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Pharmacology Exam 4 > Misc Pharm > Flashcards

Misc Pharm Flashcards

1
Q

What are the two classes of antineoplastic agents?

A

cell cycle-specific (CCS) AND cell cycle-nonspecific (CCNS)

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2
Q

Why are antineoplastics given over short intervals?

A

so good cells don’t die, less immunosuppression, work on actively dividing DNA

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3
Q

When are CCS antineoplastics used?

A

hematologic malignancies or tumors that have a large portion of cells in proliferation

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4
Q

What are some examples of CCS antineoplastics?

A

methotrexate, bleomycin, vincristine

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5
Q

When are CCNS antineoplastics used?

A

more effective in tumors that are slower to proliferate

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6
Q

What are some examples of CCNS antineoplastics?

A

cyclophosphamide, doxorubicin, cisplatin

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7
Q

What chemo drugs are alkylating agents?

A

cyclophosphamide, cisplatin

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8
Q

What chemo drugs are antimetabolites?

A

methotrexate

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9
Q

What chemo drugs are natural products?

A

vincristine

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10
Q

What chemo drugs are antitumor antibiotics?

A

bleomycin, doxorubicin

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11
Q

What is an uncommon but fatal side effect of bleomycin?

A

pulmonary fibrosis, particularly in older patients.

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12
Q

What is a consideration if a patient has had bleo in the last year?

A

use as low as possible FiO2 to prevent damage

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13
Q

What is an adverse effect of doxorubicin?

A

bone marrow suppression and CARDIAC TOXICITY d/t excessive intracellular production of free radicals within the myocardium

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14
Q

What are the 3 main types of hormones/steroids created in the adrenal cortex?

A

Mineralocorticoids (aldosterone), Glucocorticoids (cortisol), and androgenic hormones (sex hormones)

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15
Q

What’s the MOA of steroids?

A

bind to corticosteroid binding globulin in the plasma, unbind and reach a cell, cross through cellular membrane and bind to intracellular receptor

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16
Q

What do steroids do?

A

alter gene transcription and create tissue specific responses

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17
Q

What effects do steroids have on the tissues?

A

stimulate gluconeogenesis, muscle protein breakdown, stimulate insulin secretion, increase lipolysis, lipogenesis, osteoporosis, immunosuppression, anti-inflammatory, behavioral changes

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18
Q

What is acute adrenal crisis?

A

sudden onset/exacerbation of severe adrenal insufficiency, can happen in preop phase d/t stress of surgery in a patient with inadequate adrenal reserves. considered medical EMERGENCY b/c leads to CV collapse if not treated

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19
Q

What are the S/S of acute adrenal crisis?

A

weakness, nausea, hypotension (refractory/transient), fever, CNS changes

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20
Q

What is the treatment of Acute adrenal crisis?

A

steroids, electrolyte correction, fluids, inotropic support

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21
Q

Who needs perioperative steroid replacement?

A

patients at risk for adrenal insufficiency, prednisone 5mg/day, >2-3 weeks, during last 12 months

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22
Q

How do you perioperatively replace steroids?

A

mixed glucocorticoid/mineralocorticoid (hydrocortisone) so you can hit both systems. 0.8glucocorticoid/1.0mineralocorticoid.
Dose 25-150mg depending on type of surgery

23
Q

True/false. You cannot give ancef if someone is allergic to PCN.

A

False, there is a cross sensitivity but important to know what the allergy actually is to PCN. If its rash/fever, ancef probably ok.

24
Q

What is the weight based dosing of Ancef?

A

<80kg 1gm, 80-120kg 2gm, >120kg 3gm

25
Q

What is the severe side effect of beta-lactams?

A

severe allergic reaction, seizures

26
Q

What is the MOA of beta-lactams?

A

target cell wall, bactericidal (kill), partially bacterialstatic (inhibit), effective against gram + and -

27
Q

What are examples of beta lactams?

A

PCN, cephalosporins, carbapenem, monobactam

28
Q

What is ancef used for?

A

mostly gram - but does have some gram + effects, used in surgery to kill skin flora

29
Q

How is ancef eliminated?

A

renal excretion, adjust dose for renal function

30
Q

When should ancef be given?

A

within 60 min of surgical incision and redosed q3h

31
Q

What are examples of beta-lactamase inhibitors?

A

vancomycin, bacitracin

32
Q

What is the MOA of beta-lactamase inhibitors?

A

bind irreversibly to B-lactamase

33
Q

What are some s/e of vanco?

A

red man’s syndrome, hypotension–infuse slowly

34
Q

Describe vanco.

A

Bactericidal, widely distributed, body weight used for dosing, renal dependent–adjust dose

35
Q

What are aminoglycosides for?

A

treat gram -, bactericidal

36
Q

What are some examples of aminoglycosides?

A

streptomycin, gentamycin

37
Q

What are the s/e of aminoglycosides?

A

ototoxicity, nephrotoxicity, prolong action of NMBD

38
Q

What abx do you give for cardiac/thoracic/gi/gyn/neuro?

A

ancef

39
Q

What abx do you give for GI obstruction?

A

flagyl + ancef

40
Q

What abx do you give for cystoscopy?

A

ciprofloxacin PO before the come back to OR, add more in OR

41
Q

What are considerations in an asthmatic patient?

A

what inhalers do they take, how often, when was the last time they took it, have they had any ED visits in last 6 months, lung sounds, have albuterol out and ready with filter for vent tubing. (remove CO2 line before use.

42
Q

What is the goal of nitric oxide and how does it work?

A

goal improved perfusion to lung by direct pulmonary arterioles vasodilator, decreases intrapulmonary shunt.

43
Q

What is the FDA approved use of Nitric?

A

infants with respiratory distress syndrome

44
Q

What should you monitor if you use nitric over 24hours?

A

methemoglobin levels

45
Q

What are the inhaled adrenergic agonists?

A

albuterol (short acting) and saleterol/formoterol. (long acting)

46
Q

When do they recommend a long acting inhaler?

A

when short acting is used more than 2x/week. always used in combination therapy

47
Q

What are the side effects of albuterol & saleterol/formoterol?

A

tremors, tachycardia…albuterol for hyperkalemia

48
Q

What is an inhaled cholinergic antagonist and how does it work?

A

ipatropium (short acting), acts on muscarinic receptors in airway to reduce tone.

49
Q

What is ipatropium used for?

A

maintenance therapy for COPD and rescue therapy for asthma and COPD

50
Q

What are the side effects of ipatropium?

A

poor systemic absorption so few SE: dry mouth, urinary retention, pupillary dilation, blurred vision

51
Q

Which anesthetics have a beneficial effect on bronchomotor tone?

A

Volatiles: sevo/iso. IV: propofol, midazolam, ketamine

52
Q

What is HPV?

A

Hypoxic Pulmonary Vasoconstriction: an intrinsic response within the lungs that occurs with hypoxia, vasculature in a hypoxic area will constrict to direct more BF to hypoxic area.

53
Q

What medications inhibit HPV?

A

all volatiles in dose dependent fashion, systemic vasodilators: nitroglycerine/nipride

Pharmacology Exam 4 (7 decks)

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