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Pharmacology Flashcards

1
Q

CSF absorption requires lipid soluble vs insoluble? ionized vs nonionized?

A

lipid-soluble. nonionized.

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2
Q

how many half lives to reach steady state?

A

5.

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3
Q

meaning of tachyphylaxis?

A

tolerance after only a few doses.

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4
Q

drug metabolism via liver p450.

A

phase I. demthy/ox/redux/hydrol reactions… NADPH/oxygen required.
phase II. glucuronic acid and sulfates attach to make water soluble

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5
Q

p450 inhibitors

A

cimetidine, isoniazid, ketoconazle, erythromycin, cipro, flagyl, allopurinol, verapamil, amiodarone, MAOIs, disulfuram

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6
Q

p450 inducers

A

cruciform vegetables, ETOH, cigarettes, phenobarbital, phenytoin, theophylline, warfarin

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7
Q

urate crystals on microscopy

A

negative birefringent (yellow, needle shaped)

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8
Q

podagra?

A

1st MTP joint gout; MC area effected.

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9
Q

colchicine MOA

A

binds tubulin and inhibits migration CHEMOTAXIS of WBC in gout

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10
Q

allopuriol MOA

A

xanthine oxidase inhibitor; blocks urate from xanthine.

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11
Q

probenecid MOA gout

A

increase renal secretion of uric acid.

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12
Q

niacin MOA

A

inhibits cholesterol synthesis; can cause FLUSHING.

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13
Q

statin MOA

A

HMG COA REDUCTASE INHIBITOR

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14
Q

alvimopan MOA

A

binds and inhibits mu-opioid receptor for postop ileus.

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15
Q

zofran MOA

A

serotonin (central) receptor inhibitor.

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16
Q

promethazine and metoclopramide MOA

A

DA receptors; increase gastric and gut mobility

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17
Q

what agent improves survival in CHF?

A

ACEi

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18
Q

what agent improves survival after MI?

A

Bblocker.

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19
Q

highest MAC?

A

nitrous oxide NO2; low potency = high MAC = fastest!

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20
Q

malignant hyperthermia MOA?

A

ryanodine receptor defect… mucsle excitation from Ca release
after succinylcholine (IRREVERSIBLE).

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21
Q

malignant hyperthermia sx?

A

increased end tidal, fever, tachycardia, rigidity, acidosis, hyperkalemia, rhabdomyolysis

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22
Q

mgmt malignant hyperthermia?

A

dantrolene (10 mg/kg) inhibiting Ca release and decouples complex
cool, bicarb
glucose
supportive care.

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23
Q

succinylcholine and hyperkalemia

A

causes more; (depol = release K)
so avoid in: burn, neurologic injury, neuromusclar disorders, SCInjury, trauma, renal failure)

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24
Q

Hoffman effect?

A

degradation of drug in blood spontaneously.
nimbex.

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25
metabolism of rocuronium, vec, pan
roc/vec: hepatic pan: renal
26
nondepol MOA
compete with ACh
27
reverse nondepolarizing roc?
sugammadex: selective binding to paralytic.... to reverse roc and vec neostigmine/edrophonium: block Achase to increase ACh. with atropine/glycopyrrolate to reverse overwhelming ACh.
28
MOA local
increase action potential threshold preventing Na influx into neuron
29
dose of local anesthetic?
0.5 cc/kg of 1% lidocaine.
30
max dosing lido and bup
lido 4 mg/kg bup 2 mg/kg
31
SE of meperidine demerol?
tremors, fasciculations, seizures (normeperidine) avoid in RENAL FAILURE. but it also is used to treat postop shaking
32
contraindication to epidural and spinal anesthesia?
hypertrophic cardiomyopathy, cyanotic heart disease (sympathetic denervation can cause decreased afterload which worsens conditions).
33
epidural location for different thoracotomy vs laparotomy?
thoracotomy: T6-T9 laparotomy: T8-T10. T5 = affects cardiac accelerator nerves
34
spinal anesthesia location?
L2 to avoid spinal cord (subarachnoid)
35
LR composition
Na 130 K 4 Ca 2.7 Cl 109 lactate 28 (converts to HCO3- in body though)
36
NS vs HTS?
Na 154 ... 513 Cl 154 ... 513
37
calculate plasma osmolarity?
2Na + glucose/18 + BUN/2.8. normal 280-295.
38
fluid loss in major abdominal operations?
0.5-1L/hr.
39
gastrointestinal losses by organ per day?
stomach 1-2L biliary system 0.5-1L pancreas 0.5-1L duo 0.5-1L
40
hyponatremia
FW restriction and NS no more than 1 mEq/hr (8 per day) otherwise central pontine myelinosis
41
DI
decreased ADH... lots of diluted urine, hypernatremic, high serum osm etiology: head injury treat: DDAVP (or free water if chronic)
42
SIADH
increased ADFH... minimal concentrated urine, hyponatremic, low serum osm etiology: head injury, carbamazepine, SSRI, cyclophosphamid, cipro, haldol, amiodarone, vincristine, vinblastine, cisplatin, bromocriptine treat: conviaptan, tolvaptan chronic: slow diuresis and fluid restriction
43
protein adjustment for calcium
for every 1 g decrease in protein, add 0.8 to Ca
44
vit D metabolism
made in skin 7DHC to cholecalciferol goes to liver for 25 OH and then kidney for 1 OH (active)
45
flumazenil dosing
0.2 mg over 30 seconds repeat up to 3 mg
46
hofman elimination
not cleared by liver
47
renal excretion narcotics
yes: morphine, oxy, tramadol, hydrocodone no: dilaudid = hydromorphone, fentanyl, sufentanil,
48
spinal anesthesai
into intrathecal space
49
vasopressin receptor
V1 vasoconstrict and inhibit NO release via IL-1 and NO synthease
50
where is tetracycline and heavy metals stored
BONE
51
0 order kinetics
CONSTANT amount eliminated regardless of dose
52
1st order kindetics
drug eliminated proportional to DOSE
53
how many half lives tilsteady state
5
54
metyrapone and aminoglutethimide
inhibit adrenal steroid synthesis in adrenocortical carcinoma
55
leuprolide
GnRH and LHRH analogues inhibit LH and FSH release from pituitary.... for metastatic prostate ca
56
tamsulosin
alpha-receptor ANTAGONIST for BPH
57
misoprostol
PGE1 deriviative; PGE1 is GOOD! so protective prostaglandin..... decrease PUD, consider in chronic NSAID use that is causing ulcers
58
halothane
SLOW on/off... HIGH cardiac depression. smells good though. SE: halothane hepatitis... fever, eosinophilia, jaundice
59
isoflurane
for NSY... pungent decrease brain O2 consumption
60
sevo
good for mask; fast. less laryngospasm
61
enflurane
causes seizures
62
MAC and potency
small MAC = more lipid soluble = MORE potent
63
speed of induction goes up with solubility
so high MAC = less soluble = fast induction
64
propofol metabolism
liver & pseudocholinesterases
65
esters vs amides allergy
esters (I at the end only) ....cause allergy from PABA analogue
66
versed in pregnancy
aVOID; crosses placenta
67

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