pharm Flashcards
how is remifentanyl metabolized
ester hydrolysis
how is a bolus dose of thiopental terminated
redistribution from brain to periphery
this is the same for propofol, fentanyl, methohexital
doxyrubicin
does it have a dose dependnt effect on cardiotoxicity?
what are the EKG changes seen with acute toxicity
what are the other systems that it can effect?
- yes dose dependent effect during and mnths after therapy
- ST segment changes
- hepatic, renal, GI, plum, myelotoxicity can also occur
what local anesthetics can cause methemeglobinemia?
prilocaine and benzocaine
treated by methlylene blue
think i take PRIde when i roll up to the MET in my BENZ
which anticholinergic agents are best paired wth AcHesterase inhbiitors of neostigmine, pyridostigmine, edrophonium, when revering neuromuscular blockade
edrophonium –> atropine
neostigmine/pyridostigmine –> glyco
what procedure is methohexital usually used for and whalso what class of drugs is it
its a short acting barbituate
used for ECT, can trigger seizures
think you are HEXED with methohexital aka seizure activity
what is the preferred method to reverse INR
when patient needs surgery or if theres hella bleeding
prothrombin complex concentrate +vitamine K
relative contracindiations to ketamine use
ischemic heart disease (as sole agent)
vascular anuersym (as sole agent)
increased ICP / brain mass w spontaneous ventilation
open eye opthalmic injury (increased IOP)
schizophrenia
mostly bc ketamine will cause tachycardia and htn
what 2 benzos will not undergo phase 1 meabolism
lorazepam + oxazepam
phase 1 = dealkalation or alphatic hydoxylation
phase 2 = glucuronidatio + actylation
what drugs are metabolized by psuedocholinesterase in the plasma
succinylcholine
mivacurium
2 chloroprocaine
what drugs are metabolized by nonspecific ester in intestine and muscles
remifentanil
atracurium
what drug is metabolized by hoffman degrdation in the plasma
atracurium
cisatracurium
zero order vs first order kinetics
zero order is that the same amount of of drug is removed per a period of time, linear relationship
first order is dose dependent and removes a percentage of drug per unit time, this is dependent on liver blood flow
what drugs do NOT undergo anny lung metabolism
dopamine
isoproterenal
epinephrine
think if the lung touches these drugs u DIE
how to volatile anesthetics affect CBF and CMRO2
CMRO2 decreases CBF increases (vasodiation)
NO DOES NOT HAVE this uncoupling effect
from greatest to least wahts the vapor pressure of volatile anesthetics
desflurane > iso > sevo
DIS
whats the mechanism of milrinone
pde III inhibitor which decreases hydrolysis (breakdown) of cAMP
this drug will increse contractility, decrease afterload
how does introducing ccb to a patient that hasnt had it before affect paralytic agents
mild augmentation of both depolarizing and nondepolarizing agents
time of onset of oral vs IV famotadine
oral takes 1 hour
IV takes 30 min
what drugs will decrease the changes of K hole symptoms when using ketamine
benzos (versed) think u forget about the nightmates
barbituates
propofol
fluride ion production from greatest to least of the volatile gases
methoxyflurane > sevo > enflurane > isoflurane > desflurane
recurrence of hypoapnea can happen when narcan is given after what two opioids
morphine
dilaudid
think the longer acting ones because narcan only has a 30 min ish duration
narcan = nolaxone
testing for HIT
antiplatlet factor 4 has high sensitivity
serotonin release assay has high specficity
what are the hemodynamic effects of high doses of meperidine and why
hypotension bc histamine
tachycardia bc atropine like effect
If patient has hypercalcemia how should u change ur nondepolarization muscular blocking agent dose
increase dose of paralytic bc ca can antagonize it
how do paralytics affect MG patients
they are resistent to succ
and very sensitive to non depolarizating agents
chlorprocaine’s rapid onset of action is due to what property?
its high concentration
what is the mechanism of action of IV regional anesthesia
blockade of nerves with LA thorugh vasciualr beds reading peripheral nerves and nerve trunks
how does lithium affect depolarizing and non depolarizing muscle blockers
it prolongs the effects of depolarizing and non depolarizing muscle paralytics
what patients should you not use succ in
any pathology that causes an increase in ach receptors, denervating disorders etc.
you CAN use succ in MG and lambort eaton bc this will not cuase life threatening hyper k since there are less receptors available bc of the antibodies
what two things will increase metabolism of cisatricurium
its hoffman elimination and increased temp and increased pH will increase hoffman elimination
most common side effect of fospropofol
paresthesias and genital itching
its water soluble whereas propofol is lipid soluble (lipid soluble is more like to lead to bacteria growth)
what pressor should u not give IM
by what mechanism does glucagon help cardiac muscle
increases cAMP so increases chronotropy and ionotropy via nonadrenergic receptor
what agent should you avoid using alone in thyrotoxicosis
radioactive iodine, it can initally worsen thyrotoxicosis
at a MAC of 1 what volatiles preserve total hepatic blood flow the least
from greatest preservation to lease
sevo > iso > halothane
two issues with using NO for abdominal insufflation
- surgical issue if surgery is prolonged
2. PONV risk is higher if surgery > 1 hour
what substance is used to measure potency of inhaled anesthetic gases
olive oil
Meyer-overton correlation
what benzo induction agent is NOT Assocaited w myoclonus
midazolam
most effective method to reduce propofol pain
injecting it into the AC
mixing lido and prop decreases the stability of propofol
what eye drug that causes dilation can cause CNS toxicity and convulsions
cyclopentolate
mechanism of nalbuphine
mu antagoinst
kappa agonist
flumazenil has a short half so u may need to do what when administering it?
redose it, could have recrudescence of sedation after since its so short
how does succ affect LES tone and intragastric pressure
increases LES and intragastric pressure but it increases LES more
4 herbal supplements related to increased bleeding
ginger
ginko
garlic
vitamin E
what is the median time to peak plasma concentration for fentanyl patch
30 hours
onset happens in about 6-8 hours
whats the onset of action of chlorprocaine
6-12 minutes
what is normeperdidine
metabolite of meperidine from the liver that can cause CNS stimulation aka seizures
what two drugs are metabolized by psuedocholinesterase
mivacurium
succinylcholine
injecting into the corcobrachilias muscle will ensure what nerve is also blocked
musculocutaneous
if this is not properly blocked you will have sensation of the lateral forearm
what protects patient from respiratory depression when using buphreorphine
ceiling affect for respiratory depression at high doses more than analgesoa
way stronger potency than
what eyedrop drug inhibits psuedocholinesrterase and will potentiate succ // miva
echothiophase
think drug increases the ECHO “effect” of succ
what respiratory effect do benzos have
decreased minute ventilaiton mostly by decreasesing tidal volume
what does metoclompromide to to LES tone
it increaeses LES tone
think its a prokinetic and wants things to move fowrard
no affect on pH
do calcium channel blockers affect acH release?
no
CCB work on L type channels not P channels
which gas will cause megaloblastic anemia
NO
what enzyme does etomidate suppress that reduces cortisol and aldosterone
11 beta hydroxylase
what LA has the highest potency for cardiac toxicity
bupivicaine
and has the lowest cardiac:CNS toxicity ratio
think bupi will BUMP the HEART too hard that it stops
does nicardipine act more on reducing preload or afterload
reduces afterload so its easier to titrate
after stopping of antiplatlet agent how much platelets are restored each day
10-14% daily
how is vecuronium cleared
liver metabolism
what is the clinical correlation with volatile gas metabolism
more metabolism increases fluoride and can cause fluoride toxicity
sevo > enflurane > iso > des
enflurane is the only one that causes fluroide nephropathy
how long before surgery should u apply scop patch and what are the common side effects of it
should be administered 4 hours before surgery
its antimuscarininc side effects = blurry vision, dry mouth agitation
what two paralytics will have accumulation of active metabolites in renal failure patients
pancuronium
vecuronium
what opioid does not have any activity on NMDA receptor
oxymorphone
which enzyme is induced by st john wart
450 3A4
how does liver disease affect nicardipine metabolism
prolonged half life in liver disese
what two drugs are metaboliszed by non specific esterases and would not be effected by psuedocholinesterase deficiency
esmolol and remi
succ, mivacurium, ester locals (chloroprocaine) ,cocaine and heroin are metabolized by psuedocholinesterase
what is the mechanism of action of eptifibitide and tirofiban
IIb-IIIA receptor inhibitors
if patient has allergy to cyclodextrins what drug is contraindicated
suggamadex
thing the GAME incudes a CYCLE
most potent clinically used opioids
sulfentanil > fentanyl, remfentanil > alfentanil > morhpine
which synthetic opioid does not have biliary spasm
butorphanol
what drug can be used to treate scopolamine realted delirum
physostigmine
wha
how long before surgery should ticlodipine be stopped
2 weeks
what is dibucaine
LA that inhibits normal psuedocholinesterase by 80% in normal person, so dib number is 8-
bioavailabilit of midazolam based on route of admin greater to least
IV > IM > intranasal > rectal > oral
