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spring 2020 pharm final > exam 1 test rvw > Flashcards

exam 1 test rvw Flashcards

1
Q

The sodium/potassium pump is responsible for? (choose 2)

A

Maintains oncotic equilibrium
Creates sodium gradient

Extra: 3 sodium out 2 potassium in, responsible for transmembrane electrical potential.

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2
Q

Tell me about halothane in regards to potency, onset, recovery, and vapor malfuctions?

A

High potency, quick onset and recovery

Vapor malfunction caused by thymol

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3
Q

Plasma fluoride concentration is higher after administration of sevoflurane than enflurane, but exposure of renal tubules to fluoride is limited because most elimination is through the?

A

Lungs

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4
Q

what can you do with Sevo in order to prevent the breakdown of compound A?
How does Sevo eliminate hydrogen fluoride?

A

Though controversial, 2 L/min of fresh gas flow prevents the breakdown of compound A

CO2 absorbents react with sevoflurane to eliminate hydrogen fluoride

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5
Q

The ratio between the LD50 and ED50?

A

Therapeutic index (TI)

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6
Q

The time required to change the amount of drug in the by body by ½ during elimination (or during a constant infusion) represented by? (give me a formula)

A

0.7 x Vd/Cl

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7
Q

Classification of propofol?

A

GABA agonist

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8
Q

Malignant hyperthermia moa?

A

Constant leak of Ca through ryanodine receptors

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9
Q

Greatest to least hepatic effects for volatile anesthetics?

order iso, enfl, halo, and des

A

Halothane>Enflurane>Isoflurane>Desflurane

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10
Q

properties of inhaled anesthetics, what is true about concentration and effects?

A

The higher the concentration of gas, the quicker the effects take place

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11
Q

what receptors do inhaled anesthetics work on? MOA?

A

Gaba receptor

influx of Cl- ions into the cell to hyperpolarize cells

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12
Q

Most soluble anesthetic gas in blood, RANK the top 4.

A

Sevoflurane was the answer on the exam.

halo, enflurane, iso would be even more blood soluble correct?

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13
Q

Which of the following was true in regards to Desflurane (Choose 2) tell me the boiling point and vapor pressure (also blood:gas)

A

Boiling Point 22.8
Vapor Pressure 669

Extra: blood:gas 0.42
molecular weight 168

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14
Q

Sevo blood gas solubility?

A

0.69

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15
Q

Formula for calculating plasma osmolarity.

A

2(Na)+0.055(GLU)+0.36(BUN)

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16
Q

Which of the following is NOT a part of pharmacokinetics?

A

Bioavailability

Extra: pharmacokinetics would be absorption, distribution, metabolism, and excretion (what the body does to a drug).

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17
Q

What is true of hydrolysis: (give me two)

A

hydrolysis does not involve P450
Succs is broken down in the plasma by hydrolysis

Extra: occurs outside of the liver, also remifentanil, esmolol and ester LA are broken down by plasma via ester hydrolysis like Succs.

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18
Q

Na Atpase pump:(what goes in and what comes out)

A

3Na out

2K in

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19
Q

Chronic Alcoholic requiring more anesthetic gases, why?

A

Chronic alcoholism causes increased metabolism due to enzymes that break down the drug faster.

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20
Q

What is the order of potency for morphine? (order hydromorphone, morphine, sufent, and fent)

A

Sufentanil > fentanyl > Hydromorphone > morphine

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21
Q

Which drug is the least Protein binding?

A

Procaine–exam answer

tech. chloroprocaine would be correct bc it has none but I assume it was not an option on exam?

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22
Q

Exogenous epi dose

A

6mcg/kg

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23
Q

Which volatile agent causes transient increase in HR?

A

Desflurane

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24
Q

Malignant hyperthermia is caused from? (choose two)

A

Succinylcholine

Continuous release of calcium from the ryanodine receptor.

extra: volatile anesthetic gas would also be correct

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25
Q

What is the process of allowing temporary pre-op myocardial ischemia to prepare a patient for surgery?

A

Ischemic preconditioning

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26
Q

Which of the following gasses has a blood gas solubility that allows for rapid rise to equilibrium? (most rapid gas that we actually use)

A

Desflurane (most soluble)

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27
Q

Which gas is used as the first gas of the second gas effect?

A

Nitrous oxide

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28
Q

Gas that enters the mouth, pharynx, and trachea but does not reach the alveoli is referred to as?

A

Anatomical dead space

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29
Q

What is not stable in soda lime? (gas wise)

A

Sevo

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30
Q

The graph that has LD1 and ED99 and asks you which one does the CRNA want, where do you put the x?

A

you want it as close to ED99, like right on the line (third space basically), in between LD1 and ED 99

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31
Q

what LD and ED describes the need for vigilance?

A

LD1, ED99

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32
Q

Therapeutic index is not optimal. What is a more effective ratio for anesthesia?

A

LD1, ED99

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33
Q

What is the therapeutic index?

A

LD 50, ED 50

34
Q

A drug infused at a constant rate reaches 94% of steady state after how many half lifes?

A

4

35
Q

What is involved in phase 1 metabolism? (choose 2) (which enzyme and products?)

A

Cytochrome P450 enzymes
Yields water soluble metabolites

extra: conjugation is phase two

36
Q

An 80 year old patient with liver disease is expected to have (choose 2)

A

Increase in volume of distribution
Decrease in plasma protein

extra: Vd is increased bc as you age you have more fat.

37
Q

Which of the following is descriptive of fetal ion trapping (choose 3) (Basically tell me everything you know about fetal ion trapping.)

A

a. Fetal ph lower than the mother
b. Drug converting from non-ionized to ionized form in the fetus
c. Drug becoming trapped in fetus leading to toxicity.

38
Q

Which of the following is associated with fetal ion trapping (choose 2)

A

a. Fetus being more acidic than the mother
b. Specific amides

extra: does not tend to happen with esters bc they are metabolized via ester hydrolysis.

39
Q

Definition of a prodrug?

A

Inactive until metabolized

40
Q

Chloropaine has no protein binding, what are two things you can assume about it?

A

Short duration or action

Dissociates from Na channels with ease

41
Q

Choose three characteristics of lipid soluble drugs that help them spread?

A

a. can pass through the blood brain barrier.
b. high protein binding.
c. because of Vd it does not get cleared out of the body as quickly.

42
Q

What are the correct definitions for efficacy and potency

A

a. Efficacy is max effect a drug can produce

b. Potency is amount of drug needed for a given effect

43
Q

What describes the liver metabolism before the drug enters circulation?

A

first pass effect

44
Q

Receptor theory, those that are responsible for no reaction at the receptor site? (when they attach nothing happens)

A

non competitive antagonist and competitive antagonist

45
Q

Responsible for moving morphine out of the CNS?

A

P-glycoprotein

46
Q

Most ions? (pick two)

A

Are insoluble to the cell membrane

Cross through protein channels

47
Q

Glucose moves across cell membrane by: Choose 2

A

sodium co-transport system

Insulin

48
Q

O2 and CO2 move into the cell by?

A

Simple diffusion

49
Q

What are the two most abundant constituents in the cell membrane?

A

a. Protein

b. Phospholipids

50
Q

Cholesterol provides ____ and ____ to the cell membrane?

A

a. Flexibility

b. Stability

51
Q

WHAT provides specificity to the cell membrane?

A

Protein

52
Q

How many liters of plasma does average person have?

A

3 liters

53
Q

Constituent are identical but quantities varies

A

Plasma
Interstitial fluid
Intracellular fluid

54
Q

Total body weight is composed of?

A

65% water, 35% non-water

55
Q

What coefficient parallels anesthetic requirement?

A

Oil:gas partition

56
Q

Negative middle ear pressures may develop after discontinuation of nitrous oxide, then what can happen?

A

serous otitis.

57
Q

All of the following are part of phase I metabolism except? (hydrolysis, metabolism, conjugation, clearance, distribution, excretion)

A

Conjugation

58
Q

Tissue uptake is determined by?

A

pH

59
Q

Biotransformation occurs primarily in the? (what organ)

A

Liver

60
Q

Context sensitive half time: choose 2

A

a. Time it takes for the plasma concentration to decrease by 50%
b. Depends on duration of the infusion

61
Q

Half time elimination: Choose 2 (what is it directly proportional to and inversely proportional to?)

A

a. directly proportional to volume of distribution

b. inversely proportional to clearance

62
Q

Term that describes when two drugs that produce the same effect are given together and one enhances the effect of the other?

A

Synergistic

63
Q

When two drugs are present in a mixture of 50/50 they are referred to as?

A

Racemic Mixture

64
Q

What the drug does to the body is known as?

A

pharmocodynamics

65
Q

What LA’s has no protein binding?

A

The answer on the exam was procaine and chloroprocaine

but as we have learned now procaine does have a little protein binding (very little) and chloroprocaine has none.

66
Q

Generally decreases membrane fluidity and permeability?

A

Cholesterol

67
Q

A pt. Has a history of seizures. Which of the following gases would the CRNA avoid?

A

Enflurane

68
Q

Inhaled anesthetic that decreases cardiac contractility?

A

Halothane

69
Q

MOST POTENT inhaled anesthetic?

A

Isoflurane

70
Q

Osmotic Pressure goes from what tonicity to which tonicity?

A

Hypotonic to hypertonic

water is the only thing able to move, and it is trying to dilute the higher concentration

71
Q

Signs of diffusion hypoxia with decreased respirations. What gas could cause this?

A

Nitrous oxide

72
Q

Which stage of Anesthesia do you want your patient in?

A

3

73
Q

Induction, where does the gas start, go through, and then ultimate location to create anesthesia?
(order Pbr, PA, and Pa)

A

PA → Pa → Pbr

74
Q

Pt. has divergent gaze, breath holding. What stage of general anesthesia is your pt. In?

A

2 (most at risk for laryngospasm in this stage, OR needs to be quite)

75
Q

100% MAC ?

A

Nitrous oxide

76
Q

What is minute ventilation?

A

Tidal Volume x Breath/min

77
Q

Sevoflurane vapor pressure and gas coefficient?

A

170

0.69

78
Q

Not stable in soda lime? (2 gasses)

A

Sevo and Halothane

79
Q

Old people have, in relation to protein binding and volume of distribution?

A

decreased protein binding and increased volume of distribution.

80
Q

Blood gas coefficient of each gas, which are intermediately soluble and which are poorly soluble in blood?

A

intermediately soluble in blood: halothane = 2.54
enflurane = 1.90
isoflurane = 1.46

poorly soluble in blood: Sevo = 0.69
Nitrous = 0.46
Desflurane = 0.42

Xenon = 0.115

spring 2020 pharm final (3 decks)

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