Cumulative Final (remaining info) Flashcards by Liz Jarzembowski

Amino acid neurotransmitter which is a ligand for NMDA receptors is

glutamate

How well did you know this?

Not at all

Perfectly

MOA of inhaled anesthetics shows inhalation agents interact with _ component of neuronal cell membranes in the CNS.

lipid

How well did you know this?

Not at all

Perfectly

Flumazenil is contraindicated in:
a.epileptic pts receiving benzo tx long term
b. pt with known hypersensitivity
c. pts with TCA overdose
d. all the above

How well did you know this?

Not at all

Perfectly

Opiates _ the CTZ.

stimulate

How well did you know this?

Not at all

Perfectly

Opiates _ the vomit center.

inhibit

How well did you know this?

Not at all

Perfectly

FDA does NOT:

Collab with DEA to assign drug schedules

How well did you know this?

Not at all

Perfectly

Opiate induced N/V is likely from:

vestibular effects

How well did you know this?

Not at all

Perfectly

Preferred analgesic for asthma pts:

fentanyl

How well did you know this?

Not at all

Perfectly

Which opioid class is loperamide (immodium)?

Phenylpiperidine opioid agonist

How well did you know this?

Not at all

Perfectly

T/F MI CRNAs need a CS license and DEA #

false

How well did you know this?

Not at all

Perfectly

Drugs with antishiver properties:

precedex and merperidine (Demerol)

How well did you know this?

Not at all

Perfectly

T/F Xanax, Klonopin, Valium, and Midazolam are examples of schedule IV CS.

true

How well did you know this?

Not at all

Perfectly

T/F Ketamine, Bruprinophine (Suboxone), Phenobarbital, and Codeine are examples of schedule III CS

true

How well did you know this?

Not at all

Perfectly

T/F fentanyl, vicodin, adderall, hydromorphone (dilaudid), morphine, methadone, and merperidine (Demerol) are examples of schedule II CS.

true

How well did you know this?

Not at all

Perfectly

Intrathecal opioids have a _ duration of action

long

How well did you know this?

Not at all

Perfectly

Intrathecal opioids are beneficial because:

-no motor blockade
-no sensory loss
-easy to cannulate space
-minimal hemodynamic change
-undetectable vascular absorption
-small doses give equianalgesic effect

How well did you know this?

Not at all

Perfectly

T/F Opiates directly increase ICP.

false, they can INDIRECTLY increase ICP from low CO2 causing cerebrodilation

How well did you know this?

Not at all

Perfectly

T/F Opioids and delivery- can expect baby to come out respiratory depressed and have low APGAR score?

true

How well did you know this?

Not at all

Perfectly

Renal patients should avoid which opioid specifically?

Meperidine (Demerol)

How well did you know this?

Not at all

Perfectly

Overstimulated 5-HT receptors could cause:

serotonin syndrome

How well did you know this?

Not at all

Perfectly

Causes of mortality from serotonin syndrome:

-rhabdomyolysis with renal failure
-hyperkalemia
-DIC
-ARDS

How well did you know this?

Not at all

Perfectly

Diagnosis of serotonin syndrome is done with:

Hunter Serotonin Toxicity Criteria
-involves spont. clonus, agitation, diaphoresis, ocular clonus, tremor, hyperreflexia, hypertonia, temp >38*C

How well did you know this?

Not at all

Perfectly

Treatment for serotonin syndrome:

-let drugs wear off OR
-neuromuscular paralysis, sedation, intubation
-1st line: Cyproheptadine (H1 antagonist with anticholinergic and antiserotonergic qualities)

How well did you know this?

Not at all

Perfectly

Red flag drugs for serotonin syndrome:

MAOIs (phenylzine, isocarboxazid)
SSRIs (sertraline, paroxetine, citalopram)
SNRIs (venlaflaxine, duloxetine)
TCAs (amitriptyline, doxepin, clomipramine)
ABX
Opiates (meperidine, fentanyl, tramadol)
OTC cold/cough meds (dextromethorphan)
Antimigrane drugs (almotriptan, sumatriptan)
Street drugs (adderall, cocaine, LSD)
Antiemetics(metoclopramide, ondansetron)
Anticonvulsants (carbamazepine, valporic acid)
Herbals (St.John wort, ginseng, nutmeg)

How well did you know this?

Not at all

Perfectly

Neuromusc effects seen with serotonin syndrome:

-hyperreflexia -tremors -myoclonus -ocular clonus -hypertonia -rigidity

Autonomic effects seen with serotonin syndrome:

-hyperthermia -tachycardia -tachypnea -abd pain -diarrhea -diaphoresis -flushing -mydriasis -BP changes

Mental status effects seen with serotonin syndrome:

-anxiety -agitation -confusion -hallucinations -delirium -hyperreactivity -disorientation

Common NSAIDS/Non-Narc analgesics:

Acetaminophen Ibuprofen Aspirin Celecoxib Naproxen Ketorolac

MOA of NSAIDs:

inhibits cyclooxygenase (COX)

T/F All non-narcotics are antipyretic

True

T/F All non-narcotics are analgesics

True

T/F All non-narcotics are anti-inflammatory

False, not Acetaminophen

T/F All non-narcotics block COX1 and COX2

False, all except Celecoxib (selective COX2 inhibitor)

NSAID S/E:

-block platelet aggregation (decreased hemostasis) -renal dysfunction (prostaglandins dilate renal vasc. beds) -GI bleed -Decreased bone healing (ortho cases) -Chronic use can increase risk of MI

Which NSAID is contraindicated in renal pts?

Toradol/ Ketorolac

"Stop ASA therapy within _-_ days of surgery"

7-10 -really just a day before UNLESS it's an ocular, brain, or prostate case

Which NSAID is considered non-competitive in terms of binding?

Aspirin

COX 1 receptor activation causes

-platelet aggregation -homeostasis -gastric mucosal protection***

COX 2 receptor activation causes

-pain, inflammation, fever, and cardiac S/E

Asthma pts and those with sulfonamide allergies should avoid which kind of COX inhibitors?

COX-2

IV versions of NSAIDs exist as:

-acetaminophen -ketorolac -ibuprofen

#1 cause of hepatotoxicity?

Tylenol OD

Max dose of tylenol within 24hr:

Which medication should NOT be used in children for fever?

Aspirin -Reye Syndrome

Why shouldn't pregnant women have NSAIDs?

spont. miscarriage risk :( -tylenol OK

The benefit of celecoxib as an NSAID is:

doesn't affect GI tract or platelet function as a COx-2 inhibitor

Which medication should be given as an antipyretic if your patient was pregnant or a child <6months old?

tylenol

Which non-narc pain med blocks production of chemicals in bloodstream that cause inflammation/pain?

Ibuprofen

Which non-narc pain med is thought to block the perception of pain in the brain?

tylenol

Between acetaminophen and ibuprofen which would you give to someone with a swollen, sprained ankle?

ibuprofen -antiinflammatory

T/F tylenol is hepatotoxic with normal dosing

false

T/F ibuprofen is renal toxic with normal dosing

true

Between acetaminophen and ibuprofen, which is known to have impaired homeostasis, GIB, renal dysfunction, and impaired osteogenesis effects?

ibuprofen -tylenol OK

The toxic metabolite formed by tylenol is:

NAPQI N-acetyl-p-benzo-quinone imine

Which liver byproduct neutralizes NAPQI (as long as no more than 4g is given)?

Glutathione

T/F Acetylcysteine reverses the drug effects of acetaminophen

false -Reverses TOXICITY of the metabolite, NAPQI, by replenishing glutathione

Acetylcysteine works most effectively within the first _ to _ hours of an OD

8-10hr

T/F All of the metabolites of acetaminophen are toxic, including: glucuronide, sulfate, NAPQI and its metabolites, cysteine and mercapturic acid.

False, just NAPQI only

Which drug classes can be used for neuropathic/neuralgia/fibromyalgia pain?

TCAs and Gabapentanoids

T/F Gabapentanoids are agonists on the GABA receptor

false, don't directly affect GABA receptor, they're just structural analogs

MOA for gabapentanoids:

Bind to alpha 2 sigma -1 subunit of Presynaptic voltage gated CA++ channels in CNS -inhibit Ca++ influx, releasing excitatory NTs

Examples of gabapentanoids:

Gabapentin, Pregabalin, oxcarbamazepine

Examples of TCAs:

Amitriptyline, Nortriptyline, Imitriptyline

Pain reducing effects of TCAs:

sedation, decreases reuptake of serotonin and NE

IV acetaminophen dosing: - >13yo - <13yo or <50kg

>13 yo: 650mg Q4hr **OR** 1g Q6hr up to 4g MAX <13yo or <50kg: 15mg/kg Q6hr **OR** 12.5mg/kg Q4hr

Which IV non-narc pain med gives similar analgesic effect to morphine?

Ketorolac

Ketorolac shouldn't be given more than _ days?

IV ketorolac dosing: - <65yo - >65yo or renal impaired or <50kg - peds

<65yo: 30mg >65yo or renal impaired or <50kg: 15mg peds: 0.5mg/kg MAX 15mg

Dose dependent effects from known pharmacologic properties of a drug are known as:

Adverse effects

Reactions to drugs that cause endogenous histamine release are known as:

Pseudo-allergies -most commonly caused by morphine, codeine, meperidine(phenanthrenes)

Reactions to drugs that cause IgE or Tcell-mediated responses are known as:

true allergies -life-threatening with immediate anaphylaxis, increased severity with exposure

True drug allergies are immunologic drug hypersensitivity reactions that are classified into _ types based on their _

4 type mechanisms

T/F Allergic reactions aren't present at first dose unless a pt has an allergy to a structurally similar drug

true

If pt has hypersensitive skin reaction (pseudo-allergy) from an opioid, switch them to:

an opioid with less histamine

T/F A pseudo-allergy can be seen with the first dose

true

T/F Your pt has sneezing and DIB after giving an opioid analgesic. This is a known adverse effect.

False, they're having a true allergic reaction!

Your pt is experiencing mild hypotension and tachycardia after giving a drug that is known to cause QT prolongation. What kind of reaction are they having?

Pseudo-allergy

Your pt is experiencing a headache after giving a medication known to cause drowsiness, delirium, and physical dependence. Is this an adverse effect or an allergy?

Allergy (unclear if pseudo or true allergy)