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Anesthesia MM/TL > Pharmacological Principles > Flashcards

Pharmacological Principles Flashcards

1
Q

Are ionized or nonionized drugs more readily absorbed?

A

Nonionized

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2
Q

Why does oral absorption of drugs have the first pass effect,but not the sublingual absorption?

A

Because the veins of the stomach and small intestine drain directly into the portal system.
The veins of the esophagus and mouth drain into the SVC so drugs absorbed here go into the systemic system first.

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3
Q

What layer of the skin is an effective barrier to small, lipid-soluble drugs (clonidine, nitroglycerin,scopolamine, fentanyl)?

A

Stratum corneum

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4
Q

What does plasma protein levels affect?

A

The solubility of the drug in blood, but not the rate of equilibration

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5
Q

What increases the rate of onset of a drug?

A

High levels of binding in the blood compared to in the tissue because fewer molecules need to transfer into the tissue to reach an effective free drug concentration

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6
Q

What kind of PH does albumin usually bind?

A

Acidic drugs

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7
Q

What binds basic drugs?

A

Alpha 1 glycoproteins

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8
Q

What happens to drug solubility if albumin or AAG is decreased in the blood?

A

The solubility decreases

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9
Q

What conditions increase AAG levels?

A

Trauma, surgery, infection, MI, chronic pain

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10
Q

What condition decreases AAG levels?

A

Pregnancy

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11
Q

What drug is administered with its own binding molecules?

A

Propofol

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12
Q

What is the blood brain barrier made up of?

A

Pericapillary glial cells and endothelial cell tight junction

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13
Q

What kind of drugs readily pass the blood brain barrier?

A

Lipophiloc drugs (hypnotics and opioids)

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14
Q

What is redistribution?

A

The process by which the drug re-equilibration from the tissue to the plasma as drug concentration falls in the plasma.
- delays emergence following prolonged infusions

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15
Q

What is context sensitive half time?

A

The time required for a 50% decrease in plasma drug concentrations following an infusion

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16
Q

What is the context referring to in context sensitive half time?

A

Duration of the infusion

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17
Q

What is context sensitive decrement time?

A

Refers to any clinically relevant decreased concentration in any tissue

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18
Q

What is volume of distribution equation?

A

Bolus dose/plasma concentration (time)

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19
Q

What is Vdss?

A

The volume of distribution of 3 compartments
2 peripheral compartments: rapid equilibration (organ and muscle) and slow (fat and skin)
1 central compartment (blood and lung)

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20
Q

What does a small Vdss imply?

A

High aqueous solubility, stays in the blood (pancuronium)

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21
Q

What does Vdss reflect

.

A

The volume into which the drug would have to distribute to account for the observed plasma concentration given the dose that was administered

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22
Q

What is phase 1 reaction?

A

Converts parent compounds into polar molecules through redox reactions or hydrolysis

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23
Q

What is phase II?

A

Coupled or conjugated parent drugs or phase I metabolites with an endogenous substrate to form water soluble molecules that can be eliminated

24
Q

What is the extraction ratio?

A

The fraction of drug that is removed that enters the liver

25
Q

What is hepatic clearance?

A

Liver blood flow X extraction ratio

26
Q

What drug has a high extraction ratio?

A

Propofol

27
Q

What kind of clearance does Propofol have?

A

Flow-dependent clearance

28
Q

What are capacity dependent drugs?

A

Methadone and alfentanil

29
Q

What does capacity dependent mean?

A

Means the extraction ratio is low. Metabolism depends on the liver enzymes

30
Q

Dose response curves are typically what shape?

A

Sigmoidal

31
Q

What is the equation for drug effect?

A

Effect = E0 + (Emax-E0) Cgamma/C50 +Cgamma

32
Q

What is E0?

A

The baseline effect in absence of the drug

33
Q

What is E max?

A

The maximum effect from baseline

34
Q

What is C50?

A

The concentration associate with half-maximal effect

35
Q

What is gamma?

A

The steepness of the curve (dose response relationship)

36
Q

What does Emax correlate with?

A

Efficacy

37
Q

What does C50 correlate with?

A

Potency

38
Q

What gamma value suggests a gradual increase in drug effect with increasing concentration?

A

Less than 1

39
Q

What gamma value suggests a rapid increase in drug effect with increasing concentration?

A

Greater than 4

40
Q

What is the equation for therapeutic window?

A

C50 toxicity/c50 desired therapeutic effect

41
Q

What happens to the central compartment as patients get older?

A

The central compartment is smaller

42
Q

What is the volume distribution in a baby.

A

Larger

43
Q

Why does an older patient require less Propofol?

A

Smaller central compartment

Decreased clearance

44
Q

Why is time to awakening shorter than context sensitive half-time?

A

Because the decrease in plasma concentration required for awakening is generally less than 50%

45
Q

What does licorice cause?

A

Conn syndrome (hypokalemia, hypernatremia, HTN, metabolic alkalosis) by inhibition of 11-beta hydroxyl dehydrogenase, which in turn allows cortisol to activate the Na-K-ATPase channels in the renal proximal tubule like aldosterone usually does

46
Q

What is decrement time?

A

The time it takes to reach a certain plasma concentration once an infusion is terminated

Usually equal to infusion duration

47
Q

What is terminal half life?

A

Terminal half life is the half life of elimination after the tissue concentration has equilibration with the plasma concentration

48
Q

What is the time constant?

A

It is used to calculate how long it takes for a newly dialed concentration of gas anesthetic to equilibration with the gas in the circuit

49
Q

What is the ED95 for neuromuscular blockers?

A

The effective dose required to achieve 95% block of a single twitch in 50% of individuals

50
Q

What is ED95?

A

The effective dose needed to get the desired effect of 95% of the population

51
Q

What is the ED95 for rocuronium?

A

0.3mg/kg

52
Q

What is efficacy of a drug?

A

The maximum effect of a drug

53
Q

What is potency?

A

The relative dose required to achieve a desired effect

- related to receptor affinity

54
Q

What is elimination?

A

The change in plasma concentration of a drug divided by the change in time

55
Q

What is first order kinetics?

A

Drug elimination is proportional to drug concentration

Ex: depends on liver blood flow

56
Q

What is zero order kinetics?

A

Elimination is independent of drug concentration

Constant elimination

Anesthesia MM/TL (36 decks)

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