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Pharm > FINAL > Flashcards

FINAL Flashcards

1
Q

First order kinetics

A
  • constant FRACTION of drug eliminated/unit time
  • clearance directly proportional to concentration
  • most drugs
  • curved graph
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2
Q

Zero order kinetics

A
  • constant AMOUNT of drug eliminated/unit time
  • independent of concentration
  • ETOH, ASA, dilantin
  • linear graph
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3
Q

Half life

A

Amount of time it takes for 1/2 of drug to be cleared

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4
Q

Steps for determining degree of ionization of drug

A

1) is drug acidic or basic?
2) what is the pH of the tissue?
3) what is the pKa of the drug?
4) Is the pKa becoming more acidic or basic?
5) if 1 and 4 are the same= more unionized; if different= ionized

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5
Q

What % of the drug is nonionized and ionized if pKa and pH are the same?

A

50/50

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6
Q

what is pKa?

A

dissociation constant

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7
Q

What processes are in phase 1 reactions and what do they do?

A
  • oxidation- lose electron
  • reduction- gain electron
  • hydrolysis- split apart and add H2O
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8
Q

What carries out phase 1 reactions and what is the final product?

A

CP450- converts drug into polar metabolite

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9
Q

What is the phase 2 reaction?

A

Conjugation- adds polar, water soluble substrate to molecule to make it biologically inactive and ready for excretion

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10
Q

What are the enzymes involved in phase 2 reactions?

A

glucuronic acid, GST, N-acetyl-transferase, sulfotransferases

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11
Q

full agonist

A

drug has effect on receptor- high receptor affinity and high intrinsic activity- full effect

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12
Q

inverse agonist

A

binds to receptor and causes opposite effect

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13
Q

partial agonist

A

has high receptor affinity but only partial intrinsic activity

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14
Q

agonist-antagonist

A

partial agonists that also have antagonistic activity (may decrease effects of full agonists)

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15
Q

Antagonist

A

binds to receptor but blocks effect (no response)

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16
Q

Competitive vs non-competitive antagonist

A

competitive (can be reversed- ex Narcan); noncompetitive (cannot be reversed)

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17
Q

What tests evaluate effectiveness of heparin?

A

aPTT- normal is 30-35, therapeutic is 1.5-2x baseline)

ACT- normal is 90-120; therapeutic >300, <180 inadequate (measure baseline, 3 min out, and q30m after)

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18
Q

What tests evaluate effectiveness of warfarin?

A

PT- normal 10-14 seconds

INR- therapeutic 2-3

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19
Q

What monitors effectiveness of ASA?

A

no lab value- ASA is irreversible and lasts for lifetime of platelet (d/c 4-7 days preop)

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20
Q

What is bleomycin used for?

A

testicular cancer (blue balls)

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21
Q

What is a complication of bleomycin?

A

pulmonary toxicity (blebs)

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22
Q

Oxygen consideration with bleomycin?

A

maintain FiO2 below 30%

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23
Q

What is doxorubicin (adriamycin) used for?

A

mainly metastatic breast cancer (and others)

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24
Q

What is a complication of doxorubicin?

A

cardiotoxicity- may potentiate myocardial depressant effects of anesthetics

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25
Q

Dosing of Ancef

A

must decrease with renal dysfunction- excreted primarily by GFR
*with normal renal function, consider redosing 4 hours from initiation of preop dose

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26
Q

Elimination half time of vancomycin (normal vs renal failure)

A

6 hours vs 9 days

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27
Q

What type of “ring” do penicillins have?

A

thiazolidine ring connected to beta-lactam ring

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28
Q

How does chlorhexidine work?

A

disrupts cell membrane of bacterial cells

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29
Q

Chlorhexidine vs iodine and hexachlorophene

A

chlorhexidine more effective

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30
Q

What is chlorhexidine used for?

A

mainly pre-op to decrease cutaneous bacteria

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31
Q

Where should you avoid contact with chlorhexidine?

A

eyes and ears

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32
Q

What has the overuse of antibiotics led to and what are they normally prescribed for?

A

bacterial resistance; URIs/bronchitis

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33
Q

Nearly ? % of nosocomial infections occur at the following 3 sites:

A

80%; urinary tract (catheters), respiratory system (ventilators), bloodstream (vascular access catheters)

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34
Q

What is the most common nosocomial bloodstream infection and what is it treated with?

A

S. aureaus- vancomycin

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35
Q

What 2 broad categories can bacteria be divided into?

A

gram positive and negative

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36
Q

Gram positive bacteria

A

retain violet color of stain (acne, MRSA)

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37
Q

Gram negative bacteria

A

have largely impermeable cell wall- more resistant to antibiotics (lyme, pneumonia)

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38
Q

What can happen if you administer vancomycin too fast?

A

red man syndrome- massive histamine release, facial/truncal erythema- can cause hypotension and cardiac arrest (if given <30 minutes)

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39
Q

What are side effects of aminoglycosides that decrease their clinical usefulness?

A

ototoxicity, nephrotoxicity, potentiation of NMDA, skeletal muscle weakness (parallels plasma concentration- consideration with renal dysfunction)

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40
Q

What are SCIP measures and what is anesthesiology responsible for?

A

measures to decrease the incidence of nosocomial infections- responsible for glucose management, normothermia, antibiotics

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41
Q

SCIP measures

A
  • prophylactic ABX within 1 hr of surgery and d/c within 24 hours
  • controlled serum glucose (<200 at 0600)
  • normothermia
  • wound infection identified during admission
  • appropriate hair removal
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42
Q

What is pasteurization?

A

disinfection by way of hot water (destroys cell proteins)

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43
Q

What organisms is pasteurization effective against?

A

gram negative, M. tuberculosis, most fungi and viruses

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44
Q

Thiazide diuretics

A
  • work on ascending loop and distal tubule
  • prevent reabsorption of Na and Cl
  • ex) hydrochlorothiazide
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45
Q

Loop diuretics

A
  • work on ascending loop of Henle
  • inhibit Na and Cl reabsorption
  • ex) Lasix
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46
Q

Osmotic diuretics

A
  • work along whole nephron
  • prevent reabsorption of water
  • ex) mannitol
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47
Q

Aldosterone antagonists

A
  • work on collecting duct
  • prevent Na and Cl absorption and K secretion
  • ex) spironolactone
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48
Q

potassium sparing diuretics

A
  • work on DCT
  • inhibit Na, Cl, HCO3 reabsorption AND K secretion
  • ex) triamterene
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49
Q

Carbonic anhydrase inhibitors

A
  • work on PCT
  • inhibit reabsorption of HCO3
  • ex) acetazolamide
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50
Q

dopamine receptor agonists

A
  • work along renal tubule
  • stimulate dopamine 1 receptors
    ex) dopamine
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51
Q

What anti-eleptic medications are liver enzyme inducers?

A

dilantin (phenytoin), carbamazepine- increases clearance, requiring larger doses of drugs to achieve effect

52
Q

What anti-seizure med is often given during neurosurgery?

A

Keppra, phenytoin?

53
Q

What mental health med is often given for neuropathic pain and post op management pain?

A

amitriptyline and imipramine (TCAs); maybe gabapentin?

54
Q

What is the relationship between steroids and pain?

A

corticosteroids are often given to prevent post-op pain because they inhibit the phospholipase enzymes and COX pathway- also have anti-inflammatory effects

55
Q

Consideration of hypoglycemia and general anesthesia

A

GA can mask symptoms of hypoglycemia (tachycardia, sweating, hypertension, seizure, coma)- also can be masked by beta antagonists

56
Q

What is a serious complication of metformin?

A

lactic acidosis- those especially at risk: liver dysfunction, MI, CHF, dehydration, renal dysfunction, IV contrast, hypoxemia, sepsis

57
Q

When should you d/c metformin pre-op?

A

48 hours

58
Q

Very rapid acting insulins

A
  • aspart, lispro, glulisine
  • onset 5-15 minutes
  • peak 45-75 minutes
  • duration 2-4 hours
59
Q

Rapid acting insulin

A
  • regular
  • onset 30 minutes
  • peak 2-4 hours
  • duration 6-8 hours
60
Q

Intermediate acting insulin

A
  • NPH
  • onset 2 hours
  • peak 4-12 hours
  • duration 18-28 hours
61
Q

Long acting insulin

A
  • detemir, glargine
  • onset 1.5-2 hours
  • peak 3-9 hours (detemir)- glargine has no peak
  • duration- detemir (6-24 hours) glargine (20-24+)
62
Q

Very long acting insulin

A

degludac

  • onset 2 hr
  • no peak
  • duration 40 hours
63
Q

CZ insulin

A

rapid acting,
0.5-1 hour onset
2-3 hour peak
6-9 hour duration

64
Q

Which fish substance is thought to have lipid lowering properties?

A

fish oil- reduces triglycerides and possibly LDL (not FDA regulated)

65
Q

Why do we favor nonparticulate clear antacids in anesthesia?

A

rapid mixing with gastric contents, more reliable increase in gastric pH, less aspiration risk

66
Q

Examples of nonparticulate antacids

A

bicitra, polycitria, sodium citrate

67
Q

What gastric motility agent should be avoided in Parkinsons and why?

A

Reglan- antidopaminergic drug (Parkinsons are already low in dopamine- drug may cross BBB and cause EPS)

68
Q

Alpha phase

A

distribution of drug from central to peripheral compartments

69
Q

beta phase

A

excretion of drug (longer, less steep)

70
Q

Why do patients awake from propofol?

A

redistribution into periphery (alpha phase)

71
Q

How do you reverse warfarin?

A
  • Vitamin K 1-2 mg (slow)
  • FFP 1-2 units
  • recombinant factor VIIa
  • Kcentra (prothrombin complex concentrate)
72
Q

What are TXA and aminocaproic acid?

A

antifibrinolytics (prevent clot breakdown by inhibiting conversion of fibrinogen to fibrin)

73
Q

TXA considerations

A

high concentrations may actually inhibit fibrin and may cause seizures

74
Q

What are TXA and aminocaproic acid often used in?

A

cardiac procedures

75
Q

How does warfarin work?

A

inhibits Vitamin K epoxide reductase from converting clotting factors into their activated form

76
Q

What is DDAVP and how does it work?

A

analog of vasopressin that stimulates release of vWF from endothelial cells (binds to glycoprotein Ib receptors, causing platelet adherence)

77
Q

What is DDAVP used for?

A

hemophilia A and vWF disease

78
Q

Examples of pro-hemostatic agents

A

DDAVP, antifibrinolytic agents (aprotinin, epsilon aminocaproic acid, TXA), protamine, factor concentrates, prothrombin concentrates, recombinant factor VIIa, topical thrombin agents

79
Q

What do prohemostatic agents do?

A

promote clot formation or prevent clot degradation- used to treat hemorrhage

80
Q

Protamine

A
  • heparin reversal

- 1 mg for every 100 units of heparin (or 10/1000)

81
Q

Protamine considerations

A

must be given SLOW (at least 5 minutes)- can cause hypotension

82
Q

What is protamine made from?

A

salmon sperm- contraindicated in fish allergy

83
Q

What is serotonin syndrome?

A

condition of too much serotonin agonism- combo of SSRIs, TCAs, MAOIs

84
Q

clinical findings of serotonin syndrome

A

tremors, AMS, clonus, HYPERTHERMIA

85
Q

What is lovastatin made from?

A

naturally occurring from aspergillus terreus

86
Q

What is fluvastatin made from?

A

entirely synthetic

87
Q

Main side effect of statins?

A

muscle aches- can even cause rhabdo, high CK

88
Q

Which steroid has the highest anti-inflammatory property in relation to cortisol?

A

Decadron (25x) and betamethasone

89
Q

What is the primary treatment for hypothyroidism?

A

steroid replacement therapy

90
Q

What have epidural injections of corticosteroids been used for?

A

back pain due to root irritation

91
Q

Dermatologic side effects of steroids

A

hirsutism, skin thinning, cushingoid, alopecia, acne, striae, hypertrichosis

92
Q

Eye side effects of steroids

A

glaucoma, exopthalmos, cataracts

93
Q

CV side effects of steroids

A

HTN, increased serum lipoproteins, atherosclerosis, arrhythmias

94
Q

GI side effects of steroids

A

gastritis, steatohepatitis, PUD, visceral perforation, pancreatitis

95
Q

Renal effects of steroids

A

hypokalemia, fluid volume shifts

96
Q

GI and reproductive effects of steroids

A

amenorrhea/infertility, intrauterine growth retardation

97
Q

bone side effects of steroids

A

avascular necrosis, osteoporosis

98
Q

muscle side effects of steroids

A

myopathy

99
Q

neuropsychiatric side effects of steroids

A

insomnia, dysphoria/depression, euphoria, psychosis, pseudo tumor cerebri

100
Q

Endocrine side effects of steroids

A

diabetes, hypothalamic-pituitary-adrenal insufficiency

101
Q

Infectious side effects of steroids

A

heightened risk of infection, opportunistic infections, herpes zoster

102
Q

What is a stress dose and who do you give it to?

A

Solu Cortef 100 mg- give to those taking high dose steroids preop

103
Q

Radioiodine is used as treatment for what?

A

Grave’s hyperthyroidism

104
Q

treatment for hyperthyroidism

A

antithyroid drugs (methimazole, propylthioracil, carbamazole), iodine, surgery

105
Q

What herb is used as an antidepressant and was shown to be more effective than a placebo?

A

St John’s Wort- more effective than low dose TCAs and may be as effective as SSRIs

106
Q

What is caused by a Vitamin C deficiency and what are the symptoms?

A

scurvy- gum lesions, hemorrhage

107
Q

What substances are high in Vitamin C (ascorbic acid)?

A

citrus fruits

108
Q

What deficiency causes neural tube defects in pregnant women?

A

folic acid

109
Q

What herbs impair blood clotting?

A

garlic, ginger, gingko biloba

110
Q

What are the fat soluble vitamins?

A

ADEK

111
Q

What mineral is important for strong bones and who is susceptible to deficiencies?

A

calcium- elderly (osteoporosis)

112
Q

What vitamin is associated with blood clotting and where is it found in the diet?

A

Vitamin K- green leafy vegetables

113
Q

Who should avoid green leafy vegatables?

A

Those on blood thinners (Afib)

114
Q

Is there a lab test to monitor Eliquis?

A

no

115
Q

Medications processed by zero order kinetics

A

ETOH, ASA, dilantin, warfarin, heparin, theophylline

116
Q

Drug receptor equation

A

Drug (D)+receptor (R)= drug receptor complex (DRC)= tissue response

117
Q

DRC is ? whereas tissue response ?

A

constant; varies

118
Q

Potency

A

increased affinity for drug shifts drug response curve to the left (need less drug to achieve effect)

119
Q

Slope of drug response curve

A

the steeper the slope, the more receptors are occupied

120
Q

Efficacy of drug response

A

plateau- the higher it is, the greater efficacy; tissue response

121
Q

synergistic effects

A

summing of simultaneous drugs have a greater combined effect than the effect of either one when given alone (1+1=3, acting on different receptors)

122
Q

additive effects

A

two substances have total effect of sum of individual effects (1+1=2, act on same receptors)

123
Q

potentiation

A

effects of one drug enhanced by another with no effect of its own (1+0=3)

124
Q

Antagonism

A

effect of one drug cancels effect of another (1+1=0)

125
Q

What can the concurrent use of sympathomimetics and MAOIs result in?

A

hypertensive crisis

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