Pharm 101 Flashcards
lasix causes what kind of metabolic abnormality?
hypokalemic-hypochloremic metabolic alkalosis secondary to potassium excretion and a contraction alkalosis
Hyperchloremic metabolic acidosis can be seen with
acetazolamide
block the sodium-potassium chloride transporter resulting in a decreased sodium and chloride reabsorption
loop of Henle, loop diretics
inhibit sodium and chloride reabsorption.
thiazide
shortest duration of action at the benzodiazepine receptor?
Flumazenil
contraindicated in a patient with congenital methemoglobinemia
EMLA cream, 2/2 prilocaine in the formulation
EMLA=?
eutectic mixture of local anesthetics, mixture of lidocaine and prilocaine
EMLA contrainidications
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
Who is at most risk for emergence reactions after ketamine?
older female receiving a large dose of ketamine
ketamine’s effect on ICP?
incrases
ketamine-
nystagmus, pupil dilation, and increased salivation
Volatile anesthetics______ cerebral metabolic rate of oxygen but______ cerebral blood flow
decrease; increase
_____both increases CMRO2 and CBF,
Nitrous oxide
All intravenous anesthetics except____ cause a decrease in CMRO2 and a decrease in CBF. Fentanyl has no effect on CMRO2 or CBF.
ketamine results in Increased cerebral metabolism, CBF, and ICP
Chronic methadone treatment- get an EKG before what medication?
ciprofloxacin
has N-methyl-D-aspartate (NMDA) antagonistic properties in addition to opioid receptor agonism.
methadone
absolute contraindications of ACE-i?
pregnancy, allergy and angioedema (relative=hypotension and hyperkalemia)
Which medications should NOT be administered intramuscularly to improve his blood pressure
Norepinephrine can cause local ischemia and tissue necrosis.
Norepinephrine acts on?
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.
direct agonist at α1, α2, β1, and β2 adrenergic receptors.
Epinephrine
α1 agonist.
phenylephrine
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?
fluoxetine and paroxetine, significantly inhibit CYP2D6 and slow the conversion of hydrocodone to hydromorphone within the liver.
SSRIs inhibit CYP2D6
codeine, hydrocodone oxycodone to more potent forms (e.g. morphine, hydromorphone, oxymorphone).
BEST approximates the time until the maximum plasma fentanyl concentration is reached following placement of a transdermal fentanyl patch?
30 hours; Onset is approximately 6-8 hours after placement.
NOT have activity at the N-methyl-D-aspartate receptor?
Oxymorphone is an opioid agonist without activity at the N-methyl-D-aspartate (NMDA) receptor.
Dextromethorphan
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.
Ketamine is a potent, selective______ inhibitor that binds to the_______ site on the receptor.
NMDA; phencyclidine
ketamine antagonism results in?
Antagonism results in (dissociative) anesthesia, analgesia, amnesia, bronchodilation, and maintenance of protective airway reflexes.
SE of ketamine?
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.
hese patients may be agitated, violent, and have nystagmus.
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.
NMDA receptor antagonists
ketamine, magnesium sulfate, nitrous oxide, and certain opioids including methadone and tramadol.
Concentration effect
explains why the rate of rise of FA/FI for nitrous oxide is faster than that for desflurane?
0.42
blood gas: Desflurane
0.47
blood gas: N2O
2.4
blood gas: halothane
1.4
blood gas: isolfurane
0.65
blood gas: sevoflurane
young M develops elevated creatinine phosphokinase (CPK) and altered renal function
Rhabdomyolysis from prolonged immobilization in a heavy patient is the most likely cause of the elevated CPK.
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.
most; potent
inhalational anesthetic potency,
isoflurane (MAC ~1%) > sevoflurane (MAC ~2%)»_space; desflurane (MAC ~6%)»_space;> nitrous oxide (MAC ~104%).
_____ is an opiate prodrug that requires conversion to its metabolites to exert its clinical effects
Codeine
_____ is an opiate prodrug that requires conversion to its metabolites to exert its clinical effects
Codeine
milrinone casues ____ intracellular cAMP levels
increasing
milrinone is a phosphodiesterase (PDE) III inhibitor, impairs cAMP breakdown, therefore allowing increased intracellular levels of cAMP
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.
