Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia based on Nebuchanedzzer II > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

All ester LA are metabolized by ______

A

hydrolysis by pseudocholinesterase

*just like succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Succinylcholine is metabolized by _____

A

pseudocholinesterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What drugs are metabolized by pseudocholinesterase?

A
  1. Succinylcholine
  2. ester LA
  3. Cocaine
  4. Heroin

*A pseudocholinesterase deficiency will prolong the effects of the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What promotes more bradycardia, high dose or repeated doses of succinylcholine?

A

Repeat dosing

*dose > 6mg/kg produces a phase 2 block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
Prolonged immobilization (after ~16 days) results in upregulation of immature AChRs.
- Response to succinylcholine?
A

Hyper sensitivity

  • Succ is easily able to interact with these receptors
  • Substantial efflux of K (lethal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Do anticholinergic toxicity present with diaphoresis?

A

No the cause of hyperthermia is lack of perspiration

- Thyroid storm also presents with hyperthermia, but will be diaphoretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most anesthetic drugs are cleared by the (kidney / liver)

A

liver transformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Best depth for TEE probe?

A

T5-T6 mid thoracic spine

- 30-35 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Enoxaparin is a LMWH that binds and potentiates ______ , which will prolong (PTT / PT)

A

antithrombin to irreversibly inactivate factor Xa.

PTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Unfractionated heparin binds and potentiates _____

A

antithrombin III, which in turn inhibits factor II (thrombin) and Factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dabigatran is a ______, that leads to increases in (PT / PTT)

A

Direct thrombin inhibitor

both PT and PTT

*No therapeutic monitoring in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rivaroxaban is a ______, that leads to increase in (PT / PTT)

A

direct factor Xa inhibitor

Both PT and PTT

*monitor using anti-Xa levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

(True / False) Acute herpes zoster treatment, acyclovir, prevents future herpes recurrence

A

False

- its only effective as a prophylaxis if CHRONIC treatment, not acute.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Droperidol is contraindicated in any pt with ______

A

prolonged QT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The half-life of aminoamide LA is prolonged in (ESRD / End stage liver disease)

A

Liver disease

  • hepatic enzyme dysfunction
  • or immature enzymes in neonates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is bupivacaine not used for IV regional anesthesia?

A

High risk of LA toxicity and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Absolute contraindication to propofol

A

Hypersensitivity to egg lecithin/phosphatide (yolk), soy products

*most people are allergic to egg white (egg albumin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Can neuraxial opioids lead to tolerance, requiring a dosage escalation to obtain same response?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do infusion rates of remifentanil need to be cut in 1/3 in elderly pts?

Why do bolus doses of opioids need to be halved?

A

Decreased central clearance
- inc opioid effectiveness

Decreased central volume of distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The maximum dose of lidocaine with and without epi is ____.

Epi [ ] in a LA should not exceed:

A

Without: 5mg/kg
With: 7mg/kg

1:200,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A phase II block is a result of _______with ongoing cellular sodium and potassium shifts ultimately rendering the receptor unresponsive to further binding by ACh

A

Hyperactivation of ACh receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Volatile anesthetics cause muscle relaxation through ______

A

inhibition of ACh receptor sensitivity and hyperpolarization of motor neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Citrate intoxication can occur with blood transfusion and may present as a metabolic (acidosis/alkalosis)

A

alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NNT for:
Dexamethasone:
Ondansetron:
Droperidol:

A

Dexamethasone: 4
Ondansetron: 3
Droperidol: 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
GABA is an (Excitatory/Inhibitory) neurotransmitter that controls the state of chloride ion channels. - How does this contribute to muscle relaxing properties?
Inhibitory - Activation of Cl- channels -> neuronal hyperpolarization -> decreases ability for membrane potential to occur *BDZ facilitate GABA receptors (inhibitory) in the CNS (CENTRAL)
26
Midazolam bioavailability by route of administration from greatest to least
``` IV SubQ IM Sublingual Intranasal Rectal (20-50%) Oral ```
27
Concurrent use of antacids or grapefruit can (increase/decrease) the onset time and bioavailability of midazolam
Increase | by inhibiting the Cyt P450 enzyme system
28
_____ has the lowest cardiac-to-CNS dose toxicity ratio (2:1) *ratio of dose causing cardiac collapse to dose causing seizures/convulsions
Bupivacaine - and the HIGHEST relative potency for cardiac toxicity - d/t stronger affinity for both resting and inactivated sodium channels w/in myocardium *Ropivacaine has same cardiac-to-CNS dose toxicity ratio (2:1), but less cardiac toxicity
29
Do you need to monitor anti-factor Xa levels to predict safe neuraxial placement?
no | - not predictive of bleeding risk unless elderly pt with renal insufficiency receiving therapeutic doses of LMWH
30
Which one affects PTT more, LMWH or unfractionated heparin?
Unfractionated heparin *do not need to routinely monitor PTT in pts on LMWH, it is highly predictable
31
(LMWH / Unfractionated heparin) prolongs PTT to a larger extent
Unfract. Hep.
32
What is the dosing for lipid emulsion (20%) in pts with LAST?
bolus 1.5ml/kg over 1 min | infusion 0.25 ml/kg/mi
33
What is the preferred treatment of arrhythmias in pts with LAST?
amiodarone
34
How is the dose of epi changed in ACLS if LAST is suspected?
dose < 1 mcg/kg per dose | - epi is arrhythmogenic in itself and make LAST more pronounced
35
The maximum allowable dose of lidocaine: - without epi - with epi
- without epi: 5mg/kg - with epi: 7mg/kg over 60 min 1% lidocaine = 10mg/mL 2% lidocaine = 20mg/mL
36
The maximum allowable dose of bupivacaine: - without epi - with epi
- without epi: 2.5mg/kg - with epi: 3mg/kg over 120min
37
What is the maximum allowable dose of 2% lidocaine (20mg/mL) with epi in a 70kg pt?
7mg/kg * 70kg = 490mg 490mg / (20mg/mL) = 24.5 mL
38
When the pH of the soln is LESS than the pKa, the molecule will be (ionized/unionized) at physiologic pH
ionized
39
When the pH of the soln is EQUAL to the pKa, the molecule will be (ionized/unionized)
both 50% ionized 50% unionized
40
What happens when bicarbonate is added to local anesthetics? downside?
increases the non-ionized form of lidocaine - increases speed of onset * can form precipitation - unionized drugs are much less soluble than ionized drugs
41
Allergic reaction with ester type local anesthetics (procaine, benzocaine, tetracaine) most often is d/t ______
hypersensitivity to para-aminobenzoic acid (PABA) | metabolite of ester LA
42
Metformin MOA
Decrease hepatic gluconeogenesis and increase insulin sensitivity
43
Metformin is excreted by the ____. | Common adverse effect to monitor for?
kidneys | - if kidney disease, it can build up / have poor elimination -> lactic acidosis
44
Usually metformin is continued thru the periop period. When would you make an exception and d/c the metformin?
If pt has renal dysfunction | - d/c metformin 24-48hrs prior to surgery
45
Why is methylene blue (1mg/kg) used for methemoglobinemia?
methylene blue is an antioxidant for the reduction of methemoglobin using NADPH produced from the hexose phosphate pathway
46
What is the tx choice for methemoglobinemia in pts with G6PD deficiency?
``` Ascorbic acid (vitamin C) - an antioxidant (electron donor), is able to reduce Fe3+ to Fe2+ ``` *avoid methylene blue bc the hexose phosphate pathway is dysfunctional and free radicals can develop -> RBC lysis
47
Which meds can cause a transient decrease in SpO2 lasting anywhere form 30 seconds - 20 min?
1. Methylene blue 2. Indocyanine green 3. Indigo carmine *absorbance is lower at 630 nm, which correlates to SpO2 of 84-86% in pulse ox
48
Meds known to induce methemoglobinemia (7)
1. Prilocaine 2. Nitroglycerine 3. Sodium nitroprusside 4. Phenytoin 5. Sulfonamides 6. Metoclopramide 7. Benzocaine
49
Clinical sx of acetaminophen overdose
Nonspecific - N/V - Malaise - abdominal pain
50
Why is N-acetylcysteine (NAC) used for acetaminophen overdose?
NAC provides cysteine for replenishment and maintenance of hepatic glutathione stores -> enhances elimination pathway
51
Exogenous corticosteroids stimulate the negative feedback loop and suppress both _______
Corticotropin releasing hormones (CRH) and arginine vasopressin (AVP) production
52
V1 receptors vs V2 receptors Where are they located? What happens if receptors are activated?
V1: - located in vascular smooth muscle - ca2+ release and vasoconstriction V2: - located in- the distal renal tubules and collecting ducts - increase water reabsorption in states of hyperosmolarity or hypovolemia
53
How do loop diuretics cause a constriction alkalosis?
Loop diuretics inhibit the Na/K/2Cl channel in the LOH - Increase urine output - Urine is high sodium, low bicarbonate containing fluid
54
What metabolic derangements are associated w/ aspirin overdose?
Initially: respiratory alkalosis Eventually: metabolic acidosis
55
Which organs are at increased risk of injury from propofol infusion syndrome (PRIS)?
1. Cardiac muscle - HF 2. Skeletal muscle - Rhabdo 3. Liver 4. Pancreas
56
Why do some pts have green urine with propofol infusion syndrome (PRIS)?
Phenol excretion
57
Why is methadone a good choice for pts with chronic neuropathic pain?
It is an opioid analgesic with concurrent NMDA antagonistic properties Also provides serotonin reuptake
58
How does nitrous oxide affect pts with B12 deficiency? | What symptoms can get exacerbated?
Reacts with and inactivates B12 -> worsening B12 deficiency Megalobastic anemia Myelopathy Neuropathy Encephalopathy
59
Name the toxic inhalational reaction: Nitrous oxide: Methoxyflurane: Halothane:
Nitrous oxide: B12 deficiency Methoxyflurane: polyuric renal insufficiency Halothane: subclinical or fulminant hepatotoxicity
60
Max dose of bupivacaine | With and without epi
Without epi: 2.5 mg/kg With epi: 2.5 mg/kg
61
Max dose of chloroprocaine | With and without epi
Without epi: 11 mg/kg With epi: 14 mg/kg
62
1% drug = __mg/mL 2% drug = ___ mg/mL
10mg/mL 20mg/mL
63
Agents with a LOWER blood: gas partition coefficient will have a (faster/slower) onset and offset
FASTER - agent in the alveoli is also in the brain - hangs around longer
64
Agents with a HIGHER blood: gas partition coefficient will have a (faster/slower) onset and offset
SLOWER
65
A blood:gas partition coefficient of 10 means what?
[ ] of inhaled anesthetic is 10 in the blood, and 1 in the alveolar gas - high = slower onset and offset, slower induction and emergence
66
Why is epi first line tx in IgE mediated anaphylaxis?
stimulates alpha and beta receptors -> increasing SVR, CO, and bronchodilation Mast cell stabilizer -> reduces systemic histamine and thromboxane levels
67
When should you NOT redose the same anti-emetic?
if the first dose was < 6 hours prior
68
ASA MOA
potent COX inhibitor - prevent COX enzyme needed for production of prostaglandins (thromboxane A2, critical for platelet activation and thrombus formation)
69
Does ASA cause irreversible inhibition of COX?
Yes | - return of normal platelet occurs in 2-5 days
70
Glycopyrrolate causes (miosis/mydriasis)
Mydriasis - pupillary dilation * Anticholinergic drug - competitive antagonist of ACh
71
Cholinergic symptoms | - ie: acetylcholinesterase inhibitors, organophosphate poisoning (repeated receptor stimulation), nerve agents
SLUDGE-Mi "me" ``` Salivation Lacrimation Urination Defecation GI upset Emesis Miosis ```
72
Antimuscarinic drugs used in anesthesia:
atropine glycopyrrolate scopolamine
73
How does neostigmine affect a phase I block (std induction of sux)?
Augments it | - Increases the ED95
74
How does neostigmine affect a phase II block of sux?
Antagonizes it | *but unpredictable
75
The majority of anesthetic drugs/inhaled agents DECREASES lower esophageal sphincter tone. Which ones don't (increases)?
``` Succinylcholine Acetylcholinesterase inhibitors Antacids Some antiemetics - metoclopramide ```
76
Why is metoclopramide relatively contraindicated in pts with Parkinson's disease?
D2-receptor antagonism | - Worsen disease
77
Why does carbamazepine SHORTEN the effects of vecuronium?
It is metabolized by Cyt P450, and INDUCES P450 system | - Vec is metabolized by P450
78
Drugs that SHORTEN the effects of Non-depolarizing blockade
1. Anticonvulsants - phenytoin - Carbamazepine 2. Cholinesterase inhibitors - neostigmine
79
Drugs that PROLONG the effects of Non-depolarizing blockade
A lot (better to memorize the ones that shorten effects) 1. Abx 2. Antiarrhythmics 3. Dantrolene 4. Ketamine 5. Local anesthetics 6. Lithium 7. Magnesium 8. Volatile anesthetic agents 9. Hypocalcemia 10. Hypermagnesemia
80
Desflurane has a low blood gas partition coefficient of ____. Meaning ____
0. 42 - very little dissolved in tissues - Quick onset and termination of effects
81
How does Hypermagnesemia and lithium PROLONG the effects of Non-depolarizing blockade
Blocks calcium from entering alpha motor neurons -> preventing release of some ACh containing vesicles
82
What type of antiarrhythmic can exacerbate bronchospasm in pts with asthma?
Nonspecific (beta1 and beta2) beta-blockade
83
What are Morphine's active and inactive metabolites?
Active: Morphine-6-glucuronide Inactive: Morphine-3-glucuronide
84
What happens if morphine's active metabolite, M-6-G builds up?
Highly potent | - significant respiratory depression in renal failure d/t accumulation from delayed excretion
85
What happens if morphine's inactive metabolite, M-3-G builds up?
Neuroexcitatory effects - myoclonus - allodynia - seizures
86
What happens to barbiturates in the setting of renal and/or hepatic failure?
Decreased protein binding | - increased sensitivity d/t higher concentrations of free active molecules
87
How is mivacurium cleared?
hydrolyzed by pseudocholinesterase *very similar to succinylcholine
88
Meperidine molecule resembles what drug? What side effect is expected?
Atropine | - tachycardia
89
Diphenhydramine MOA
1. Antihistamine 2. Anticholinergic 3. SNRI 4. potentiates opioid induced analgesia
90
Chronic Dantrolene use is associated with ______.
Liver failure | - check LFT
91
Why does barium hydroxide absorbents produce more carbon monoxide than soda lime?
D/t decreased water content of hydroxide absorbents
92
What does ketamine increase?
``` CBF ICP CMRO2 IOP Salivation Lacrimation HR BP ```
93
Why shouldn't you give pts on digoxin Calcium if their K is severely high? (Dig can cause hyperK)
Digoxin inhibits Na-K ATPase -> inc intracellular Ca2+ to improve inotropy - if you give more Ca2+ -> lethal "stone heart"
94
Anaphylaxis is a type _____ hypersensitivity reaction
Type 1 - Antigens bind to IgE antibodies on mast cells and basophils - If activated -> Hypotension, bronchospasm, urticaria *NMBs most common offenders
95
What lab should you check in pts with suspected anaphylaxis?
Tryptase - released from mast cells when activated by IgE - half life is 2 hours
96
What are the causes of anaphylaxis in Amino ester LAs vs Amino amide LAs?
Esters: PABA Amides: Methylparaben preservative (structurally similar to PABA)
97
Metabolic derrangements associated with Thiazide diuretics
HYPO - Hypokalemia - Hypomagnesemia - Hyponatremia HYPER - Hypercalcemia - Hyperuricemia - Hyperglycemia - Hypercholesterolemia - Hypertriglyceridemia
98
Local anesthetics with lower pKa to physiologic pH will have more drug in which form?
Nonionized - more drug available for use *exception is 2-chloroprocaine with pKa of 9, works faster than bupi with pKa of 8, but that is d/t [ ] effect
99
Btwn desflurane, sevoflurane, isoflurane, which is the most lipid soluble? What is this d/t?
Isoflurane: 91 - lipid solubility aka oil:gas partition coefficient *Sevo is 47 Des is 19
100
Which one is correlated to the SPEED of onset and offset of an anesthetic, blood-gas partition coefficient or the oil:gas partition coefficient?
blood-gas partition coefficient Isoflurane >> sevoflurane > desflurane inversely proportional to speed of onset and offset Desflurane > sevoflurane >> isoflurane
101
Which one is correlated to the POTENCY of an anesthetic, blood-gas partition coefficient or the oil:gas partition coefficient?
lipid solubility aka oil:gas partition coefficient | Isoflurane (MAC 1) > sevoflurane (MAC 2) >> desflurane (MAC 6) >>> nitrous oxide (MAC 104)
102
Milrinone MOA
PDE III inhibitor, - inc intracellular cAMP lvls -> inc calcium stores -> inc cardiac inotropy and peripheral and pulmonary vasodilation *inodilator = Inotropy + vasodilation
103
The order of volatile anesthetic potentiation of NDNMBs?
Desflurane > sevo > iso > halothane > TIVA
104
All V/Q mismatch has which 2 effects on alveolar and arterial partial pressure?
1. INCREASES alveolar anesthetic partial pressure 2. DECREASES arterial anesthetic partial pressure *degree of change is dependent on the solubility of the inhalational agent
105
When perfusion is decreased (ie. reduced cardiac output, pulmonary embolism), what happens to the speed of induction of inhalational agent?
INCREASED - more so with soluble agents like isoflurane: - lipid solubility aka oil:gas partition coefficient of 91 - The rise of FA/FI is steeper with lower perfusion of the lungs
106
When ventilation is decreased (ie. intrapulmonary shunt), what happens to the speed of induction of inhalational agent?
DECREASED - more so with insoluble agents (desflurane) - lipid solubility aka oil:gas partition coefficient of 19
107
What is the efficacy of a drug?
The maximum effect produced by the drug, does not depend on dose - potency is not related to maximal effect at all
108
What is the potency of a drug?
POTENCY is the Relative dose required to achieve given effect (related to receptor affinity) - EFFICACY is the opposite and has nothing to do with dose
109
The difference between morphine and buprenorphine is based on (efficacy / potency)
efficacy (max effect of drug) - morphine is full agonist - buprenorphine is partial agonist
110
The difference between isoflurane and desflurane is based on (efficacy / potency)
potency (dose required to produce given effect)
111
Dextromethorphane MOA
Over the counter cough suppressant with NMDA antagonist properties - high doses = dissociative anesthetic
112
Drugs that have NMDA receptor antagonist properties
``` Ketamine Magnesium Nitrous oxide Methadone Tramadol Dextromethorphan ```
113
Most common problem with dobutamine?
tachyarrhythmias
114
Drug of choice to increase heart rate in a denervated heart
Isoproterenol - beta agonist *denervated heart cannot respond to antimuscarinic meds, needs direct agonism
115
Supplements assoc with inc risk of bleeding
Vit E GInger Ginko Garlic
116
What is Ma-huang herbal supplement used for and what adverse effects are assoc?
weight loss - herbal supplement of Ephedra plant - HTN, Palpitations, CVA, sz
117
Which drug can cause dose dependent inhibition of adrenal mitochondrial 11-B-hydroxylase?
Etomidate | - can cause adrenal cortisol suppression
118
Do you worry about nicardipine in renal failure or hepatic insufficiency?
Hepatic insufficiency | - prolonged half life
119
MOA of nicardipine
CCB - coronary and peripheral arterial dilator - antihypertensive in neurosurgical pts - does NOT decrease cardiac fxn - increases HR d/t sympathetic activation NOT baroreceptor response
120
What dose of magnesium do we expect to see QRS prolongation?
6-12 mg/dL - goal in obstetrics are 4.8-9.6 *nl levels are 1.8-2.5 mg/dL
121
Magnesium effects on NDMBs?
increases sensitivity - need to decrease dose - presynaptic CCB (prevents calcium release into synaptic cleft) -> less ACh to compete
122
Tx for hypermagnesemia (muscle weakness, respiratory depression, hypotension, bradycardia, prolong QRS)
IV calcium
123
Echothiophate MOA
anticholinesterase used to tx refractory glaucoma by causing miosis - can potentiate succinylcholine. May take 4-6 weeks after d/c to return to nl
124
Does bumex, spironolactone and amiloride cause hyperkalemia?
bumex - no, its used to tx hyperK Spironolactone and Amiloride - yes, blocks aldosterone -> hyperK
125
Do ACEi and ARBs cause hyperK or hypoK?
Hyperkalemia - inhibit angiotensin II -> prevents aldosterone formation *aldosterone acts on distal tubules and collecting ducts to increase Na/fluid retention and Inc K+ excretion
126
Concern regarding St. Johns wort (antidepressant)?
Cyt P450 inducer | - results in subtherapeutic drug levels, inc risk of transplant rejection (on cyclosporine), DVT (on warfarin)
127
Mivacurium is a NMB | - effects in pts with pseudocholinesterase / butyrylcholinesterase deficiency?
DOA is prolonged in pts with deficiency | - It is metabolized by pseudocholinesterase / plasma cholinesterase / butyrylcholinesterase
128
What are the most common variants in pts with pseudocholinesterase / butyrylcholinesterase deficiency
A and K variants
129
Succinylcholine is a NMB | - effects in pts with pseudocholinesterase / butyrylcholinesterase deficiency?
DOA is prolonged in pts with deficiency
130
Lorazepam and Oxazepam metabolism
Glucuronidation w/o any phase I metabolism | - less affected by age and renal disease
131
All Benzodiazepines undergo metabolism where?
in Liver either by: - Phase I metabolism (N-dealkylation or aliphatic hydroxylation) or - Phase II metabolism (glucuronidation or acetylation)
132
Midazolam and Diazepam metabolism
Hepatic oxidation-reduction | - clearance decreases with age
133
Barbiturates are (inducers/inhibitors) of cyt P450, drugs that undergo elimination via that system will require what sort of drug dosage adjustment?
INDUCERS increases in drug doses - note: phenytoin, rifampin, carbamazepine, ethanol are all P450 inducers
134
How is propofol metabolized?
Hepatic glucuronidation
135
How are ester local anesthetics metabolized?
Pseudocholinesterase
136
how is clonidine (alpha 2) helpful in post op period?
Pain control Reduce post op shivering Reduce PONV
137
How can you differentiate anaphylactic rxn vs anaphylactoid rxn?
You cannot - both histamine mediated Anaphylaxis: IgE mediated mast cell degranulation and histamine release Anaphylactoid: uncontrolled histamine release not involving IgE - Mast cell tryptase levels rise in both
138
Use of opioids as adjuncts for neuraxial anesthesia enhances block quality, density, and duration. - What side effects are greatly increased?
1. sedation 2. Respiratory depression 3. Pruritus 4. N/V** - Morphine (hydrophilic) > Fentanyl (lipophilic)
139
Dosing for sugammadex for 2 twitches? No twitches + 1-2 post-tetanic count? Immediate reversal after 1.2 mg/kg of roc?
2 twitches: 2 mg/kg No twitches + 1-2 post-tetanic count: 4mg/kg Immediate reversal after 1.2 mg/kg of roc: 16mg/kg
140
MOA and DOA of naloxone?
Opioid antagonist (competes for mu, kappa, sigma receptor) 30-60 min - renarcotization - better for rev. short acting opioids
141
Pts most at risk of emergence rxn receiving lg doses ketamine?
Older female with psych hx
142
Ketamine effect on ICP? CMRO2
Increases both | - avoid in head injury or intracranial mass lesions
143
Why is EMLA cream avoided in pts with methemoglobinemia or G6PD deficiency?
its a mixture of LA, likely d/t the prilocaine in the formula - oxidizes hemoglobin to methemoglobin
144
Contraindications to EMLA
1. Allergy to amide anesthetics 2. Concomitant class II anti-arrhythmics 3. COngenital or idiopathic methemoglobinemia 4. Infants < 12 mo getting tx w/ methemoglobin inducing agents
145
Where is nitric oxide produced?
Endothelial cells - vasodilatory - anti-aggregating fx on plts Immune cells - Cellular signaling and homeostasis - Immunomodulation bone marrow - mod pain response Pancreas - stim insulin release in pancreas *localized effects of nitric oxide at site of production determines its function
146
What is the clinical importance of volatile anesthetic metabolism?
It's relation to fluoride-induced nephrotoxicity Sevo (5%) > Iso (0.2%) > Des (<0.2%) Sevo undergoes the most metabolism -> highest elevation in fluoride (behind methoxyfluorane)
147
Dopamine receptor (agonists / antagonists) can lead to EPS
antagonists | - can prevent nausea
148
Should you be cautious prescribing meperidine in pts with Kidney or Liver failure?
Both - metabolized in liver - eliminated by both *CNS stimulant: tremors, twitches, sz
149
What is the partition coefficient of fentanyl vs morphine?
Fentanyl: 816 - faster onset Morphine: 1.4 *alfentanil is exception - 4x faster than fent, but d/t its lower pKA 6.5
150
Nicardipine causes _____ dilation, while nitroglycerin causes _____ dilation.
Arteriolar - spares preload Venous
151
Nesiratide and Sodium nitroprusside causes _______ vasodilation
Arteriolar AND venous | - decreases BOTH afterload and preload
152
___________ is a recombinant form of BNP and causes ______
Nesiritide vasodilation, natriuresis, and diuresis
153
What drugs are metabolized by the CYP450 3A4 enzyme?
1. alfentanil 2. midazolam 3. lidocaine 4. OCPs (think of the pain meds, OCP could also be anti-pain for pts with PCOS . . .) ST JOHN'S WORT induces 34A, so these drugs bcomes less efficacious
154
What drugs are metabolized by the CYP450 2C19 enzyme?
1. Clopidogrel 2. Prasugrel 3. PPIs 4. Antidepressants
155
What does metoclopramide and succinylcholine have in common?
Both INCREASES lower esophageal sphincter tone

Anesthesia based on Nebuchanedzzer II (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions