Pharmacology

Question 1

What are the phase I reactions in hepatic metabolism?

Answer 1

oxidation reduction hydrolysis

Question 2

What are the phase II reactions in hepatic metabolism?

Answer 2

glutathione conjugation sulfation acetylation glucuronidation

Question 3

How does blood flow affect extraction ratio?

Answer 3

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.

Question 4

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

Answer 4

high extraction ratio

Question 5

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

Answer 5

low extraction ratio

Question 6

What is context dependent half-life?

Answer 6

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

Question 7

Name some drugs that show tachyphylaxis.

Answer 7

ephedrine nitroglycerine opioids local anesthetics dobutamine hydralazine

Question 8

What drugs most commonly cause anaphylactic reactions?

Answer 8

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

Question 9

What patient factors increase MAC?

Answer 9

hyperthermia chronic etOH use increased catechol levels daytime cocaine use

Question 10

What patient factors decrease MAC?

Answer 10

hypothermia pregnancy hypotension hypoxemia acute etOH use nighttime

Question 11

What is the Meyer-Overton correlation?

Answer 11

linearly decreasing potency of anesthetic agents with increasing lipophilicity

Question 12

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

Answer 12

nitrous oxide desflurane sevoflurane isoflurane

Question 13

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

Answer 13

slows induction

Question 14

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

Answer 14

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

Question 15

What is the concentration effect?

Answer 15

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.

Question 16

What is the second gas effect?

Answer 16

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.

Question 17

Which inhaled anesthetic best preserves SVR?

Answer 17

halothane

Question 18

What are the predominant respiratory effects of inhaled anesthetics?

Answer 18

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

Question 19

What is the effect of inhaled anesthetics on NMBs?

Answer 19

potentiate the activity of both classes of NMBs

Question 20

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

Answer 20

increase PVR

Question 21

What kind of hepatic toxicity is caused by inhaled anesthetics?

Answer 21

immune-mediated centriobular necrosis

Question 22

Which inhaled anesthetic agents release the most fluoride ion?

Answer 22

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

Question 23

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

Answer 23

carbon monoxide production

Question 24

What is the recommended exposure limit for inhaled anesthetics?

Answer 24

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

Question 25

What are the cardiovascular side effects of barbiturates?

Answer 25

decreased CO and MAP venous pooling decreased sympathetic output

Question 26

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

Answer 26

methohexital thiopental

Question 27

What are the undesirable side effects of etomidate?

Answer 27

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

Question 28

What are the cardiovascular effects of ketamine?

Answer 28

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

Question 29

What are the respiratory effects of ketamine?

Answer 29

bronchodilator - good for refractory asthma

Question 30

What is propofol infusion syndrome?

Answer 30

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

Question 31

What happens to CO2 responsiveness with Precedex?

Answer 31

preserved

Question 32

What are the cardiovsacular effects of Precedex?

Answer 32

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

Question 33

What are the side effects of scopolamine?

Answer 33

Blurred vision, dizziness, dried mouth, agitation

Question 34

Which serum proteins bind most drugs?

Answer 34

albumin binds acidic drugs alpha-1 glycoprotein binds basic drugs

Question 35

Which opioid effects are associated with Mu1 receptors?

Answer 35

euphoria and urinary retention

Question 36

Which opioid effects are associated with Mu2 receptors?

Answer 36

hypoventilation, constipation, physical dependence

Question 37

Which opioid receptors are associated with dysphoria?

Answer 37

delta and sigma

Question 38

Which opioids cause significant histamine release?

Answer 38

morphine and meperidine - can cause bronchospasm

Question 39

Which opioid can cause tachycardia?

Answer 39

meperidine - similar structure to atropine

Question 40

Which opioid effects do not show tolerance?

Answer 40

miosis and constipation

Question 41

What is the target of neuraxial opioids?

Answer 41

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

Question 42

How is remifentanil metabolized?

Answer 42

plasma esterases

Question 43

Which opioid is also an NMDA antagonist?

Answer 43

methadone

Question 44

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

Answer 44

Ca channel blockers local anesthetics volatile anesthetics ketamine aminoglycosides lithium

Question 45

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

Answer 45

hypernatremia hypokalemia hypocalcemia

Question 46

Metabolism of which NMBs produces laudanosine and lowers seizure threshold?

Answer 46

atracurim and cis-atracurium

Question 47

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

Answer 47

Normal: 80 Atypical: 20

Question 48

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

Answer 48

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

Question 49

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

Answer 49

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

Question 50

Which benzodiazepine does not have active metabolites?

Answer 50

Lorazepam

Question 51

Which drugs may prolong the sedative effects of midazolam?

Answer 51

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

Question 52

Which food allergies are associated with latex allergy?

Answer 52

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

Question 53

What is the timing of allergic reactions to latex?

Answer 53

More than 30 min after exposure

Question 54

What is ritodrine and how is it commonly used?

Answer 54

a selective beta-2 agonist as a tocolytic

Question 55

What is the dosing of 20% intralipid?

Answer 55

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