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Advanced Pharm Final > Chem/Diuretics/Aging > Flashcards

Chem/Diuretics/Aging Flashcards

12-13 questions ch 22, 42, 46

1
Q

What three things does the kidney secrete?

A
  1. Calcitriol
  2. Renin
  3. Erythropoetin
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2
Q

What things do chemo drugs target?

A

malignant cells and other quickly proliferating cells such as hair, skin, bone, and gi mucosa

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3
Q

What labs should be conducted preop for individuals on chemotherapy?

A

EKG, CXR, Hemoglobin , platelet count, WBC, coag profile, ABGs, blood glucose, Electrolytes, LFT, renal function tests

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4
Q

What chemotherapeutic agent causes acoustic nerve injury and nephrotoxicity?

A

Cisplatin (leads to unsteadiness and increased falls)

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5
Q

What chemotherapeutic agent causes peripheral neuropathy?

A

vincristine,blastine

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6
Q

What chemotherapeutic agent causes pulmonary fibrosis?

A

Bleomycin

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7
Q

What chemotherapeutic agent causes cardiotoxicity?

A

doxorubicin

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8
Q

What 2 chemotherapeutic agents cause bone marrow suppression?

A

5-fluorouracil and methotrexate

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9
Q

Why are there so many side effects of chemotherapeutic drugs and what are they??

A

narrow therapeutic index caused tissue damage to nonmalignant cells
n/v, myelosuppression, mucositis, and alopecia

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10
Q

How do alkylating agents
(nitro must, alk sulf, nitrosour, triaze) work?

A

inhibit plasma cholinesterase and covalently binds to RNA and DNA protiens, activity for 2-3 weeks post admin (bone marrow supp. most limiting SE)

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11
Q

What is an anesthesia consideration for alkylating agents?

A

Can lead to prolonged skeletal muscle paralysis after giving succinylcholine (due to inhibitor of plasma cholinesterase 2-3 weeks)

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12
Q

What drug is frequently used in Hodgkin’s disease and what are the side effects?

A

Mechlorethamine: n/v, myelosuppression

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13
Q

What chemo drug treats myelogenous leukemia and what are side effects?

A

Alkyl sulfonates, se: pulm fibrosis
Elim by kidneys

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14
Q

What class is cisplatin in, MOA, and side effects?

A

Plastinating drugs, similar MOA to alkylating drugs (inhibit DNA replication)
SE: loss of proprioception, neurotoxicity, renal toxicity (limiting dose and causing AKI/ATN), ototoxicity

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15
Q

What types of cancer does cisplatin treat?

A

lung, bladder, testicular, and ovarian

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16
Q

What chemo drug could be a contraindication for regional anesthesia?

A

Cisplatin due to subclinical neurotoxicity and potential to mask a nerve injury that already occurred

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17
Q

What drug is an antimetabolite, indication, moa, and side effects?

A

Methotrexate, hemo and non hemo cancers, ped leukemia, inhibits folate that is used in dna/rna production
SE: BMS, gi effects, pulm tox (edema), hepatic dysfnctn, renal insuff, alopecia, dermatitis

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18
Q

Which chemo drug can cause death due to intestinal perforation?

A

Methotrexate

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19
Q

What are topoisomerase inhibitors, MOA, indications, and side effects?

A

Doxorubicin/Daunorubicin enzymes that control the 3d structure of DNA/alter dna synthesis, treats leukemia
SE: free radicals hurt cardiac antioxidant defenses > cardiotox,

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20
Q

Doxorubicin/Daunorubicin considerations

A

dont cross BBB, red urine 1-2 days, cardiac concerns, CHF, LF failure for up to 3 years

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21
Q

previous treatment with what chemo drug can cause enhanced myocardial depressant effects related to anesthesia? (even with normal cardiac function)

A

doxorubicin

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22
Q

What is the sign of acute doxorubicin cardiomyopathy?

A

dry nonproductive cough- fatal in 3 weeks after in 60% of patients

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23
Q

Major bleomycin side effects

A

pulm tox: type 1 and 2, interstitial fibrosis
s/s: cough, dyspnea, and basilar rales
ranges from mild-severe

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24
Q

How should patients with bleomycin induced respiratory side effects be managed?

A

administer FiO2 at <30%, don’t give excessive crystalloid (give colloids to prevent interstitial edema), can give albuterol

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25
Q

Vincristine indication, moa, and side effects

A

Hodgkin disease, non-Hodgkin lymphoma, and peds solid tumors
neuropathy, paresthesia, foot drop, skeletal m pain, loss of achilles reflex, CN issues, hypotension, tremors

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26
Q

What is a major consideration for preop management of patients taking chemo drugs?

A

aggressive PONV treatment: Emend, Marinol, Scope patch, ondansetron, promethazine

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27
Q

What drug can be used off label to produce analgesia effects in patients taking chemo drugs?

A

Tricyclic antidepressants

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28
Q

What is an example of a loop diuretic, where do they work in the nephron, and what is the MOA?

A

furosemide, medullary thick ascending loop of henle, inhibit reabsorption of na, k, and cl by impairing transporter in medullary portion of thick ascending loop. 20-30% filtered na reabsorbed here

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29
Q

What is an example of a carbonic anhydrase diuretic, where do they work in the nephron, and what is the MOA?

A

acetazolamide (diamox), noncompetitive inhibition of enzyme activity in proximal convoluted tubule, decreases na and hco3 reabsorption

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30
Q

What is an example of a thiazide diuretic, where do they work in the nephron, and what is the MOA?

A

hydrochlorothiazide, cortical ascending loop of henle, decrease na reabsorption and therefore decreased fluid reabsorption

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31
Q

What is an example of a osmotic diuretic, where do they work in the nephron, and what is the MOA?

A

mannitol, inhibit water reabsorption in the proximal convoluted tubule and the thin descending loop of Henle and collecting duct

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32
Q

What is an example of a potassium sparing diuretic, where do they work in the nephron, and what is the MOA?

A

Amiloride, collecting duct, selectively blocks na transport, inhibiting sodium-potassium exchange

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33
Q

What is an example of a aldosterone blocker diuretic, where do they work in the nephron, and what is the MOA?

A

spironolactone, collecting duct, increases na and h2o secretion while retaining k

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34
Q

What diuretic is used as first line therapy for hypertension?

A

thiazides (also, osteoporosis, resistant HTN, decrease edema)

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35
Q

What diuretic is first line for renal impairment?

A

Loop diuretics (also treats hypertension, and acute HF)

36
Q

What diuretic is used to decrease intracranial pressure?

A

osmotic diuretics (other: prevent periop AKI)

37
Q

What diuretic class is used as an adjunct to loop/thiazide therapy?

A

Potassium sparing diuretics (also: enhance diuresis, limit K loss, cystic fibrosis)

38
Q

What diuretic class is used for altitude sickness and glaucoma?

A

carbonic anhydrase inhibitors
also used for idiopath intracranial htn, familial periodic paralysis, stimulate resp drive (hyperchloremic metabolic acidosis), central sleep apnea

39
Q

What are the three primary indications for diuretic therapy?

A

used for htn and heart failure
to increase urine flow and promote diuresis
blocks sodium reabsorption at different points along the nephron

40
Q

What are side effects of carbonic anhydrase inhibitors?

A

fatigue, decreased appetite, depression, and paresthesia

41
Q

What are side effects of loop diuretics?

A

fluid/electrolyte imbalances, hypok, hight BG, increased dig tox, “braking phenomenon”, low BP, and ototox

42
Q

Furosemide metabolism, onset, half life, and dosing:

A

highly protein bound, renal: 50% tubular secretion, 50% conjugate in kidneys, onset 5-10 min, peak 30min 1/2 life 1-2 hrs,
D; 40mg norm renal fnctn, CRF: 160-200mg

43
Q

What is an administration consideration for loop diuretics?

A

push slowly to prevent ototoxicity

44
Q

Thiazide diuretics are contraindicated in what disease?

A

renal insufficiency

45
Q

What are the side effects of thiazide diuretics?

A

Orthostatic HOTN, Hypokalemia,Hypochloremia, Hyponatremia, Hypomagnesemia, Increase aldosterone, Hypercalcemia, Glucose intolerance, Hyperlipidemia

46
Q

What are the anesthesia considerations for Thiazide diuretics?

A

increased effects of NDMB
NSAIDs decrease effectiveness
high risk of lithium tox

47
Q

What are side effects of osmotic diuretics?

A

Pulm edema, hypovolemia, hypokalemic, hypochloremia alkalosis, plasma hyperosmolarity

48
Q

What are the indications and side effects for aldosterone antagonists?

A

I: Essential HTN, Refractory HTN, “Aldosterone Escape”, Edema & fluid overload
SE: high K, gynecomastia, breast tenderness

49
Q

Which potassium-sparing diuretic antagonizes aldosterone at the mineralocorticoid receptors?

A

Spironolactone

50
Q

How does advanced age affect mortality and heart function?

A

increased mortality, decreased heart function

51
Q

Why do elderly individuals poorly tolerate being in Afib?

A

their heart depends on atrial kick for ventricular filling due to diastolic dysfunction

52
Q

How does advanced age affect the respiratory system?

A

less lung compliance and poor cough reflex (high risk for aspiration)

53
Q

How does advanced age affect coagulability?

A

Increased clotting factors which results in hypercoag

54
Q

How does advanced age affect body temperature management?

A

decreases temp, changes in regulation

55
Q

What are two adverse effects of anesthesia that more commonly occur in older individuals?

A

vomiting and delirium (increase blood pressure to decrease chances)

56
Q

What results from chemo induced myelosupression?

A

pancytopenia (increased need for transfusion)

57
Q

What is an anesthesia consideration for alkylating agents?

A

decreases pulm compliance due to pulm fibrosis (high risk of barotrauma)

58
Q

What are platinating drugs made of?

A

platinum

59
Q

What chemo drug contraindicates use of general anesthesia and why?

A

cisplatin, can cause tumor proliferation/rogue cell migration

60
Q

What two drugs are frequently given to decrease risks of renal toxicity w/ cisplatin

A

mannitol and lasix

61
Q

What could giving methotrexate to a pregnant woman cause?

A

neural tube defect in baby due to lack of folate

62
Q

What chemo drug cannot be given with recent live vaccine?

A

methotrexate

63
Q

What chemo drug is frequently used to treat testicular cancer?

A

bleomycin

64
Q

What diuretics should not be used in patients with a sulfa allergy?

A

carbonic anhydrase inhibitors

65
Q

Why are carbonic anhydrase inhibitors given to decrease intraocular pressure?

A

carbonic anhydrase increases production of aqueous humor (fluid in eye)

66
Q

Overall, what are the effects of diuretics on chloride and potassium?

A

increase chloride, decrease potassium

67
Q

What are the effects of diuretics on cardiac function?

A

decreases

68
Q

What paralytic agent should be deeply considered prior to administration with diuretics and why?

A

succs because they patient could have hypokalemia which would alter efficiency of drug

69
Q

What type of diuretic is isosorbide and what is its primary indication?

A

osmotic, heart failure

70
Q

What is important to remember about aldosterone antagonists?

A

they cause hormonal changes

71
Q

How does advanced age affect response to opioids?

A

more sensitive to medications and have a larger respiratory depressive effect

72
Q

What drug should never be given with chemo and why?

A

Ketamine, decreases cardiac effects

73
Q

What are the two volatiles of choice for patients on chemo?

A

iso and des

74
Q

Physical signs of moon face and buffalo hump could indicate:

A

Cushing syndrome

75
Q

Why do patients receiving cisplatin have a high risk for falls?

A

vestibular neurotoxicity with balance

76
Q

What should be given to prevent neurotoxicity r/t cisplatin use?

A

mannitol and lasix

77
Q

NSAIDs and Salicylates cause ______ drug level when given with __________.

A

increased, methotrexate

78
Q

how does acetazolamine influence pH?

A

decrease bicarb reabsorption that causes alkaline urine. treats metabolic alkalosis (leads to metabolic acidosis)
off label tx for kidney stones

79
Q

which diuretic exhibits potential for sulfa allergy cross reaction?

A

carbonic anhydrase inhibitor

80
Q

what is a major factor regarding the bioavailability of loop diuretics?

A

protein level due to excessive protein binding

81
Q

which diuretic increases risk of kidney stones and why?

A

thiazides due to calcium reabsorption

82
Q

What are the most impactful physiological changes that accompany aging?

A

alteration in hepatic and renal function

83
Q

What drugs are older individuals especially sensitive to and what is our response?

A

propofol, fentanyl, midazolam
give smaller doses, higher pain threshold, require less anyways
(also have prolonged NMB effects)

84
Q

What is a pharmacokinetic consideration for elderly individuals?

A

they have low serum protein levels and more body fat which results in a larger volume of distribution which can cause longer medication effects (esp in the setting of kidney/renal dysfunction)

85
Q

What two drugs increase the risk for delirium in older adults?

A

ketamine and volatile gases

86
Q

What anesthetic management should be practiced regarding the respiratory and neuro system in older adults?

A

provide COMPLETE reversal prior to extubation to prevent aspiration due to WEAK pharyngeal muscles

87
Q
A

Advanced Pharm Final (5 decks)

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