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ABSITE > Drugs > Flashcards

Drugs Flashcards

1
Q

SEs of Succinylcholine

A

Malignant hyperthermia, hyperkalemia

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2
Q

SEs Ketamine

A

Tachycardia/increased secretions (sympathetic stimulatory effect), Hallucinations

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3
Q

SEs Propofol

A

Hypotension (peripheral vasodilation and myocardial depression), propofol-related infusion syndrome (Brady -> systole, acidosis, rhabdo; MC in kids with high doses)

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4
Q

SEs etomidate

A

Adrenal insufficiency

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5
Q

SEs meperidine

A

Seizures

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6
Q

SEs morphine

A

Histamine release, hypotension

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7
Q

MOA ketamine

A

Phencyclidine derivative

Dissociation of thalamus and limbic systems.

Amnesia, analgesia

Sympathetic stimulatory effect therefore CI in pts w/ ischemic heart disease

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8
Q

propofol infusion syndrome

A

RFs: longer use (>48 hr), doses > 4mg/kg/h, concomitant steroid and pressor use, presence of neurons injury or pathology

metabolic acidosis, rhabdo, renal insufficiency, refractory bradycardia, hyperlipidemia, transaminitis

tx: d/c, cardiopulmonary support, HD

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9
Q

Amphotericin B MOA

A

binds fungal cell wall sterols, causing cell death via lysis

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10
Q

Amphotericin B SEs

A

nephrotoxicity, electrolyte abnormality (hypokalemia, hypomagnesemia)

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11
Q

-Azole agents MOA

A

inhibit fungal sterol synthesis (needed for cell wall growth)

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12
Q

caspofungin

A

inhibits fungal cell wall synthesis

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13
Q

Sevoflurane

A

MC inhalation induction agent
Fast, minimal laryngospasm
Mask induction

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14
Q

Desflurane

A

Most rapid onset/offset
pungent odor
Not used for induction; used for maintenance anesthesia

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15
Q

Nitrous oxide

A

fast, minimal myocardial depression

Diffuses into closed spaces - not used in pts with SBO or PTX

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16
Q

Volatile anesthetic hepatitis

A

fever, eosinophilia, jaundice, increased LFTs

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17
Q

Propofol

A

MC IV induction agent
Not analgesic
SEs: hypotension (MC), resp depression

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18
Q

Propofol infusion syndrome

A

metabolic acidosis, renal failure, cardiac failure, death

MC in long-term use; MC in children

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19
Q

Etomidate

A

Used in RSI
Not analgesic
Fewest cardiac effects
SEs: adrenocortical suppression

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20
Q

Dexmedetomidine (Precedex)

A 
\+Analgesia
Doesn't blunt respiratory drive
Used for early extubation protocols
CNS alpha-2 rec agonist
SEs: BP lability
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21
Q

Ketamine

A

Mech: NMDA rec antagonist; dissociation of thalamic and limbic systems
+analgesia
Good in kids
SEs: hallucinations, catecholamine release, increased airway secretions, increased cerebral blood flow
CI: head injury

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22
Q

Meperidine (Demerol)

A

acts on mu-opioid agonist
Toxic metabolite = normeperidine (analgesic activity, longer half-life)

Accumulates in pts w/ renal failure.

Toxic doses –> seizures and CNS irritability

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23
Q

Varenicline

A

selective nicotinic receptor partial agonist for a4b2 receptors

most effective adjunctive measure in aiding smoking cessation - superior to both nicotine replacement therapy and bupropion

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24
Q

MOA Norepi

A

Mixed alpha > beta adrenergic

1st-line for septic shock

May cause tachycardia

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25
Q

MOA Vaso

A

V1 receptors -> vasoconstrictor
V2 receptors on kidney -> water resorption (decreases UOP)

2nd-line for septic shock

May cause decreased stroke volume & CO in pts w/ myocardial dysfunction or cause ischemia in pts w/ CAD

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26
Q

MOA Epi

A

Mixed beta > alpha adrenergic

1st-line for anaphylactic shock
2nd/3rd-line for septic shock

May induce tachyarrythmias and ischemia. Decreases mesenteric perfusion

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27
Q

MOA Neo (Phenylephrine)

A

Pure alpha1 agonist -> vasoconstrictor

Added for hypotension in pts w/ preserved cardiac output

May decrease stroke volume & CO in pts w/ cardiac dysfunction

28
Q

MOA Milrinone

A

PDE-3 inhibitor

Short-term cardiac output augmentation in cardiogenic shock refractory to other agents.

Renal cleared.

May cause peripheral vasodilation, hypotension, ventricular arrhythmia

29
Q

MOA Dobutamine

A

Beta-1 & Beta-2 adrenergic

1st-line for cardiogenic shock
Added to norepinephrine in septic shock in pts w/ decreased cardiac output

Augments CO in pts w/ myocardial dysfunction or ongoing hypo perfusion despite adequate intravascular volume
Increases contractility and HR. May cause hypotension

30
Q

MOA Dopamine

A

Dose-dependent

Low (0.5-3mcg/kg/min): dopamine recs. increases mesenteric and renal blood flow –> diuresis
Mod (3-5mcg/kg/min): beta-adrenergic. increases contractility
High (>5mcg/kg/min): alpha-adrenergic. vasoconstrictor

31
Q

Warfarin reversal

A

Vit K

PCC

32
Q

Dabigatran reversal

A

Praxbind - idarucizumab

direct thrombin inhibitor

33
Q

Argatroban

A

Reversible direct thrombin inhibitor
Often used in pts with HIT
No reversal agent
Short half-life (45 min), stopping med and supportive care is enough for reversal

34
Q

Rivaroxaban (Xarelto), Apixaban (Eliquis) & reversal agent

A

Inhibits factor Xa

Andexanet alfa (Andexxa)

35
Q

Protamine

A

Cationic. Binds anionic heparin. Forms stable salt with no anticoagulant activity.

Also reverse anti factor Xa activity in LMWH. Partial reversal activity (~60%).

Administer slowly. Rapid infusion can cause hypotension and CV collapse.

Component of insulin aspart protamine and NPH insulin. DM pts can have hypersensitivity reactions.

Dosage depends on amount of heparin given. 1mg for 100u. Also adjusted depending on duration of time since heparin given b/c heparin half-life is 60-90min.

Cleared by reticuloendothelial system (not renal or hepatic). Dose doesn’t need to be adjusted for renal for hepatic insufficiency.

36
Q

Neostigmine

A

Parasympathomimetic
Tx acute colonic pseudo-obstruction (2.5mg IV over 3 min)
Successful decompression in ~90% of pts w/in 10 min
Recurrence rate of 5%
SEs: brady, hypotension, dizziness.
Excreted by kidneys

37
Q

Mafenide acetate

A

Eschar penetration for severe burns.
Gram neg coverage (Pseudomonas)
CI: TBSA >40%, allergy to sulfonamides

38
Q

Aminoglycosides

A 
Inhibit 30S ribosome. stop protein synthesis
Aerobic GNR coverage (Pseudomonas)
Bactericidal
Resistance: decreased active transport
SEs: ototoxicity, nephrotoxicity
39
Q

Silver alginate

A

Used in wounds like burns, pressure ulcers, leg ulcers
Reduces bacterial load
Silver has antimicrobial properties: ribosomal toxicity, intercalates into DNA, denaturation of proteins, disruption of bacterial cell membrane

40
Q

Acetaminophen toxicity

A

Acetylcysteine

41
Q

Black widow spider antidote

A

Antivenum (latrodectus mactans)

42
Q

Ca Channel Blocker toxicity antidote

A

Ca Gluconate

43
Q

Malignant hypothermia, neuroleptic malignant syndrome antidotes

A

Dantrolene

44
Q

Iron toxicity antidote

A

Deferoxamine mesylate

45
Q

Benzo toxicity antidote

A

Flumazenil

46
Q

Cyanide toxicity antidote

A

Amyl nitrate, hydroxycobalamin, sodium nitrite, sodium thiosulfate

47
Q

Methotrexate toxicity antidote

A

Leucovorin calcium

48
Q

Methemoglobinemia tx

A

Methylene blue

49
Q

Anticholinergic toxicity antidote

A

Physostigmine

50
Q

Heparin reversal

A

protamine

51
Q

Lithium toxicity

A

Normal pharmakokinetics: absorbed in GI tract, excreted in kidneys. After gastric bypass surgery, increases gastric pH, increases deprotonated form of lithium -> increased absorption

2/2 decreased GFR, significant wt loss

Increased calc & mag reabsorption in LOH. Elevates PTH

52
Q

Effects on Gastric bypass on drugs

A

Decreases absorption:
Phenytoin, erythromycin, warfarin, ampicillin, tamoxifen, cyclosporine, levonorgestrel, imatinib, tacrolimus

Increases absorption:
Digoxin, lithium, PCN, atorvastatin

53
Q

SEs silver sulfadiazine

A

transient neutropenia and thrombocytopenia

54
Q

Vancomycin infusion reaction

A

Hypersensitivity reaction to rapid infusion of Vanc
Degranulation of mast cells and basophils –> increased histamine
Tx: antihistamine

55
Q

Meds that cause histamine release

A

Opioids (morphine, dilaudid, oxycodone)
Ketamine
Cipro
Rifampin

56
Q

What meds can chelate fluoroquinolone?

A

Calcium
Iron
Mag
Aluminum

57
Q

Anastrazole

A 
Aromatase inhibitor (reversible binding of aromatase enzyme through competitive inhibition)
Blocks conversion of androgens to estrogens in peripheral (extra-gonadal) tissue
58
Q

Tamoxifen

A

Selective estrogen receptor modulator

Partial agonist of estrogen receptors

59
Q

Trastuzumab

A

Monoclonal Ab binding of domain IV of extracellular segment of Her2/neu receptor
Makes cells undergo arrest during G1 phase
Reduced proliferation
Down-regulates activation of serine/threonine kinase Act
Suppresses angiogenesis by induction of antiangiogenic factors & repression of proangiogenic factors

SEs: cardiotoxicity (need echo)

60
Q

Taxanes (paclitaxel, docetaxel)

A

impair cell division through inhibition of microtubule disassembly during mitosis

61
Q

Doxorubicin (adriamycin)

A

impair DNA repair by inhibiting topoisomerase II

62
Q

Bacitracin

A

bacteriostatic and bactericidal
inhibits bacterial cell wall synthesis & bacterial replication
nephrotoxic - tubular and glomerular necrosis -> oliguria and edema

63
Q

cyclosporine

A

Calcineurin inhibitor, inhibit expression of IL-2, stops propagation of immune response

used for maintenance therapy in heart transplant patients

assoc with formation of gallstones, renal arterial constriction -> renal toxicity, hirsutism, gingival hyperplasia, thrombocytopenia

64
Q

Tacrolimus

A

binds immunophilin FKBP12
inhibits calcineurin, dephosphorylates of nuclear factor of activated T cells, inhibits T cell activation

SEs: nephrotoxic, seizures, tremors, H/A, new onset T2DM, hyperlipidemia, HTN, alopecia

65
Q

Dabigatran

A

non-vit-K oral anticoagulant (NOAC)
Direct thrombin inhibitor for VTE tx/prevention

Check creatinine clearance prior to deciding when to discontinue meds for surgery (cleared renally).
If CrCl <50mL/min -> d/c 3-5 days before surgery
If CrCl >50mL/min -> d/c 2 days before surgery

don’t need to bridge with heparin

66
Q

tamoxifen med interactions

A

affected by SSRIs (fluoxetine, paroxetine) - decreases formation of active metabolites of tamoxifen -> decreases efficacy

67
Q

Isoproterenol action

A

Pure beta-adrenergic agonist
Inotrope and chronotrope
Increases heart rate and cardiac contractility, peripheral vasodilation

Poor side effect profile to induce arrhythmias and increase cardiac demand (used solely for diagnostic procedures to provoke arrhythmias)

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