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PHARM EXAM 2 > PHARM EXAM 2 > Flashcards

PHARM EXAM 2 Flashcards

1
Q

Balanced anesthesia

A

use multiple meds to achieve the overall goal

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2
Q

Nitrous Oxide (laughing gas)

A

• Type of gaseous General Anesthetic

Decreases inhibitions & things that normally wouldn’t be funny may be funny

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3
Q

Action of Nitrous Oxide

A

Produces narcosis, analgesia, and amnesia to varying degrees by causing progressive depression of CNS; GABA-receptor agonist, opioid agonist.
• Sedative, analgesic effect
• GABA = neuroinhibitory – inhibits function of CNS

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4
Q

ADRs for Nitrous Oxide

A

 Very well tolerated and free of toxicities
 MUST be given with oxygen  may compromise normal tissue oxygenation if not administered in conjunction w oxygen
• Blocks reuptake of oxygen
• Can lead to hypoxia
 Not a complete LOC or muscle relaxation
 *** VERY GOOD ANALGESIC w/ low anesthetic effect
• Highly analgesic w/ low anesthetic effect (won’t depress CNS completely)

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5
Q

Special info for nitrous oxide

A
  • MUST be given with 30% oxygen  compromise normal tissue oxygenation  block reuptake of O2  hypoxia
  • Inhaled & exhaled into the lungs – doesn’t do much anywhere else
  • VERY GOOD ANALGESIC – pain control & relief
  • Greatest use = an induction agent
  • HIGHLY analgesic w/ LOW anesthetic effect
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6
Q

Volatile Anesthetic

A

Isoflurane (Forane)

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7
Q

Action of Isoflurane

A

GABA & Glutamate receptor agonist
• Progressive depression of CNS – crosses BBB
• Triggers inhibitory receptors for GABA and glutamate

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8
Q

ADR of Isoflurane

A
  • Hypotension
  • Shallow respirations
  • Respiratory depression (RARE)
  • “trigger” malignant hyperthermia
  • less efficient gas exchange**
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9
Q

Special Info for Isoflurane

A

• More soluble in blood, intercellular fluid and fatty tissue than gaseous anesthetics
• Relaxes tracheal area – simplifies intubation
• If alone – not a potent analgesic, but a good anesthetic –> give w/ something else
Patient may shiver coming out of the anesthetic

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10
Q

contraindications for Propofol

A

patients with severe heart disease or respiratory difficulties

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11
Q

Disadvantages of Iv anesthetics

A

bronchospasm and laryngospasm*, hypotension, and respiratory arrest
-concerned for heart and lungs

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12
Q

Advantages of IV anesthetics

A

rapid pleasant induction, absence of explosive hazards, and low incidence of postop nausea and vomiting.

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13
Q

What is the major difference between inhalation anesthetics and IV anesthetics

A

SAFETY

a. inhalation–anesthetist controls minute-by-minute administration and removal.
b. IV–once administered, course of events must continue until out of system.

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14
Q

What is the major difference between inhalation anesthetics and IV anesthetics

A

SAFETY

a. inhalation–anesthetist controls minute-by-minute administration and removal.
b. IV–once administered, course of events must continue until out of system.

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15
Q

Propofol (Diprivan)

A

Prototype drug for barbiturates that is short acting and used for short procedures

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16
Q

Action of Propofol

A
  • promotes the release of GABA

• Ultra-short acting duration of anesthesia action  should be used as an induction agent

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17
Q

ARD for Propofol (Diprivan)

A

1) respiratory depression
2) hypotension fron vasodilation
3) risk for bacterial infection (in lipid based emulsion)
4) injection site pain
5) actually has anti-emetic properties

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18
Q

Etomidate (Amidate)

A
  • other type of IV anesthetic
  • hypnotic agent used for induction of anesthesia
  • useful for those with heart issues who cannot tolerate Propofol since it has minimal cardiac effects
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19
Q

Fentanyl/Droperidol combination (Innovar)

A

-other type of IV anesthetic

an opioid and neuroleptic combo used for neurolept amnesia

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20
Q

Fentanyl (sublimaze)

A

-opioid agonist- VERY EFFECTIVE ANALGESIC*

Extremely potent and prescribed in MICROGRAMS as opposed to morphine that’s prescribe in milligrams

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21
Q

Fentanyl action

A

Morphine like action except it’s 100 times more potent w a short duration

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22
Q

ADR of fentanyl

A

1) euphoria
2) Miosis (pin-point constriction of pupils
3) N/V
4) Pruitis
5) Constipation
6) hypotension
7) Respiratory depression
8) Bradycardia

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23
Q

Which medication has the anterograde amnesia effect?

A

Midazolam (Versed)

-has neuroleptic effects

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24
Q

Which drug is nick named “milk of amnesia”

A

Propofol (Diprivan)

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25
Q

Special info for Fentanyl

A
  • rapid IV injection or large doses can lead to muscle rigidity
  • topical patches Duragesic used for long acting pain relief is used every 72 hours BUT only give this to someone who has been on opioids and has some degree of tolerance; also never give on a heated area
  • Lozenge on stick (Actiq) and buccal tablets (Fentora)
26
Q

Action of Fentanyl

A
  • similar to morphine
  • Central action on perception of pain [in the brain]. Primary site is sensory cortex. Also alters attitudes by psychological, sedative, and hypnotic effects.
27
Q

Action of Midazolam

A

-benzodiazepine
-acts on the limbic, hypothalamic regions to cause CNS depression, and skeletal muscle relaxation
-also prevents seizure activity
(probably potentiates GABA)

28
Q

ADRs of Midazolam

A
  1. Respiratory depression/arrest
  2. Decreased alertness
  3. Amnesia
  4. Hypotension
  5. Tachycardia
  6. Laryngospasm
  7. Muscle tremors
    BLACK BOX WARNING
29
Q

Special Info for Midazolam

A
  1. produces an anterograde amnesia effect and decreases anxiety
  2. has a prolonged post anesthetic recovery compared to barbs
  3. other Benzos- diazepam (Valium), lorazepam (Ativan)
30
Q

Prototype drugs for Local Anesthetics

A
  1. Mepivacaine (Carbocaine)-short duration
  2. Lidocaine (Xylocaine)
  3. Long acting Bupivocaine Marcaine
31
Q

Special Info for Local Anesthetics

A
  1. loss of all sensation occurs, but pain fibers affected first
  2. If it becomes systemic, can have serious reaction–especially heart and brain
  3. VASOCONSTRICTORS must be used to decrease systemic absorption
  4. Topical example= Benzocaine
32
Q

Recuronium (Zemuron)

A

non-depolarizing (competitive) neuromuscular blocking agent

33
Q

Recuronium Action

A

Prevents acetylcholine from acting by occupying cholinergic receptor sites. Competitive antagonist.

  • Jumps on ACH receptor site – attracted to same receptor site
  • Stays there so ACH cannot bind so muscle cannot contract
34
Q

ADRs for Recuronium

A

1) tachycardia
2) muscle weakness
3) salivation
4) HTN

35
Q

How is Recuronium reversed?

A

by administering anticholinesterase like Neostigmine (allows for accumulation of Ach, or a newer agent called sugammadex
-this will lead to muscle contraction

36
Q

Succinylcholine

A

depolarizing neuromuscular blocking agent that looks like Ach to the body except it gives an extended depolarization and does not allow for repolarization

37
Q

Action of Succinylcholine

A

Repolarization of end-plate does not occur after discharge.
Resembles acetylcholine - but produces more prolonged depolarization of motor endplates–partially due to slower inactivation by cholinesterase.
- Causes twitchy contraction throughout body and doesn’t allow for a second one b/c no repolarization  causes the person to be paralyzed

38
Q

ADRs of Succinylcholine

A
  • Muscle weakness, bronchospasm, apnea, bradycardia, hypotension, arrhythmias, increased salivation, postop muscle pain, hyperthermia. However, has low level toxicity.
39
Q

Biggest ADR of Succinylcholine

A

Post op muscle pain

40
Q

Action of Morphine

A
  • Central action on perception of pain [in the brain]. Primary site is sensory cortex. Also alters attitudes by psychological, sedative, and hypnotic effects.
  • opioid agonist
41
Q

CNS effects of Morphine

A

1) analgesia
2) drowsiness
3) changes in mood
4) euphoria (+) or negative
5) mental clouding

42
Q

Effects of Morphine

A

1) Miosis- constricted pupils
2) Depresses brain stem, decreases response to CO2
3) Post-medualla-chemoreceptor trigger zone (CTZ) is directly stimulated–> makes people nauseous and vomit

43
Q

Who is most at risk for respiratory depression w Morphine

A
  • the very young,
  • those w underlying respiratory disease
  • elderly
44
Q

Cardiovascular effects of Morphine

A

while patient is laying supine, there is no major effects on BP, pulse rate and rhythm but it DILATES THE VESSELS leading to POSTURAL HYPOTENSION

  • we also don’t give morphine if they have a head injury because it also dilates the cerebral vessels which may further increase ICP
  • most opioids provoke the release of histamine which may be the cause of hypotension
45
Q

GI effects of Morphine

A

CONSTIPATION

1) decreases motility
2) decreases secretions

46
Q

Smooth muscle effects of Morphine

A

URINARY RETENTION

a. ureter– INCREASES tone and amplitude of contractions of ureters, especially lower 1/3
b. bladder– INCREASES tone leading to urgency. Increases tone of sphincter leading to retention

INCREASE tone of contractions makes you feel like you have to urine but  tone of sphincter will not allow you to urinate

		c. uterus--prolongs labor; male-decreases libido
		d. bronchial--large doses lead to bronchoconstriction
47
Q

Morphine effects on skin

A

therapeutic doses cause cutaneous blood vessels to dilate–leading to flushed and warm face, neck and upper thorax. (may be due to release of histamines–also reason for pruritus and sweating.)

48
Q

trade name for Recuronium

A

Zemuron

49
Q

trade name for Succinylcholine

A

Anectine

50
Q

trade name for Isoflurane

A

Forane

51
Q

trade name for Propofol

A

Diprivan

52
Q

trade name for Fentanyl

A

Sublimaze

53
Q

trade name for Midazolam

A

Versed

54
Q

Actions of Aspirin

A

1) Antipyretic
2) Anti-inflammatory
3) Analgesia
4) Anti-coagulation/Anti platelet
5) GI- local irritation and also stimulation of vomiting center in the brain

55
Q

Special Info for Ibuprofen

A

1) Topical NSAIDs should be considered before oral NSAIDs for knee and hand osteoarthritis pain (Voltaren)
2) Therapeutic response usually occurs in 2 weeks for chronic disease.
3. Give with food to reduce GI symptoms.
4. ALL NSAIDs except salsalate and celecoxib can interfere with platelet function and prolong bleeding time. This effect is reversible (unlike aspirin).
5. Contraindicated in patients with a history of aspirin-induced bronchospasm, or those with symptoms of asthma, rhinitis, nasal polyps, angioedema, urticaria
6. If any visual difficulties with the drug should have a complete eye exam and stop drug.
7. New drug – Caldolor – IV ibuprofen (rarely used)

56
Q

Class effect of NSAIDs (except ASA)

A 
Class effect – “potential increased risk for cardiovascular events”
	Can increase risk of thrombotic events, MI, CVA, and heart failure – especially with higher doses, longer use, or in patients with CV disease or risk factors for CV disease
•	Entire class of NSAIDs  risk of CV disease (MI, stroke, etc.)
57
Q

Aminoglycosides

A
  • Affect protein synthesis in the bacteria – NOT cell walls
  • Either bactericidal or bacteriostatic
  • Used for serious infections  usually gram (-) organisms
  • Monitor peak and trough levels closely! – coordinate w/ lab values
58
Q

Cephalosporins

A

• Probably the most extensively-used antimicrobials worldwide
o Each generation has better improvements
• Generic name = “ – Cef” or “ – Ceph”
• Often used as an alternative to penicillins (especially in penicillin-allergic individuals)
o Fewer people are allergic to cephalosporins

59
Q

Penicillin

A

o One of the first major class of anti-infective agents
o Work by interfering w/ proper bacterial cell wall formation
o Allow cells to take up water – increases osmotic pressure, then they can rupture
 Make faulty cell well when organism is forming then water can leak in and organism can burst
o GI side effects most common, but group also causes allergic and anaphylactic reactions
o Generic names = end in “ –cillin”

60
Q

Azothioprine (Imuran) Classification and Action

A

Immunosupressant, Anti Inflammatory
Action: works by inhibiting cell proliferation by interfering with synthesis of DNA and RNA
-affects purine metabolism

61
Q

Why do we use Azothioprine (Imuran)

A

used to prevent organ transplant rejection but in many parts of the world it is used as an inflammatory still due to it’s immunosupression

62
Q

ADRS for Azothioprine (Imuran)

A

1) Bone marrow suppression
2) Jaundice
3) Hemorrhagic cystitis
4) N/V, anorexia
5) increased risk of infection
6) Cancers/ neoplasms bc of the immunosuppression

PHARM EXAM 2 (1 decks)

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