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Advanced Pharm For NA 1 > Cumulative Final (remaining info) > Flashcards

Cumulative Final (remaining info) Flashcards

1
Q

Amino acid neurotransmitter which is a ligand for NMDA receptors is

A

glutamate

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2
Q

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

A

lipid

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3
Q

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

A

D

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4
Q

Opiates _ the CTZ.

A

stimulate

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5
Q

Opiates _ the vomit center.

A

inhibit

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6
Q

FDA does NOT:

A

Collab with DEA to assign drug schedules

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7
Q

Opiate induced N/V is likely from:

A

vestibular effects

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8
Q

Preferred analgesic for asthma pts:

A

fentanyl

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9
Q

Which opioid class is loperamide (immodium)?

A

Phenylpiperidine opioid agonist

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10
Q

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

A

false

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11
Q

Drugs with antishiver properties:

A

precedex and merperidine (Demerol)

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12
Q

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

A

true

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13
Q

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

A

true

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14
Q

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

A

true

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15
Q

Intrathecal opioids have a _ duration of action

A

long

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16
Q

Intrathecal opioids are beneficial because:

A

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

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17
Q

T/F Opiates directly increase ICP.

A

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

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18
Q

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

A

true

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19
Q

Renal patients should avoid which opioid specifically?

A

Meperidine (Demerol)

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20
Q

Overstimulated 5-HT receptors could cause:

A

serotonin syndrome

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21
Q

Causes of mortality from serotonin syndrome:

A

-rhabdomyolysis with renal failure
-hyperkalemia
-DIC
-ARDS

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22
Q

Diagnosis of serotonin syndrome is done with:

A

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

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23
Q

Treatment for serotonin syndrome:

A

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

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24
Q

Red flag drugs for serotonin syndrome:

A

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)

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25
Q

Neuromusc effects seen with serotonin syndrome:

A

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

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26
Q

Autonomic effects seen with serotonin syndrome:

A

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

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27
Q

Mental status effects seen with serotonin syndrome:

A

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

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28
Q

Common NSAIDS/Non-Narc analgesics:

A

Acetaminophen
Ibuprofen
Aspirin
Celecoxib
Naproxen
Ketorolac

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29
Q

MOA of NSAIDs:

A

inhibits cyclooxygenase (COX)

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30
Q

T/F All non-narcotics are antipyretic

A

True

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31
Q

T/F All non-narcotics are analgesics

A

True

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32
Q

T/F All non-narcotics are anti-inflammatory

A

False, not Acetaminophen

33
Q

T/F All non-narcotics block COX1 and COX2

A

False, all except Celecoxib (selective COX2 inhibitor)

34
Q

NSAID S/E:

A

-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

35
Q

Which NSAID is contraindicated in renal pts?

A

Toradol/ Ketorolac

36
Q

“Stop ASA therapy within - days of surgery”

A

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

37
Q

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

A

Aspirin

38
Q

COX 1 receptor activation causes

A

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

39
Q

COX 2 receptor activation causes

A

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

40
Q

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

A

COX-2

41
Q

IV versions of NSAIDs exist as:

A

-acetaminophen
-ketorolac
-ibuprofen

42
Q

1 cause of hepatotoxicity?

A

Tylenol OD

43
Q

Max dose of tylenol within 24hr:

A

4g

44
Q

Which medication should NOT be used in children for fever?

A

Aspirin
-Reye Syndrome

45
Q

Why shouldn’t pregnant women have NSAIDs?

A

spont. miscarriage risk :(
-tylenol OK

46
Q

The benefit of celecoxib as an NSAID is:

A

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

47
Q

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

A

tylenol

48
Q

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

A

Ibuprofen

49
Q

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

A

tylenol

50
Q

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

A

ibuprofen
-antiinflammatory

51
Q

T/F tylenol is hepatotoxic with normal dosing

A

false

52
Q

T/F ibuprofen is renal toxic with normal dosing

A

true

53
Q

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

A

ibuprofen
-tylenol OK

54
Q

The toxic metabolite formed by tylenol is:

A

NAPQI
N-acetyl-p-benzo-quinone imine

55
Q

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

A

Glutathione

56
Q

T/F Acetylcysteine reverses the drug effects of acetaminophen

A

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

57
Q

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

A

8-10hr

58
Q

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

A

False, just NAPQI only

59
Q

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

A

TCAs and Gabapentanoids

60
Q

T/F Gabapentanoids are agonists on the GABA receptor

A

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

61
Q

MOA for gabapentanoids:

A

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

62
Q

Examples of gabapentanoids:

A

Gabapentin, Pregabalin, oxcarbamazepine

63
Q

Examples of TCAs:

A

Amitriptyline, Nortriptyline, Imitriptyline

64
Q

Pain reducing effects of TCAs:

A

sedation, decreases reuptake of serotonin and NE

65
Q

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

A

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

66
Q

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

A

Ketorolac

67
Q

Ketorolac shouldn’t be given more than _ days?

A

5

68
Q

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

A

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

69
Q

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

A

Adverse effects

70
Q

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

A

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

71
Q

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

A

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

72
Q

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

A

4 type
mechanisms

73
Q

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

A

true

74
Q

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

A

an opioid with less histamine

75
Q

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

A

true

76
Q

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

A

False, they’re having a true allergic reaction!

77
Q

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?

A

Pseudo-allergy

78
Q

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?

A

Allergy (unclear if pseudo or true allergy)

Advanced Pharm For NA 1 (4 decks)

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