pharm Flashcards by Sanjana Apte

how is remifentanyl metabolized

ester hydrolysis

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how is a bolus dose of thiopental terminated

redistribution from brain to periphery

this is the same for propofol, fentanyl, methohexital

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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

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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

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which anticholinergic agents are best paired wth AcHesterase inhbiitors of neostigmine, pyridostigmine, edrophonium, when revering neuromuscular blockade

edrophonium –> atropine

neostigmine/pyridostigmine –> glyco

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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

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what is the preferred method to reverse INR

when patient needs surgery or if theres hella bleeding

prothrombin complex concentrate +vitamine K

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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

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what 2 benzos will not undergo phase 1 meabolism

lorazepam + oxazepam

phase 1 = dealkalation or alphatic hydoxylation
phase 2 = glucuronidatio + actylation

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what drugs are metabolized by psuedocholinesterase in the plasma

succinylcholine
mivacurium
2 chloroprocaine

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what drugs are metabolized by nonspecific ester in intestine and muscles

remifentanil

atracurium

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what drug is metabolized by hoffman degrdation in the plasma

atracurium

cisatracurium

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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

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what drugs do NOT undergo anny lung metabolism

dopamine
isoproterenal
epinephrine

think if the lung touches these drugs u DIE

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how to volatile anesthetics affect CBF and CMRO2

CMRO2 decreases 
CBF increases (vasodiation)

NO DOES NOT HAVE this uncoupling effect

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from greatest to least wahts the vapor pressure of volatile anesthetics

desflurane > iso > sevo

DIS

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whats the mechanism of milrinone

pde III inhibitor which decreases hydrolysis (breakdown) of cAMP

this drug will increse contractility, decrease afterload

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how does introducing ccb to a patient that hasnt had it before affect paralytic agents

mild augmentation of both depolarizing and nondepolarizing agents

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time of onset of oral vs IV famotadine

oral takes 1 hour

IV takes 30 min

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what drugs will decrease the changes of K hole symptoms when using ketamine

benzos (versed) think u forget about the nightmates
barbituates
propofol

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fluride ion production from greatest to least of the volatile gases

methoxyflurane > sevo > enflurane > isoflurane > desflurane

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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

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testing for HIT

antiplatlet factor 4 has high sensitivity

serotonin release assay has high specficity

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what are the hemodynamic effects of high doses of meperidine and why

hypotension bc histamine

tachycardia bc atropine like effect

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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

1. 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

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