ACE Review - Pharm Flashcards
1
Q
Moa clopidogrel and ticlopidine
A
Inhibit adenosine diphosphate receptors.
2
Q
Moa aspirin
A
Stops cox1 from changing arach to thromboxane.
3
Q
Moa tirofibran and abciximab.
A
Irrev binder of g3p2 receptors.
4
Q
Moa of Gabapentin.
A
L type calcium channels on the alpha 2 delta subunit.
5
Q
Does Gabapentin work on GABA receptors?
A
no
6
Q
common triggers for malig hypertherm
A
volatiles and succ
7
Q
what gene mutation is prone to malignant hyperthem
A
ryr1 gene in chrom 19
8
Q
malignant hyperthermia moa
A
irregular release of intracell calcium…intracell contraction, atp, depletion, acidosis, cell death
9
Q
dose if dantrolene
A
2.5mg/kg
10
Q
does nitrous oxide cause MH
A
no
11
Q
does intravenous anesthestics cause MH
A
no
12
Q
how to treat hyperkalemia in MH
A
bicarb, glucose/insulin, calcium chloride
13
Q
is cacl or ca gluconate adding to hypercalemic state of MH
A
no, the hypercalcemic state occurs intracell, not extracell, main goal is to treat arrythmia
14
Q
what is not a treatment drug for MH assoc arrythmia
A
calcium channel blockers because they work against dantrolene
15
Q
goal urine output in MH
A
2cc/kg/min
16
Q
goal temp of MH
A
36-38, not higher or lower
17
Q
is 2.5mg/kg dantrolene enough
A
no sometimes titrated up to 10mg/kg
18
Q
what kind of mm relaxant is roc
A
monoquaternary aminosteriod
19
Q
what is likely to decrease when given atropine
A
decrease in bronchopulmonary tone
20
Q
what happens to body temp when given atropine
A
it increases body temp because there is a decrease in sweat gland secretions
21
Q
what happens to the urine when given atropine
A
decrease urine output because it prevents urethral relaxation
22
Q
what happens to the gi tract when given atropine
A
constipation, decrease acid secretion, decrease LES tone
23
Q
what happens to the eye with atropine
A
mydriasis and increased intraocular pressure
24
Q
which muscarinic recepter does atropine work on
A
m3
25
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
26
what is the value used to measure the solubility of a gas
bloodgas partition coefficient
27
what gases are more affected by a decrease or change in cardiac output
soluble gases
28
what are the solubility of the gases
iso 1.46 sevo 0.65 dess 0.46, nitro 0.42
29
what are the effects of IV anesthetics on cerebral blood flow
most decrease cbf...like propofol.
30
what is the one IV anesthetic that actually increases cbf
ketamine
31
what do gases do to your cerebral blood flow
increase
32
what kind of cancer does doxyrubicin help treat
leukemia and lymphoma; wilms tumor, osteogenic sarcoma, breast carcinoma
33
what is the most common pathology seen by using doxyrubicin
cardiomyopathy
34
what is the screening test of choice for doxyrubicin
echocardiogram
35
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
36
if a pt is getting 400mg/m^2, what is the chance of having cardiomyopathy
0.14%
37
if a pt is getting 550mg/m^2 doxyrubicin, what is the chance of having cardiomyopathy
7%
38
what does the increase in dose to increase of chances of cardiomyopathy with doxyrubicin mean?
cardiomyopathy is dose dependant
39
when can late onset of doxyrubicin induced cardiomyopathy occur
4 years after completion of doxy treatment
40
how common is doxy cardiomyopathy of late onset
it happens in 65% of patients
41
how specific and sensitive is echo in detecting doxy assoc cardiomyopathy
81%specific, 64% sensitive
42
what is the echo followup timeline after completing doxy treatment
at 3 6 and 12 months after completion and q 2 years after that
43
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
44
what is propofol infusion syndrome
myocardial failure, dysrythmia pluse 2 of 3 other criteria
45
what is the other possible criteria of propofol infusion syndrom
metabolic acidosis, rhyabdomyolysis, hyperkalemia
46
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
47
why do you mainly see propofol infusion sydrom in critically ill pt
because they have a very high energy requirement
48
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
49
what is precentage of death In peds poplulation with propofol infusion syndrome
71%
50
what is the percentage of death in adults with propofol infusion syndrome
31%
51
what is the difference of an infiltrated IV versus an extravasiated IV
extravasiated iv has vesicants
52
what are vesicants
those that causes blisters
53
what are examples of vesicants
pressors, drugs that has Ca and K, some abx, mannitol and chemo agents
54
how does mannitol cause blisters
because it is hyperosmolar…driving fluid into the extravasation
55
what is the treatment for mannitol blisters
pressors and pH neutralizing solutions
56
when is surgery needed for mannitol extravasation
when compartment syndrome is present
57
what is the cross reactivity of pcn to 3/4th gen cephalosporins
5-12%
58
what are the other drugs can you use if pcn allergy
vanco and clindamycin
59
is there data to support premedication to prevent anaphylactic reaction to meds?
no..
60
what factors affect placental tranfer in drugs
lipid soluble, unionized, small molec weight, low protien binding
61
what affects a drugs ionization
the drugs pka and the environment ph
62
why does neuromuscular blocking drugs not cross placenta
because it is highly ionized
63
why does isoflurane cross over placenta so fast
because it is highly lipid soluble and low molec weight
64
why does sufent cross the placenta so fast
because it is highly lipid soluble
65
what narcotic has a black box warning
methadone
66
what kind of black box risk is there for methadone
cardiac arrythmias
67
what are 2 things dangerous about methadone
it prolongs QTc, it has a huge variability in patients bioavailability
68
what other drug do you have to do serial EKGS for like methadone users
droperidol
69
where does methadone get broken down
liver
70
what p450 enzymes does methadone get broken down into
3A4, 2D6
71
what meds might increase methadone because they inhibit 3A4 P450?
grape fruit and fluoroquinone antibiotics
72
what meds might increase methadone because they inhibit p450 2d6
SSRI fluoxetine, paroxitine
73
why does methadone vary so much in patients.
at certain doses, methadone actually induces its own metabolism, bioavailability varies among pts as well
74
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
75
do inhaled steriods for asthma cause adrenal corticoid suppression
no
76
what electrolyte abnormality do you see in pt using short actiing beta 2 agonist
hypOkalemia and hypOmag
77
what caution do you need to have when using mucolytics with asthma patients
they can actually cause bronchospasm
78
what is the onset and duration of short acting beta 2 agonist drugs for asthma
onset 5 mins duration 4-5 hours
79
what is an example of a short acting beta 2 agonist asthma drug
albuterol
80
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
81
what are some examples of long acting beta2 agonist asthma drugs
salmaterol
82
what is bad about long beta 2 agonist
black box warning showing an association of increased mortality 1/1125 pts studied
83
along with short acting betal 2 agonist, what other drugs are used to treat asthma
inhaled corticosteriods
84
does using short term beta 2 agonist along with long acting beta 2 agonist
no they do not affect eachother
85
if the beta2/steriods inhaler fails to work, what is the next step of meds
parentral steriods
86
when do you see the effect of parentral steriods
4-6 hours onset
87
when pt becomes intolerant to beta 2 steriods…what other drugs can be used
anticholinergic…like ipratroprium
88
when is ipratroprium most effective
it is more effective in COPD pts
89
what is albuterol plust ipratropium
that is combivent
90
what is a dangerous side effect of combivent
flu like symptoms that occur in 1/20 pts
91
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
92
what happen to electrolytes with chronic lasix
hypoKalemia hypoMag
93
what is increased in chronic lasix usage
bicarb
94
how is calcium affected with chronic lasix usage
it is not affected
95
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
96
is poor o2 sat a good indicator of cyanide toxicity
no, actually your pulse ox would actually read a normal sat
97
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
98
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
99
what drug has cyanide as a metabolite
nitroprusside
100
what happens to the mix venous blood of cyanide poisoning
it is elevated
101
why dose cyanide cause a mix venous to have a higher amount of o2
because it displaces o2 from the hemoglobin
102
if cyanide displaces o2 from hemoglobin, what else is elevated other than mix venous o2
partial pressure of o2 in blood
103
what is the best and easiest way to check for toxicity by cyanide
check blood ph it will show metabolic acidosis
104
what is a drug that can help with cyanide toxicity
thiosulfate, vitamin b12
105
how dose thiosulfate work
it increases renal elimination of cyanide
106
how does cyanide work to cause metabolic aciosis
it binds cytochrome oxidases and thus, prevents aerobic metabolism
107
how does vitamin b12 prevent cyanide toxicitiy
it chelates cyanide
108
what poison can be used to treat cyanide toxicity
methhemoglobin
109
what is the byproduct if methemoglobin is used for cyanide toxicity
cyanmethhemoglobin
110
what drugs can produce methemoglobin
amyl nitrite and sodium nitrite
111
what is the risk of using thiosulfate for cyanide toxicity
thiosulfate has sulfar that pushes cyanide to metabolize into a renal excreted metabolite…thiocyanide…this in itself is toxic
112
which patients should not use thiosulfate to treat cyanide toxicity
renal patients bc the thiocyanide that is produced cannot be excreted
113
what are the symptoms of thiocyanide toxicity
tinnitus, visual changes, seizures
114
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115
what ionotrop causes increase cardiac ouput and decrease pulm vascular resistanc
milrinone
116
what is the tem for a drug able to increase ionotropy and decrease vascular resistance
inodilator
117
what does milrinone do moa
it is a phosphodiesterase inhibitor
118
what happens when you inhibit phosphodiesterase
it increases cAMP
119
what does that increase increase in cyclic amp do to pulm vasculature
it dilates pulm vasculator
120
what is the mechanism of action of epi
both beta and alpha direct activity
121
what is baclofen
it is a GABA B Agonist
122
what is baclofen used for
muscle spasticity
123
when is baclofen intrathecally indicated
multiple sclerosis, ALS, cerebral palsy, spinal cord injury
124
when is baclofen indicated for peripheral nerve problems
peripheral, trigeminal, and glossphypharyngeal neuropathy
125
what is the side effect of baclophen
drowsy, weakness, hypotonia,
126
what is amytriptyline
it is a tca for antidepressant
127
what is amitriptyline moa
serotinine reuptake inhibitor
128
what is fluoxetine
it is a ssri
129
what is the danger of getting both tca and ssri tx
serotinine syndrome
130
what is the danger of serotonine syndrome
qt prolongation…inhibition of the perkinje fibers
131
how do you treat qt prolongation of serotonin syndrome
bicarb
132
why do you treat prolongation of serotonine syndrome with bicarb
because bicarb helps secrete tca out faster
133
can you diurese or hemodyalize pt to get rid of tca
no, it is not good as bicarb…bc tca is highly protien bound, its very difficult to excrete the drug these ways
134
how does bicarb excrete tca fast
it makes tca the neutral form, so it is less protien bound
135
When does anaphylaxis occur in anesthesia
It occurs a few minutes after induction of anesthesia
136
What are 3 predictors that the anaphylactic reactions will be severe
It's rapid onset. Bradycardia. The absence of rash before hemodynamic changes
137
Whst are 2 labs that need to be drawn to confirm the diagnosis of anaphylaxis
Histamine and tryptase levels
138
How many different grades of anaphylaxis are there.
There are 4 grades of anaphylaxis
139
Grade 1 anaphylaxis
Presence of cutaneous mucous signs
140
Grade 2 anaphylaxis
Multivisceral signs
141
Grade 3 anaphylaxis
Life threatening multivisceral signs
142
Grade 4 anaphylaxis
Cardiovascular collapse
143
When should histamine be collected
Within 30 min for grade 1 and 2. Within 2hr for grade 3 and 4
144
When. Should tryptase be ordered
Within 15-60 min for grade 1 and 2. Within 30min to2hr for grade 3 and 4
145
What is the most common med in anesthesia that causes allergies
Muscle relaxants
146
What is the first medication to give during severe anaphylaxis
Epinephrine. Cardiovascular stability is priority
147
What is associated with poor outcomes of anaphylaxis.
Late or absence of epinephrine administration
148
Should fluids be giving during anaphylactic reactions ?
Yes. 50% of intravascular volume could third space secondary to increase vascular permeability
149
What happens if epi is not able to reverse anaphylaxis instability.
Use vasopressin
150
If anaphylaxis is not severe, what medications can be used
Hydrocortisone and benadryl
151
What two nmb causes histamine release
Mivacurium and atricurium
152
What influences the amount of histamine release from mast. Cells by nmb
The dose and rate of admin
153
What toxicity is amiodarone associated with
Pulmonary toxicity
154
What other drug is associated with pulmonary toxicity
Bleomycin
155
What percent of pt get pulmonary toxicity associated with amiodarone
6%
156
What is the best predictor of pulmonary toxicity associated with amiodarone
Cumulative dose
157
What is the mortality rate of pulmonary toxicity secondary to amiodarone
10%
158
What is associated with patients who get ARDS related to amiodarone
High oxygen fio2 given intraoperatively
159
Besides pulmonary complications what are other complications associated with amiodarone
Thyrotoxocosis
160
What complication is associated with doxorubicin
Cardio toxicity
161
high or low blood to gas partition coefficient will have a faster rate of induction
a lower blood to gas partition coefficient will have a faster rate of induction
162
what drug can be used PO for chemo related nausea and vomitting
emend aka aprepitant
163
how does emend work
it is an NK1 antagonist....antagonist of substance P
164
what are the adverse effects of emend
none
165
which is more effective, zofran or emend
emend, about 50 times more
166
when should emend be given
1-3 hours before surgery
167
can u use zofran even after giving emend
no interactions at all
168
what are the 3 side effects of protatmine
histamine release, igE mediated allergic reaction, of anaphylactoid reaction
169
what is ige mediated hypersensitivity
it is a type II hypersensitivity (aka previous exposure to protamine will cause allergic response after a second exposure
170
what kind of pre-exposure will cause a type II hypersensitivity to protaine
pts getting NPH, protamine zinc insulin, fish allergy
171
what kind of surgry predisposes pt to protamine type II hypersensitivity
vasectomy
172
what is an anaphylactoid reaction
it is a type iii hypersensitivity...it is like an allergic reaction (igE mediated) but is actually complement and IgG mediated
173
what is the risk associated with protamine anaphylactoid reaction
it causes massive pulmonary htn and possible right sided heart faiilure
174
what is the dose of protamine to fully reverse heparin
0.6 to 1 mg protamine for every 100Units heparin used
175
what is the most common side effect of protamine
hypotension
176
does protamine affect platelets
yes, it may decrease the count...but this is transient and clinically insignificant
177
what two herbal meds may cause irreversible platelet function
garlic and gensing
178
what herbal medication is taken as a sedative
kava
179
what happens if acute injestion of kava, what are the anesthestic requirements
decreased anesthestic requirements
180
what happens if prolong use of kava...what happens to anesthestic requirements
increase anesthetic requirement
181
what herbal medicine has been used for weight lost
ma huang aka ephedra
182
wat are adverse effects of mahuang
stroke and cardiac attacks and tachycardia
183
What is benzocaine toxicity
Methemoglobinemia
184
What patients are prone to damage from methemoglobinemia
G6PD deficiency, M type hemoglobin, Methemoglobin reductase deficiency
185
What age in pediatric patient does methemoglobinemia hurt
less than four months
186
What is the saturation of oxygen methemoglobinemia
84%
187
Treatment for methemoglobinemia
Methylene blue
188
Treatment for Cyanide toxicity
Sodium thiosulfate
189
What treatment for Cyanide toxicity next methemoglobin
amyl nitrite and sodium nitrate,...They make red blood cells form methemoglobin which displaces cyanide from cytochrome oxidase molecules
190
What treatment for cyanide toxicity and that making vitamin B12
Hydroxocobalamin
191
Herbal medicine. When should it be stopped before surgery.
If there is unknown data for the herbal medicine, stop it 2weeks before surgery
192
Herbal medicine. What is ginger used for
Has been used for nausea.
193
Herbal medicine. What problem can ginger cause.
It is antiplatele and can cause bleeding.
194
Herbal medicine. What is kava
It is a pepper derivative that can be used for anxiety.
195
Herbal medicine. How does kava affect anesthesia.
It potentiates benzos
196
Herbal medicine. Does kava cause and change in bleeding.
No
197
Herbal medicine. What is St. John's wart.
It is believed to work like an snri for depression.
198
Herbal medicine. Is St. John warts an MAOI
No.
199
Herbal medicine. What effects does St. John's wart have on the body.
It can inhibit some liver enzymes
200
Herbal medicine. What anesthetic problem can happen when St. John warts inhibit liver function.
It can make drugs like alfentanil, benzos , and snri increase in the system
201
Herbal medicine. What does St. John's wart do to bleeding.
It can become an antagonist to warafin
202
Herbal medicine. What is valerian.
It is a medicine believed to help with anxiety.
203
Herbal medicine. When should valerian be stopped prior to surgery
It should not be stopped because it can cause withdrawl
204
acetylcholinesterase inhibitors. where do they function
at the acetylchoinesterase enzyme
205
acetylcholineasterase inhibitors. how does neostigmine work at the enzyme
it makes a covalent bond with the enyzme
206
acetylcholinesterase inhibitors. how does edrophonium work at the enzyme site
it makes an ionic bond with the enzyme
207
scopolamine patch. what is it used for
post op nausea and vomit
208
scopolamine patch. when should it be started.
it should be started the night prior to surgery
209
scopolamine patch. what is the most common side effect
dry mouth
210
scopoloamine patch. what is the least likely side effect
agitation
211
atricurium. how is it degraded
1/3 hoffman and 2/3 nonspecific plasma esterases
212
atricurium. are nonspecific plasma esterases the same as plasma cholinesterases
nope
213
cisatricurium. how is it degraded
by hoffman elimination
214
gabapentin. how does it work
voltage gated calcium channel
215
gabapentin. where on on the voltage gated calcium channel does it work.
the alpha 2 delta subunit
216
gabapentin. what happens after it binds to the calcium channels
it decreases glutamate and excitation of nociceptive pathways.
217
GABAa. what drugs work here
benzo, prop, flumazenil, etomidate
218
voltage gated Na channels. what drugs work here
local anesthetics
219
phase II block. what characteristics on a twitch monitor
twitchs with fade. fasiculations after post tetanic stimulation
220
phase II block. who is more prone to get it, adults or children
adults
221
atypical plasma cholinesterase. what is it aka
pseudocholinesterase, butyrylcholinesterase
222
alcohol withdrawl syndrome. what is the mortality if withdrawl occurs
up to 35%
223
alcohol withdrawl syndrom. in operative pt. what is the best treatment for these pt
pre-emptive treatment...identifying the pts at rist and pre-emptive treatment. decreases mortality risk from 35 down to 5%
224
allergic reaction. what is the cross reactivity between pcn and cephalosporins
10 percent
225
allergic reaction. if a pt has a pcn allergy, would they be more prone to get allergic reaction after admin of a 1st gen cephalosporin or later gen
1st generation beause they share a side chain of pcn
226
allergic reaction. how specific is skin testing for allergy to pcn / cephalosporins
95-97% specific
227
allergic reaction. how sensitive is skin testing for allergy to pcn/ cephalosporin
50% sensitive
228
amidarone. how long is the half life
about 29 days
229
amiodarone. how long after discontinuation do u see its effects
up to 45 days
230
amiodarone. what endo side effect do u see
hyper hypo thyroxicosis can all be seen
231
amiodarone. what is the most serious consequence of amiodarone use
irreversible pulmonary fibrosis
232
Organophosphate. What kind of drug is it.
Anticholinesterase.
233
Organophosphate. What symptoms do you see.
Ach overload. You get bradycardia. Excess gi diarrhea. All your glands secrete. Bronchoconstriction.
234
Organophosphates. What do you see on EKG.
Qt prolonged because the heart conduction slowed down.
235
Organophosphates. What is the treatment
Atropine.
236
Organophosphates. How can you tell it is ortanophosphate on the exam.
Mitosis. Look at the eyes.
237
Organophosphates. What is it the reciprocal of.
Atropine toxicity.
238
toxicity treatment. what does methylene blue treat
methhemoglobinemia
239
toxicity treatment. what does n-acetylcysteine treat
acetaminophen toxicity
240
toxicity treatment. what does amyl nitrite treat
cyanide toxicity
241
lithium. what is the effect on muscle blockade
it increases sensitivity to both depol and non depol mm blockers
242
lithium. what electrolyte effects of li
hypOk and hyper Ca
243
Lithium. what effects on barbs and benzos
increase effect
244
remi. how does it help in neuro cases in pt w seizures
when ready to resect seizure focus, a high dose of remi can be given and it can decrease eeg at non seizure area and expose the seziure focus
245
somatostatin. what med is this used for
carcinoid crisis
246
dexemetomidine. what is its moa
alpha 2 blocker
247
dexemetomidine. how does it work similarly to an snri
both snri and dex promote alpha 2 block in the spinal cord...which prevent ascending pathway of nociception
248
dexemetomidine. what does it do to cpp
drecreases bc it decreases map
