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Pharmacology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the maximum daily dose of gabapentin?

A

3600mg

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2
Q

What are the effect on HR and blood pressure by ketamine?

A

tachycardia and HTN

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3
Q

What is the most significant adverse effect of etomidate?

A

transient inhibition of adrenal steroid synthesis

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4
Q

What is the treatment for etomidate induced adrenal insufficiency?

A

100mg hydrocortisone IV push

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5
Q

What is the mechanism behind the etomidate induced adrenal insufficiency?

A

dose-dependent inhibition of 11 beta-hydroxylase
-can last 6 - 12hrs

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6
Q

What is the common symptom seen of etomidate induced adrenal insufficiency?

A

refractory hypotension even to vasopressors

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7
Q

At what dose does the dissociative state seen in ketamine occur?

A

IV 1-1.5mg/kg or IM 3-4mg/kg

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8
Q

What is the MOA of ketamine?

A

-noncompetitive N-methyl-D-aspartate (NMDA) and glutamate receptor antagonist
-blocks HCN1 receptors

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9
Q

How is ketamine metabolized?

A

via hepatic system by way of N-dealkylation, hydroxylation, conjugation, and dehydration

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10
Q

What is the half life of ketamine?

A

45min

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11
Q

What are contraindications for ketamine use?

A

anything where HTN would pose a risk
-aortic dissection
-uncontrolled HTN
-MI
-aneurysms
also
-pregnancy
-EtOH intoxication d/t additive sedation
-schizophrenia d/t exacerbation of underlying condition
-questionable if can be used in ICP elevation

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12
Q

What is first line treatment for hepatorenal syndrome?

A

midodrine
-want a systemic vasoconstrictor

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13
Q

What is the most common resistance factor to carbapenem antibiotic?

A

Klebsiella pneumoniae carbapenemase (KPC)

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14
Q

What is first line for treating agitation in the elderly patient?

A

haloperidol
-has minimal sedating effects

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15
Q

What is the effect of nitroprusside?

A

potent vasodilator of both arteries and veins
-acts quickly
-good for lower systemic vascular resistance quickly

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16
Q

What are the indications for nitroprusside use?

A

-tx of acute decompensated heart failure
-management of HTN crises
-controlled hypotension during surgery
-(off label) tx of HTN in acute ischemic stroke
-(off label) medical management of acute mitral regurg in preparation for surgery

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17
Q

With what should amniocaproic acid be diluted with?

A

250mL NS, 5% dextrose, or LR

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18
Q

What are the two classes of DOACs and give examples of each.

A

-direct Xa inhibitors (rivaroxaban/xarelto, apixaban/eliquis, edoxaban, betrixaban/bevyxxa)
-direct thrombin inhibitors (dabigatran/pradaxa)

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19
Q

What 3 beta-blockers have been shown to be beneficial in heart failure?

A

-bisopropol
-metoprolol succinate (not tartrate)
-carvedilol

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20
Q

Which beta-blocker for heart failure is best for pts w/ concomitant COPD (highest FEV1 w/ fewest adverse effects)?

A

bisopropol

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21
Q

Which beta-blocker for heart failure is worst for pts w/ concomitant COPD (lowest FEV1)?

A

carvedilol

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22
Q

What is the MOA of furosemide?

A

inhibits Na reabsorption via Na-K-Cl cotransporter in the loop of Henle

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23
Q

What is the intracellular penetration, distribution, and excretion method of hydrophilic drugs?

A

-low intracellular penetration
- limited distribution
-renally excreted

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24
Q

What is the intracellular penetration, distribution, and excretion method of lipophilic drugs?

A

-high intracellular penetration
-extensive distribution
-hepatically excreted

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25
Q

What are examples of hydrophilic antibiotics?

A
  • beta-lactams
  • aminoglycosides
  • vancomycin
  • colistin
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26
Q

What are examples of lipophilic antibiotics?

A
  • fluoroquinolones
  • linezolid
  • tigecycline
  • lincosamides (clindamycin)
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27
Q

What is the definition of MIC?

A

minimum inhibitory concentration
-lowest serum concentration of an abx that is required to inhibit visible growth of bacteria

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28
Q

What is a “time-dependent” antibiotic?

A

once that depends on the amount of time that the drug concentration is > MIC
-i.e. beta-lactams

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29
Q

What is a “concentration-dependent” antibiotic?

A

one that depends on how high the concentration is above MIC
-exactly how much above is drug dependent

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30
Q

What needs to be considered in dosing drugs during early sepsis?

A

Vd is increased in early sepsis

31
Q

What is bioavailability?

A

proportion of drug that reaches the systemic circulation when given not IV
-IV is always 100%

32
Q

What affects bioavailability?

A

-intestinal absorption
-first pass effect of hepatic metabolism

33
Q

What is the volume of distribution?

A

-Vd
-amount of drug in the body in relation to a simultaneously occurring drug concentration in plasma, blood, or other fluid at an identical time

34
Q

What determines the loading dose of a drug?

A

Vd

35
Q

What affects the Vd of water soluble drugs?

A

increases Vd and lowers concentration:
-edema
-ascites
-infection

decreases Vd and increases concentration:
-hypovolemia
-muscle wasting

36
Q

What determines a drug’s maintenance dose?

A

pharmokinetics

37
Q

What enzymes are increased by alcohol? Decreased? Which drugs potentiate this?

A

-alcohol increases: CYP2E1 and P4A
-alcohol decreases: glutathione synthesis
-potentiated by: isoniazid, acetaminophen, cocaine, methotrexate, vit A

38
Q

Which step of hepatic metabolism creates the majority of active and potentially toxic metabolites?

A

phase 1

39
Q

What is phase 1 of hepatic metabolism?

A

transforms lipophilic molecules into hydrophilic using p450 enzymes

40
Q

What is phase 2 of hepatic metabolism?

A

conjugation of metabolites

41
Q

What medications reduce the actions of phase 2 of hepatic metabolism?

A

-chlorpromazine
-valproate

42
Q

What is phase 3 of hepatic metabolism?

A

transport of metabolites across the membrane and into the bile

43
Q

What medications inhibit phase 3 of hepatic metabolism? Increase it?

A

inhibit:
-atorvastatin
-clarithromycin
-carvedilol
-sertraline

increase it:
-amiodarone
-diltiazem
-erythromyin

44
Q

What are risk factors for altered drug metabolism?

A

-renal impairment
-hepatic impairment
-obesity (> 30)
-advanced age (>65)
-critical illness

45
Q

What are the most common medications that have active or toxic metabolites requiring renal clearance (so very careful w/ renal impairment)?

A

-morphine
-meperidine
-nitroprusside
-tramadol
-dapsone
-procainamide
-ACEIs

-aminoglycosides
-vanco
-cephalosporins
-carbapenems
-aztreonam

46
Q

What analgesic medications require dose adjustments in hepatic failure?

A

-acetaminophen
-NSAIDs (avoid d/t portal HTN gastropathy and decreased renal function)
-morphine
-methadone
-benzodiazepines

47
Q

What type of anticoagulation (other than enoxaparin) should be avoided in CP class B and C?

A

direct oral anticoagulants
-if argatroban is required carefully measure factor IIa levels and hepatically dose

48
Q

How many half lives are required before a medication is said to be in steady state?

A

5

49
Q

Why should ACE inhibitors be avoided in renal impairment?

A

inhibit afferent arteriole dilation and can worsen renal hypoperfusion

50
Q

Why should NSAIDs be avoided in renal impairment?

A

inhibit prostaglandin synthesis and causes vasoconstriction

51
Q

What is the estimated CrCl during CRRT that should be used to dose medications?

A

15-25%

52
Q

Why do medication dose adjustments need to be considered in obesity?

A

-increased blood volume leading to increased cardiac output, splanchnic flow, and hepatic flow
-a/w fatty liver disease and leading to decreased CYP3A function and decreased CYP2E1 function
-bioavailability is often altered
-volume of distribution is altered

53
Q

What changes are seen in >65 yrs that can require dose adjustments?

A

-decreased cardiac reserve
-increased blood pressure
-decreased vascular compliance (dec. BP)
-loss of myocardial contractility
-decreased vagal tone
-LV hypertrophy

54
Q

What changes are seen in critically ill that can require dose adjustments?

A

-3rd spacing of fluids (incr. Vd)
-protein synthesis decreases (esp. susceptible is lidocaine, dilatiazem, milrinone, propranolol, nicardipine. fentanyl, and phenytoin)
-on things like vasopressors which decrease hepatic flow; nitroglycerine increases hepatic flow; dobutamine increases CO

55
Q

What type of antipyschotic is haloperidol and are its adverse effects?

A

-typical
-akathisia
-dystonia
-Parkinsonism

has minimal vital sign changes

56
Q

What is the half life in hours of haloperidol?

A

12-36

57
Q

What type of antipyschotic is olanzapine and are its adverse effects?

A

Zyprexa
-atypical

-akathisia
-Parkinsonism
-can worsen DM

58
Q

What type of antipyschotic is quetiapine and are its adverse effects?

A

Seroquel
-atypical

-agitation
-severe orthostatic hypotension

the one to use of pt has Parkinson’s

59
Q

What type of antipyschotic is risperidone and are its adverse effects?

A

-atypical

-Parkinsonism
-severe orthostatic hypotension

60
Q

What type of antipyschotic is aripiprazole and are its adverse effects?

A

Ability
-atypical

-akathisia
-agitation
-moderate orthostatic hypotension
-can cause hypoactive delirium

61
Q

What is the half life in hours of olanzapine?

A

21-54

62
Q

What is the half life in hours of quetiapine?

A

6

63
Q

What is the half life in hours of risperidone?

A

20

64
Q

What is the half life in hours of aripiprazole?

A

75

65
Q

What type of drug is ondansetron?

A

zofran

serotonin receptor (5HT3) antagonist

66
Q

What is the antiemetic dosing of dexamethasone?

A

4-10mg IV after induction for PONV

67
Q

What type of drug is droperidol and its MOA?

A

butyrophenone (antipsychotic) but can be used for severe n/v or PONV

Largely unknown seems to stem from potent dopamine receptor antagonism. Also has minor effects on alpha-1 adrenergic receptors

68
Q

What type of drug is aprepitant?

A

Neurokinin (NK-1) receptor antagonists

69
Q

What type of drug is scoplamine and what are its adverse effects?

A

Anticholinergic

-dizziness
-dry mouth
-visual

70
Q

What type of drug is metoclopramide and what are its adverse effects?

A

Dopamine antagonists

-sedation
-hypotension

71
Q

What are the signs/symptoms of propofol infusion syndrome?

A

-metabolic acidosis
-hyperkalemia
-hyperlipidemia
-rhabdomyolysis
-arrhythmias
-bradycardia/decreased myocardial contractility/asystole
-renal failure

72
Q

What are the risk factors for propofol infusion syndrome?

A

-prolonged infusion/high dose
-young age
-critical illness
-excess lipid state
-corticosteroid use
-inborn errors in metabolism

73
Q

Which benzodiazepine does not create active metabolites and is not cleared hepatically?

A

lorazepam

74
Q

Which benzodiazepine is short acting?

A

midazolam

Pharmacology (5 decks)

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