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Anesthesia Pharm > Melanie's Guide > Flashcards

Melanie's Guide Flashcards

1
Q

daily aspirin therapy – why?

A

inhibits platelets, antiinflammatory

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2
Q

flumazenil: metabolism

A

hepatic (99%, according to the eenernets) Residation

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3
Q

local anesthetics – target channels

A

Na+ (activated state)

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4
Q

mechanism of action for barbituates

A

chloride conduction

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5
Q

propofol: CV effects

A

decreased BP and increased HR

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6
Q

induction drugs: hiccups

A

brevital(methohexital) and Etomidate

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7
Q

alpha 1 glycoprotein (protein binding)

A

basic compounds

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8
Q

local anesthetics: epinephrine concentration

A

1:200,000 (5mcg/mL)

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9
Q

propofol: additives

A

1% propofol, 10% soybean oil, 2.25 glycerol (burns), 1.2 egg phosphatide, 0.005 disodium edetate (bacteriostatic)

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10
Q

midazolam – clinical effects

A

anxiolysis, sedation, anterograde amnesia, anticonvulsant

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11
Q

midazolam – oral preperation

A

For peds: 0.5mg/kg up to 15mg total. No grapefruit juice (P450)

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12
Q

benzodiazepine contraindication

A

pregnancy

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13
Q

aspirin – effect on platelets

A

decreased production of thromboxane A2

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14
Q

pH for ionization of basic drugs

A

pH < pKa

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15
Q

penicillin: cephalosporin cross reactivity

A

low risk: 20% immunological studies, 1% clinical study

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16
Q

midazolam: drug interactions

A

increased ventilatory depression w/ opioids

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17
Q

opoid receptors: dynorphins

A

kappa

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18
Q

ketamine: treatment for emergence delirium

A

benzos

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19
Q

myastenia gravis: succynlcholine

A

increase dose – 2.6 x ED95

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20
Q

division of cardiac ouput

A

VRG = 75%; Muscle = 19%; Fat = 6%; VPG = 0%

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21
Q

steroids: stress dose

A

100 mg

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22
Q

inhaled anesthetic agents: metabolism

A

Breath it off - respiratory

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23
Q

uptake: increase inspired partial pressure

A

increase FGF, decrease circuit volume, decrease absorption

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24
Q

uptake and distribution: alveolar partial pressure

A

uptake = solubility x CO x (Pa - Pv)

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25
Q

percodan: combination

A

oxycodone and aspirin

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26
Q

volatile anesthetics: cerebral blood flow

A

increased vasodilation, decreased vascular resistance, increased CBF and ICP, halothane worst and iso minimal

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27
Q

isoflurane: cardiovascular effects

A

decreased SVR, increased HR, coronary steal

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28
Q

desflurane: physical properties

A

liquid at room temperature

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29
Q

inhaled anesthetics: circulatory effects

A

increased HR with iso and des

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30
Q

inhaled anesthetics: cerebral metabolic rate of oxygen

A

decreased CRMO2

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31
Q

definiton of pKa

A

50% ionized and 50% of unionized

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32
Q

side effects of opioid administration

A

respiratory depression, constipation, biliary colic

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33
Q

opioid potency

A

compared to morphine (1.0) – Meperidine = 0.1, Fentanyl = 75-125, Sufentanil = 1000 (5-10x more than fentanyl), Alfentanil = 10-20 (1/5-1/10x more than fentanyl), Remifentanil = 100, Hydropmorphone = 8

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34
Q

midazolam: 1st pass metabolism

A

PO = 50%

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35
Q

opioids: metabolism

A

remi: plasma/tissue esterases
morphine: liver and kidneys
meperidine: liver metabolism and renal elimination
fentanyl: pulmonary uptake

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36
Q

premedication: children

A

Versed 0.5 mg/kg PO 30 minutes before, often mixed with juice and acetaminophen

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37
Q

cortisol secretion – induction drugs

A

Etomidate

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38
Q

thiopental stability

A

anhydrous, refrigerated lasts 2 weeks after reconstitution

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39
Q

racemeic mixture definiton

A

50% L andd 50% D

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40
Q

benzos: clinical effects

A

GABA, no analgesia, anxiolytic, anterograde amnesia

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41
Q

induction drugs: effect on ICP

A

propofol and ketamine increase, thipental and etomidate decrease

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42
Q

volatile anesthetics: analgesia

A

N20 & Methoxyflurane

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43
Q

synergism definition

A

1+1=3

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44
Q

thiopental pH

A

10.5

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45
Q

barbituates: Side effects

A

decreased ventilatory action, still have laryngeal response

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46
Q

drugs that do and do not interact with GABA

A

Ketamine doesn’t

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47
Q

propofol: physical properties

A

white emulsion

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48
Q

antihypertensive therapy

A

Dexmetomidate/Clonidine (alpha 2 agonists)

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49
Q

volatile anesthetics: preservatives

A

halothane: thymol

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50
Q

induction drugs: mechanism of action

A

GABA, except ketamine

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51
Q

MAC: factors affecting

A

increased with: hyperthermia, hypernatremia, and catecholamines

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52
Q

volatile anesthetics: blood:gas coefficient

A

des: 0.42, nitrous: 0.47, sevo: 0.5, iso: 1.4, halo: 2.4

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53
Q

induction drugs: analgesia

A

ketamine

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54
Q

induction drugs: dose of etomidate

A

0.3 mg/kg

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55
Q

thiopental concentration

A

2.50%

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56
Q

treatment of myastenia gravis

A

anticholinesterase – pyridostigmine

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57
Q

induction drugs – myoclonus

A

Etomidate

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58
Q

volatile anesthetics: coronary blood flow

A

Iso

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59
Q

inhaled anesthetics potency

A

nitrous<halo

60
Q

thiopental: pharmacokinetics

A

GABA, 80% protein bound

61
Q

anesthetic uptake: CO

A

/\CO delays onset

62
Q

propofol dose and concentration

A

1-2.5 mg/kg

10 mg/ml

63
Q

anticholinergic drugs and sedation

A

scopolamine is most potent sedative

64
Q

EMLA definition

A

Eutectic Mixture Locain Anesthestic

65
Q

local anesthetic – methemoglobinemia

A

prilocaine and benzocaine

66
Q

anticholinergic: lipid solubility

A

atropine and scopolamine cross BBB but glycopyrrolate does not

67
Q

EMLA components

A

5% lidocaine, 5% prilocaine

68
Q

calculation: bupivicaine in epidural infusion

A

10-20 minutes

69
Q

propofol: ICU

A

3 days then hyperlipidemia

70
Q

routes of drug administration: parenteral

A

IM, IV, SubQ, pulmonary, nasal, topical

71
Q

opioids in renal failure

A

Alfentanyl

72
Q

cell membrane diffusion: factors affecting

A

blood flow, surface area, solubility of drug

73
Q

inhaled anesthetics - time constants

A

volume/flow

74
Q

vancomycin side effects

A

redman syndrome

75
Q

desflurane and CO2 absorber

A

carbon monoxide production over time

76
Q

bupivicaine dose

A

2.5 mg/kg

77
Q

duration of antiplatelet effects of aspirin

A

~10 days

78
Q

effect of volatile anesthetics on pattern of spontaneous ventilation

A

Small, rapid breathing. net decrease in MV.

79
Q

opioid for neurological assessment post op

A

Remifentanyl

80
Q

local anesthetics – metabolism

A

amides = liver, esters = cholinesterase enzymes

81
Q

desflurane CV effects

A

tachycardia due to SNS stimulation

82
Q

local anesthetics and nodes of ranvier

A

2

83
Q

compound A formulation

A

sevo interaction with CO2 absorbers

84
Q

benzodiazepine ion channel effect

A

Cl- hyperpolarization

85
Q

inhaled agents: bone marrow suppression

A

N2O

86
Q

opioids: histamine release

A

morphine and meperidine

87
Q

glycopyrrolate: premedication

A

secretions, best antisaligogue, doesn’t cross BBB so no sedation, less HR increase than atropine

88
Q

opioid receptors

A

mu: endorphins, morphines, and synthetic opioids
kappa: dynorphins and agonist-antagonists
delta: enkephalins

89
Q

opioids: seizures

A

meperidine

90
Q

local anesthetics: signs of cardiotoxicity

A

circumoral numbness, tinitis

91
Q

dibucaine number

A

80

92
Q

succinylcholine: reason for short duration

A

plasma cholinesterases break it down

93
Q

anitcholinesterases: lipid solubility

A

Physostigmine is lipid soluble, crosses the BBB

94
Q

opioid side effects: glucagon

A

treatment of biliary colic (2 mg IV)

95
Q

anticholinesterases: pharmacologic effectts

A

BBLUDS

96
Q

thiopental: redistribution

A

effects of thiopental last 5-10 minutes because of redistribution

97
Q

anticholinesterases: onset

A

(fastest to slowest) Edrophonium, neo, pyridostigmine

98
Q

edrophonium: onset

A

fastest

99
Q

local anesthetics – signs of toxicity

A

circumoral numbness, tinitis

100
Q

opioid receptors: dynorphins

A

kappa

101
Q

rocuronium: rapid sequence

A

1 mg/kg

102
Q

neuromuscular blocking drugs: CV effects

A

Pancuronium causes tachycardia

103
Q

nondepolarizing NMB: onset

A

fast as sux with highest dose roc

104
Q

neuromuscular blockade: phase I block

A

twitches and tetani with no fade

105
Q

succinylcholine: electrolyte levels

A

hyperkalemia

106
Q

local anesthetic: function of epinepherine

A

increased duration due to vasoconstriction

107
Q

inhaled anesthetics and MH

A

discontinue

108
Q

local anesthetics: cauda equine syndrome

A

5% lidocaine causes highest risk

109
Q

mivacurium and laryngeal muscle spasm

A

IM mivacurium to treat laryngospasm in peds

110
Q

antibiotics – penicillin allergy

A

use clindamycin

111
Q

chloroprocaine – contraindicated in spinal

A

neurotoxic

112
Q

properties of meperidine

A

antimuscarinic

113
Q

volatiles: reactive airway

A

des contraindicated

114
Q

maximum dose of Bupivicaine

A

2.5 mg/kg

115
Q

dysrhythmias with sympathomimetics

A

epi

116
Q

clinical use of dopamine

A

Increase CO and GFR

117
Q

NMBD: choice for trauma patient with head injury

A

Roc

118
Q

beta blockers – airway resistance

A

Systemic absorption of timolol (normally eyedrops) causes increased airway resistance

119
Q

beta blockers – treatment of glaucoma

A

Timolol

120
Q

beta blockers – metabolism of

A

esmolol – plasma esterases

121
Q

benzodiazepine – ion channel effect

A

hyperpolarization

122
Q

side effects of neuraxial opioids

A

pruritis, N/V, urinary retention, ventilatory depression

123
Q

antimicrobial prophylaxis: clean orthopedic procedure

A

ancef or vanc

124
Q

antimicrobial, aminoglycoside class

A

gentamycin?

125
Q

anticholinergic overdose

A

anticholinesterase

126
Q

indirect agonist: definition

A

stimulates the release of an agonist (like ephedrine)

127
Q

antacids – side effects

A

metabolic alkalosis?

128
Q

sympathomimetics associated with tachyphylaxis

A

ephedrine because it depletes N

129
Q

oett drug administration

A

NAVEL: naloxone, atropine, valium, epi, lido

130
Q

antimicrobial prophylaxis: knee replacement, PCN allergy

A

Vanco 1 g

131
Q

routes of administration of epi

A

subQ, IM, IV, IO

132
Q

milrinone dose

A

0.05 mg/kg loading dose, 0.5 mcg/kg/min infusion

133
Q

surgical site infection: blood glucose

A

hyperglycemia, increased m/m at 200 mg/dL

134
Q

side effect of milrinone

A

torsades, bronchospasm, severe infusion site reaction, ventricular arrhythmias

135
Q

NMBD and histamine release

A

atracurium

136
Q

IM ketamine dosing

A

4-8 mg/kg

137
Q

cocaine for ENT

A

topical, vasoconstricts? pterygopalatine ganglion block?

138
Q

norepi release regulated by what receptor

A

alpha 2

139
Q

epinephrine – arrythmias

A

PVCs and V-tac

140
Q

local anesthetics and ion trapping

A

if baby is acidotic, local can be trapped in the baby and cause toxicity

141
Q

milrinone method of action

A

cAMP

142
Q

effects of norepi

A

Alpha (1&2) and Beta1

143
Q

clinical uses for sympathomimetics

A

increase BP/CO

144
Q

contraindications for acute intermittent prophyria

A

barbiturates

145
Q

phosphodiesterase inhibitor – myocardial contractility

A

cAMP

Anesthesia Pharm (11 decks)

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