Lecture 3

Question 1

How many mg in 2% lido carp

Answer 1

34 mg

Question 2

How many mg epi in 1:100k epi carp

Answer 2

0.018 mg

Question 3

Where are amides/local anesthetics metabolized?

Answer 3

Liver

Question 4

Two drugs that cause higher conc of LA in pt

Answer 4

Propanolol

Cimetidine

Question 5

Early overdose symptoms of LA

Answer 5

Tachycardia and hypertension, Metallic Taste, confusion, sweating, tinging of lips

Question 6

Late signs of overdose of LA

Answer 6

Bradycardi and hypotension, decrease CP, Loss of consciousness

Question 7

Vasoconstrictors: use

Answer 7

Helps w/ Hemostasis
Keeps LA localized
Reduces endogenous release of catecholamines

Question 8

Two vasoconstrictors we use and which is more potent

Answer 8

Epi - Most potent

Levonordefrin

Question 9

Epi what receptors

Answer 9

A1, B1, B2

Question 10

A1 effects

Answer 10

Inc BP (vasoconstriction)

Question 11

B1 effects

Answer 11

Inc HR and cardiac contraction

Question 12

B2 Effects

Answer 12

Vasodilation in bronchioles

Question 13

Summary of A1, B1, B2

Answer 13

A1- Inc BP
B1- Inc HR
B2- Dec BP

Question 14

When to use combined A and B blockers

Answer 14

Pts with more cardiovascular needs

Question 15

Non-Selective B blocker causes:

Answer 15

Hypertension and bradycardia

Question 16

Caution w/ pts on SNRI and Tricyclics

Answer 16

Keep epi around because blocking reuptake so could theoretically exaggerate response to epi

Question 17

Blocking A1 causes

Answer 17

Hypotension and tachycardia

Question 18

Parkinson’s Meds?

Answer 18

COMT Inhibitors - Tolcapone and Entacapone! - EXAGGERATED response to Epi

Question 19

Recommend max epi dose in healthy aduly

Answer 19

0.2 mg = 11 carps

Question 20

Max epi for CV compromised pt

Answer 20

0.04 mg = 2.2 carps

Question 21

Endogenous secretion of epi in stressed patient

Answer 21

up to 0.28 mg/minute!

Question 22

NSAIDS can cause issue with

Answer 22

Asthmatic or COPD patients –> everything goes down lipoxygenase pathway and production of leuktotrienes

Question 23

NSAIDs adverse effects

Answer 23

GI problems, renal problems, platelet problems, exacerbation of asthma, CNS things like dizziness, tinnitus

Question 24

NSAIDS have adverse interactions with these drugs

Answer 24

Oral hypoglycemics
Warfarin
Digoxin
Lithium
Cyclosprine
Tacrolimus

Question 25

NSAID + warfarin

Answer 25

Inc bleeding

Question 26

NSAID + Oral hypoglycemic

Answer 26

Hypoglycemia

Question 27

NSAID + Tacrolimus or Cyclosporine

Answer 27

Inc renal toxicity

Question 28

NSAID + Digoxin or Lithium

Answer 28

Inc their levels! Beware of toxic levels!

Question 29

Necessary to break down opioids

Answer 29

CYP 2D6

Question 30

Opioids interact w/

Answer 30

Antihistamines and depressants–> excessive sedation
Anticholinergics and Imodium–> constipation
Antihypertensives–> hypotension

Question 31

What to use on pts whom opioids don’t work on

Answer 31

NSAIDs!

Can also give Dilauded or Demerol but very very rare

Question 32

Erythro and Clarithro -mycin Adverse interactions

Answer 32

Inc blood levels of Warfarin, Digoxin, Triazolam, Corticosteroids, cyclosporine

Question 33

Penicillin and Metronidazole

Answer 33

Inc anticoagulation in pts on Warfarin

Question 34

Metronidazole and Coumadin

Answer 34

Inhibits metabolism of Coumadin

Question 35

Penicillin and Coumadin

Answer 35

Penicillin dec Vit K synthesis in Gut - so synergistic with warfarin

Question 36

Rifampin Adverse interaction

Answer 36

Decreases oral contraceptive levels

Question 37

Tetracycline adverse interaction

Answer 37

Inc lithium levels

Question 38

Metronidazole interaction

Answer 38

Severe nausea/vomiting w/ alcohol

Question 39

Adverse SE’s of antibiotics in general

Answer 39

Decreased gut flora
Decreased hydrolysis of metabolites
Decreased parent drug resorption
Decrease enteroheptic circulation