES tone
what happens to the eye with atropine
mydriasis and increased intraocular pressure
which muscarinic recepter does atropine work on
m3
if there is a decrease in cardiac output, the rate of change of FA/FI is less likely affected by what
the less soluable gas is minimally affected by a decrease in cardiac output
what is the value used to measure the solubility of a gas
bloodgas partition coefficient
what gases are more affected by a decrease or change in cardiac output
soluble gases
what are the solubility of the gases
iso 1.46 sevo 0.65 dess 0.46, nitro 0.42
what are the effects of IV anesthetics on cerebral blood flow
most decrease cbf…like propofol.
what is the one IV anesthetic that actually increases cbf
ketamine
what do gases do to your cerebral blood flow
increase
what kind of cancer does doxyrubicin help treat
leukemia and lymphoma; wilms tumor, osteogenic sarcoma, breast carcinoma
what is the most common pathology seen by using doxyrubicin
cardiomyopathy
what is the screening test of choice for doxyrubicin
echocardiogram
why cant you use an ekg for doxyrubicin
ekgs most likely will show non-specific changes…like sinus tach, st segment changes, low voltage qrs
if a pt is getting 400mg/m^2, what is the chance of having cardiomyopathy
0.14%
if a pt is getting 550mg/m^2 doxyrubicin, what is the chance of having cardiomyopathy
7%
what does the increase in dose to increase of chances of cardiomyopathy with doxyrubicin mean?
cardiomyopathy is dose dependant
when can late onset of doxyrubicin induced cardiomyopathy occur
4 years after completion of doxy treatment
how common is doxy cardiomyopathy of late onset
it happens in 65% of patients
how specific and sensitive is echo in detecting doxy assoc cardiomyopathy
81%specific, 64% sensitive
what is the echo followup timeline after completing doxy treatment
at 3 6 and 12 months after completion and q 2 years after that
should we use cxray to screen doxy assoc cardiomyopathy
no…it usually detects late signs…and pts benefit from early intervention rather than late intervention
what is propofol infusion syndrome
myocardial failure, dysrythmia pluse 2 of 3 other criteria
what is the other possible criteria of propofol infusion syndrom
metabolic acidosis, rhyabdomyolysis, hyperkalemia
what kind of EKG finding do you find in propofol infusion syndrome
brugada like ekg signs…st elevated in v1-v3 without actually having ischemia
why do you mainly see propofol infusion sydrom in critically ill pt
because they have a very high energy requirement
how does propofol infusion syndrome hurt critically ill pt
at doses 130mcg/kg/min or higher, it can inhibit mitochondrial energy production and prevent oxidation of fatty acids
what is precentage of death In peds poplulation with propofol infusion syndrome
71%
what is the percentage of death in adults with propofol infusion syndrome
31%
what is the difference of an infiltrated IV versus an extravasiated IV
extravasiated iv has vesicants
what are vesicants
those that causes blisters
what are examples of vesicants
pressors, drugs that has Ca and K, some abx, mannitol and chemo agents
how does mannitol cause blisters
because it is hyperosmolar…driving fluid into the extravasation
what is the treatment for mannitol blisters
pressors and pH neutralizing solutions
when is surgery needed for mannitol extravasation
when compartment syndrome is present
what is the cross reactivity of pcn to 3/4th gen cephalosporins
5-12%
what are the other drugs can you use if pcn allergy
vanco and clindamycin
is there data to support premedication to prevent anaphylactic reaction to meds?
no..
what factors affect placental tranfer in drugs
lipid soluble, unionized, small molec weight, low protien binding
what affects a drugs ionization
the drugs pka and the environment ph
why does neuromuscular blocking drugs not cross placenta
because it is highly ionized
why does isoflurane cross over placenta so fast
because it is highly lipid soluble and low molec weight
why does sufent cross the placenta so fast
because it is highly lipid soluble
what narcotic has a black box warning
methadone
what kind of black box risk is there for methadone
cardiac arrythmias
what are 2 things dangerous about methadone
it prolongs QTc, it has a huge variability in patients bioavailability
what other drug do you have to do serial EKGS for like methadone users
droperidol
where does methadone get broken down
liver
what p450 enzymes does methadone get broken down into
3A4, 2D6
what meds might increase methadone because they inhibit 3A4 P450?
grape fruit and fluoroquinone antibiotics
what meds might increase methadone because they inhibit p450 2d6
SSRI fluoxetine, paroxitine
why does methadone vary so much in patients.
at certain doses, methadone actually induces its own metabolism, bioavailability varies among pts as well
why does methadone not work so well in cancer patients.
methadone is highly protien bound. In cancer patients, they have a reactive protien Alpha1A that is increased and binds the drug…decreasing its availabilty
do inhaled steriods for asthma cause adrenal corticoid suppression
no
what electrolyte abnormality do you see in pt using short actiing beta 2 agonist
hypOkalemia and hypOmag
what caution do you need to have when using mucolytics with asthma patients
they can actually cause bronchospasm
what is the onset and duration of short acting beta 2 agonist drugs for asthma
onset 5 mins duration 4-5 hours
what is an example of a short acting beta 2 agonist asthma drug
albuterol
what is the onset and duration of long acting beta 2 agonist for asthma drugs
no immediate effect…duration 12 hours s/p inhaler use
what are some examples of long acting beta2 agonist asthma drugs
salmaterol
what is bad about long beta 2 agonist
black box warning showing an association of increased mortality 1/1125 pts studied
along with short acting betal 2 agonist, what other drugs are used to treat asthma
inhaled corticosteriods
does using short term beta 2 agonist along with long acting beta 2 agonist
no they do not affect eachother
if the beta2/steriods inhaler fails to work, what is the next step of meds
parentral steriods
when do you see the effect of parentral steriods
4-6 hours onset
when pt becomes intolerant to beta 2 steriods…what other drugs can be used
anticholinergic…like ipratroprium
when is ipratroprium most effective
it is more effective in COPD pts
what is albuterol plust ipratropium
that is combivent
what is a dangerous side effect of combivent
flu like symptoms that occur in 1/20 pts
when is a pt on oral/parentral steriods for asthma be considered andreal suppressed
at least 2 weeks usage w/in the last 6 months
what happen to electrolytes with chronic lasix
hypoKalemia hypoMag
what is increased in chronic lasix usage
bicarb
how is calcium affected with chronic lasix usage
it is not affected
what happens to bicarb in chronic lasix usage
it is increased 2ndry to contraction alkalosis and due to H and Cl secretion for Na preservation
is poor o2 sat a good indicator of cyanide toxicity
no, actually your pulse ox would actually read a normal sat
is measuring serum cyanid levels a good way to test for cyanide toxicity
toxicity is dependant on dose and rate of release of cyanide…cyanide levels are difficult to attain and thus not a good way to check for toxicity
is a brown color of blood a good way to check for cyanide toxicity
actually the blood will be bright red…think of other pathology like meth-hemoglobinemia…which will be brown
what drug has cyanide as a metabolite
nitroprusside