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ABA Basic Exam > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What are the phase I reactions in hepatic metabolism?

A

oxidation reduction hydrolysis

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2
Q

What are the phase II reactions in hepatic metabolism?

A

glutathione conjugation sulfation acetylation glucuronidation

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3
Q

How does blood flow affect extraction ratio?

A

For drugs with high intrinsic clearance, extraction ratio is nearly independent of blood flow. For drugs with low intrinsic clearance, extraction ration is inversely proportional to blood flow.

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4
Q

Should drugs with a high or low extraction ratio be adjusted for low liver blood flow states?

A

high extraction ratio

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5
Q

Should drugs with a high or low extraction ratio be adjusted for liver failure?

A

low extraction ratio

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6
Q

What is context dependent half-life?

A

The longer you infuse a drug, its half-life steadily rises to approach the elimination half-life.

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7
Q

Name some drugs that show tachyphylaxis.

A

ephedrine nitroglycerine opioids local anesthetics dobutamine hydralazine

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8
Q

What drugs most commonly cause anaphylactic reactions?

A

muscle relaxants latex barbiturates antibiotics local anesthetics (esters >> amides)

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9
Q

What patient factors increase MAC?

A

hyperthermia chronic etOH use increased catechol levels daytime cocaine use

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10
Q

What patient factors decrease MAC?

A

hypothermia pregnancy hypotension hypoxemia acute etOH use nighttime

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11
Q

What is the Meyer-Overton correlation?

A

linearly decreasing potency of anesthetic agents with increasing lipophilicity

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12
Q

Which anesthetic agents have the fastest rate of rise of FA/FI (fastest to slowest)?

A

nitrous oxide desflurane sevoflurane isoflurane

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13
Q

What is the effect of a R to L shunt on speed on inhaled induction?

A

slows induction

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14
Q

What is the effect of a L to R shunt on speed on inhaled induction?

A

no effect on its own but can attenuate the slowing of induction caused by a co-existing R to L shunt

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15
Q

What is the concentration effect?

A

Nitrous oxide is taken up so quickly into the blood stream that a void is created in the alveolus that draws in more fresh gas and increases the rate of rise of FA/FI.

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16
Q

What is the second gas effect?

A

When another anesthetic gas is used in the presence of nitrous oxide, the rate of rise of its FA/FI is faster as rapid uptake of nitrous oxide concentrates the remaining gases in the alveolus.

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17
Q

Which inhaled anesthetic best preserves SVR?

A

halothane

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18
Q

What are the predominant respiratory effects of inhaled anesthetics?

A

decreased tidal volume and increased respiratory rate decreased PaCO2 responsiveness increased dead space decreased FRC

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19
Q

What is the effect of inhaled anesthetics on NMBs?

A

potentiate the activity of both classes of NMBs

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20
Q

What is the effect of nitrous oxide on the pulmonary vasculature?

A

increase PVR

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21
Q

What kind of hepatic toxicity is caused by inhaled anesthetics?

A

immune-mediated centriobular necrosis

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22
Q

Which inhaled anesthetic agents release the most fluoride ion?

A

methoxyflurane >> enflurane > sevoflurane > isoflurane = desflurane = halothane

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23
Q

What problem can arise from dried CO2 adsorbent? (“First case Monday morning effect”)

A

carbon monoxide production

24
Q

What is the recommended exposure limit for inhaled anesthetics?

A

25 ppm per hour for nitrous oxide 2 ppm per hour for all others

25
Q

What are the cardiovascular side effects of barbiturates?

A

decreased CO and MAP venous pooling decreased sympathetic output

26
Q

Which IV anesthetics should not be used in patients with porphyria?

A

methohexital thiopental

27
Q

What are the undesirable side effects of etomidate?

A

adrenal suppression (11-beta hydroxylase inhibition) nausea/vomiting thrombophlebitis/pain at injection site

28
Q

What are the cardiovascular effects of ketamine?

A

releases endogenous catecholamines to increase CO, HR, SVR direct cardiac depressant if endogenous catecholamines are depleted

29
Q

What are the respiratory effects of ketamine?

A

bronchodilator - good for refractory asthma

30
Q

What is propofol infusion syndrome?

A

associated with 4 mg/kg/h infusion for >48 h refractory bradycardia, metabolic acidosis, rhabdomyollysis, and fatty liver

31
Q

What happens to CO2 responsiveness with Precedex?

A

preserved

32
Q

What are the cardiovsacular effects of Precedex?

A

initial HTN with bolus then reduced HR, SVR, and CO

33
Q

What are the side effects of scopolamine?

A

Blurred vision, dizziness, dried mouth, agitation

34
Q

Which serum proteins bind most drugs?

A

albumin binds acidic drugs alpha-1 glycoprotein binds basic drugs

35
Q

Which opioid effects are associated with Mu1 receptors?

A

euphoria and urinary retention

36
Q

Which opioid effects are associated with Mu2 receptors?

A

hypoventilation, constipation, physical dependence

37
Q

Which opioid receptors are associated with dysphoria?

A

delta and sigma

38
Q

Which opioids cause significant histamine release?

A

morphine and meperidine - can cause bronchospasm

39
Q

Which opioid can cause tachycardia?

A

meperidine - similar structure to atropine

40
Q

Which opioid effects do not show tolerance?

A

miosis and constipation

41
Q

What is the target of neuraxial opioids?

A

mu receptors in the substantia gelatinosa that inhibit the release of substance P

42
Q

How is remifentanil metabolized?

A

plasma esterases

43
Q

Which opioid is also an NMDA antagonist?

A

methadone

44
Q

Which drugs can prolong the action of non-depolarizing NMBs?

A

Ca channel blockers local anesthetics volatile anesthetics ketamine aminoglycosides lithium

45
Q

Which electolyte abnormalities can prolong the action of non-depolarizing NMBs?

A

hypernatremia hypokalemia hypocalcemia

46
Q

Metabolism of which NMBs produces laudanosine and lowers seizure threshold?

A

atracurim and cis-atracurium

47
Q

What is the dibucaine number of normal pseudocholinesterase? Atypical pseudocholinesterase?

A

Normal: 80 Atypical: 20

48
Q

What conditions decrease plasma esterase concentration and prolong succinylcholine’s effects?

A

Drugs (metoclopramide, esmolol, OCPs) liver failure pregnancy hypothermia

49
Q

Why does diazepam have such a long duration of action despite its quick onset?

A

Diazepam has two active metabolites, oxazepam and desmethyldiazepam, that extend its duration of action

50
Q

Which benzodiazepine does not have active metabolites?

A

Lorazepam

51
Q

Which drugs may prolong the sedative effects of midazolam?

A

Erythromycin, calcium channel blockers, protease inhibitors, and grapefruit juice

52
Q

Which food allergies are associated with latex allergy?

A

Avocado, banana, mango, kiwi, passion fruit, chestnut

53
Q

What is the timing of allergic reactions to latex?

A

More than 30 min after exposure

54
Q

What is ritodrine and how is it commonly used?

A

a selective beta-2 agonist as a tocolytic

55
Q

What is the dosing of 20% intralipid?

A

Bolus 1.5 mg/kg Infuse 0.25 mL/kg/min

ABA Basic Exam (17 decks)

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