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Pharmacology > Pharm A Test 2 > Flashcards

Pharm A Test 2 Flashcards

1
Q

What is pharmacokinetics?

A

What the body does to the drug

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2
Q

What are the 4 main mechanisms of pharmacokinetics?

A
  • Absorption
  • Distribution
  • Metabolism
  • Elimination
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3
Q

The depth of general anesthesia with inhaled agents depends on what?

A

The partial pressure exerted by the inhalational agent in the patient’s brain

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4
Q

The partial pressure of the inhalational agent in the patient’s brain depends on what?

A

The partial pressure of the inhalational agent in the arteries

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5
Q

The arteriolar partial pressure of an inhalational agent in a patient’s arteries depends on what?

A

The partial pressure of the inhalational agents in the alveoli

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6
Q

The partial pressure of an inhalational agent in a patient’s alveoli depends on what?

A

The partial pressure of the agent in the inspired gas

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7
Q

What is the pathway an inhalational agent takes from the machine to its point of action?

A

Vaporizer –> circuit –> lungs (alveoli) –> blood (arteries) –> brain

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8
Q

How would you get a more rapid increase in expired sevo concentration - if you turn up the dial on the sevo vaporizer or if you turn up fresh gas flows?

A

Turning up fresh gas flows

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9
Q

When is an inhalation agent in equilibrium?

A

When there is no different in partial pressure between its two phases

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10
Q

What is the volume a common anesthesia circuit?

A

About 5-6 liters

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11
Q

In what ways can the partial pressure of an inspired agent be increased?

A
  • Increase concentration by turning up the dial on the vaporizer
  • Increase flows
  • Decrease volume of the circuit
  • Decrease absorption by the machine
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12
Q

How does the solubility of an inhaled anesthetic agent affect its onset?

A

The more soluble an inhaled agent is, the slower the onset time

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13
Q

How do we calculate the partial pressure of an inhaled agent in the alveoli?

A

Input into the alveoli - uptake into the blood

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14
Q

In what 2 ways can we increase the partial pressure of inhaled agents in the alveoli?

A
  • Increase ventilation

- Increase concentration of agent

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15
Q

How does minute ventilation influence the partial pressure of inhaled agents in the alveoli?

A

The higher the minute ventilation, the higher the rate of rise of anesthetic partial pressure in the alveoli

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16
Q

What value do we use to measure the partial pressure of an inhaled anesthetic in the brain?

A

The partial pressure of the gas in the alveoli (expired % agent)

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17
Q

What are 2 effects that increase initial concentration and uptake of inhaled anesthetic gases?

A

1) Concentration effect

2) Second gas effect

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18
Q

What is the concentration effect?

A

Impact of the inspired partial pressure of the agent increases the rate of rise of the partial pressure of the alveolus

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19
Q

What is the second gas effect?

A

When a high volume of uptake of one gas accelerates the rate of increase in the alveolar partial pressure of the companion gas

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20
Q

When is the second gas effect most commonly seen?

A

When nitrous oxide is used in combination with sevo in pediatric cases

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21
Q

How does the solubility of an anesthetic agent affect its partial pressure in the brain?

A

When an agent is very soluble in the blood, it will dissolve and not be able to exert its effect in the brain. The more soluble an agent is, the less partial pressure in the brain will be present

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22
Q

How does cardiac output affect the partial pressure of anesthetic agents in the brain?

A

The higher the cardiac output, the lower the partial pressure in the brain

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23
Q

How do you calculate the uptake of an anesthetic gas into the blood?

A

Solubility x Cardiac Output x (PA - Pv)

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24
Q

How does the alveolar-venous difference affect the partial pressure of anesthetic agents in the brain?

A

The higher the alveolar-venous difference, the lower the partial pressure in the brain

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25
Q

How does increasing solubility of an inhaled anesthetic affect the PA/Pi value? How does this affect induction time?

A

Increasing solubility=lower PA/Pi=slower induction

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26
Q

How does decreasing solubility of an inhaled anesthetic affect the PA/Pi value? How does this affect induction time?

A

Decreasing solubility=higher PA/Pi=quicker induction

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27
Q

How does the blood/gas coefficient of an inhaled agent affect induction time?

A

Higher blood/gas coefficient=slower induction

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28
Q

What does a blood/gas coefficient of 2.4 actually mean?

A

There has to be 2.4 times more agent dissolved in the blood than present in the alveoli before it can be equilibrated and exert its effect

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29
Q

List the inhaled anesthetic agents in order of greatest to least blood/gas coefficient (aka slowest to fastest induction time)

A

Halo > Iso > Sevo > Nitrous > Des

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30
Q

How does decreased cardiac output affect the rise of PA/Pi?

A

Increases

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31
Q

Why do elderly patients often go to sleep with inhalational agents very quickly?

A

They have a lower cardiac output so less of the agent is being taken up and dissolved in the blood and more is available to affect the brain

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32
Q

Why do septic patients go to sleep more slowly with inhaled anesthetics?

A

They have a higher cardiac output so more agent is being taken up and dissolved in the blood and less is available to exert its affect in the brain

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33
Q

Does venous blood coming back to the lungs have more or less inhaled agent than arterial gas? Why?

A

It has less agent because there is some absorption by peripheral tissues

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34
Q

What 3 components affect uptake of anesthetic gases by the tissues?

A
  • Tissue solubility
  • Tissue blood flow
  • Difference in partial pressure between blood and tissue
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35
Q

What percentage of cardiac output goes to vessel rich groups?

A

75%

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36
Q

What percentage of cardiac output goes to muscle?

A

19%

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37
Q

What percentage of cardiac output goes to fat?

A

6%

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38
Q

What percentage of cardiac output goes to vessel poor groups?

A

0%

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39
Q

When you turn off the sevo and increase fresh gas flows during wake up, why is there usually ~0.4% that does not blow off quickly?

A

That is the sevo that is soaked into the fat and muscles and takes longer to come off

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40
Q

What 3 ways do we get rid of anesthetic gases?

A
  • Biotransformation (halothane)
  • Transcutaneous loss
  • Exhalation
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41
Q

What is the most metabolized inhaled anesthetic?

A

Halothane

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42
Q

What is the least metabolized inhaled anesthetic?

A

Nitrous oxide

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43
Q

Is there a concentration effect during elimination of inhaled anesthetics?

A

No, only during induction

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44
Q

What variables change the pharmacokinetics of inhaled anesthetics? (6)

A
  • Age
  • Lean muscle
  • Body fat
  • Hepatic function
  • Pulmonary gas exchange
  • Cardiac output
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45
Q

What is pharmacodynamics?

A

What the drug does to the body

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46
Q

What MAC value prevents movement in 95% of patients?

A

1.3 MAC

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47
Q

MAC decreases __% per decade of age after the age of __

A

6%, 40

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48
Q

MAC values allow for a comparison of _______ of different drugs

A

Potency

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49
Q

What is the value of MAC awake?

A

0.1-0.3 MAC

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50
Q

What is MAC awake?

A

Concentration of agent at which 50% of patients appropriately respond to verbal commands

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51
Q

What is value of MAC bar?

A

1.7-2 MAC

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52
Q

What is MAC bar?

A

The concentration required to block autonomic reflexes to nociceptive stimuli

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53
Q

What is the value for MAC amnesia?

A

~0.4-0.6

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54
Q

What 3 factors increase MAC requirements?

A
  • Hyperthermia
  • Drug-induced increase in catecholamines
  • Hypernatremia
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55
Q

How does chronic alcohol abuse affect MAC requirements?

A

No effect

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56
Q

How does a patient’s potassium level affect MAC requirements?

A

No effect

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57
Q

How does thyroid dysfunction affect MAC requirements?

A

No effect

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58
Q

How does hypothermia affect MAC requirements?

A

Decreases

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59
Q

How does acute alcohol intoxication affect MAC requirements?

A

Decreases

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60
Q

How does sepsis affect MAC requirements?

A

Increases

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61
Q

How do alpha-2 agonists such as dexmedetomidine affect MAC requirements?

A

Decrease

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62
Q

A PaO2 below __ mmHg decreases MAC requirements

A

38

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63
Q

A blood pressure below __ mmHg decreases MAC requirements

A

40

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64
Q

How do opioids affect MAC requirements?

A

Decrease

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65
Q

How does lidocaine affect MAC requirements?

A

Decrease

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66
Q

How does hyponatremia affect MAC requirements?

A

Decrease

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67
Q

Which inhaled anesthetic has a history of evoking seizures?

A

Enflurane

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68
Q

How do inhaled anesthetics affect cerebral blood flow and intracranial pressure?

A

Increase

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69
Q

What can be done to oppose the increase cerebral blood flow/ICP caused by inhaled anesthetics?

A

Hyperventilation

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70
Q

Which inhaled anesthetic increases ICP by up to 200%?

A

Halothane

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71
Q

How do inhaled anesthetics affect CMRO2?

A

Decrease

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72
Q

Which inhaled anesthetic is used for burst suppression? What MAC level is used?

A

1.5 MAC Isoflurane

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73
Q

What is the maximum MAC level you can run when surgeons are monitoring motor evoked potentials?

A

0.5 MAC

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74
Q

How do inhaled anesthetics affect CSF production?

A

Increase

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75
Q

Which inhaled anesthetics decrease blood pressure due to their effects on myocardial contractility?

A

Halothane and enflurane - they both decrease myocardial contractility thus decreasing blood pressure

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76
Q

Why do iso, des, and sevo cause a decrease in blood pressure?

A

They all decrease systemic vascular resistance via vasodilation

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77
Q

Which inhaled anesthetic produces no change or a slight increase in blood pressure?

A

Nitrous oxide

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78
Q

Which inhaled anesthetic can cause tachycardia?

A

Desflurane

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79
Q

Why does desflurane cause tachycardia?

A

It elicits stimulation of the sympathetic nervous system, esp. with rapid increases in vapor concentrations

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80
Q

Which inhaled anesthetic does not cause an increase in HR?

A

Halothane

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81
Q

Which inhaled anesthetics decrease cardiac output most profoundly? Why?

A

Halothane and enflurane because they depress myocardial contractility

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82
Q

Which inhaled anesthetic increases cardiac output?

A

Nitrous oxide

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83
Q

Which inhaled anesthetic acts as a sympathomimetic?

A

Nitrous oxide

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84
Q

How do volatile anesthetics affect pulmonary vascular resistance?

A

Decrease or no change

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85
Q

Nitrous oxide is known to increase pulmonary vascular resistance in patients with what comorbidity?

A

Pulmonary hypertension

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86
Q

Which inhaled anesthetic can cause the coronary steal phenomenon?

A

Isoflurane

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87
Q

Which inhaled anesthetic is a potent coronary vasodilator?

A

Isoflurane

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88
Q

A combination of what volatile agent paired with what other drug could induce arrhythmias?

A

Halothane and epinephrine

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89
Q

How do volatile agents affect respiratory rate?

A

Increase

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90
Q

How do volatile agents affect tidal volume?

A

Decrease

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91
Q

How do volatile agents affect minute ventilation?

A

Decrease

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92
Q

How do volatile agents affect PaCO2?

A

Increase

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93
Q

Des and Sevo produce apnea at what MAC levels?

A

1.5-2 MAC

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94
Q

How do volatile agents affect the function of the carotid bodies?

A

They decrease the ventilatory response to hypoxemia which is mediated by the carotid bodies

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95
Q

What is the only inhaled agent that doesn’t decrease airway resistance?

A

Desflurane

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96
Q

Which inhaled agent should you avoid in asthmatics?

A

Desflurane

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97
Q

How do volatile agents affect FRC?

A

Decrease

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98
Q

How do volatile agents affect renal blood flow?

A

Decrease

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99
Q

How do volatile agents affect glomerular filtration rate?

A

Decrease

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100
Q

How do volatile agents affect urine output?

A

Decrease

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101
Q

The volatile agents we use today don’t directly decrease renal blood flow and GFR, so why do these parameters still decrease?

A

Because volatiles decrease the MAP which in turn decreases blood flow and GFR

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102
Q

How do volatile agents affect hepatic blood flow and clearance?

A

Decrease

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103
Q

How do volatile agents affect uterine smooth muscle contractility and blood flow?

A

Decrease

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104
Q

Can inhaled drugs cross the placenta?

A

Yes

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105
Q

Are inhaled drugs harmful to the baby?

A

No because the baby can blow them off

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106
Q

Which inhaled agents produce the most muscle relaxation?

A

Ether derived - iso, sevo, des

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107
Q

Which inhaled agent does not produce muscle relaxation?

A

Nitrous oxide

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108
Q

Which inhaled agent may produce muscle rigidity?

A

Nitrous oxide

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109
Q

How do volatiles affect the core temperature set point at which thermoregulatory vasoconstriction is activated?

A

Lowers the core set point

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110
Q

How do volatiles affect metabolic oxygen consumption? How does this affect heat generation?

A

Decreases, decreases

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111
Q

Which volatiles can trigger MH in susceptible patients?

A

All

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112
Q

Which volatile is the most potent MH trigger?

A

Halothane

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113
Q

Which inhaled agent is the weakest MH trigger?

A

Nitrous oxide

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114
Q

What can cause compound A to accumulate in CO2 absorbers?

A

Using flows lower than 2L with Sevoflurane

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115
Q

What deleterious effects can be caused by compound A?

A

Nephrotoxicity

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116
Q

What can cause carbon monoxide to accumulate in CO2 absorbers?

A

Using a dry, desiccated absorber

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117
Q

Which volatile is most likely to cause an accumulation of carbon monoxide in the CO2 absorber?

A

Desflurane

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118
Q

What inactive fluoride metabolite can cause nephrotoxicity?

A

Methoxyflurane

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119
Q

Which volatile agent is associated with hepatitis?

A

Halothane

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120
Q

What are the 2 types of halothane hepatitis?

A

1) Mild, self-limited form

2) Rare, life threatening hepatic necrosis

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121
Q

Which volatile uses Thymol as a preservative?

A

Halothane

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122
Q

Halothane is metabolized up to __%.

A

20%

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123
Q

Isoflurane is great for which cases?

A

Neuro cases

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124
Q

What MAC level of isoflurane is utilized to obtain an isoelectric EEG?

A

2 MAC of ISO

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125
Q

Which volatiles are airway irritants?

A

Isoflurane and desflurane

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126
Q

Which volatile should you avoid in asthmatics?

A

Desflurane b/c it is a pungent airway irritant

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127
Q

Which volatile is the least irritating to airways?

A

Sevoflurane

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128
Q

What is the best choice of a volatile for an inhalational induction?

A

Sevoflurane

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129
Q

What percentage of Sevo is metabolized?

A

2-5%

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130
Q

What percentage of Iso is metabolized?

A

0.2%

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131
Q

Which inhaled agent can decrease MAC requirements?

A

Nitrous oxide

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132
Q

How does nitrous oxide affect pulmonary vascular resistance?

A

Increases

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133
Q

How does nitrous oxide affect CMRO2?

A

Increases

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134
Q

Which inhaled agent is associated with analgesic effects?

A

Nitrous oxide

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135
Q

Which inhaled agent is associated with diffusion hypoxia?

A

Nitrous oxide

136
Q

Which inhaled agent should you not use in laparoscopic cases?

A

Nitrous oxide

137
Q

Nitrous oxide is __x more soluble than nitrogen

A

34x

138
Q

What amount of nitrous will double a pneumothorax?

A

75% nitrous for 10 minutes

139
Q

What is the solution for diffusion hypoxia?

A

Supplemental oxygen with nasal cannula or a face mask

140
Q

Somatic pain is alleviated by which medications?

A

Opioids and NSAIDS

141
Q

Visceral pain is alleviated by which medication?

A

Just opioids (not NSAIDs)

142
Q

Which receptors are activated during somatic pain?

A

1) Nociceptors for heat, cold, vibration, stretch
2) Inflammation
3) O2 starvation

143
Q

The only nociceptors activated during visceral pain are activated by what?

A

Stretch

144
Q

What type of drug is Tylenol and Ketorolac?

A

NSAIDs

145
Q

What is the major natural opioid from which most major opioids are derived?

A

Morphine

146
Q

What is an example of a semisynthetic opioid?

A

Heroin

147
Q

What are the 3 major morphine agonists?

A

Fentanyl, demerol, dilaudid

148
Q

What is the major opioid agonist/antagonist

A

Nalbuphine

149
Q

What is the major opioid antagonist?

A

Naloxone (Narcan)

150
Q

What is the mechanism of action of opioids?

A

Bind to specific G protein-coupled receptors that are located in brain and spinal cord regions involved in pain transmission and modulation

151
Q

What are the 3 endogenous ligands that are mimicked by opioid agonists?

A

1) Enkephalins
2) Endorphins
3) Dynorphins

152
Q

How do opioids affect the release of pain modulating neurotransmitters?

A

Decrease

153
Q

What are the major pain modulating neurotransmitters?

A
  • Ach
  • Dopamine
  • NE
  • Substance P
154
Q

Where do NSAIDs work?

A

In the periphery

155
Q

Where do alpha 2 agonists work?

A

In the brain (dexmedetomidine) and spinal cord

156
Q

Where do local anesthetics for pain management work?

A

Spinal cord and periphery

157
Q

What are the 3 major opioid receptors?

A

1) Mu (1 and 2)
2) Kappa
3) Delta

158
Q

Where are Mu1 receptors located?

A

In the brain and spinal cord

159
Q

What is the main action of Mu1 receptors?

A

Analgesia

160
Q

What are the side effects of Mu1 receptors?

A

N/V, pruritis

161
Q

Do Mu1 receptors cause euphoria?

A

Yes

162
Q

How do Mu1 receptors affect the heart rate?

A

Decrease - can cause bradycardia

163
Q

Where are Mu2 receptors located?

A

Spinal cord

164
Q

What are the negative side effects of Mu2 receptor activation?

A
  • Hypoventilation
  • Euphoria
  • Sedation
  • Physical dependence
  • Constipation
165
Q

Although Mu2 receptors are responsible for the majority of bad opioid effects, do they produce analgesia?

A

Yes, some

166
Q

Where are kappa receptors located?

A

Brain and spinal cord

167
Q

Do kappa receptors cause respiratory depression?

A

Yes, but less than Mu receptors

168
Q

What are the negative side effects of Kappa receptor activation?

A

1) Dysphoria

2) Diuresis

169
Q

What are the desired effects from Kappa receptor activation?

A

Analgesia

170
Q

Which endogenous ligands bind to Kappa receptors?

A

Dynorphins

171
Q

Which opioid drug class principally works on Kappa receptors?

A

Opioid agonist-antagonists

172
Q

Which opioid receptor does Nalbuphine agonize? Antagonize?

A
  • Agonist at Kappa

- Antagonist at Mu

173
Q

Where are Delta receptors located?

A

Brain and spinal cord

174
Q

What are the wanted effects of delta activation by opioids?

A

Analgesia

175
Q

What are the negative effects caused by delta activation by opioids?

A
  • Respiratory depression
  • Physical dependence
  • Urinary retention
176
Q

What endogenous ligand binds to delta receptors?

A

Enkaphalins

177
Q

What endogenous ligand binds to mu receptors?

A

Endorphins

178
Q

Which 2 opioid receptors can cause physical dependence?

A
  • Mu2

- Delta

179
Q

What opioid receptor is responsible for urinary retention?

A

Delta

180
Q

What part of the spinal cords are Mu receptors located in?

A

Substania gelatinosa

181
Q

Opioids used for neuraxial anesthesia are specific for what type of pain?

A

Visceral pain

182
Q

What are the 4 classic side effects of neuraxial opioids?

A

1) Pruritis
2) N/V
3) Urinary retention
4) Ventilatory depression

183
Q

What is the dosing of morphine for…

  • IV
  • Epidural
  • Spinal (intrathecal)
A
  • 10mg IV
  • 1 mg epidural
  • 0.1mg spinal
184
Q

What is the dosing for hydromorphone for…

  • IV
  • Epidural
  • Intrathecal
A
  • 1mg IV
  • 0.2mg epidural
  • 0.04mg spinal
185
Q

What is the dosing of fentanyl for…

  • IV
  • Epidural
  • Intrathecal
A
  • 100mcg IV
  • 33mcg epidural
  • 6-10mcg intrathecal
186
Q

Which opioid used in neuraxial anesthesia is very hydrophilic?

A

Morphine

187
Q

Which opioid used in neuraxial anesthesia is very lipophilic?

A

Fentanyl

188
Q

What drug can be given to alleviate itching associated with neuraxial opioids?

A

Benadryl

189
Q

Morphine and codeine have high first pass metabolism, with about __% remaining in circulation after a PO dose

A

25%

190
Q

How are opioids metabolized?

A

Converted to polar metabolites then excreted by the kidneys

191
Q

Which opioids are metabolized by tissue esterases?

A

Heroin and remifentanil (the reason they are so fast acting)

192
Q

What is normeperidine?

A

The polar metabolite of Demerol and a CNS stimulant that can cause seizures

193
Q

How are opioids excreted?

A

By the kidneys

194
Q

Which opioid agonist can cause orthostatic hypotension?

A

Fentanyl

195
Q

How do opioid agonists affect the CV system?

A

Decrease sympathetic tone, blood pressure, and heart rate

196
Q

How do opioids affect heart contractility?

A

Don’t really effect contractility, which is why you can use opioids so heavily in heart cases

197
Q

Which opioid agonist has antimuscarinic effects?

A

Meperidine (demerol)

198
Q

Which opioid agonist can increase HR?

A

Meperidine (demerol)

199
Q

The majority of respiratory depression caused by opioids are mainly due to action at which receptors?

A

Mu2

200
Q

How do opioids affect the brain’s ventilatory response to CO2?

A

Depresses this response, people will forget to breath if they’ve had too much

201
Q

How do opioids affect PaCO2 levels?

A

Increase

202
Q

How do opioids affect tidal volume?

A

Increase

203
Q

How do opioids affect respiratory rate?

A

Decrease

204
Q

How do opioids affect minute ventilation?

A

Decrease

205
Q

Which opioids are used for cough suppression?

A
  • Dextromethorphan

- Codeine

206
Q

How do opioids affect MAC levels?

A

Decrease by up to 30%

207
Q

How do opioids affect cerebral blood flow and metabolism?

A

Decrease

208
Q

How do opioids affect intracranial pressure?

A

Increase due to hypoventilation

209
Q

Which opioid can cause seizures?

A

Meperidine (demerol) due to the accumulation of normeperidine

210
Q

Which side effects of opioids do patients not build up a tolerance to?

A

1) Miosis

2) Constipation

211
Q

What side effect of opioids can mimic angina?

A

Biliary colic

212
Q

What is biliary colic?

A

A spasm of the sphincter of Oddi

213
Q

What drug can relieve the pain caused by biliary colic?

A

Naloxone

214
Q

What drug reverses biliary colic?

A

Glucagon 2mg IV

215
Q

Biliary colic will be seen less with what opioid?

A

Meperidine (demerol)

216
Q

Which drug should you not use if you are trying to diagnose biliary colic vs. angina?

A

Nitroglycerin because it relieves both

217
Q

What are the major GI side effects of opioids?

A
  • Constipation
  • N/V
  • Delayed gastric emptying
  • Biliary colic
218
Q

What are the GU side effects of opioids?

A

Urinary retention

219
Q

Why do opioids cause urinary retention?

A

Activation of delta receptor causes an increase in the tone of the ureter and vesicle sphincter

220
Q

Opioids cause the release of what chemical that causes flushing, itching, and a decrease in BP?

A

Histamine

221
Q

Which opioids cause a greater release of histamine?

A

Morphine and demerol

222
Q

What can happen to the thoracic cage as a result of large doses of opioids?

A

Truncal rigidity

223
Q

Do opioids cross the placenta?

A

Yes

224
Q

Which opioid is associated with less neonatal respiratory depression?

A

Meperidine

225
Q

What opioid can be used to alleviate the bad withdrawal symptoms of morphine/heroin?

A

Methadone

226
Q

What are the classic triad of symptoms associated with opioid overdose? (MCR)

A

1) Miosis
2) Respiratory depression
3) Coma

227
Q

What is the relative potency of morphine?

A

1

228
Q

What is the onset time of morphine?

A

15-30 minutes

229
Q

How can morphine be administered?

A

IV and IM

230
Q

When is the peak effect of morphine?

A

45-90 minutes

231
Q

What is the duration of morphine?

A

3-4 hours

232
Q

What is the metabolite of morphine?

A

Morphine-6-glucaronide

233
Q

How is morphine metabolized?

A

Via conjugation with glucuronic acid in the liver, extrahepatic areas, and kidneys

234
Q

Accumulation of morphine and its metabolite can lead to prolonged narcosis and ventilatory depression in which patients?

A

Kidney failure patients

235
Q

Which opioid causes the largest release of histamine?

A

Morphine

236
Q

How is Meperidine (demerol) administered?

A

IV, IM, PO

237
Q

What is the relative potency of demerol?

A

0.1 of morphine

238
Q

When is the peak effect of demerol?

A

5-7 minutes

239
Q

What is the duration of demerol?

A

2-4 hours

240
Q

What causes the atropine-like side effects associated with demerol?

A

The blockade of sodium channels that causes tachycardia, dry mouth, mydriasis (pupil dilation)

241
Q

Demerol is often used in the treatment of what?

A

Post-op shivering

242
Q

What is the dose of demerol used for post-op shivering?

A

12.5-25mg

243
Q

How can Fentanyl be administered?

A

IV, transdermal, PO, intranasal

244
Q

What is the relative potency of fentanyl?

A

75-125x more potent than morphine

245
Q

When is the peak effect of fentanyl?

A

3-5 minutes

246
Q

What is the duration of fentanyl?

A

30-60 minutes

247
Q

What percentage of fentanyl undergoes first pass pulmonary uptake?

A

75%

248
Q

Fentanyl has a synergistic response with what drug class?

A

Benzodiazepines

249
Q

What is the induction dose of fentanyl with a sedative hypnotic?

A

2-6mcg/kg

250
Q

What is the infusion dose/rate of fentanyl?

A

0.5-5mcg/kg/hour

251
Q

Sufentanil is __ times as potent as fentanyl

A

10x

252
Q

When is the peak effect of sufentanil?

A

3-5 minutes

253
Q

What is the duration of sufentanil?

A

30-60 minutes

254
Q

What is the dosing of sufentanil for a DL?

A

0.3-1 mcg/kg 1-3 minutes before DL

255
Q

What is the dosing of sufentanil for analgesia during surgery?

A

0.5mcg/kg

256
Q

During what surgeries is sufentanil useful?

A

During neuro surgeries to alleviate the pain of the headframe

257
Q

What is the potency of alfentanyl compared to fentanyl?

A

It is 1/5 to 1/10 as potent as fentanyl

258
Q

What is the duration of alfentanyl?

A

10-20 minutes

259
Q

When is the peak effect of alfentanyl?

A

1.5-2 minutes

260
Q

What contributes to the short half life of alfentanyl?

A

It has a small volume of distribution

261
Q

Which fentanyl derivatives are good for retrobulbar blocks?

A

Alfentanyl or remifentanyl

262
Q

What is the dose of alfentanyl that provides good analgesia?

A

5-10mcg/kg

263
Q

What is the potency of remifentanyl when compared to fentanyl?

A

It has a similar potency to fentanyl

264
Q

When is the peak effect of remifentanyl?

A

1.5-2 minutes

265
Q

What is the duration of remifentanyl?

A

6-12 minutes

266
Q

How is remifentanyl metabolized?

A

Plasma and tissue esterases

267
Q

Which fentanyl derivative can cause the patient’s to develop and acute tolerance to opioids?

A

Remifentanyl

268
Q

List fentanyl and its derivatives in order of shortest to longest half life after a 4 hour infusion.

A

Remi, su, al, fentanyl

269
Q

What are the common uses of codeine?

A

1) Antitussive for coughing

2) Analgesia for mild to moderate pain

270
Q

What are the common uses of methadone?

A

1) Long term relief of chronic pain

2) Opioid withdrawal

271
Q

Hydromorphone is __ times as potent as morphine

A

8

272
Q

What advantages does hydromorphone have over morphine?

A

More sedation, less euphoria, less histamine release

273
Q

How can methadone affect the EKG?

A

Prolong QT interval

274
Q

What are 3 commonly used opioids agonist/antagonists?

A

1) Pentazocine
2) Butorphanol
3) Nalbuphine

275
Q

Opioid agonist/antagonists are _____ agonists and/or _______ antagonists at opioid receptors

A

Partial agonists, competitive antagonists

276
Q

What class of opioid drugs are associated with a ceiling effect?

A

Agonist/antagonists

277
Q

What class of drug is naloxone (narcan)?

A

Opioid antagonist

278
Q

Which opioid receptor does Narcan antagonize?

A

Mu

279
Q

What are the common uses of Narcan?

A
  • Opioid overdose

- Respiratory depression

280
Q

What is the duration of Narcan?

A

30-45 minutes

281
Q

What is the dose of Narcan?

A

1-4mcg/kg

282
Q

What are the unwanted side effects caused by Narcan?

A

N/V, pain, tachycardia, increased sympathetic activity

283
Q

What is the dose of remifentanil for a DL?

A

0.5-1mcg/kg

284
Q

What is the infusion dose of remifentanil?

A

0.5mcg/kg/min

285
Q

What drug class is Valsartan?

A

Angiotensin II receptor antagonist

286
Q

What is the dose of Valsartan?

A

160mg

287
Q

What is the dose of Acetaminophen?

A

10-15mg/kg every 4 hours

288
Q

What is the drug class and dosing of Naproxen?

A

NSAID 250mg qid or 500 bid

289
Q

What is Novolin?

A

Recombinant engineered human insulin

290
Q

What is the dose of Novolin?

A

6 units subq every 12 hours

291
Q

How is Novolin supplied?

A

100units/ml or 3.6mg/ml

292
Q

What is Novolin used for?

A

To treat diabetes

293
Q

What class of drug is Metformin?

A

A biguanide class hypoglycemic drug

294
Q

What is the action of Metformin?

A

Reduces glucose levels by decreasing hepatic glucose production and increasing insulin action

295
Q

What is the primary use for Metformin?

A

Type II Diabetes

296
Q

What class of drug is Nimodipine?

A

Calcium channel blocker

297
Q

What are the cardiovascular effects of Nimodipine?

A

Decreases systemic BP, increase coronary blood flow, delay AV conduction, decrease HR

298
Q

What is Simvastatin (Zocor) used to treat?

A

Dyslipidemia

299
Q

What is Vicodin?

A

Hydrocodone + acetaminophen

300
Q

What are the 2 warnings associated with Vicodin?

A
  • Respiratory depression

- Increased ICP

301
Q

What is Colace? What is it used for?

A

An anionic surfactant which lowers the surface tension in stool, allowing easier defecation

302
Q

What class of drug is Pepcid (Famotidine)? What is it used for?

A

Histamine H2 blocker used for GERD and GI ulcers

303
Q

What is the physiologic cause of diabetes mellitus?

A

Pancreatic beta cells either don’t produce insulin or don’t produce enough

304
Q

What kind of disease is Type I Diabetes?

A

Autoimmune

305
Q

What are the insulin levels like in a Type I Diabetic?

A

Low

306
Q

Which type of diabetes is insulin dependent?

A

Type I

307
Q

Which type of diabetes is non-insulin depedent?

A

Type II

308
Q

A fasting blood glucose above __ mg/dl is diagnosed as Type II Diabetes

A

125

309
Q

How do Sulfonylureas work to treat Diabetes Mellitus?

A

They stimulate insulin secretion from the Beta cells and increase binding of insulin to their receptors

310
Q

How does Repaglinide work to treat Diabetes Mellitus?

A

Stimulates insulin secretion

311
Q

Granulocyctic function and collagen synthesis are suppressed with glucose levels above ___mg/dL, which is a concern for wound healing

A

200

312
Q

Diabetics should be posted as which case of the day if at all possible?

A

First case of the day

313
Q

Which pre-op condition is of the greatest concern - hypoglycemia or hyperglycemia?

A

Hypoglycemia

314
Q

A glucose below __ mg/dL should be treated with 50% Dextrose

A

50

315
Q

What amount of 50% Dextrose should you give as a starting bolus for patients with hypoglycemia?

A

15ml

316
Q

If a perioperative insulin infusion is needed, what rate should you start at?

A

1 unit per hour

317
Q

When you begin infusing insulin, what other solution should you infuse?

A

D5W with 20mEq KCl

318
Q

How often should you monitor glucose levels during surgery if you are infusing insulin?

A

Every hour

319
Q

You should adjust your perioperative insulin infusion rate to meet what level of glucose?

A

100-200mg/dL

320
Q

What are the most common causes of asthma?

A

Inhaled allergens, stress, airway instrumentation, recurring pulmonary infections

321
Q

What is the physiologic response of an asthma attack?

A

Mast cells release mass amounts of histamine

322
Q

What are the 2 types of aerosols used for drug administration?

A
  • Metered dose

- Nebulizers

323
Q

What is the onset time of short acting beta-2 agonists, such as albuterol, used in the treatment of asthma?

A

1-5 min

324
Q

What is the duration of action of short acting beta-2 agonists, such as albuterol, used in the treatment of asthma?

A

2-6 hours

325
Q

What are the 2 long acting beta-2 agonists used for the treatment of asthma?

A
  • Salmeterol

- Formoterol

326
Q

What is the duration of the long acting beta-2 agonists such as Salmeterol and Formoterol?

A

12 hours

327
Q

What antiinflammatory agents are used for the treatment of severe chronic asthma?

A

Glucocorticoids

328
Q

Which glucocorticoid is common in the treatment of chronic asthma?

A

Beclomethasone

329
Q

What are Accolate and Singulair?

A

Leukotriene receptor antagonists used for the treatment of chronic asthma

330
Q

What recombinant monoclonal antibody targeting IgE is used for the treatment of chronic asthma?

A

Xolair

331
Q

What phosphodiesterase inhibitor is used for the treatment of chronic asthma?

A

Theophylline

332
Q

What are the top 3 complications associated with aneurysm coiling surgeries?

A

1) Aneurysm rupture with hemorrhage
2) Thromboembolism
3) Vasospasm

333
Q

Which type of diabetes mellitus is susceptible to ketoacidosis?

A

Type I

334
Q

What are the 4 major anesthetic considerations for a cerebral aneurysm surgery?

A

1) Immobility of the patient - general anesthesia and NMB
2) Hemodynamic stability - A line, maintenance of cerebral perfusion, prevent aneurysm rupture
3) Anticoagulation - heparin
4) Rapid emergence for neurologic assessment

335
Q

Which inhaled anesthetic suppresses bone marrow formation?

A

Nitrous oxide

Pharmacology (6 decks)

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