Ex1 Flashcards
1
Q
corticosteroids MOA
A
inhibit phospholipase A2
- decr leukotrines
- decr prostaglandins
inhibit Th2 cells
- decr IL4/IL5
2
Q
corticosteroids SE
A
oral thrush (inhaled)
adrenal supression (systemic)
incr infections
slow growth
bruising
hyperglycemia
weight gain
3
Q
mast cell stabilizer MOA
A
inhibit prostaglandin/leukotrine release
4
Q
mast cell stabilizer SE
A
mild anti-inflammatory
5
Q
inhaled cortocosteroids: indication
A
chronic asthma/COPD
6
Q
oral corticosteroids: indication
A
severe chronic asthma
7
Q
IV corticosteroids: indication
A
acute asthma attack
8
Q
mast cell stabilizer indication
A
mild-mod asthma
9
Q
leukotrine R antagonist MOA
A
block leuk-R
- decr sm muscle contraction
- decr mucus
- decr inflammation
10
Q
leuk R antagonist SE
A
headache
rash
11
Q
leuk R antagonost indication
A
add-on therapy to corticosteroids for chronic asthma
12
Q
leuk synthesis inhibitor MOA
A
inhibits 5-lipoxygenase
13
Q
leuk synth inhibitor SE
A
hepatoxicity
14
Q
leuk synth inhibitor indication
A
exercise/allergy-induced asthma
15
Q
anti-IgE antibody MOA
A
binds IgE antibodies
- decr mast cell activation
16
Q
anti-IgE antibody SE
A
incr infections
injection site pain
$$$$
17
Q
anti-IgE antibody indications
A
last-line defense for allergic asthma
18
Q
b2 agonist MOA
A
promotes B2 receptors
- incr adenyl cyclase
- incr cAMP
- incr relaxation
stabilizes mast cells
19
Q
SABA indication
A
acute asthma
exercise bronchospasm
20
Q
SABA SE
A
incr sympathetics
21
Q
LABA indication
A
mx therapy as combo drug
22
Q
LABA SE
A
significant incr sympathetics
arrythmias
HF
23
Q
muscarinic antagnoist MOA
A
bind M3R
- decr sm muscle contraction
24
Q
muscarinic antagonist SE
A
incr sympatheticsm
25
muscarinic antagonist CI
narrow angle glaucoma
26
muscarinic antagnoist indications
COPD additive w/LABA
27
methylxanthines MOA
inhibit PDE
- sm muscle relaxation
decr adenosine
- sm muscle relaxation
- vasoconstriction
28
methylxanthines SE
incr HR
arrythmia
insomnia
N/V
seizure
narrow therapeutic window
29
methylxanthines therapeutic window
narrow (5-15 mcg/mL)
30
methylxanthines CI
fluoxetine
ciproflaxin
(block CYP450 - inhibits metabolism)
31
intermittent asthma mgmt
SABA
32
mild asthma mgmt
low dose ICS
33
mod asthma mgmt
low dose ICS + LABA
OR
med dose ICS
34
severe asthma (4) mgmt
med dose ICS + LABA
35
severe asthma (5) mgmt
high dose ICS + LABA
optional omalizumab
36
severe asthma (6) mgmt
high dose ICS + LABA + corticosteroids
optional omalizumab
37
mild/intermittent COPD mgmt
SABA + SAMA
38
frequent CPOD (FEV1<60%) mgmt
LABA + LAMA
39
loading dose is dependent on
volume of distribution
40
LD equation
LD = tgt conc * Vd
41
when is LD required
if drug has long half life
(slow onset)
42
mx dose is dependent on
drug clearance
43
what physiology can cause abnormal drug clearance
major impairement to kidney, liver, heart
44
how are drugs predominantely excreted
via kidney/liver
45
excreted drug characteristics
water soluble
polarized
small size
free (not bound)
46
lipid soluble drugs require
hepatic metabolism to incr water solubility
47
drug filtration factos
renal BF
GFR
plasma protein binding
48
GA ____ renal BF by _____%
GA decreases renal BF by 50%
49
routine labs to assess kidney function
BUN
serum Cr
GFR
urine albumin
50
normal BUN
10-20 mg/dL
51
normal serum Cr
0.6-1.3 mg/dL
52
normal GFR
110-140 mL/min
53
normal urine albumin
<150 mg/day
54
specialized labs for kidney function
urine specific gravity
urine osmolarity
urine Na+
55
factors that influence lab interpretation
dehydration
protein intake
GI bleed
catabolism
adv age
sk muscle mass
timing of measurement
56
G1
normal/high
57
G2
mild decrease
58
G3a
mild-mod decrease
59
G3b
mod-severe decrease
60
G4
severe decrease
61
G5
kidney failure
62
what GFR categories indicate CKD
G3a-G5
63
A1
normal/mild albuminuria
64
A2
moderate albuminuria
65
A3
severe albuminuria
66
which albuminuria category indicates nephrotic syndrome
A3
67
what labs can be used to estimate renal function
serum Cr
Cr clearance
cystatin C
125I-iothalamate
inulin
68
types of renal function calculations
CG
MDRD
CKD-EPI
69
which calculation is the primary use for drug development by FDA
CG
70
which calculation could replace CG in drug development
MDRD
71
which calculation is the most accurate est of gFR
CKD-EPI
72
when is CG most inaccurate
with fluctuating serum Cr
73
how should you properly dose drugs in pts with renal dysfunction
measure renal function w/any equation
adjust according to package insert
74
what drugs have incr accumulation in renal pts (9)
sugammadex
neostigmine
atropine
glyco
digoxin
hydralazine
milrinone
antimicrobials
midazolam
75
which drug has active metabolites build up in kidney
midazolam
76
what drugs req decr dose in renal pts (5)
codeine
fentanyl
ketorolac
meperidine
morphine
77
what drugs req incr dosing interval in renal pts
acetominophen
acetylsalycilic acid
78
what drugs are safest for rental pts
remifentanil
sufenta
alfenta
79
AKI Serum Cr
increased
80
AKI urine volume
decreased
81
AKI urine Na+
low
82
AKI Cr/plasma ration
high
83
prerenal
blood cannot get to kidney
84
intrinsic
issue with kidneys
85
postrenal
block between kidney and urinary tract
86
_____- % of periop AKIs are ______
70% of periop AKIs are prerenal
87
how can you prevent periop AKI
adequate hydration and BP
88
prehepatic
incr bilirubin
89
causes of pre-hepatic dysfunction
hemolysis
hematoma
blood transfusion
90
intrahepatic
incr bilirubin
incr AST/ALT
91
cause of intrahepatic dysfunction
virus
drugs
alcohol
sepsis
hypoxemia
cirrhosis
92
posthepatic
incr bilirubin
incr AST/ALT
incr Alk phos
93
causes of posthepatic dysfunction
billiary stones/tumors
sepsis
94
factors in liver drug elimination
BF through liver
free drug level
intrinsic ability of hepatic enzymes to metabolize drug
95
child pugh score
grades liver disease
96
child pugh is based on
bilirubin
albumin
PT/INR
ascites
encephalopathy
97
child pugh safe to proceed with surgery
A/B
98
child pugh defer elective surgery
C
99
safest NMB in liver pts
atracurium
cisatracurium
100
which NMB req decr dose in liver pts
Roc
Vec
101
safest opioids in liver pts
remi
sufenta
fenta
102
opioids that req decr dose in liver pts
morphine
hydromorphone
103
opioids to avoid in liver pts
meperidine
104
can you give benzos to liver pts
yes but decrease dose
105
hepatic dysfunction impact on drug disposition is related to
type/severity of disease
characteristics of the drug
106
are high or low protein bound drugs going to be impacted more in liver pts
high bound drugs
107
low extraction ration
clearance dependent on intrinsic activity of metabolizing enzymes
difficult metabolism
108
high extraction ration
hepatic clearance dependent on hepatic blood flow
easiest metabolism
109
low extraction ratio drugs
(NTW VIP)
indomethacin
naproxen
theophylline
warfarin
valrpoic acid
procainamide
110
intermediate extraction ratio drugs
(PNACQ)
aspirine
quinidine
codeine
nifedipine
phenytoin
111
high extraction ratio drugs
cocaine
lidocaine
meperidine
morphine
nicotine
NTG
propranolol
verapamil
112
MAC req in pregnancy
decreased by 30-40%
113
pregnant pts have ______ absorption
increased absorption
114
pregnant pts have _______ distribution
increased distribution
115
pregnant pts have _____ free drugs
increased free drug
116
pregnant pts have ______ change to CYP enzyme activiity
can increase or decrease CYP metabolism
117
pregnant pts have ____ GFR and drug elimination
increased GFR and drug elimination
118
drugs impacted by incr GFR
decr concentration of:
enoxaparin
levetiracetam
119
what MW drug easily crosses placenta
low (<500) cross easily
120
do heparin and insulin cross the placenta
no
(too heavy)
121
what level of protein binding drugs cross placenta
free drugs cross easily
122
what level of ionized drugs cross placenta
only unionized
123
what level of lipophilic drugs cross placenta
high lipophilic cross easily
124
what level of maternal blood flow aids placental crossing
high maternal blood flow
125
do efflux proteins help placental crossing
no - they pump meds back into maternal system
126
teratrogen
agent that has the potential to cause abnormal fetal growth and development
127
teratrogenicity risk
3-6%
128
causes of tetragonicity
unknown cause: 75%
genetic: 15%
environmental: 10%
medication: <1%
129
teratrogenicity timing of exposure
blastogenesis: week 1-2
- embryo destruction
organogenesis
- structural anomalies
growth/maturation
- slow growth
- CNS anomalies
130
tetragon drugs
nitrous oxide (avoid 1-2 trimester)
midazolam (avoid high dose)
131
properties that influence placental transfer
molecular weight
protein binding
solubility
ionization
132
anesthetic drugs safe in non-ob surgery for pregnant pts
regional is best
propofol
ketamine
sux
IV opioids
acetaminophen
133
which induction drug should you use in hypovolemic preg pts
ketamine
134
can you give preg pts NSAIDs
avoid
especially after 32 weeks
135
CCB MOA
decr Ca2+ into cells
- decr sm muscle contraction
first line to delay labor
136
CCB SE
maternal hypotension
137
b2 agonist MOA
incr cAMP
decr sm muscle contraction
138
b2 agonist indication
uterine hypertonus (treat excess oxytocin administration)
139
b2 agonist CI
maternal heart problems
hypotension
hyperglycemia
hypoklameia
140
prstaglandin inhibitors MOA
reversible inhibir Cox 1/2
decr sm muscle contraction
141
prostaglandin inhibitor SE
nausea
GERD
bleeding
142
prostaglandin inhibitor fetal SE
premature closure of ductus arteriosis
143
first line drug to delay labor
nifedipine
144
2nd line to delay labor
indomethacin
ketorolac
significant risk to fetus
145
NTG MOA
incr NO
incr relaxation
146
NTG uses
short duration procedures
placenta removal
uterine inversion
fetal head entrapment
147
NTG SE
hypotension
headache
148
what drug do you give to promote fetal lung maturation
antenatal corticosteroids
- dexamethasone
- betamethasone
149
what drug should you give to protect fetal neuro function
mag sulfate
150
oxytocin SE
hypotension
tachycardia
fluid retention
151
oxytocin fetal SE
hypoxia
fetal bradycardia
152
methergine MOA
alpha adrenergic receptors
153
methergine uses
uterine atony
postpartum hemorrhage
154
methergine SE
incr BP
N/V
155
methergine CI
avoid in HTN
Preeclampsia
156
prostaglandins use
atony
labor induction
cervical ripening
157
carboprost CI
asthma
renal/hepatic
158
carboprost SE
N/V
HTN
pyrexia
159
misoprostol/dinoprostone SE
tachysystole
fetal HR decel
shivering
pyrexia
160
MgSo4 purpose in pre-ecclampsia/eclampsia
prevent maternal seizures by lowering maternal BP
161
MgSo4 MOA
inhibits Ca in SR binding sites
162
MgSo4 SE
palpitations
nausea
sedation
decr fetal HR
muscle weakness
163
MgSO4 consideration
decr SVR
neuraxial safe
GA safe
164
treat MgSo4 toxicity
CaCl
Ca Gluc
165
hypertension mgmt in preg pt
hydralazine
labetalol
nifedipine
sodium nitrotprusside
fenoldopam
NTG
166
pulm aspiration prevention in preg
rantidine
metoclopramide
