Exam 2 Review Questions Flashcards
Sulfonylureas
Stimulates the release of insulin from the pancreas (Glucotrol)
Weight gain
Biguanide
Metformin
NO hypoglycemia/No insulin secretion stimulation
Decrease hepatic glucose
Meglitinide analogs
repaglinide
2nd line drug like sulfonylureas
Thiazolinediones
(TZDs)
PPAR gamma receptor
Increase insulin sensitivity
Avandia
DPP-4 Inhibitors
Januvia
No weight gain
Increased incretins
GLP-1 Agonists
-glutides
Trulicity (SQ) & Ozembic (Orally)
Weight Loss!
SGLT2 Inhibitors
Work on S2 portion of proximal tubule
Increased urination/UTIs/Fungal infections/dehydration
t-Pa (Tissue plasminogen activator)
Activates fibrin-bound plasminogen better than free plasminogen; thrombolytic
Metabolism of Eliquis and Xarelto
CYP3A4
Pradaxa MOA
Direct inhibitor of thrombin (Factor 2)
Xarelto and Eliquis MOA
Factor Xa
Warfarin (Coumadin)
Delayed action (36-72 hours)
Vitamin K inhibitor (Factors 7, 9, and 10)
Heparin
Factor Xa inhibition
Can be used in pregnancy
Protamine sulfate “antidote”
Angina Cause
Hypoxic conditions on mycardium, leading to pain
- Decreased coronary blood flow
- Increased oxygen supply
Nitrates/nitrites
Increase oxygen supply/demand ratio
NO activates cGMP, leading to relaxation/vasodilation/hyperpolarization
Side effects (notable): throbbing vascular headache and face flushing
*Not to be used with glaucoma patient! (hypotension)
Five primary effects of Anesthesia
Unconsciousness
Amnesia
Analgesia
Inhibition of autonomic reflexes
Skeletal muscle relaxation
Mechanism of action of Nitrous Oxide
Antagonizes NMDA receptors, thus blocking cation movement and depolarization
Sevoflurane
Volatile subcategory of inhaled anesthetics
Indicated for patients with asthma/COPD
The MAC of halothane is 0.75 and the MAC of isoflurane is 1.4. Which drug is more potent?
Halothane
SH is a 65 year old female with underlying diabetes and severe COPD. The anesthesiologist would like to use an inhaled anesthetic as an adjunct for induction for his surgery. Which of the following would be the option?
- isoflurane
- halothane
- sevoflurane
- nitrous oxide
Sevoflurane is only good option
Propofol
No analgesic properties
Antiemetic action
Most pronounced decrease in BP (along with potential for bradycardia and asystole)
Potent respiratory depressant as well
Nitrous oxide contraindications
Cystic fibrosis
Acute respiratory infection
Pregnancy
History of psycological care
Which of the following structures confers hydrophilic property of LA?
- Amino group
- Aromatic nucleus
- Ester linkage
- Amide linkage
Amino group
Should lidocaine be injected into infected tissue?
It will cause therapeutic failure so best to avoid it
Which local anesthetic has the longest duration of action?
Bupivicaine
Which LAs are more lipid soluble?
Tetracaine, bupivicaine, and ropivicaine
Which LA should be used for liver impairment?
Citanest (prilocaine)
Which is the best anesthetic to use during pregnancy?
Lidocaine
Which LA has known allergicity associated with PABA formation?
Procaine (Novocaine)
What are 3 reasons why we use epinephrine in LA?
- Decreased blood flow/bleeding
- Decreased rate of systemic absorption
- Increased duration of action of anesthesia (MOST IMPORTANT)
What is the maximum dose of epinephrine for a CV patient?
0.04 mg (or 2 carpules of 2% lidocaine 1:100,000)
Should patients that have had a heart attack in the past 6 months receive a local vasoconstrictor like epinephrine during dental work?
Not ideal. Use mepivicaine (Carbocaine) instead
What is the only local anesthetic that has vasoconstrictor properties?
Cocaine
Which LA is connected to methemoglobinemia? What is the treatment for this and how does it manifest?
Topical Benzocaine
Blue finger nail beds
Treatment: Methylene blue (IV injection)
What is another use for Lidocaine aside from being a LA?
Antiarrythmic agent (1B)
If a patient has a sulfa allergy, what LA should be used?
Mepivicaine (Carbocaine)
Do Esters have cross allergicity? What about Amides? (For LAs)
Esters: YES
Amides: No
Allergic Reaction to LA
Swelling or edema, redness, breathing issues
JD is.a 68 year old female who comes to your office for a filling. You note in her chart that she has an allergy to procaine. She reports she developed a mild rash after a dental procedure in the past. The dentist would like to use lidocaine during this procedure. Is this appropriate?
Yes; procaine is an ester while lido is an amide. No cross allergicity
Most Common LA side effects
Syncope, hyperventillation, headache, facial edema, seizure, muscle twitching
Hypertension/tachycardia
Visual/auditory disturbances
Restlessness
Sedation
What is the order of action of a differential nerve block? (4)
- Pain is blocked
- Temperature perception
- Loss of sense of touch
- Muscle tone is effected (Overdose sign)
Oraverse
Alpha 1/2 blocker
LA reversal agent 1:1 ratio
OG is a 67 year old female with type 2 DM. She has been taking oral hypoglycemic agents and is gradually losing control of her blood sugars, especially postprandial. Which insulin is short acting to control mealtime sugars?
- Glargine (Lantus)
- Detemir (Levermir)
- NPH
- Lispro (Humalog)
Lispro (Humalog) is short acting
- and 2. are long acting
NPH is an intermediate acting insulin
JD is a 73 year old morbidly obese female that presents with complaints of increased thirst and urination. Her HA1C is 7.5. Which drug is first line for type 2 diabetes and won’t cause hypoglycemia?
- Metformin (Glucophage)
- Repalinide (Prandin)
- Acarbose (Precose)
- Glyburide (Micronase)
Metformin (Glucophage)
- is a Meglitinide analog (stimulates pancreatic insulin secretion)
- is an Alpha Glucosidase Inhibitor
- is a a Sulfonylurea (stimulates release of insulin from pancreas too)
Match the following drug families with Cholesterol or Triglycerides:
- Statins
- Fibrates
- Bile Acid Sequestrants
- Niacin
- Omega-3 Fatty Acids
- Ezetimibe
- Cholesterol
- Triglycerides
- Cholesterol
- Increased HDLs
- Triglycerides
- LDL cholestorol
What are the big 3 statins? Which statin is the baby statin and what’s special about it?
Lipitor, Mevacor, and Zocor
prevastatin: very few side effects and won’t cause hyperglycemia
Finasteride
BPH and male pattern baldness treatment
5-alpha reductase inhibitor
Antiandrogen
What is the main side effect of corticosteroids?
Hyperglycemia
What is the major side effect of insulin?
Hypoglycemia
What are the major side effects of oral contraceptives?
Venous thromboembolism, MI, Cancer
Increase BP/triglycerides
Headache
Weight gain
Mastalgia
Acne
GI Discomfort
Heart Failure Von Williams Classifications
- Na Channel Blockers
1a - Quinidine/Procainamide
1b Lidocaine
1c Flecainide/Propafenone
- Beta Blockers: Propanolol
- K Blockers: Sotalol (special because also a beta blocker); Amiorodone (pulmonary fibrosis/thyroid dysfxn)
- Ca Channel Blockers: diltiazem/verapamil; first choice for supraventricular AVNRTs
ACE Inhibitors Suffix
-pril
ARBs Suffix
-artan
Example: Valsartan is the only one that can be utilized to treat post-MI
What are the 4 stages of Anesthesia? What follows anesthesia?
- Induction/Analgesia
- Excitement
- Surgical/Deep plane
- Death
Emergence and Recovery follow anesthesia
Oswald Coefficient and how it relates to speed of anesthesia onset
Coefficient indicating the solubility of the anesthetic agent in the blood
High —-> slow onset
Low —-> fast onset
MAC: meaning and how it relates to anesthetic potency
Minimum Alveolar Concentration; MAC is equatable to ED50 in normal pharmacologic agents;
Small MAC —> Very potent
Example: Nitrous Oxide MAC=100, therefore it is not very potent
