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Block 3 > Pharm 2 > Flashcards

Pharm 2 Flashcards

1
Q

before rxing NMB, what are 2 things you must make sure of? are NMB analgesics or anesthetics?

A

pt on ventilator AND sedated before giving NMB. no, they just paralyze muscles

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2
Q

MOA vs reversed by vs indications NMB

A

nondepol competitive antag or depol agonist vs chEI vs intracavitary procedures, endotrach intub, vent; convuls: epi, electroconvulsive therapy, local anesthetic tox, tetanus, malig hyperthermia

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3
Q

MOA vs indic succinylcholine

A

AchR agonist –> depol postsynaptic membrane like Ach –> excite motor end plate –> but can cause flaccid paralysis –> do 2 phase vs induct NM blockade, adjunct gen anes, rapid seq intub

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4
Q

phase 1 vs 2 of succinylcholine

A

very short; cont depol, bolus, augmented by chEI vs cont infusion or rpt dosing, prolonged end plate depol w/ gradual repol –> resistant to further depol –> tachyphylaxis, reversed by chEI

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5
Q

ADME succinylcholine

A

rapid on/off, IV/IM; distributed in extracell fluid; 80% hydrolysis, plasma pseudocholinesterase makes succinylmonocholine –> succinic acid + choline –> inactive (not metab by AchE); 10% renal elim

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6
Q

CI vs BBW succinylcholine

A

acute phase injury (burns, skel muscle denerv), malig hyperthermia, skel muscle myopathies/UMN injury vs cardiac arrest from hyperkal rhabdo

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7
Q

DI succinylcholine

A

aminoglycosides, inhaled anesthetics –> malig hyperthermia, atra/pancuronium, digoxin, donepezil, lidocaine/procainamide

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8
Q

highest to lowest risk of malig hyperthermia meds. what is malig hyperthermia? tx?

A

isoflurane > sevo > des > en > halothane. abnl Ca2+ release –> skel musc ctx, rigid, heat, metabolic acidosis, tachy, inc CO2. dantrolene

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9
Q

AE succinylcholine

A

H/oTN, br/tachy, inc IOP, musc fasc, postop myalgia; cardiac arrhythmia & arrest d/t hyperkal rhabdo & renal failure => BBW

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10
Q

MOA vs indic competitive nondepol AchR antag. know the meds & their differences

A

keep AchR in closed or nonfxnal position; paralytic effects last longer vs muscle denerv, MG, critically ill pts. cis/atra, pan, roc, vecuronium; Lec 18, slide 25

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11
Q

AE nondepol NMB

A

aspiration, bronchospasm, dec hypoxic drive, postop residual curarization –> injurious airway & resp fxn compromise. DOES NOT PROVIDE SEDATION, if given: w/draw NMB then w/ sedation

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12
Q

DI nondepol NMB

A

aminoglycoside abx, inhaled anes, polypeptide abx, procainamide, Ca2+ channel blockers

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13
Q

EMG vs acceleromyography

A

periph n stim, surrogate for action on diaphragm, interrater variability vs more objective, train of 4 ratio, reduce incidence of unexpected PORC

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14
Q

MOA vs indic vs AE vs DI vs CI neo/pyridogistine

A

AchEI –> counteracts neuromuscular blockade of nondepol blockers vs reverse NM blockade vs DUMBBELLs, bradyrhythmia; give atropine to minimize DUMBBELLs vs succinylcholine, glucocorticoids vs bowel/blad obstruction

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15
Q

MOA vs AE vs DI sugammadex

A

bind tightly to steroid of roc/vecuronium –> dec free fraction in plasma vs pruritus, urticaria, anaphylaxis, cardiac arrest/brady vs binds to other steroid hormones even progesterone –> backup for ocp

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16
Q

what is a sedative-hypnotic drug?

A

sedative –> dec anxiety; hypnotic –> produce drowsiness & maintain sleep. all cause CNS depression x/ buspirone & propranolol

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17
Q

5 C’s of addiction. addiction vs dependence?

A

compulsive, chronic, cont despite harm, impaired ctrl, craving. loss of ctrl in self-limiting intake of drug vs w/drawal syndrome after abrupt cessation of drug

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18
Q

what kind of receptors are GABAa vs MT1/2 vs OX1/2 aka hypocretin 1/2 vs H1 receptors?

A

Cl- channel vs GPCR in suprachiasmatic nucleus –> bind melatonin or MRAs –> sleep or sedation vs Gq & Gi –> release GABA and gluE vs Gq –> IP3/DAG in CNS

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19
Q

what is the GABA receptor? 3 subtypes?

A

gamma-aminobutyric acid; inhibitory NT –> hyperpol –> more difficult for neuron to fire. A = activates Cl- channel to hyperpol neurons; B = G protein to hyperpol; C = GABA is 10-100x more potent

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20
Q

benzos w/drawal sxs. how to tx?

A

sz, adrenergic stim, autonomic instability, flumazenil (w/ caution). more benzos, taper slowly

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21
Q

tolerance vs cross tolerance

A

alters GABAA receptor physiology for sedative-hypnotic drugs –> reduces efficacy of drug –> need inc dose for similar effect vs tol to one drug –> tol to another drug of same class –> inc dose to get desired effect

22
Q

Beers Criteria. what drugs to avoid per criteria?

A

by Mark Beers 1991 to address potentially inappropriate med use in elderly >65yo. BZD, barbs, Z cmpds, meprobamate

23
Q

what’s insomnia? subj dx? what happens if insomnia = persistent? risk factors?

A

difficulty initiating or staying asleep. sleep diary, >3 nights/wk for >3mo, PMG to differentiate b/w RLS or OSA (but not required to dx insomnia). psych d/o, mortality. age, female, fhx, psychological stress

24
Q

nonpharm tx for insomnia

A

exer 3-4x/wk, sleep environ, dc EtOH/nic/caffeine, avoid diuretics & lg fluid consumption before bed, relax; cog behavioral therapy –> progressive muscle relax, abd breathing; stimulus ctrl therapy –> set sleep schedule, sleep only when needed/sleep restriction, avoid blue lights, schedule time to worry

25
Q

what to do for insomnia in preg? are BZDs safe in BF?

A

common in 3rd trimester –> no guideline recs for pharm –> do nonpharm tx. avoid BZD (cleft palate) & Z cmpds (zolpidem –> neonate sedation & resp dep). moderately per ACOG

26
Q

nml physio of muscle ctx

A

sensory/stretch receptors in muscle send afferent info to U/LMN –> muscle ctx & resist further stretch. extent of ctx = based on inhibitory signals like GABA

27
Q

what’s spasticity?

A

dmg to descending inhib pathways –> hyperexcite –> inc muscle tone, tonic stretch reflex, passive movements w/ inc resistance, impaired dexterity & coordination, spont muscle spasms. brain/spinal cord injury (L > UMN), cerebral palsy, ALs, Ms, stroke (U > LMN)

28
Q

how to tx spasticity?

A

physiotherapy, daily passive muscle stretching, orthoses, PT, chemical neurolysis, electrical stim, surgical rhizotomy

29
Q

diazepam. AE vs BBW

A

dec neuronal AP & depol at spinal cord by binding to postsynaptic GABAa receptors –> Cl- channels open –> Cl- enters cell –> similar effect to BZD –> abuse potential. HoTN, ataxia, incoordination, somnolence, neutropenia, resp dep vs profound sedation, resp dep w/ opioids

30
Q

CI vs DI vs PK diazepam

A

narrow angle glaucoma, MG, sleep apnea, hep insuff, peds <6mo (like BZD) vs CNS depressants, flumazenil. extensive hep metab –> metab w/ active ox/temazepam

31
Q

onabotulinumtoxin A. AE vs CI. BBW?

A

anaerobe spore forming bacterial toxin disabling Ach from cholinergic nerve endings. injxn site pain, URI; sz, MI, anaphylaxis, resp depression vs infxn at injxn site, preg/lactation. iatrogenic botulism –> distant spread of toxin effects

32
Q

how is acute local spasm diff from spasticity? how to tx?

A

self limiting localized pain, diminished mobility, temporally assoc w/ injury, resolves in a wk. RICE, time, PT, OTC/rx NSAIDs

33
Q

class notes on antispasmodic agents

A

drugs give relief but not improve fxn –> ineffective at txing spasticity. AVOID skel muscle relaxants and BZDs in elderly per Beers x/ tizanidine (antispastic/spasmodic)

34
Q

carisoprodol. active metabolite?

A

central acting blocking interneuronal activity in descending reticular formation & spinal cord –> muscle relax. meprobamate

35
Q

AE vs CI vs DI carisoprodol

A

sedation/somnolence, dizzy; sz, resp dep, drug abuse potential, w/drawal vs acute intermittent porphyria vs EtOH –> soma coma, CNS depressants

36
Q

chlorozoxazone

A

General CNS depression; Inhibits multisynaptic reflex arcs at spinal cord and subcortical brain

37
Q

AE vs DI chlorzoxazone

A

paradoxical excitement, dizzy, somnolence, malaise; hepatotoxicity, anaphylaxis vs CNS depressants

38
Q

metaxalone. AE vs CI vs DI

A

gen CNS depression; less sedating than other spasmodics. dizzy, somnolence, anxiety; hemolytic anemia, jaundice, hypersensitivity rxn vs drug-induced hemolytic anemia, hep/renal insuff vs CNS depressants

39
Q

methocarbamol. AE vs CI vs DI

A

General CNS depression, no action on muscles themselves; Derivative of guaifenesin. anaphylactoid rxn, sz vs renal impair vs CNS depressants

40
Q

orphenadrine. AE vs CI vs DI

A

analgesic & anticholinergic, structurally similar to benadryl. dizzy, blurred vision, tachy/palpitations, anaphylaxis vs glaucoma, MG, BPH, blad obstruction, pyloric/duodenal obstruction vs CNS depressants, anticholinergics

41
Q

ctrlled substance act of 1971

A

heroin = C-I
opioid analgesics = C-II –> no refills on rx
opioid derivatives w/ potential abuse = C-III

42
Q

prescription drug monitoring programs

A

in q state. limited days supply for non-chronic users; formulate ER/LA preps; CDC posted guidelines

43
Q

how to tx opioid w/drawal?

A

clonidine, lofexidine, buprenorphine+/- naloxone, methadone
* = w/ restriction in rxing; Treat emesis w/ chlorpromazine; cog behav therapy + pharm therapy

44
Q

opioid toxicity: CNS and resp dep can lead to?

A

apnea, bradycardia, hypoxia, coma/death. supportive (ABCs), naloxone

45
Q

VDH/naloxone standing order

A

allows licensed pharmacists to educate pts & dispense naloxone –> autoinject, nasal spray, intranasal; drs can give naloxone rx & training to pts w/ high risk opioid OD or prescribed chronic opioid therapy

46
Q

nociceptive vs neurologic vs mixed vs visceral pain examples

A

O/RA, acute pain vs central –> stroke, MS, spinal cord injury; periph –> neuropathy/algia vs fibromyalgia, ca pain, LBP vs internal organs

47
Q

what’s pt-ctrlled analgesia?

A

when pt presses button for PCA dose, but there’s a lock-out period. ONLY PT CAN PREss BUTTON

48
Q

ca pain = txed w/ chronic opioids. how to manage? NCCN recommends the 5 A’s:

A

do maintenance dose & add prn dose –> APAP/NsAID –> weak opioids –> strong opioids; use the right drug to tx 80-90% of pain. analgesia, activities, AE, aberrant drug taking, affect

49
Q

NCCN recs for txing mild 1-3 vs mod 4-7 vs severe >8 ca pain for opioid naives

A

nonopioids + adjunct vs nonopioids + adjunct –> IR & PO oxycodone, hydrocodone/morphone, morphine –> ER vs hosp admission, r/o oncologic emergency, IV meds

50
Q

prophylaxis for migraines vs cluster vs tension HA

A

beta blockers vs Ca2+ channel blockers vs amitriptyline

Block 3 (23 decks)

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