Pharm A Test 2 Flashcards
1
Q
What is pharmacokinetics?
A
What the body does to the drug
2
Q
What are the 4 main mechanisms of pharmacokinetics?
A
- Absorption
- Distribution
- Metabolism
- Elimination
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
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
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
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
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
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
9
Q
When is an inhalation agent in equilibrium?
A
When there is no different in partial pressure between its two phases
10
Q
What is the volume a common anesthesia circuit?
A
About 5-6 liters
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
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
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
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
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
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)
17
Q
What are 2 effects that increase initial concentration and uptake of inhaled anesthetic gases?
A
1) Concentration effect
2) Second gas effect
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
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
20
Q
When is the second gas effect most commonly seen?
A
When nitrous oxide is used in combination with sevo in pediatric cases
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
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
23
Q
How do you calculate the uptake of an anesthetic gas into the blood?
A
Solubility x Cardiac Output x (PA - Pv)
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
25
How does increasing solubility of an inhaled anesthetic affect the PA/Pi value? How does this affect induction time?
Increasing solubility=lower PA/Pi=slower induction
26
How does decreasing solubility of an inhaled anesthetic affect the PA/Pi value? How does this affect induction time?
Decreasing solubility=higher PA/Pi=quicker induction
27
How does the blood/gas coefficient of an inhaled agent affect induction time?
Higher blood/gas coefficient=slower induction
28
What does a blood/gas coefficient of 2.4 actually mean?
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
29
List the inhaled anesthetic agents in order of greatest to least blood/gas coefficient (aka slowest to fastest induction time)
Halo > Iso > Sevo > Nitrous > Des
30
How does decreased cardiac output affect the rise of PA/Pi?
Increases
31
Why do elderly patients often go to sleep with inhalational agents very quickly?
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
32
Why do septic patients go to sleep more slowly with inhaled anesthetics?
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
33
Does venous blood coming back to the lungs have more or less inhaled agent than arterial gas? Why?
It has less agent because there is some absorption by peripheral tissues
34
What 3 components affect uptake of anesthetic gases by the tissues?
- Tissue solubility
- Tissue blood flow
- Difference in partial pressure between blood and tissue
35
What percentage of cardiac output goes to vessel rich groups?
75%
36
What percentage of cardiac output goes to muscle?
19%
37
What percentage of cardiac output goes to fat?
6%
38
What percentage of cardiac output goes to vessel poor groups?
0%
39
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?
That is the sevo that is soaked into the fat and muscles and takes longer to come off
40
What 3 ways do we get rid of anesthetic gases?
- Biotransformation (halothane)
- Transcutaneous loss
- Exhalation
41
What is the most metabolized inhaled anesthetic?
Halothane
42
What is the least metabolized inhaled anesthetic?
Nitrous oxide
43
Is there a concentration effect during elimination of inhaled anesthetics?
No, only during induction
44
What variables change the pharmacokinetics of inhaled anesthetics? (6)
- Age
- Lean muscle
- Body fat
- Hepatic function
- Pulmonary gas exchange
- Cardiac output
45
What is pharmacodynamics?
What the drug does to the body
46
What MAC value prevents movement in 95% of patients?
1.3 MAC
47
MAC decreases __% per decade of age after the age of __
6%, 40
48
MAC values allow for a comparison of _______ of different drugs
Potency
49
What is the value of MAC awake?
0.1-0.3 MAC
50
What is MAC awake?
Concentration of agent at which 50% of patients appropriately respond to verbal commands
51
What is value of MAC bar?
1.7-2 MAC
52
What is MAC bar?
The concentration required to block autonomic reflexes to nociceptive stimuli
53
What is the value for MAC amnesia?
~0.4-0.6
54
What 3 factors increase MAC requirements?
- Hyperthermia
- Drug-induced increase in catecholamines
- Hypernatremia
55
How does chronic alcohol abuse affect MAC requirements?
No effect
56
How does a patient's potassium level affect MAC requirements?
No effect
57
How does thyroid dysfunction affect MAC requirements?
No effect
58
How does hypothermia affect MAC requirements?
Decreases
59
How does acute alcohol intoxication affect MAC requirements?
Decreases
60
How does sepsis affect MAC requirements?
Increases
61
How do alpha-2 agonists such as dexmedetomidine affect MAC requirements?
Decrease
62
A PaO2 below __ mmHg decreases MAC requirements
38
63
A blood pressure below __ mmHg decreases MAC requirements
40
64
How do opioids affect MAC requirements?
Decrease
65
How does lidocaine affect MAC requirements?
Decrease
66
How does hyponatremia affect MAC requirements?
Decrease
67
Which inhaled anesthetic has a history of evoking seizures?
Enflurane
68
How do inhaled anesthetics affect cerebral blood flow and intracranial pressure?
Increase
69
What can be done to oppose the increase cerebral blood flow/ICP caused by inhaled anesthetics?
Hyperventilation
70
Which inhaled anesthetic increases ICP by up to 200%?
Halothane
71
How do inhaled anesthetics affect CMRO2?
Decrease
72
Which inhaled anesthetic is used for burst suppression? What MAC level is used?
1.5 MAC Isoflurane
73
What is the maximum MAC level you can run when surgeons are monitoring motor evoked potentials?
0.5 MAC
74
How do inhaled anesthetics affect CSF production?
Increase
75
Which inhaled anesthetics decrease blood pressure due to their effects on myocardial contractility?
Halothane and enflurane - they both decrease myocardial contractility thus decreasing blood pressure
76
Why do iso, des, and sevo cause a decrease in blood pressure?
They all decrease systemic vascular resistance via vasodilation
77
Which inhaled anesthetic produces no change or a slight increase in blood pressure?
Nitrous oxide
78
Which inhaled anesthetic can cause tachycardia?
Desflurane
79
Why does desflurane cause tachycardia?
It elicits stimulation of the sympathetic nervous system, esp. with rapid increases in vapor concentrations
80
Which inhaled anesthetic does not cause an increase in HR?
Halothane
81
Which inhaled anesthetics decrease cardiac output most profoundly? Why?
Halothane and enflurane because they depress myocardial contractility
82
Which inhaled anesthetic increases cardiac output?
Nitrous oxide
83
Which inhaled anesthetic acts as a sympathomimetic?
Nitrous oxide
84
How do volatile anesthetics affect pulmonary vascular resistance?
Decrease or no change
85
Nitrous oxide is known to increase pulmonary vascular resistance in patients with what comorbidity?
Pulmonary hypertension
86
Which inhaled anesthetic can cause the coronary steal phenomenon?
Isoflurane
87
Which inhaled anesthetic is a potent coronary vasodilator?
Isoflurane
88
A combination of what volatile agent paired with what other drug could induce arrhythmias?
Halothane and epinephrine
89
How do volatile agents affect respiratory rate?
Increase
90
How do volatile agents affect tidal volume?
Decrease
91
How do volatile agents affect minute ventilation?
Decrease
92
How do volatile agents affect PaCO2?
Increase
93
Des and Sevo produce apnea at what MAC levels?
1.5-2 MAC
94
How do volatile agents affect the function of the carotid bodies?
They decrease the ventilatory response to hypoxemia which is mediated by the carotid bodies
95
What is the only inhaled agent that doesn't decrease airway resistance?
Desflurane
96
Which inhaled agent should you avoid in asthmatics?
Desflurane
97
How do volatile agents affect FRC?
Decrease
98
How do volatile agents affect renal blood flow?
Decrease
99
How do volatile agents affect glomerular filtration rate?
Decrease
100
How do volatile agents affect urine output?
Decrease
101
The volatile agents we use today don't directly decrease renal blood flow and GFR, so why do these parameters still decrease?
Because volatiles decrease the MAP which in turn decreases blood flow and GFR
102
How do volatile agents affect hepatic blood flow and clearance?
Decrease
103
How do volatile agents affect uterine smooth muscle contractility and blood flow?
Decrease
104
Can inhaled drugs cross the placenta?
Yes
105
Are inhaled drugs harmful to the baby?
No because the baby can blow them off
106
Which inhaled agents produce the most muscle relaxation?
Ether derived - iso, sevo, des
107
Which inhaled agent does not produce muscle relaxation?
Nitrous oxide
108
Which inhaled agent may produce muscle rigidity?
Nitrous oxide
109
How do volatiles affect the core temperature set point at which thermoregulatory vasoconstriction is activated?
Lowers the core set point
110
How do volatiles affect metabolic oxygen consumption? How does this affect heat generation?
Decreases, decreases
111
Which volatiles can trigger MH in susceptible patients?
All
112
Which volatile is the most potent MH trigger?
Halothane
113
Which inhaled agent is the weakest MH trigger?
Nitrous oxide
114
What can cause compound A to accumulate in CO2 absorbers?
Using flows lower than 2L with Sevoflurane
115
What deleterious effects can be caused by compound A?
Nephrotoxicity
116
What can cause carbon monoxide to accumulate in CO2 absorbers?
Using a dry, desiccated absorber
117
Which volatile is most likely to cause an accumulation of carbon monoxide in the CO2 absorber?
Desflurane
118
What inactive fluoride metabolite can cause nephrotoxicity?
Methoxyflurane
119
Which volatile agent is associated with hepatitis?
Halothane
120
What are the 2 types of halothane hepatitis?
1) Mild, self-limited form
| 2) Rare, life threatening hepatic necrosis
121
Which volatile uses Thymol as a preservative?
Halothane
122
Halothane is metabolized up to __%.
20%
123
Isoflurane is great for which cases?
Neuro cases
124
What MAC level of isoflurane is utilized to obtain an isoelectric EEG?
2 MAC of ISO
125
Which volatiles are airway irritants?
Isoflurane and desflurane
126
Which volatile should you avoid in asthmatics?
Desflurane b/c it is a pungent airway irritant
127
Which volatile is the least irritating to airways?
Sevoflurane
128
What is the best choice of a volatile for an inhalational induction?
Sevoflurane
129
What percentage of Sevo is metabolized?
2-5%
130
What percentage of Iso is metabolized?
0.2%
131
Which inhaled agent can decrease MAC requirements?
Nitrous oxide
132
How does nitrous oxide affect pulmonary vascular resistance?
Increases
133
How does nitrous oxide affect CMRO2?
Increases
134
Which inhaled agent is associated with analgesic effects?
Nitrous oxide
135
Which inhaled agent is associated with diffusion hypoxia?
Nitrous oxide
136
Which inhaled agent should you not use in laparoscopic cases?
Nitrous oxide
137
Nitrous oxide is __x more soluble than nitrogen
34x
138
What amount of nitrous will double a pneumothorax?
75% nitrous for 10 minutes
139
What is the solution for diffusion hypoxia?
Supplemental oxygen with nasal cannula or a face mask
140
Somatic pain is alleviated by which medications?
Opioids and NSAIDS
141
Visceral pain is alleviated by which medication?
Just opioids (not NSAIDs)
142
Which receptors are activated during somatic pain?
1) Nociceptors for heat, cold, vibration, stretch
2) Inflammation
3) O2 starvation
143
The only nociceptors activated during visceral pain are activated by what?
Stretch
144
What type of drug is Tylenol and Ketorolac?
NSAIDs
145
What is the major natural opioid from which most major opioids are derived?
Morphine
146
What is an example of a semisynthetic opioid?
Heroin
147
What are the 3 major morphine agonists?
Fentanyl, demerol, dilaudid
148
What is the major opioid agonist/antagonist
Nalbuphine
149
What is the major opioid antagonist?
Naloxone (Narcan)
150
What is the mechanism of action of opioids?
Bind to specific G protein-coupled receptors that are located in brain and spinal cord regions involved in pain transmission and modulation
151
What are the 3 endogenous ligands that are mimicked by opioid agonists?
1) Enkephalins
2) Endorphins
3) Dynorphins
152
How do opioids affect the release of pain modulating neurotransmitters?
Decrease
153
What are the major pain modulating neurotransmitters?
- Ach
- Dopamine
- NE
- Substance P
154
Where do NSAIDs work?
In the periphery
155
Where do alpha 2 agonists work?
In the brain (dexmedetomidine) and spinal cord
156
Where do local anesthetics for pain management work?
Spinal cord and periphery
157
What are the 3 major opioid receptors?
1) Mu (1 and 2)
2) Kappa
3) Delta
158
Where are Mu1 receptors located?
In the brain and spinal cord
159
What is the main action of Mu1 receptors?
Analgesia
160
What are the side effects of Mu1 receptors?
N/V, pruritis
161
Do Mu1 receptors cause euphoria?
Yes
162
How do Mu1 receptors affect the heart rate?
Decrease - can cause bradycardia
163
Where are Mu2 receptors located?
Spinal cord
164
What are the negative side effects of Mu2 receptor activation?
- Hypoventilation
- Euphoria
- Sedation
- Physical dependence
- Constipation
165
Although Mu2 receptors are responsible for the majority of bad opioid effects, do they produce analgesia?
Yes, some
166
Where are kappa receptors located?
Brain and spinal cord
167
Do kappa receptors cause respiratory depression?
Yes, but less than Mu receptors
168
What are the negative side effects of Kappa receptor activation?
1) Dysphoria
| 2) Diuresis
169
What are the desired effects from Kappa receptor activation?
Analgesia
170
Which endogenous ligands bind to Kappa receptors?
Dynorphins
171
Which opioid drug class principally works on Kappa receptors?
Opioid agonist-antagonists
172
Which opioid receptor does Nalbuphine agonize? Antagonize?
- Agonist at Kappa
| - Antagonist at Mu
173
Where are Delta receptors located?
Brain and spinal cord
174
What are the wanted effects of delta activation by opioids?
Analgesia
175
What are the negative effects caused by delta activation by opioids?
- Respiratory depression
- Physical dependence
- Urinary retention
176
What endogenous ligand binds to delta receptors?
Enkaphalins
177
What endogenous ligand binds to mu receptors?
Endorphins
178
Which 2 opioid receptors can cause physical dependence?
- Mu2
| - Delta
179
What opioid receptor is responsible for urinary retention?
Delta
180
What part of the spinal cords are Mu receptors located in?
Substania gelatinosa
181
Opioids used for neuraxial anesthesia are specific for what type of pain?
Visceral pain
182
What are the 4 classic side effects of neuraxial opioids?
1) Pruritis
2) N/V
3) Urinary retention
4) Ventilatory depression
183
What is the dosing of morphine for...
- IV
- Epidural
- Spinal (intrathecal)
- 10mg IV
- 1 mg epidural
- 0.1mg spinal
184
What is the dosing for hydromorphone for...
- IV
- Epidural
- Intrathecal
- 1mg IV
- 0.2mg epidural
- 0.04mg spinal
185
What is the dosing of fentanyl for...
- IV
- Epidural
- Intrathecal
- 100mcg IV
- 33mcg epidural
- 6-10mcg intrathecal
186
Which opioid used in neuraxial anesthesia is very hydrophilic?
Morphine
187
Which opioid used in neuraxial anesthesia is very lipophilic?
Fentanyl
188
What drug can be given to alleviate itching associated with neuraxial opioids?
Benadryl
189
Morphine and codeine have high first pass metabolism, with about __% remaining in circulation after a PO dose
25%
190
How are opioids metabolized?
Converted to polar metabolites then excreted by the kidneys
191
Which opioids are metabolized by tissue esterases?
Heroin and remifentanil (the reason they are so fast acting)
192
What is normeperidine?
The polar metabolite of Demerol and a CNS stimulant that can cause seizures
193
How are opioids excreted?
By the kidneys
194
Which opioid agonist can cause orthostatic hypotension?
Fentanyl
195
How do opioid agonists affect the CV system?
Decrease sympathetic tone, blood pressure, and heart rate
196
How do opioids affect heart contractility?
Don't really effect contractility, which is why you can use opioids so heavily in heart cases
197
Which opioid agonist has antimuscarinic effects?
Meperidine (demerol)
198
Which opioid agonist can increase HR?
Meperidine (demerol)
199
The majority of respiratory depression caused by opioids are mainly due to action at which receptors?
Mu2
200
How do opioids affect the brain's ventilatory response to CO2?
Depresses this response, people will forget to breath if they've had too much
201
How do opioids affect PaCO2 levels?
Increase
202
How do opioids affect tidal volume?
Increase
203
How do opioids affect respiratory rate?
Decrease
204
How do opioids affect minute ventilation?
Decrease
205
Which opioids are used for cough suppression?
- Dextromethorphan
| - Codeine
206
How do opioids affect MAC levels?
Decrease by up to 30%
207
How do opioids affect cerebral blood flow and metabolism?
Decrease
208
How do opioids affect intracranial pressure?
Increase due to hypoventilation
209
Which opioid can cause seizures?
Meperidine (demerol) due to the accumulation of normeperidine
210
Which side effects of opioids do patients not build up a tolerance to?
1) Miosis
| 2) Constipation
211
What side effect of opioids can mimic angina?
Biliary colic
212
What is biliary colic?
A spasm of the sphincter of Oddi
213
What drug can relieve the pain caused by biliary colic?
Naloxone
214
What drug reverses biliary colic?
Glucagon 2mg IV
215
Biliary colic will be seen less with what opioid?
Meperidine (demerol)
216
Which drug should you not use if you are trying to diagnose biliary colic vs. angina?
Nitroglycerin because it relieves both
217
What are the major GI side effects of opioids?
- Constipation
- N/V
- Delayed gastric emptying
- Biliary colic
218
What are the GU side effects of opioids?
Urinary retention
219
Why do opioids cause urinary retention?
Activation of delta receptor causes an increase in the tone of the ureter and vesicle sphincter
220
Opioids cause the release of what chemical that causes flushing, itching, and a decrease in BP?
Histamine
221
Which opioids cause a greater release of histamine?
Morphine and demerol
222
What can happen to the thoracic cage as a result of large doses of opioids?
Truncal rigidity
223
Do opioids cross the placenta?
Yes
224
Which opioid is associated with less neonatal respiratory depression?
Meperidine
225
What opioid can be used to alleviate the bad withdrawal symptoms of morphine/heroin?
Methadone
226
What are the classic triad of symptoms associated with opioid overdose? (MCR)
1) Miosis
2) Respiratory depression
3) Coma
227
What is the relative potency of morphine?
1
228
What is the onset time of morphine?
15-30 minutes
229
How can morphine be administered?
IV and IM
230
When is the peak effect of morphine?
45-90 minutes
231
What is the duration of morphine?
3-4 hours
232
What is the metabolite of morphine?
Morphine-6-glucaronide
233
How is morphine metabolized?
Via conjugation with glucuronic acid in the liver, extrahepatic areas, and kidneys
234
Accumulation of morphine and its metabolite can lead to prolonged narcosis and ventilatory depression in which patients?
Kidney failure patients
235
Which opioid causes the largest release of histamine?
Morphine
236
How is Meperidine (demerol) administered?
IV, IM, PO
237
What is the relative potency of demerol?
0.1 of morphine
238
When is the peak effect of demerol?
5-7 minutes
239
What is the duration of demerol?
2-4 hours
240
What causes the atropine-like side effects associated with demerol?
The blockade of sodium channels that causes tachycardia, dry mouth, mydriasis (pupil dilation)
241
Demerol is often used in the treatment of what?
Post-op shivering
242
What is the dose of demerol used for post-op shivering?
12.5-25mg
243
How can Fentanyl be administered?
IV, transdermal, PO, intranasal
244
What is the relative potency of fentanyl?
75-125x more potent than morphine
245
When is the peak effect of fentanyl?
3-5 minutes
246
What is the duration of fentanyl?
30-60 minutes
247
What percentage of fentanyl undergoes first pass pulmonary uptake?
75%
248
Fentanyl has a synergistic response with what drug class?
Benzodiazepines
249
What is the induction dose of fentanyl with a sedative hypnotic?
2-6mcg/kg
250
What is the infusion dose/rate of fentanyl?
0.5-5mcg/kg/hour
251
Sufentanil is __ times as potent as fentanyl
10x
252
When is the peak effect of sufentanil?
3-5 minutes
253
What is the duration of sufentanil?
30-60 minutes
254
What is the dosing of sufentanil for a DL?
0.3-1 mcg/kg 1-3 minutes before DL
255
What is the dosing of sufentanil for analgesia during surgery?
0.5mcg/kg
256
During what surgeries is sufentanil useful?
During neuro surgeries to alleviate the pain of the headframe
257
What is the potency of alfentanyl compared to fentanyl?
It is 1/5 to 1/10 as potent as fentanyl
258
What is the duration of alfentanyl?
10-20 minutes
259
When is the peak effect of alfentanyl?
1.5-2 minutes
260
What contributes to the short half life of alfentanyl?
It has a small volume of distribution
261
Which fentanyl derivatives are good for retrobulbar blocks?
Alfentanyl or remifentanyl
262
What is the dose of alfentanyl that provides good analgesia?
5-10mcg/kg
263
What is the potency of remifentanyl when compared to fentanyl?
It has a similar potency to fentanyl
264
When is the peak effect of remifentanyl?
1.5-2 minutes
265
What is the duration of remifentanyl?
6-12 minutes
266
How is remifentanyl metabolized?
Plasma and tissue esterases
267
Which fentanyl derivative can cause the patient's to develop and acute tolerance to opioids?
Remifentanyl
268
List fentanyl and its derivatives in order of shortest to longest half life after a 4 hour infusion.
Remi, su, al, fentanyl
269
What are the common uses of codeine?
1) Antitussive for coughing
| 2) Analgesia for mild to moderate pain
270
What are the common uses of methadone?
1) Long term relief of chronic pain
| 2) Opioid withdrawal
271
Hydromorphone is __ times as potent as morphine
8
272
What advantages does hydromorphone have over morphine?
More sedation, less euphoria, less histamine release
273
How can methadone affect the EKG?
Prolong QT interval
274
What are 3 commonly used opioids agonist/antagonists?
1) Pentazocine
2) Butorphanol
3) Nalbuphine
275
Opioid agonist/antagonists are _____ agonists and/or _______ antagonists at opioid receptors
Partial agonists, competitive antagonists
276
What class of opioid drugs are associated with a ceiling effect?
Agonist/antagonists
277
What class of drug is naloxone (narcan)?
Opioid antagonist
278
Which opioid receptor does Narcan antagonize?
Mu
279
What are the common uses of Narcan?
- Opioid overdose
| - Respiratory depression
280
What is the duration of Narcan?
30-45 minutes
281
What is the dose of Narcan?
1-4mcg/kg
282
What are the unwanted side effects caused by Narcan?
N/V, pain, tachycardia, increased sympathetic activity
283
What is the dose of remifentanil for a DL?
0.5-1mcg/kg
284
What is the infusion dose of remifentanil?
0.5mcg/kg/min
285
What drug class is Valsartan?
Angiotensin II receptor antagonist
286
What is the dose of Valsartan?
160mg
287
What is the dose of Acetaminophen?
10-15mg/kg every 4 hours
288
What is the drug class and dosing of Naproxen?
NSAID 250mg qid or 500 bid
289
What is Novolin?
Recombinant engineered human insulin
290
What is the dose of Novolin?
6 units subq every 12 hours
291
How is Novolin supplied?
100units/ml or 3.6mg/ml
292
What is Novolin used for?
To treat diabetes
293
What class of drug is Metformin?
A biguanide class hypoglycemic drug
294
What is the action of Metformin?
Reduces glucose levels by decreasing hepatic glucose production and increasing insulin action
295
What is the primary use for Metformin?
Type II Diabetes
296
What class of drug is Nimodipine?
Calcium channel blocker
297
What are the cardiovascular effects of Nimodipine?
Decreases systemic BP, increase coronary blood flow, delay AV conduction, decrease HR
298
What is Simvastatin (Zocor) used to treat?
Dyslipidemia
299
What is Vicodin?
Hydrocodone + acetaminophen
300
What are the 2 warnings associated with Vicodin?
- Respiratory depression
| - Increased ICP
301
What is Colace? What is it used for?
An anionic surfactant which lowers the surface tension in stool, allowing easier defecation
302
What class of drug is Pepcid (Famotidine)? What is it used for?
Histamine H2 blocker used for GERD and GI ulcers
303
What is the physiologic cause of diabetes mellitus?
Pancreatic beta cells either don't produce insulin or don't produce enough
304
What kind of disease is Type I Diabetes?
Autoimmune
305
What are the insulin levels like in a Type I Diabetic?
Low
306
Which type of diabetes is insulin dependent?
Type I
307
Which type of diabetes is non-insulin depedent?
Type II
308
A fasting blood glucose above __ mg/dl is diagnosed as Type II Diabetes
125
309
How do Sulfonylureas work to treat Diabetes Mellitus?
They stimulate insulin secretion from the Beta cells and increase binding of insulin to their receptors
310
How does Repaglinide work to treat Diabetes Mellitus?
Stimulates insulin secretion
311
Granulocyctic function and collagen synthesis are suppressed with glucose levels above ___mg/dL, which is a concern for wound healing
200
312
Diabetics should be posted as which case of the day if at all possible?
First case of the day
313
Which pre-op condition is of the greatest concern - hypoglycemia or hyperglycemia?
Hypoglycemia
314
A glucose below __ mg/dL should be treated with 50% Dextrose
50
315
What amount of 50% Dextrose should you give as a starting bolus for patients with hypoglycemia?
15ml
316
If a perioperative insulin infusion is needed, what rate should you start at?
1 unit per hour
317
When you begin infusing insulin, what other solution should you infuse?
D5W with 20mEq KCl
318
How often should you monitor glucose levels during surgery if you are infusing insulin?
Every hour
319
You should adjust your perioperative insulin infusion rate to meet what level of glucose?
100-200mg/dL
320
What are the most common causes of asthma?
Inhaled allergens, stress, airway instrumentation, recurring pulmonary infections
321
What is the physiologic response of an asthma attack?
Mast cells release mass amounts of histamine
322
What are the 2 types of aerosols used for drug administration?
- Metered dose
| - Nebulizers
323
What is the onset time of short acting beta-2 agonists, such as albuterol, used in the treatment of asthma?
1-5 min
324
What is the duration of action of short acting beta-2 agonists, such as albuterol, used in the treatment of asthma?
2-6 hours
325
What are the 2 long acting beta-2 agonists used for the treatment of asthma?
- Salmeterol
| - Formoterol
326
What is the duration of the long acting beta-2 agonists such as Salmeterol and Formoterol?
12 hours
327
What antiinflammatory agents are used for the treatment of severe chronic asthma?
Glucocorticoids
328
Which glucocorticoid is common in the treatment of chronic asthma?
Beclomethasone
329
What are Accolate and Singulair?
Leukotriene receptor antagonists used for the treatment of chronic asthma
330
What recombinant monoclonal antibody targeting IgE is used for the treatment of chronic asthma?
Xolair
331
What phosphodiesterase inhibitor is used for the treatment of chronic asthma?
Theophylline
332
What are the top 3 complications associated with aneurysm coiling surgeries?
1) Aneurysm rupture with hemorrhage
2) Thromboembolism
3) Vasospasm
333
Which type of diabetes mellitus is susceptible to ketoacidosis?
Type I
334
What are the 4 major anesthetic considerations for a cerebral aneurysm surgery?
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
Which inhaled anesthetic suppresses bone marrow formation?
Nitrous oxide
