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Pharm 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

what is the best clinical indicator of if you need to re-dose

A

twitch monitor

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2
Q

increased RESISTANCE of NMBs*
block is ______ dense
patient will recover _________
must give _________ dose
there is a __________ duration*

A

block is LESS dense
patient will recover FASTER
must give BIGGER dose
there is a SHORTER duration of the drug*

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3
Q

what 4 pharmacologic drugs cause increased RESISTANCE to NMBs

A

phenytoin (seizures)
corticosteroids (CHRONIC doses)
aminophylline/theophylline (bronchodilators)
lasix (LARGE doses)

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4
Q

inhibition of phosphodiesterase leads to __________ cAMP which ____________ Ach

A

Inhibition of phosphodiesterase leads to INCREASED cAMP which leads to INCREASED Ach

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5
Q

nondepolarizers are more _______ to chronic hyperkalemia patients*

depolarizers are more __________ to chronic hyperkalemic patients*

A

nondepolarizers = RESISTANT
depolarizers (Sch) = SENSITIVE

this is because the resting membrane potential is closer to depolarization

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6
Q

increased SENSITIVITY of NMBs*
block is ___________
patient will recover _________
give __________ dose

A

block is denser/POTENTIATED
patient will recover SLOWER
give SMALLER dose

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7
Q

retardation of anticholinesterase leads to _____ circulating Ach = ______ sensitivity to nondepolarizers*

A

retardation/decrease of anticholinesterase = LESS Ach =MORE sensitivity to nondepolarizers

sch is the opposite!

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8
Q

what drugs lead to increased SENSITIVITY to non-depolarizers

A

volatile anesthetics
aminoglycosides
lithium
lasix (NORMAL doses)
Sch
NMBs + NMBs
calcium channel blockers
anti HTN
local anesthetics

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9
Q

example of aminoglycosides*

A

gentamicin, neomycin, streptomycin, kanamycin, amikacin, tobramycin

NOT erythromycin

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10
Q

Oat cell carcinoma of the lung (be suspicious of biopsy lung cases/thoracostomy/cancer)

A

Myasthenic syndrome (eaton lambert)

causes increased SENSITIVITY

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11
Q

peds = _______ Vd = _______ recovery

A

large Vd (“water babies”), faster recovery

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12
Q

elderly = _______ Vd = _______ recovery = _________ dose*

A

small Vd (“dried up”), slower recovery, give SMALLER dose

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13
Q

what is the only drug to dose based on TOTAL body weight*

A

Sch (plasma cholinesterase is greater)

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14
Q

ANTIcholinesterases ____________ depolarization and contraction of the muscle

A

ANTIcholinesterases FACILITATE contraction

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15
Q

ACETYLcholinesterases _____________ contraction

A

DECREASE contraction

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16
Q

REVERSIBLE anticholinesterase

A

edrophonium
neostigmine
pyridostigmine
physostigmine

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17
Q

only anticholinesterase that is lipid soluble/tertiary amine*

A

physostigmine

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18
Q

IRreversible complex anticholinestrase

A

insecticides (dog dipper)
echothiophate (eye drops)
nerve gases

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19
Q

carbamylation of AChE

A

________stigmine group

20
Q

electrostatic binding

A

edrophonium

21
Q

anticholinesterases (4)

A

neostigmine
pyridostigmine
edroponium
physostigmine

22
Q

once acetylcholinesterase is max inhibited, giving more ANTIcholinesterase will ____ reverse a block

A

NOT reverse the block
ceiling effect

23
Q

if giving Sch after laryngospasm and nondepolarizer, block will be _______________*

A

PROLONGED
you must wait for block to end! only time!

24
Q

reversal of NMB is prolonged by (6)*

A

o Antibiotics
o Hypothermia
o Respiratory acidosis (PaCO2>50 mm Hg)
o Patients with increased volatile agents
o Metabolic acidosis
o Hypokalemia

25
Q

anticholinesterase overdose (

A

Nicotinic
o weakness ranging to paralysis
Muscarinic
o MIOSIS, inability to focus vision, copious salivation, bronchoconstriction, bradycardia, abdominal cramps, loss of control of bowel and bladder
CNS
o Confusion, ataxia, seizures, coma, resp depression

26
Q

treatment for anticholinesterase overdose*

A

pralidoxime (must give within minutes)

27
Q

anticholinergics treat against __________________

A

anticholinesterases (take away the nasty side effects)

28
Q

anticholinergics compete with Ach for ____________ receptors

A

muscarinic receptors

29
Q

examples of anticholinergics (3)

A

robinul
atropine
scopolamine

30
Q

treatment for antiCHOLINERGIC overdose
(restlessness, hallucinations, somnolence, unconsciousness)

A

physostigmine

31
Q

Encapsulates the STEROID class NMB and forms a stable complex, prevents the NMB to have action on the NMJ

A

sugammadex

32
Q

Reduces effects of progesterone; can bind to birth control drug up to 1 week

similar allergic reaction as stabilizers in food, increased bleeding

be careful with ESRD

incompatible with zofran, verapamil, ranitidine

A

sugammadex

33
Q

if giving Roc and Vec 5 MINUTES AFTER suggamadex, _________ dose*

A

increase the dose

34
Q

When do you pair atropine with neostigmine?

A

infant

35
Q

what affects calcium channels

A

cAMP

36
Q

Hypercalcemia=Hypomagnesium=_________Ach=greater ____________ to nondepolarizing NMBs

A

increased Ach
greater RESISTANCE

37
Q

Hypocalcemia=Hypermagnesium=_________Ach=greater _____________ to nondepolarizing NMBs

A

decreased Ach
greater sensitivity

38
Q

what drug for a patient who is an aspiration risk

A

Roc or Sch

39
Q

if giving Sch first, ___________ dose of non-depolarizer

A

DECREASE the dose of the nondepolarizer!

40
Q

drug for difficult airway (broken jaw)

A

Sch

41
Q

organ failure (but NO cardiac/pulm issues)

A

atracurium

42
Q

short case, how do you know how long til reversal?

A

Post tetanic twitch

43
Q

patient 7 days post burn with risk of aspiration

A

roc

44
Q

if giving non-depolarizer FIRST (defasiculating dose), _________ the Sch dose

A

increase the dose of Sch!

45
Q

what inhibits plasma cholinesterase*

A

neostigmine
cyclophosphamide
metoclopramide (reglan)

46
Q

what drug for a longer case (30 minutes)*

A

atracurium (NOT Sch)

Pharm 1 (9 decks)

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