Drugs

Question 1

Reversal for dabigatran?

Answer 1

idaricizumab

Question 2

MOA of dabigatran?

Answer 2

direct thrombin inhibitor

Question 3

Can we get rid of dabigatran via dialysis?

Answer 3

YES

Question 4

MOA of rivaraxaban?

Answer 4

Factor Xa inhibitor

Question 5

Reversal for rivaraxaban?

Answer 5

andexanet alfa

Question 6

For immediate reversa of rivaraxoba, where we dont have andexanet alfa, what do we use for reversal?

Answer 6

4-factor PCC

Question 7

MOA of fondaparinux?

Answer 7

binds to anti-thrombin III, resulting in inhibition of factor Xa

Question 8

MOA of clopidrogel?

Answer 8

irreversably blocks ADP receptor P2Y12 on platelet membrane

Question 9

Reversal agents for warfarin?

Answer 9

PO vit K

FFP

PCC

Question 10

What abx can precipitate serotonin syndrome?

Answer 10

linezolid

Question 11

Sxs of serotonin syndrome?

Answer 11

high body temp
agitation
sweating, diarrhea, dilated pupils

Question 12

Mu-opioid antagonist can mitigate the GI effects of narcotics without interfering with their analgesic affects and has been shown to be beneficial in ERAS protocols:

Answer 12

alvimopam

Question 13

Idaricizumab is reversal for what?

Answer 13

dabigatran

Question 14

Onset of idaricizumab for dabigatran reversal?

Answer 14

immediate onset

good for 24 hrs

**idaricizumab is a direct antibody that neutralizes dabigatran directly

Question 15

If idaricizumab is not available, how do we reverse dabigatran?

Answer 15

4 factor PCC

Question 16

Optimal reversal agent of all factor Xa inhibitors and warfarin?

Answer 16

4-factor PCC

Question 17

Onset of 4-factor PCC in reversing factor Xa inhibitors and warfarin?

Answer 17

5-15 mins

lasts for 12-24 hrs

Question 18

Half life of dabigatran?

Answer 18

12-17 hrs

Question 19

Half life of rivaraxaban or apixaban?

Answer 19

riv—-> 5-9 hrs

apixaban–> 12 hrs

Question 20

Pt has epidural catheter in place, post-op develops LE weakness and numbness; what are you thinking?

Answer 20

epidural hematoma

get an MRI

Question 21

Pts with coronary stents on dual anti platelet therapy; ASA and plavix, when should their elective surgeries be performed?

Answer 21

defer for at least 6 weeks after bare-metal stent

defer for at least 6 months after drug-eluting stent

Question 22

MOA of methadone?

Answer 22

full opioid agonist

dosed daily

Question 23

4 factor PCC is used or warfarin reversal, what does it contain?

Answer 23

factors II, VII, IX, X

proteins C, S, antithrombin III

Question 24

This direct thrombin inhibitor is given orally;

Answer 24

dabigatran

Question 25

What thrombin inhibitors given IV?

Answer 25

argatroban | bivalurdin

Question 26

Dabigatran is an oral direct thrombin inhibitor that should be used with caution in pts with?

Answer 26

renal problems metabolized by the kidneys

Question 27

Dabigatran is metabolized by?

Answer 27

kidneys

Question 28

This Xa inhibitor is metabolized by kidneys and should not be given to pts with low Cr clearance;

Answer 28

rivaraxoban

Question 29

What Xa inhibitor can be given to pts with renal problems?

Answer 29

apixaban | hepatically cleared

Question 30

Apixaban is cleared by?

Answer 30

liver OK in renal insufficiency

Question 31

vWF is a carrier protein for which factor?

Answer 31

VIII

Question 32

HIT has two types, what is type I?

Answer 32

hep associated thrombocytopenia heparin clumps platelets directly usually within first 48-72 hrs mild/transient thrombocytopenia, with return to normal no lab tests needed, can continue heparin

Question 33

IgG antibody against platelet factor 4?

Answer 33

HIT type 2 can cause thromboses seen 4-5 days after starting UH/LMWH

Question 34

Half life of rivaraxoban?

Answer 34

5- 9 hrs in healthy pts 11-13 in elderly pts

Question 35

TXA shown the greatest benefits when used within what time frame?

Answer 35

within 3 hrs

Question 36

Only vasopressor that acts on all 5 adrenergic receptors;

Answer 36

epinephrine

Question 37

Pure a-adrenergic vasoconstrictor;

Answer 37

phenylephrine

Question 38

Can produce reflex bradycardia when sympathetic tone is lacking;

Answer 38

phenylephrine

Question 39

Toxic metabolite of meperidine?

Answer 39

normeperidine

Question 40

MOA of meperidine?

Answer 40

u-opioid agonist

Question 41

What do we have to be careful with with meperidine?

Answer 41

toxic metabolite normeperidine accumulates in renal failure pts can cause CNS irritability, seizures

Question 42

MOA of dantrolene?

Answer 42

ryanodine receptor antagonist

Question 43

What causes malignant hyperthermia?

Answer 43

mutation in raynodine receptor type 1

Question 44

SE of reglan/metoclopramide?

Answer 44

acute dystonic reaction (involuntary muscle contractions)

Question 45

Flumazenil>

Answer 45

antidote for benzo overdose GABA-A antagonist

Question 46

How do you correct Ca levels for hypoalbuminemia?

Answer 46

0.8 x [4 - measured albumin]

Question 47

Free Water Deficit Formula;

Answer 47

total body water x weight (kg) x (current Na/desired Na -1)

Question 48

MOst common side effect of pancuronium?

Answer 48

tachycardia

Question 49

How long does pancuronium last>

Answer 49

up to 90 mins

Question 50

SE of atracurium?

Answer 50

histamine release

Question 51

PTLD caused by what virus?

Answer 51

EB virus transplant pts develop lymphomas tx-> reduce immunosuppression first, rituximab if needed, surgery doesnt have a role

Question 52

What makes up CHOP therapy?

Answer 52

cyclophosphamide doxarubicin vincristine prednisolone

Question 53

MOA of IV magnesium when used as a tocolytic in pre-term labor?

Answer 53

blocks influx of Ca at motor end plate tocolysis delays delivery up to 48 hrs so steroids can be given for lung maturity

Question 54

MC side effect of mciphenolate mofetil?

Answer 54

leukopenia