Pharm 101

Question 1

lasix causes what kind of metabolic abnormality?

Answer 1

hypokalemic-hypochloremic metabolic alkalosis secondary to potassium excretion and a contraction alkalosis

Question 2

Hyperchloremic metabolic acidosis can be seen with

Answer 2

acetazolamide

Question 3

block the sodium-potassium chloride transporter resulting in a decreased sodium and chloride reabsorption

Answer 3

loop of Henle, loop diretics

Question 4

inhibit sodium and chloride reabsorption.

Answer 4

thiazide

Question 5

shortest duration of action at the benzodiazepine receptor?

Answer 5

Flumazenil

Question 6

contraindicated in a patient with congenital methemoglobinemia

Answer 6

EMLA cream, 2/2 prilocaine in the formulation

Question 7

EMLA=?

Answer 7

eutectic mixture of local anesthetics, mixture of lidocaine and prilocaine

Question 8

EMLA contrainidications

Answer 8

allergy to amide anesthetics, concomitant class III anti-arrhythmic drugs (e.g., amiodarone, sotalol), congenital or idiopathic methemoglobinemia, infants receiving treatment with methemoglobin-inducing agents

Question 9

Who is at most risk for emergence reactions after ketamine?

Answer 9

older female receiving a large dose of ketamine

Question 10

ketamine’s effect on ICP?

Answer 10

incrases

Question 11

ketamine-

Answer 11

nystagmus, pupil dilation, and increased salivation

Question 12

Volatile anesthetics______ cerebral metabolic rate of oxygen but______ cerebral blood flow

Answer 12

decrease; increase

Question 13

_____both increases CMRO2 and CBF,

Answer 13

Nitrous oxide

Question 14

All intravenous anesthetics except____ cause a decrease in CMRO2 and a decrease in CBF. Fentanyl has no effect on CMRO2 or CBF.

Answer 14

ketamine results in Increased cerebral metabolism, CBF, and ICP

Question 15

Chronic methadone treatment- get an EKG before what medication?

Answer 15

ciprofloxacin

Question 16

has N-methyl-D-aspartate (NMDA) antagonistic properties in addition to opioid receptor agonism.

Answer 16

methadone

Question 17

absolute contraindications of ACE-i?

Answer 17

pregnancy, allergy and angioedema (relative=hypotension and hyperkalemia)

Question 18

Which medications should NOT be administered intramuscularly to improve his blood pressure

Answer 18

Norepinephrine can cause local ischemia and tissue necrosis.

Question 19

Norepinephrine acts on?

Answer 19

direct α1, α2, and β1 agonist
α»β; It significantly increases blood pressure but its effects on heart rate and cardiac output are dependent on systemic vascular resistance.

Question 20

direct agonist at α1, α2, β1, and β2 adrenergic receptors.

Answer 20

Epinephrine

Question 21

α1 agonist.

Answer 21

phenylephrine

Question 22

MOST LIKELY explanation for increased hydrocodone requirements in a patient with a history of chronic pain who has just started fluoxetine for the treatment of fibromyalgia?

Answer 22

fluoxetine and paroxetine, significantly inhibit CYP2D6 and slow the conversion of hydrocodone to hydromorphone within the liver.

Question 23

SSRIs inhibit CYP2D6

Answer 23

codeine, hydrocodone oxycodone to more potent forms (e.g. morphine, hydromorphone, oxymorphone).

Question 24

BEST approximates the time until the maximum plasma fentanyl concentration is reached following placement of a transdermal fentanyl patch?

Answer 24

30 hours; Onset is approximately 6-8 hours after placement.

Question 25

NOT have activity at the N-methyl-D-aspartate receptor?

Answer 25

Oxymorphone is an opioid agonist without activity at the N-methyl-D-aspartate (NMDA) receptor.

Question 26

Dextromethorphan

Answer 26

is an over-the-counter cough suppressant with NMDA antagonist properties. It can be abused recreationally in large doses where it acts as a dissociative anesthetic.

Question 27

Ketamine is a potent, selective______ inhibitor that binds to the_______ site on the receptor.

Answer 27

NMDA; phencyclidine

Question 28

ketamine antagonism results in?

Answer 28

Antagonism results in (dissociative) anesthesia, analgesia, amnesia, bronchodilation, and maintenance of protective airway reflexes.

Question 29

SE of ketamine?

Answer 29

Side effects include hallucinations or other psychomimetic reactions (improved or prevented with benzodiazepines or propofol), salivation (improved or prevented with antisialagogues such as glycopyrrolate), and increases in intraocular pressure, intracranial pressure, and cerebral metabolic rate.

Question 30

hese patients may be agitated, violent, and have nystagmus.

Answer 30

Phencyclidine (PCP), also known as “angel dust”, is a dissociative drug with no known medical use. Despite agitation and possible violence, they likely have reduced MAC requirements.

Question 31

NMDA receptor antagonists

Answer 31

ketamine, magnesium sulfate, nitrous oxide, and certain opioids including methadone and tramadol.

Question 32

Concentration effect

Answer 32

explains why the rate of rise of FA/FI for nitrous oxide is faster than that for desflurane?

Question 33

0.42

Answer 33

blood gas: Desflurane

Question 34

0.47

Answer 34

blood gas: N2O

Question 35

2.4

Answer 35

blood gas: halothane

Question 36

1.4

Answer 36

blood gas: isolfurane

Question 37

0.65

Answer 37

blood gas: sevoflurane

Question 38

young M develops elevated creatinine phosphokinase (CPK) and altered renal function

Answer 38

Rhabdomyolysis from prolonged immobilization in a heavy patient is the most likely cause of the elevated CPK.

Question 39

Isoflurane is the_____ lipid soluble of the three commonly used volatile anesthetics in the United States (desflurane, sevoflurane, and isoflurane) and is also the most______ of the three.

Answer 39

most; potent

Question 40

inhalational anesthetic potency,

Answer 40

isoflurane (MAC ~1%) > sevoflurane (MAC ~2%)&raquo_space; desflurane (MAC ~6%)&raquo_space;> nitrous oxide (MAC ~104%).

Question 41

_____ is an opiate prodrug that requires conversion to its metabolites to exert its clinical effects

Answer 41

Codeine

Question 42

_____ is an opiate prodrug that requires conversion to its metabolites to exert its clinical effects

Answer 42

Codeine

Question 43

milrinone casues ____ intracellular cAMP levels

Answer 43

increasing

Question 44

milrinone is a phosphodiesterase (PDE) III inhibitor, impairs cAMP breakdown, therefore allowing increased intracellular levels of cAMP

Answer 44

increases cardiac inotropy and causes peripheral and pulmonary vasodilation via increased intracellular cAMP levels and calcium stores. Milrinone is also referred to as an inodilator for these reasons.