Drugs Flashcards
what benzo is metabolized exclusively through hepatic glucuronidation
lorazepam
good L aka GL= lorazzepam
phosphogene
chemical warefare agent that can cause severe pulmonary damage, treatment is supportive
interaction between non depolarizatizing neuro muscular blocking agents
- augmentation of antagonists affinity at receptor site
- central effects on alpha motor neurons and synapses
- inhibitiion of post synaptic nicotinic receptors
order of effect greatest to least:
des> sevo> iso> halogene > NO/propofol
think des is longer acting so has the strongest effect
mechanims of action of NO
breaks down GTP into GMP which is a smooth muscle dialator and anti inflammatory and inhibits platelet aggregation
what inhaled agent should be avoided in children w asthma
desflorane can cause increased airway reactivity and bronchospasms in children with ongoing pulm issues
** think if u give DES
what inhaled agent should be avoided in children w asthma
desflorane can cause increased airway reactivity and bronchospasms in children with ongoing pulm issues
** think if u give DES to asthma patient they may end up DED
protective mechanisms for spinal cord ischemic injury during aorta cross clamping include:
shunts
bypass
hypotherapy
spinal drain placement
drugs that prevent physiologic hypoxic pulmonary vasoconstriction
- nitroprusside
- nitroglycerine
- ACE
- ARB
- CCB
what drugs cause direct cerebral vasodilation
nitroglycerine nitroprusside CCB adenosine hydralazine
which drugs can potentiate the effects of neuromuscular blockades
aminoglycosides
tetracyclines
lincomycin
polymyxin
what drugs are associated w intense perineal itching
dexamethasone
fospropofol
long term use of barbituates causes what change to cytochrome p450
induces cyt p450 so will need higher doses of benzos etc. and other drugs metabolized by that enzyme
what drug works via the kappa opioid receptor
meperidine
1/10 as potent for analgesia as morphine
used for shivering
what drug works via the kappa opioid receptor
meperidine
1/10 as potent for analgesia as morphine
used for shivering
what drug is a glutamate antagonist
ketamine
NMDA is a subset of excitatory glutamate receptor
whats the concern with giving hydromorphone in renal insufficiency patients
all the mu opioid side effects will be metabolized by the liver so thats fine
but hydropmorphone via liver breaks down into H3G which is NEUROtoxic and removed by kidneys
what inhaled anesthetic can inhibit DNA synthesis in fetus
chronic NO expsosure can cause megaloblastic anemia
the rest of them are safe
what volatile gas blunts the baroreceptor reflex
isoflurane
think iso..static…no responding ….aka blunting baroreceptor
what beta blocker is most likely to cause bronchoconstriction
labetalol
mixed receptor blocker….beta 2 blockade causes bronchoconstriction
how does precedex effect evoked potential monitoring
precedex mimics non rem sleep–
so it will have little effect on evoked potential monitoring
high altitude pulmonary edema is is from diffuse hypoxic pulmonary constriction.. what drugs will prevent HAPE
nifedipine and PDE-5 inhibitors
hepatic metabolism of what gas causes inorganic fluoride production
Sevo
think sevo SEEPS into body (liver) and will give u the FLU (fluoride)
what class of drugs can decrease clopedigrel’s efficacy
PPI
think PPI poop (make worse) on clopedigrel
what is doxapram and when is it used clinically
respiratory stimulant, stmulates chemoreceptors on carotid body
used in hypercapnic respiratory failure in COPD patients with supplemental oxygen
what receptors does epinephrine hit
alpha 1 causing vaso constriction
but also beta receptor agonist causing vasodilation in coronary vesse;s (think beta agonism is why its used for bronchospasm)
what is the MOA of cilostazol
PDE3 inhibitor aka increases cAMP leading to vasodialtion
its also a anti platelet ?
what opioids re metqabolized by liver
fentanyl aka good option for renal patients
hydrocodone —> H3G, if this accumulates its neuro excitatory
what is isproterenol MoA
nonselective beta agonist
can be used for heart block or bradycardia
remember b1 is for the heart
morphine and atracurium release what that means asthma exacerbation a possbilit y
histamine
what volatile anesthetics potentiates neuromuscular the most
desflurane
think DES = DEATH
bad for asthmatics
will be the one to prolongate NMDA the most.. think MOST death the longest
how is the drug effect of succinhylcholine mostly terminated
there is some psuedocholinesterase activity but the termination of the drug effect is mostly through succ passive diffusion out of the neuromuscular junction
how is the drug effect of succinhylcholine mostly terminated
there is some psuedocholinesterase activity but the termination of the drug effect is mostly through succ passive diffusion out of the neuromuscular junction
what is the initial dose vs the dose after acute rxn for dantrolene treating MH
intitially do 2.5 mg/kg every 5 ish minutes
think MH has 2 letters + give every 5 min so dose is 2.5
then 1 mg/kg every 4-6 hours or 0.25 mg/kg/hr infusion for 24 hours
how does milirione effect preload
decreases preload
because of venodilation
but overall improved
CO and SV
when stopping an irresversible antiplatlet drug how many platelts are replenished in 24 hours
10%-14% every 24 hours
so can take 7-10 days to replenish the whole pool
what drug is ppx for organophosphate poisoning
pyridostigmine must be taken 30 min prior to organophosphase exposire, it prevents organophospahtes from binding to the AcHase it will bind to
the first line treatment is atropine then pralidoxime is the definite treatment
what are risk factors for bradycardia when giving succ
repeat succ doses
young age
which inhaled anesthetic decreases BP mainly by decreasing cardiac output
halothane
what drug increases ICP
ketamine
oral dose of versed in peds patients
0.5 mg/kg
how doe hypercalcemia afffect roc
causes antagonism of roc so u will need higher doses
what drugs decrease IOP
benzos
barbituates
volatile anesthetics
common complications of spinal anesthesia
think unopposied parasympathetic
post dural puncture headache increased ventilatory response to hypercapnia vasodilation increased GI activity hypothermia/vasodilation transient hearing loss
mechanisms by which mag causes hypotension
calcium antagonism in vascular smooth muscle
more NO production
