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SRNAPharmacology II > EXAM 1 PQ > Flashcards

EXAM 1 PQ Flashcards

1
Q

Mu opiod receptor activation leads to supraspinal analgesia via

A

Decrease release of GABA from periaqueductal gray matter

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2
Q

Activatoin of opiod receptors leads to activation of which intracellular transduction mechanism

A

G protein

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3
Q

most hydrophillic opioid

A

Morphine

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4
Q

Altered duration and potency with reduced renal function due to this metabolite

A

Morphine 6 glucuronide

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5
Q

Clinical effect of fentanyl terminated by

A

Redistribution

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6
Q

OPIOD with LONGEST CONTEXT sensitive half time

A

FENTANYL

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7
Q

OPIOD with longest duration after EPIDURAL

A

MORPHINE

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8
Q

Fentanyl to a low dose bupivacaine decrease

A

Failed block incidence

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9
Q

Best opiods for patient with combined hepatic and renal impairment

A

REMIFENTANYL

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10
Q

Converted from product to active

A

CODEINE

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11
Q

OPIOD that cause TACHYCARDIA

A

MEPERIDINE

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12
Q

Decrease the risk of respiratory depression

A

CLONIDINE

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13
Q

Biliary spasm side effect of

A

MORPHINE

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14
Q

OPIOD metabolite to cause seizure

A

Normeperidine ( from meperidine)

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15
Q

Prolonged administraton lead to loss of drug effect

A

tolerance

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16
Q

Best choice for patients taking MAOI

A

Morphine to prevent serotonin syndrome

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17
Q

OPIOD for surgery requiring quick recovery

A

REMIFENTANYL

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18
Q

Primary mechanism of waking following induction dose of thiopental

A

Redistribution of drug to lean tissues

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19
Q

Compared to thio, the reason patient awakens more rapidly form IV methohexital is

A

Metho has higher rate of hepatic clearance

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20
Q

Short acting barbiturate to accelerate elimination of for exmple phenobarbital give

A

SODIUM BICARBONATE

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21
Q

Following administration CV effect of thiopental

A

PERIPHERAL VENODILATION

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22
Q

Barbiturates on pulmonary

A

brief apnea lasting 30-45 sec

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23
Q

Uremia increases free fraction of thiopental by

A

100%

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24
Q

Thiopental cannot reduce the CMRO2 below 50% because

A

it only affects the neuron’s functional cellular processes

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25
Q

Barbiturates are the classic anesthetic trigger agent for

A

PORPHYRIA

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26
Q

PROPOFOL rapid termination of action due to

A

Redistribution to the periphery

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27
Q

Organ responsible for extra hepatic metabolism of propofol is

A

Kidneys

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28
Q

Propofol increase elimination half time in elderly due to

A

age related

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29
Q

Which hemodynamic decreases the most after induction of anesthesia with propofol

A

Systolic BP

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30
Q

Which IV anesthetic , causes the greatest decrease in mean BP

A

Propofol

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31
Q

After propofol most frequent effect on Resp system

A

APNEA

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32
Q

IV anesthetics causing EPILEPTOGENIC ACTIVITY

A

Methohexital

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33
Q

Most common side effect of propofol during induction

A

HYPOTENSION

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34
Q

PROPOFOL infusion syndrome is characterized by

A

Rhabdomyolysis

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35
Q

Causes ADRENOCORTICAL SUPPRESION

A

ETOMIDATE

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36
Q

Not associated with ETOMIDATE

A

increase IOP

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37
Q

ETOMIDATE on CNS

A

Decrease CMRO2, decrease CBF, Increase CPP

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38
Q

To increase water solubility of ETOMIDATE formulated with

A

PROPYLENE GLYCOL

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39
Q

Metabolism of etomidate

A

Liver by ester hydrolysis

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40
Q

Not a pharmacological effect of benzo

A

ANALGESIA

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41
Q

MOA of midazolam

A

allosteric modulation of GABA binding to GABAa receptor

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42
Q

Significantly increase metabolism of midazolam

A

Chronic alcohol consumptino

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43
Q

Benzo with inactive metabolite

A

Lorazepam

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44
Q

Midazolam hemodynamic changes

A

Decrease CIFm

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45
Q

Flumazenil reverse effects of

A

benzo

competitive antagonists

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46
Q

elimination directly proportional to drug clearance, and concentration

A

1st order elimination

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47
Q

HIGHLY lipid soluble

A

ETOMIDATE

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48
Q

ETOMIDATE INDUCTION DOSE

A

0.2-0.3 mg/kg

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49
Q

May attenuate CV stimulating effects of ketamine

A

Benzos

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50
Q

Net effect of ketamine induction is

A

Increase BP, HR, CO and Myocardial oxygen consumption.

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51
Q

Ketamine in critically ill patient

A

decrease in BP and CO , who have depleted their catecholamines stores and lack ability to compensate via the SNS

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52
Q

Catalepsy

A

Ketamine

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53
Q

Dissociative anesthesia

A

Ketamine

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54
Q

Contraindicated in brain injury

A

KETAMINE (increase ICP)

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55
Q

Potent stimulator of bronchial secretion______give?

A

Ketamine; give with glycopyrrolate

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56
Q

Emergence Delirium

A

Ketamine

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57
Q

Prolong effect of ketamine

A

Diazepam

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58
Q

Change in hepatic blood flow affect

A

KETAMINE metabolism

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59
Q

Use in burn patients

A

KETAMINE

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60
Q

What is emergence delirium attenuated by

A

Benzodiazepines

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61
Q

Ketamine IV dose

A

1-2mg/kg

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62
Q

Ketamine redistribution is

A

WITHIN 10 MIN

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63
Q

Minimal effect of RR, mV

A

Ketamine

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64
Q

Use to induce seizures

A

Methohexital

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65
Q

Allergic to propofol use

A

Barbiturates

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66
Q

Decrease BP and Increase HR

A

Barbiturates

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67
Q

Dose dependent respiratory Depression

A

Barbiturates

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68
Q

Decrease ICP aand CBF

A

Barbiturates

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69
Q

Lack histamine release

A

ETOMIDATE

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70
Q

NO alteration in HR, CO CVP or PWCP

A

ETOMIDATE

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71
Q

Benzo with perfusion limited clearance (high hepatic ratio)

A

Midazolam

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72
Q

Capacity limited clearance

A

Lorazepam and diazepam

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73
Q

Benzo containing propylene glycol

A

Diazepam and lorazepam

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74
Q

Dose related reduction in CMRO2

A

Benzos

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75
Q

Relatively safe drug

A

Benzo

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76
Q

Depress swallowing reflex and upper airway reflex

A

Benzos

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77
Q

Most likely to be un-ionized (uncharged) at physiological pH

A

Alfentanyl

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78
Q

swallow and corneal reflexes present with this med

A

Ketamine

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79
Q

Morphine vs fentanyl solubility

A

Morphine is LOW lipid solubility

80
Q

Thrombophlebitis associated with

A

Etomidate

81
Q

myoclonus associated with

A

Etomidate

82
Q

nausea and vomiting associated with

A

ETOMIDATE

83
Q

inhibition of steroid synthesis

A

ETOMIDATE

84
Q

not approved in the U.S. for sedation of pediatric ICU patients

A

PROPOFOL

85
Q

______administration may increase intraoperative wheezing in patients with asthma (causes bronchodilation)

A

Propofol (Diprivan)

86
Q

EEG activation, consistent with possible epileptogenic activity

A

ETOMIDATE

87
Q

More likely to require fentanyl (Sublimaze) to reduce hemodynamic effects caused by direct laryngoscopy

A

ETOMIDATE

88
Q

More likely to cause anterograde amnesia

A

Midazolam

89
Q

Suppression of recall for events before amnestic drugs are administered:

A

Retrograde amnesia

90
Q

Suppression of recall for events after amnestic drugs are administered:

A

Anterograde amnesia

91
Q

Reduction the cerebral edema following surgery; useful in head injury cases and management of cerebral ischemia:

A

barbiturates

92
Q

Main tissue reservoir for opiods

A

SKELEtAL MUSCLE

93
Q

Anatomical sites of opioid action: pain-modulating descending pathways –

A

rostral ventral medulla
locus ceruleus
periaqueductal gray

94
Q

Principal alkaloid in opium (derived from opium poppy)

A

morphine

95
Q

Most reliable indicator of opioid-mediated respiratory depression:

A

depressed patient response to a carbon dioxide challenge

96
Q

Opioid direct action on neurons:

A

may close a voltage-gated calcium channel on presynaptic nerve terminals, resulting in reduced transmitter release

97
Q

Contraindications/caution for opioid use:

A

Addison’s disease
impaired pulmonary function
patients with head injury

98
Q

Morphine effect/effects on bronchomotor status.

A

Bronchoconstrictive secondary to histamine release.

Worsening of asthmatic attacks

99
Q

Meperidine administration results in effects generally similar to those caused by

A

morphine

100
Q

Analgesic effects associated with codeine occurs because of its

A

conversion of morphine.

101
Q

Morphine, principally as morphine-3-glucuronide, is eliminated by

A

renal glomerular filtration

102
Q

2 are examples of drugs that increase meperidine induced respiratory depression.

A

Chlorpromazine and tricyclic antidepressant medications (first-generation agents)

103
Q

Opiods exhibits local anesthetic properties which can be observed following epidural administration.

A

Meperidine

104
Q

Increased cerebral blood flow with increased cerebrospinal fluid pressure secondary to drug-induced respiratory depression leading to increased carbon dioxide levels.

A

meperidine

105
Q

IV administration of _________is likely to produce a notable elevation in heart rate.

A

meperidine

106
Q

OPioids may induce delayed resp depression

A

Fentanyl or sufentanil administration may induce delayed respiratory depression

107
Q

principal, primary anesthetic in cardiac surgery or for patients with pre-existing poor cardiac status because of LIMITED CARDIOVASCULAR ACTIVITY

A

Fentanyl or sufentanil

108
Q

Slowest time to peak analgesic effect following IV administration:

A

MEPERIDINE

109
Q

Administration of nonsteroidal anti-inflammatory drugs may induce pain relief comparable to that provided by about

A

60 mg codeine.

110
Q

The major ion channel affected by benzodiazepine sedative-hypnotics is:

A

Chloride

111
Q

T/F Benzodiazepine administration results in comparable degrees of neuronal depression as barbiturates.

A

false

112
Q

T/F Benzodiazepines are not GABA type A receptor activators but rather modulate GABA effects at the receptor.

A

True

113
Q

T/F Benzodiazepine sedative hypnotic drugs are examples of patients which even at high doses do not induce by themselves surgical anesthesia.

A

True

114
Q

T/F Benzodiazepines at higher doses appropriately qualify as anaesthetics.

A

False

115
Q

Midazolam has been associated with

A

both decreased respiratory rate in tidal volume, even given without accompanying CNS depressant agents.

116
Q

The major receptor system targeted by clinically used benzodiazepines is:

A

GABA

117
Q

T/F At normal benzodiazepine doses cardiovascular effects are usually minor in normal individuals.

A

TRUE

118
Q

Highly plasma protein bound

A

Benzo

119
Q

Which one of the following benzodiazepines is classified as an intermediate-acting drugs

A

Lorazepam

120
Q

Refers to drug concentration producing 50% of that drug’s maximal effect:

A

EC50

121
Q

This type of drug, even at doses that fully saturate the receptor, does not elicit a response as great as that seen with a full agonist

A

partial agonist

122
Q

TI

A

TD50/ED50

123
Q

In women, morphine associated with

A

Greater analgesic potency

124
Q

Greatest amount of ROSTRAL SPREAD into intrathecal space (cephalad migration into the CSF)

A

Morphine

125
Q

Most common side effect of opioids

A

Pruritus

126
Q

Route associated with the reactivation of the HSV

A

Epidural

127
Q

Mu receptor activation associated with

A

Bradycardia

128
Q

Morphine does not

A

Cause MYOCARDIAL DEPRESSION

129
Q

2 medications that are most effective at reducing OPIOID INDUCED HYPERANALGESIA caused by REMIFENTANYL?

A

Ketamine

Magnesium

130
Q

Which benzodiazepine is more effective in preventing emergence delirium?

A

Midazolam is more effective than diazepam

131
Q

Which barbiturate has a greater lipid solubility and what does it result in?

A

Thiobarbiturates, results in greater hypnotic potency, faster onset and shorter duration of action.

132
Q

Which agent produces modest decreases in hepatic blood flow?

A

Thiopental.

133
Q

Which agent is useful for induction of anesthesia in patients with increased ICP?

A

Thiopental

134
Q

What is the opioid receptor activity of ketamine?

A

Interacts with mu, delta, and kappa receptors. May be an antagonist at mu receptors and an agonist at kappa receptors.

135
Q

Which agent is the only barbiturate with actions sufficiently different from the thiobarbiturates to offer an alternative to other IV induction agents?

A

Methohexital.

136
Q

What is the modest fall in renal blood flow and glomerular filtration rate due to?

A

Decrease in BP and CO.

137
Q

Which agent is the most potent enzyme inducer of the barbiturates?

A

Phenobarbital

138
Q

Which agent is contraindicated in hypovolemic

patients?

A

Thiopental

139
Q

Which agent causes anaphylaxis in 1:30,000 patients?

A

Thiopental

140
Q

Which agent can be mixed with propofol for production of TIVA and has more stable hemodynamics than propofol and fentanyl without incidence of emergence reactions?

A

Ketamine

141
Q

What is the metabolism of thiopental dependent on?

A

Thiopental has a low hepatic extraction ratio so metabolism is dependent on hepatic enzyme activity not hepatic blood flow.

142
Q

What is the metabolism of methohexital dependent on?

A

CO and hepatic blood flow

143
Q

Where is methohexital metabolized?

A

Liver

144
Q

What side effect occurs with thiopental and thiamylal (1:30,000)

A

histamine release

145
Q

Etomidate

A

Use cautiously in patients with focal seizures. Can cause hypotension if given to hypovolemic patients
Pain occuring during IV injection is frequent (80%).

146
Q

Use with caution or avoid in patients that may require an intact cortisol response (sepsis or hemorrhage patients).

A

Etomidate

147
Q

What is the side effect with overdose or large doses of barbiturates required to lower ICP?

A

Direct mYocardial depression

148
Q

Disadvantage of mEthohexital

A

Increased incidence of excitatory phenomena such as involuntary skeletal muscle movements (myoclonus) and hiccough.

149
Q

Between barbiturates and isofulrane which agent is preferable if profound EEG is desired?

A

Barbiturates

150
Q

How are thiobarbiturates metabolized?

A

Break down in extra hepatic sites such as the kidneys

151
Q

What are the risk factors of emergence delirium associated with ketamine?

A

Age >15, females, doses >2 mg/kg, history of personality disorders or frequent dreaming.

152
Q

What beneficial effect does propofol have on the lungs?

A

Causes bronchodilation and decreases the incidence of intra-operative wheezing in patients with asthma.

153
Q

What beneficial effect does ketamine have on the lungs?

A

Has bronchodilatory activity (successful in treatment of status asthmaticus).

154
Q

May increase ICP placing patients with intracranial pathology at risk. Increases salivary secretions necessitating protection of airway.

A

Ketamine

155
Q

What agent can impair neutrophil functions?

A

Thiopental.

156
Q

How much of thiopental and methohexital is excreted unchanged in the urine?

A

Less than 1%.

157
Q

How can venous thrombosis be prevented with barbiturate use?

A

By using diluted concentrations: methohexital 1%, thiopental 2.5%.

158
Q

What agents may increase the incidence of emergence delirium?

A

Atropine or droperidol, and scopolamine.

159
Q

What agents may decrease the incidence of emergence delirium?

A

Thiopental or inhalation agents.

160
Q

Sufentanyl vs morphine

A

1000 times more potent than morphine

161
Q

Meperidine vs morphine

A

0.1 times more potent than morphine

162
Q

Remifentanyl vs morphine

A

100 times more potent than morphine

163
Q

Alfentanyl vs morphine

A

10 times more potent than morphine

164
Q

Hydromorphone vs morphine

A

8 times more potent than morphine

165
Q

Opiods with active metabolites

A

Morphine

Meperidine

166
Q

Opioids with anticholinergic effects

A

Meperidine

167
Q

Demythlation in the liver metabolism of

A

Meperidine

168
Q

Can lead to SEROTONIN SYNDROME

A

Meperidine with MAOI

169
Q

What is the effect equillibration of ALfentanyl

A

1.4 min

170
Q

Why is the effect equilibration time so fast in ALFENTALY

A

Low degree of ionization

171
Q

90 % unionized in Physiologic pH

A

Alfentanyl

172
Q

For short but INTENSE periods of stimulation used

A

Alfentanyl

173
Q

Dose of remi

A

0.1 to 1mcg/kg/min

174
Q

Mu agonist rapid on and off

A

Remifentanyl

175
Q

Context sensitive half life of remifentanyl

A

4 minutes

176
Q

Is Bradycardia a side effect of Narcan

A

No

177
Q

AMnesia associated with Midazolam

A

ANTEROGRADE

178
Q

Clearance directly related to

A

blood flow to organ

Extraction ratio

179
Q

Steady state is achieved after

A

5 half lives

180
Q

Circumstance for Ion trapping

A

Maternal ALKALOSIS

Fetal ACIDOSIS

181
Q

Constant AMOUNT per unit of time (ZA)

A

ZERO

182
Q

Constant FRACTION per unit of time (FF)

A

FIRST order

183
Q

Perfusion dependent HEPATIC elimination meds

A

Fentanyl
Lidocaine
Propofol

184
Q

CAPACITY dependent HEPATIC elimination meds

A

Rocuronium

DIAZEPAM

185
Q

Acidic drugs

A

better ABSORBED in ACIDIC

186
Q

Basic drugs

A

BASIC Better ABSORBED in BASIC

187
Q

Drugs dose and plasma concentration is PHARMD or PHARK

A

PHARMACOKINETICS

188
Q

Effect site and clinical effect is PHARMD or P ARK

A

Pharmacodynamics

189
Q

Dose response curve x axis is (PX)

A

potency

190
Q

Dose response curve y axis is

A

Efficacy

191
Q

From top to bottom dose response curve

A

Agonist
Partial agonist
Antagonist
Inverse Agonist

192
Q

TI formula

A

LD50/ ED 50

193
Q

Chiral molecules non-superimposable

A

Enantiomers

194
Q

Levorototary rotaes

A

counterclockwise

195
Q

WK ACIDS ph and pKa

A

if ph < pka NON-IONIZED

if ph>pka IONIZED

196
Q

WK Bases pH and pKa

A

If ph PKA IONIZED

SRNAPharmacology II (32 decks)

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