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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
What are examples of hydrophilic antibiotics?
- beta-lactams - aminoglycosides - vancomycin - colistin
26
What are examples of lipophilic antibiotics?
- fluoroquinolones - linezolid - tigecycline - lincosamides (clindamycin)
27
What is the definition of MIC?
minimum inhibitory concentration -lowest serum concentration of an abx that is required to inhibit visible growth of bacteria
28
What is a "time-dependent" antibiotic?
once that depends on the amount of time that the drug concentration is > MIC -i.e. beta-lactams
29
What is a "concentration-dependent" antibiotic?
one that depends on how high the concentration is above MIC -exactly how much above is drug dependent
30
What needs to be considered in dosing drugs during early sepsis?
Vd is increased in early sepsis
31
What is bioavailability?
proportion of drug that reaches the systemic circulation when given not IV -IV is always 100%
32
What affects bioavailability?
-intestinal absorption -first pass effect of hepatic metabolism
33
What is the volume of distribution?
-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
What determines the loading dose of a drug?
Vd
35
What affects the Vd of water soluble drugs?
increases Vd and lowers concentration: -edema -ascites -infection decreases Vd and increases concentration: -hypovolemia -muscle wasting
36
What determines a drug's maintenance dose?
pharmokinetics
37
What enzymes are increased by alcohol? Decreased? Which drugs potentiate this?
-alcohol increases: CYP2E1 and P4A -alcohol decreases: glutathione synthesis -potentiated by: isoniazid, acetaminophen, cocaine, methotrexate, vit A
38
Which step of hepatic metabolism creates the majority of active and potentially toxic metabolites?
phase 1
39
What is phase 1 of hepatic metabolism?
transforms lipophilic molecules into hydrophilic using p450 enzymes
40
What is phase 2 of hepatic metabolism?
conjugation of metabolites
41
What medications reduce the actions of phase 2 of hepatic metabolism?
-chlorpromazine -valproate
42
What is phase 3 of hepatic metabolism?
transport of metabolites across the membrane and into the bile
43
What medications inhibit phase 3 of hepatic metabolism? Increase it?
inhibit: -atorvastatin -clarithromycin -carvedilol -sertraline increase it: -amiodarone -diltiazem -erythromyin
44
What are risk factors for altered drug metabolism?
-renal impairment -hepatic impairment -obesity (> 30) -advanced age (>65) -critical illness
45
What are the most common medications that have active or toxic metabolites requiring renal clearance (so very careful w/ renal impairment)?
-morphine -meperidine -nitroprusside -tramadol -dapsone -procainamide -ACEIs -aminoglycosides -vanco -cephalosporins -carbapenems -aztreonam
46
What analgesic medications require dose adjustments in hepatic failure?
-acetaminophen -NSAIDs (avoid d/t portal HTN gastropathy and decreased renal function) -morphine -methadone -benzodiazepines
47
What type of anticoagulation (other than enoxaparin) should be avoided in CP class B and C?
direct oral anticoagulants -if argatroban is required carefully measure factor IIa levels and hepatically dose
48
How many half lives are required before a medication is said to be in steady state?
5
49
Why should ACE inhibitors be avoided in renal impairment?
inhibit afferent arteriole dilation and can worsen renal hypoperfusion
50
Why should NSAIDs be avoided in renal impairment?
inhibit prostaglandin synthesis and causes vasoconstriction
51
What is the estimated CrCl during CRRT that should be used to dose medications?
15-25%
52
Why do medication dose adjustments need to be considered in obesity?
-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
What changes are seen in >65 yrs that can require dose adjustments?
-decreased cardiac reserve -increased blood pressure -decreased vascular compliance (dec. BP) -loss of myocardial contractility -decreased vagal tone -LV hypertrophy
54
What changes are seen in critically ill that can require dose adjustments?
-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
What type of antipyschotic is haloperidol and are its adverse effects?
-typical -akathisia -dystonia -Parkinsonism has minimal vital sign changes
56
What is the half life in hours of haloperidol?
12-36
57
What type of antipyschotic is olanzapine and are its adverse effects?
Zyprexa -atypical -akathisia -Parkinsonism -can worsen DM
58
What type of antipyschotic is quetiapine and are its adverse effects?
Seroquel -atypical -agitation -severe orthostatic hypotension the one to use of pt has Parkinson's
59
What type of antipyschotic is risperidone and are its adverse effects?
-atypical -Parkinsonism -severe orthostatic hypotension
60
What type of antipyschotic is aripiprazole and are its adverse effects?
Ability -atypical -akathisia -agitation -moderate orthostatic hypotension -can cause hypoactive delirium
61
What is the half life in hours of olanzapine?
21-54
62
What is the half life in hours of quetiapine?
6
63
What is the half life in hours of risperidone?
20
64
What is the half life in hours of aripiprazole?
75
65
What type of drug is ondansetron?
zofran serotonin receptor (5HT3) antagonist
66
What is the antiemetic dosing of dexamethasone?
4-10mg IV after induction for PONV
67
What type of drug is droperidol and its MOA?
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
What type of drug is aprepitant?
Neurokinin (NK-1) receptor antagonists
69
What type of drug is scoplamine and what are its adverse effects?
Anticholinergic -dizziness -dry mouth -visual
70
What type of drug is metoclopramide and what are its adverse effects?
Dopamine antagonists -sedation -hypotension
71
What are the signs/symptoms of propofol infusion syndrome?
-metabolic acidosis -hyperkalemia -hyperlipidemia -rhabdomyolysis -arrhythmias -bradycardia/decreased myocardial contractility/asystole -renal failure
72
What are the risk factors for propofol infusion syndrome?
-prolonged infusion/high dose -young age -critical illness -excess lipid state -corticosteroid use -inborn errors in metabolism
73
Which benzodiazepine does not create active metabolites and is not cleared hepatically?
lorazepam
74
Which benzodiazepine is short acting?
midazolam

Pharmacology (5 decks)

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