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Anesthesia Written Board Questions > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What antiemetic should MOST be avoided in patients undergoing assisted reproductive therapy?

A

Metoclopramide

Along with droperidol, metoclopramide is avoided in the assisted reproductive therapy population because it can cause increased prolactin levels. High prolactin levels have been shown to impair follicle maturation and corpus luteum function, decreasing the likelihood of a successful reproductive outcome.

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2
Q

The highest serum fluoride levels are seen following the administration of which volatile anesthetic?

A

Sevoflurane

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3
Q

How is mivacurium metabolized?

A

It undergoes hydrolysis by plasma cholinesterase at a rate equivalent to 88% that of succinylcholine

It therefore, would have a prolonged duration of action in a patient who is homozygous for atypical plasma cholinesterase

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4
Q

What are the common side effects of anticholinergics?

A

Hot as a hare: increased body temperature
Blind as a bat: mydriasis (dilated pupils)
Dry as a bone: dry mouth, dry eyes, decreased sweat
Red as a beet: flushed face
Mad as a hatter: delirium

Decreased intestinal motility and peristalsis (constipation)
Lower esophageal sphincter pressure is reduced

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5
Q

What is an adverse effect of prolonged intravenous administration of nitroglycerin?

A

Methemoglobinemia, which causes a false reading of SaO2 of 85% (whether the patient’s saturation is higher or lower)

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6
Q

Systemic opioids modify pain through action at what neurological site?

A

The substantia gelatinosa

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7
Q

What are the special characteristics of alfentanil’s pharmokinetics.

A

It has a very small volume of distribution, which is why it has a short elimination half-life (1.5 hr)

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8
Q

What are the manifestations of anthrax poisoning?

A

It is an influenza-like disease with cough, myalgia,fever and malaise.

After a few days, the patient improves, but the a couple of days later, the patient becomes much sicker with dyspnea, cyanosis, hemoptysis, stridor, and chest pain.

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9
Q

What is the most notable finding on CXR for anthrax exposure?

A

Widened mediastinum

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10
Q

What is the treatment for anthrax?

A

Ciprofloxacin and doxycycline

(Penicillin G was the treatment of choice, but weaponized anthrax has been engineered to be resistant to this medication)

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11
Q

What is the bacteriology of anthrax?

A

It is a gram-positive, spore-forming bacillus that is transmitted to humans from contaminated animals and their carcasses.

Inhalational anthrax is rare but has an 80% mortality rate.

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12
Q

Describe the 2 types of HIT. How is it diagnosed?

A

1) Mild form: shows a transient decrease in platelet count after heparin exposure.
2) Severe form: autoimmune-mediated, with IgG antibodies to heparin and platelet factor IV.

Diagnosis is made my observing a 50% drop in platelets after heparin exposure, recovery after discontinuation of heparin, and exclusion of other causes and confirmation of antibodies.

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13
Q

Methadone (potency vs. Morphine; where does it act; what ECG changes can it cause)

A

It is 3 times as potent as morphine

It can also act on NMDA receptors (mu receptors as well)

It can cause a prolongation of the QT interval

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14
Q

What effects does acute vs. chronic use of cocaine have on MAC?

A

Acute use of cocaine increases MAC, due to increased sympathetic discharge, which can lead to coronary spasm and STEMI

Chronic use does not affect MAC. Synaptic catecholamines are spent with chronic use and indirect pressors like Ephedrine are often ineffective in increasing the blood pressure

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15
Q

What does magnesium do at the neuromuscular junction?

A

It antagonizes the release of acetylcholine at the neuromuscular junction and therefore, potentiates both depolarizing and non depolarizing neuromuscular paralytics

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16
Q

What common medication lowers the activity of the plasma cholinesterase?

A 
Medications that inhibit pseudocholinesterase are:
neostigmine
cyclophosphamide
phenelzine
pancuronium
esmolol
metoclopramide
monoamine oxidase inhibitors (MAOIs)
oral contraceptives
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17
Q

What dose of the benzocaine can cause methemoglobinemia?

A

Doses > 200-300mg

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18
Q

What effects does terbutaline have on electrolytes?

A

It is a beta1 & 2 agonist, with predominantly beta 2 properties. It therefore produces hyperglycemia, hypokalemia, and tachycardia

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19
Q

What effect does clonidine have on blood glucose?

A

Clonidine improves blood glucose control and decreases insulin requirements during surgery in type II diabetics by inhibiting sympathoadrenal activity as an alpha-2 agonist

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20
Q

How does Cimetidine effect hepatic drug metabolism? Name other drugs that are similar in effect.

A

It inhibits hepatic drug metabolism

Ketoconazole
Erythromycin
Disulfiram
Ritonavir

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21
Q

What are some common drugs that increase/promote hepatic drug metabolism?

A 
Phenobarbital
Phenytoin
Rifampin
Carbamazepine
Ethanol
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22
Q

Which volatile anesthetic has the largest impact on global warming?

A

Desflurane has the highest potential to produce global warming (although all anesthetics are recognized as greenhouse gases)

Sevoflurane and Isoflurane may contribute almost equally when used in conjunction with high fresh gas flow rates and 60% nitrous oxide.

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23
Q

What drugs cause a histamine release and transient hypotension?

A 
Morphine
Atracurium
Mivacurium
Doxacurium
d-tubocurarine

Because all of these drugs possess the benyzlisoquinoline structure

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24
Q

What effect does lithium have on anesthetic drugs?

A

Lithium decreases anesthetic requirements & interferes with the action of several anesthetic agents.

It prolongs the effects of barbiturates, benzodiazepines, succinylcholine and non depolarizing muscle relaxants.

It blocks the effect of ADH on the renal tubules

It can produce hypokalemia and hypercalcemia

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25
Q

What drugs are myotoxic?

A

Statins, carbon monoxide (CO), ethylene glycol, seizures, cocaine, and colchicine

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26
Q

What drug induces serotonin release, inhibits the reuptake of norepinephrine, antagonizes NMDA receptors, and has opioid-like activity?

A

Tramadol

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27
Q

What physiologically occurs when phenylephrine is given to a patient?

A

Efferent signals respond (to the increased pressure detected by baroreceptors found in the carotid sinus and aortic arch) by decreasing sympathetic activity, leading to decreased cardiac contractility, heart rate, and vascular tone.

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28
Q

What are some drugs that have a first-pass effect in the liver?

A

Metoprolol
Diphenhydramine
Lidocaine

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29
Q

What diuretic causes metabolic acidosis?

A

Acetazolamide, which is a carbonic anhydrase (CA) inhibitor that acts at the proximal convoluted tubule of the kidney, interfering with bicarbonate and sodium reabsorption, which cases a hyperchloremic metabolic acidosis.

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30
Q

What diuretic(s) cause metabolic alkalosis?

A

1) Loop diuretics such as furosemide and torsemide, which inhibit a Na+/K+ ATPase that ultimately results in loss of sodium, potassium, chloride, hydrogen ion, magnesium, and calcium.
2) HCTZ and metolazone both work at the distal convoluted tubule and inhibit NaCl cotransporter mechanism that results in the loss of sodium, potassium, chloride, hydrogen ion, and preservation of calcium (hypercalcemia).

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31
Q

How is chloroprocaine metabolized?

A

It is an ester local anesthetic metabolized by pseudocholinesterase.

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32
Q

How is esmolol metabolized?

A

By red cell esterase (NOT plasma-cholinesterase)

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33
Q

What drugs can lead to postoperative jaundice?

A 
Acetaminophen
Cephalosporins
NSAIDs
Insulin
Contrast media
Procainamide
Thiopental
Ranitidine
Hydralazine
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34
Q

What drugs have been shown to decrease MAC?

A 
Clonidine
Lithium
Opioids
Barbiturates
Lidocaine
Neostigmine
Pancuronium
Hydroxyzine
Ketamine
Verapamil
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35
Q

What herbal medication can decrease the hepatic metabolism of anesthetic agents and cause delayed emergence?

A

St. John’s Wort, which is frequently take for anxiety, insomnia, and depression

Side effects include:
hepatic enzyme induction
prolonged anesthesia
decreased metabolism of digoxin, warfarin, anticonvulsants and cyclosporin

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36
Q

What is licorice used for as an herbal medication? Side effects?

A

Gastritis and duodenal ulcers

Side effects:
Hypertension
Hypokalemia
Edema

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37
Q

Medicinal benefits of Purple Cone Flower? Side effects?

A

Treatment of burns, wounds, UTIs, and cough

Side effects:
Decrease corticosteroid effects

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38
Q

Medicinal benefits of Goldenseal? Side Effects?

A

It is used as a diuretic, anti-inflammatory, laxative, and hemostatic effects

Side effects: 
Ototoxicity
Paralysis in overdose
Edema
Hypertension
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39
Q

What are the 4 ways to prevent platelet aggregation?

A

1) Cyclooxygenase inhibition (i.e. Aspirin) - lasts for the life of the platelet
2) Phosphodiesterase inhibition increases cyclic AMP and decreases platelet aggregation
3) Inhibition of the ADP receptor, and therefore blocking ADP-induced platelet aggregation (i.e. Ticlopidine and Clopidogrel)
4) Inhibition of glycoprotein IIb/IIIa receptors (i.e. abciximab and tirofiban)

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40
Q

Describe the symptoms of Digoxin toxicity

A

It characteristically produces transient numbness, tingling, and altered yellow vision with nausea and vomiting.

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41
Q

Which volatile anesthetic gas produces the most carbon monoxide (CO) by reacting with carbon dioxide (CO2) absorbents?

A

Desflurane

(When CO2 absorbents are maintained at or above room temperature, Desflurane under 1 MAC produces 8,000 ppm CO compared to Sevoflurane at 2 MAC, which produces 79 ppm CO.)

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42
Q

What properties of Cisatracurium make it appealing to use in ICU patients?

A

Its Elimination does NOT depend on end-organ function

Its metabolism depends on Hoffman elimination as well as ester hydrolysis

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43
Q

Hetastarch interferes with coagulation by decreasing the levels of which blood factor/component?

A

One liter of 6% Hetastarch decreases the levels of factor VIII by 50% and prolongs the aPTT

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44
Q

What is the half life of nitric oxide?

A

Less than 5 seconds

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45
Q

List the names of some common Angiotensin Receptor Blockers (ARBs)

A

Candesartan
Losartan
Valsartan

Act as vasodilators

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46
Q

What is the MOA of Trimethaphan

A

It is a vasodilator that is a ganglionic blocker

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47
Q

Name some common DIRECT vasodilators

A 
Calcium channel blockers
Hydralazine
Minoxidil
Nitroglycerin
Nitroprusside
Trimethaphan
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48
Q

List some common alpha-adrenergic blockers

A

Labetalol
Phentolamine
Prazosin
Terazosin

Act as vasodilators

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49
Q

List the names of common central alpha 2 agonists

A

Clonidine
Guanabenz
Guanfacine

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50
Q

What is Nesiritide and how does it act?

A

It is a vasodilator that BINDS NATRIURETIC FACTOR RECEPTORS

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51
Q

What illicit drug increases the risk of malignant hyperthermia with volatile anesthetics and succinylcholine?

A

MDMA “Ectasy-Molly”

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52
Q

What is the half-life of cocaine?

A

23.6 min

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53
Q

What is the treatment for patients exposed to organophosphates?

A

Leads to an anticholinergic crisis treated with Pralidoxime

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54
Q

What are the signs and symptoms of a cholinergic crisis?

A

Similar to a myasthenic crisis

Diarrhea
Sweating
Lacrimation
Miosis
Bradycardia
Hypotension
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55
Q

What are the major side effects of beta blockers?

A

Hypoglycemia
Hyperkalemia
Bronchospasm

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56
Q

What is the treatment for acute dystonia that may arise as a side effect of metoclopromide?

A

IV Benztropine, an anticholinergic, is effective for most dystonic reactions with 5 minutes

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57
Q

What factors increase the rate of rise of FA?

A

1) Anesthetic concentration (FD); a higher FD leads to an higher FI, which increases the rate of rise of FA
2) Alveolar ventilation (VA); hyperventilation increases rate of rise of FA
3) Characteristics of the breathing circuit; high gas inflow from anesthesia machine speeds rise of FI

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58
Q

Which volatile anesthetic is the MOST soluble?

A

1) Methoxyflurane

Halothane is the second most soluble volatile anesthetic

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59
Q

What volatile anesthetic is the LEAST soluble? why?

A

Nitrous oxide is the LEAST soluble volatile anesthetic over Desflurane (2nd most) although Nitrous oxide has a higher blood gas solubility because of the high concentrations of nitrous oxide used

Xenon is actually the least

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60
Q

How does hyperventilation vs. hypoventilation effect the FI/FA ratio?

A

HYPERVENTILATION delivers more anesthetic to lungs INCREASING the rate of rise of FA/FI

HYPOVENTILATION thus DECREASES the rate of rise of FA/FI

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61
Q

How does cardiac output effect the FI/FA ratio?

A

As CO increases, the uptake increases, thus DECREASING the rise of alveolar partial pressure and slowing inhalational induction

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62
Q

How does a left to right cardiac shunt effect the FI/FA ratio vs. a right to left cardiac shunt?

A

Left to right: NO CHANGE in FA and NO change in induction

Right to left: DECREASED rise of arterial concentration of anesthetic and slower induction

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63
Q

How does FRC effect the FI/FA ratio?

A

An INCREASE in FRC yield more air space with a dilution of anesthetic and, therefore, DECREASES the rate of rise

A DECREASE in FRC (in pregnant patients) thus INCREASES the rate of rise

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64
Q

What enzyme in steroid synthesis is inhibited by Etomidate?

A

11 beta OH hydroxylase

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65
Q

What effect do barbiturates have on the brain?

A
  • Vasoconstriction leads to decreased CBF
  • CPP increases since the drop in ICP exceeds the decline in MAP (CPP = MAP - ICP)
  • May protect the brain from FOCAL ISCHEMIA but probably not from GLOBAL ISCHEMIA
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66
Q

What does Ketamine dissociate?

A

It functionally “dissociates” the thalamus from the limbic system

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67
Q

MOA of Ketamine

A

NMDA receptor antagonism

also inhibits the reuptake of norepinephrine leading to its sympathomimetic effect

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68
Q

Describe Morphine’s lipid solubility

A

It has a very LOW lipid solubility and is known to be more hydrophilic

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69
Q

What opioid may depress cardiac contractility?

A

Meperidine (Demerol)

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70
Q

What subunit of the Na+ channel receptor local anesthetics bind to?

A

The alpha subunit

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71
Q

What affects nerve fiber sensitivity to local anesthetics?

A

The axonal diameter and myelination

  • spinal nerves sensitivity is autonomic > sensory > motor
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72
Q

What is the key determinant of local anesthetic POTENCY?

A

Lipid Solubility

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73
Q

What are the 3 environments that antagonize local anesthetic blockade?

A

1) Acidic pH
2) HYPOkalemia
3) HYPERcalcemia

74
Q

What is the key determinant of local anesthetic ONSET of action?

A

pKa

  • the higher the pKa, the more is in ionized form at tissue pH
  • local anesthetics with a pKa closer to physiologic pH will have a higher concentration of non-ionized base that can pass through the cell membrane
75
Q

What is the main determinant of DURATION OF ACTION of local anesthetics?

A

Protein binding

76
Q

Systemic absorption of local anesthetics is dependent on what?

A

Blood flow

77
Q

What local anesthetics can cause methemoglobinemia? How is it treated?

A

Prilocaine and Benzocaine

Treatment with methylene blue IV 1-2 mg/kg of a 1% solution over 5 mins

78
Q

What is the treatment for local anesthetic toxicity?

A

Infuse 20% Lipid Emulsion

*Bolus 1.5 mL/kg (lean body mass) IV over 1 min
(Repeat bolus once or twice for persistent CV collapse)

*Continuous infusion at 0.25 mL/kg/min
(Double infusion rate to 0.5 mL/kg/min if BP remains low)

Upper limit is ~ 10 mL/kg over the 1st 30 mins

79
Q

What is the structure of the motor end plate?

A

It is made up of 5 sub units:

2 alpha subunits
1 beta subunit
1 delta subunit
1 gamma subunit

80
Q

What is the significance of the Dibucaine number?

A

Dibucaine, an amide local anesthetic inhibits 80% of the activity of normal pseudocholinesterase

Therefore,

  • 20% inhibition of atypical enzyme = homozygous
  • 40-60% inhibition of atypical enzyme - heterozygous
81
Q

What is the MOA of botulinum toxin?

A

It blocks the release of Ach from presynaptic vesicles

82
Q

What can occur if Meperidine is administered to someone on an MAOI? Describe.

A

Monoamine oxidase is an enzyme that regulates presynaptic biogenic amines (NE, Dopamine, Epi, and serotonin). When inhibited, these amines build up at the presynaptic nerve terminal.

Merperidine & MAOIs can lead to SEROTONIN SYNDROME: excitation, hyperpyrexia, HTN, diffuse sweating, rigidity, seizures, coma, and death

83
Q

What herbal medication can cause hepatotoxicity?

A

Echinacea

84
Q

How does cAMP effect platelets?

A

cAMP inhibits platelet aggregation

85
Q

What is the MOA of ticlopidine and clopidogrel?

A

They block the ADP receptor, and therefore INHIBIT ADP-induced platelet aggregation

86
Q

What drugs inhibit platelet aggregation by inhibiting glycoprotein IIB/IIIa receptors?

A

Abciximab
Tirofiban
Eptifibatide (Integrilin)

87
Q

How does the sympathetic nervous system effect the: eyes, lungs, heart, blood vessels, GI, bladder, uterus?

A 
Eyes:  Dilates pupils
Lungs:  Dilates bronchioles
Heart:  Increases heart rate
Blood vessels:  constricts blood vessels
GI:  Relaxes smooth muscles of GI tract
Bladder:  Relaxes bladder muscle
Uterus:  Relaxes uterine muscle
88
Q

How does the parasympathetic nervous system effect the eyes, lungs, heart, blood vessels, GI, bladder, salivary glands?

A 
Eyes:  Constricts pupils
Lungs:  Constricts bronchioles and increases secretions
Heart:  Decreases heart rate
Blood vessels:  Dilates blood vessels
GI:  Increases peristalsis
Bladder:  Constricts the bladder
Salivary Gland:  increases salivation
89
Q

What is the MOA of Prazosin (Minipress)?

A

It is an alpha blocker used to treat mild to moderate HTN

90
Q

MOA of Pilocarpine

A

It is a direct acting parasympathomimetic (cholinergic agent) used in ophthalmic procedures

91
Q

MOA of Bethanechol (Urecholine)

A

It is selective to muscarinic receptors and mimics the action of Ach (cholinergic agent) used for urinary retention

92
Q

Define dromotrophy

A

Conduction

93
Q

Define tonotrophy

A

Cardiac output

94
Q

Define bathmotrophy

A

Excitability

95
Q

Define chronotrophy

A

Heart rate

96
Q

Define inotrophy

A

Contractility

97
Q

How do amphetamines act at the neuromuscular junction?

A

They block the reuptake of NE and dopamine into the presynaptic neuron and increase the release of these monoamines into the extra neuronal space

98
Q

Examples of cytotoxic drugs

A 
Azathioprine
Myclophenolate Mofetil
Leflunomide
Methotrexate
Cyclophosphamide (alkylating agent)
99
Q

Evidence of an anaphylactic reaction to a muscle relaxant 1-2 hours after the episode could be best established by blood levels of?

A

Tryptase, which is secreted by mast cells in the skin, lungs and intestines

Peaks between 15-120 min

100
Q

How does meperidine reduce post anesthetic shivering?

A

The anti-shivering effect is most likely mediated by Kappa-opioid receptors

101
Q

Which opioid receptor is most likely responsible for urinary retention?

A

The delta-opioid receptor

102
Q

What antihypertensive decreases the peripheral conversion of T4 to T3?

A

Propranalol

Good treatment in patients with hyperthyroidism

103
Q

What metabolic derangements can occur with lithium?

A

HYPOkalemia and HYPERcalcemia (it blocks the effect of ADH on the renal tubules)

104
Q

What action of clonidine makes it beneficial to use in type II DM?

A

As a centrally acting alpha 2 agonist, it inhibits sympathoadrenal activity and provides better glycemic control

105
Q

What is the MOA of fenoldopam?

A

Selective agonist on the dopamine type 1 receptor

106
Q

Concurrent use of a tricyclic antidepressant (i.e. amitriptyline) and an anticholinergic (i.e. atropine) may result in what derangement/disease process?

A

Anticholinergic Syndrome

Hyperthermia, paralytic ileus, dry mouth, sedation blurred vision, confusion/delirium

107
Q

Name common drugs with significant renal excretion

A 
Neostigmine
Atenolol
Nadolol
Normeperidine
Penicillins
Procainamide
Pancuronium
Rocuronium
Quinolone
Cephalosporins
Digoxin
108
Q

What is the potency of alfentanil?

A

10 times the clinical potency of Morphine

109
Q

How does digoxin affect intracellular calcium?

A

It increases intracellular calcium (treated with Digibind - direct antibodies to digoxin)

110
Q

Which opioid receptor is responsible for chest wall rigidity?

A

The mu receptor: pruritus, analgesia, biliary spasm, and chest wall rigidity

111
Q

What is the ORL opioid receptor?

A

Is the the nociceptive receptor opioids stimulate and can produce tolerance to mu receptor effects, depression, and anxiety

112
Q

What is the kappa opioid receptor responsible for?

A

Sedation and it has an antipruritic effect

113
Q

How does Hetastarch interfere with coagulation?

A

One liter of 6% hetastarch decreases the levels of factor VIII by 50% and prolongs the aPTT

114
Q

Which volatile anesthetic undergoes the greatest degree of metabolism?

A

Sevoflurane > Isoflurane > Desflurane

115
Q

What anxiolytic should be avoided in patients treated for a long time on methylphenidate (Ritalin)? Why?

A

Clonidine (or Dexmedetomidine) because children on long time Ritalin treatment may have bradycardia and develop cardiovascular collapse at induction with its administration.

116
Q

What is the most potent trigger for MH?

A

Halothane

117
Q

Describe the second gas effect.

A

Administration of a less soluble gas with a more soluble gas results in an acceleration of the rise in the alveolar concentration of the more soluble gas

118
Q

What are the side effects of chronic droperidol therapy?

A

Hallucinations
Loss of body image
Extrapyramidal side effects
Hypotension (secondary to alpha blockade)

119
Q

What are the side effects of cyclosporine therapy?

A 
Nephrotoxicity
Hepatotoxicity
Pancreatitis
Peptic ulcers
Neuropathies
120
Q

What are the side effects of terbutaline?

A 
Tachycardia
Hypotension
Myocardial ischemia
Pulmonary edema
Inhibition of Hypoxic Pulmonary Vasoconstriction (HPV)
Hyperglycemia
Metabolic (lactic) acidosis
Hypokalemia
Anxiety and nervousness
121
Q

What is a characteristic side effect of mivacurium?

A

Transient flushing

122
Q

What antiemetic is safely administered in patients with Parkinson’s disease?

A

Ondansetron

123
Q

What are the signs and symptoms of hypermagnesemia? What is the treatment?

A

Signs/Symptoms: Nausea/vomiting & Flushing of the skin

Treatment includes:
Discontinue magnesium therapy
Administer calcium (antagonize magnesium effects)
Give IV fluids and forced diuresis (i.e. lasix), which will promote renal excretion of magnesium

124
Q

MOA of buprenorphine

A

A mu receptor partial agonist (less euphoria and respiratory depression) and a kappa/delta (less craving and partial analgesia) receptor antagonist

125
Q

Define the splitting ratio of a volatile anesthetic and how it is affected.

A

The splitting the ratio is the ratio of the flow between the bypass chamber and vaporizer chamber in variable bypass vaporizers.

The ratio is dependent on the temperature, the vapor pressure, the concentration, and the anesthetic agent itself.

126
Q

As a volatile anesthetic increases, the FA/FI ratio of which agent will rise the most?

A

The most soluble VA (i.e. Isoflurane) agents will increase dramatically due to their propensity to diffuse into the blood and have a low baseline Fa/Fi ratio.

127
Q

What anesthetic drugs have anticholinergic properties and can trigger an anticholinergic crisis?

A

Halogenated Inhalational agents (i.e. Desflurane, Isoflurane)

Propofol

Barbiturates

128
Q

What is the MOA of amitryptiline and how does it cause cardiotoxicity?

A

It is a tricyclic antidepressant (TCA) that not only inhibits the reuptake of norepinephrine and serotonin, but also inhibits sodium and calcium channels, which is how it is cardiotoxic.

129
Q

At what serum magnesium level do arrhythmias become apparent? SOB? Loss of DTRs? Sedation?

A
  • Arrhythmias at > 20 mEq/L
  • SOB with respiratory paralysis at > 15 mEq/L
  • Loss of DTRs at > 10 mEq/L
  • Sedation at 8 mEq/L
130
Q

Chronic therapy with what drug is most likely to decrease a patient’s maximum dose of lidocaine?

A

Any drug that interferes with/inhibits the cytochrome P450 enzymes (i.e. Nicardipine)

131
Q

What is the MOA of Rivaroxaban (Xarelto)? When should it be discontinued prior to elective procedures?

A

It inhibits Factor Xa directly and has a relatively short half-life or about 7-11 hours

It is stopped 24 hours prior to surgical intervention

132
Q

What is the MOA of argatroban?

A

It is a direct thrombin inhibitor that has a very short half-life of about 39-51 minutes

Caution in patients with liver impairment

133
Q

What is the MOA of Ticagrelor (Brilinta)? When should it be stopped prior to an elective procedure?

A

It is an inhibitor of platelet activation at the P2Y12 chemoreceptor for ATP.

It is co-administered with aspirin and is stopped 5 days prior to surgery?

134
Q

What is the MOA of cilostazol (Pletal)?

A

It inhibits platelet phosphodiesterase III, which results in inhibition of platelet adhesion and aggregation

135
Q

Describe opioid tolerance

A

A phenomenon that occurs when an individual over time requires greater amounts of a drug to continue to obtain the original degree of its desired, therapeutic effect.

It is marked by initial analgesia that seems to wane over time

136
Q

Describe Pseudoaddiction

A

A drug-seeking behavior that simulates true addiction, which occurs in patients with pain who are receiving inadequate pain medication.

Patients cease taking increased doses of opioids once the pain is better controlled

137
Q

Describe opioid-induced hyperalgesia

A

Patients who develop worsening pain with increased opioid dosing, which may be difficult to distinguish from opioid tolerance

138
Q

What antibiotics DO NOT effect/ prolong the effect of neuromuscular blockade?

A

Ampicillin
Erythromycin
Cephalosporins

[Although PCN, aminoglycosides (gentamicin, kanamycin, amikacin, streptomycin, neomycin, and tobramycin), bacitracin, and polymyxins DO prolong the duration of NMB)]

139
Q

How do beta blockers effect insulin secretion?

A

The SUPPRESS insulin secretion

140
Q

How do beta blockers effect potassium during a KCl infusion?

A

An exaggerated INCREASE in potassium occurs during KCl infusion

141
Q

What induction agent is associated with an increase in nausea and vomiting?

A

Etomidate

142
Q

What are complications associated with TPN therapy?

A
  • Hypercarbia
  • HYPO or HYPERphosphatemia
  • Metabolic acidosis
  • Fatty acid deficiency
  • HYPO or HYPERglycemia
  • Sepsis
143
Q

What are the side effects of 15-Methyl PGF2a (carboprost, Hemabate)?

A

Used to treat refractory uterine atony

Side effects include:

  • fever
  • diarrhea
  • hypoxemia (due to intrapulmonary shunting)
  • bronchospasm
  • nausea/vomiting
144
Q

MOA of heparin

A

It potentiates the action antithrombin III, allowing antithrombin III to act on factors VII, IX, X, and XI and inhibit their coagulant properties.

145
Q

MOA ot tPA

A

activates plasmin to plasminogen

146
Q

MOA of warfarin (Coumadin)

A

Inhibits factors 2, 7, 9, and 10 (vit K dependant) along with protein C and S.

147
Q

MOA of clopidogrel (Plavix)

A

ADP receptor inhibitor

148
Q

MOA of eftifibatide (integrillin)

A

IIb/IIIa inhibitor

149
Q

What effect does 1 MAC of desflurane have on the respiratory system?

A

At 1 MAC, Desflurane :

  • decreases tidal volume
  • increases respiratory rate (although, this increase does not offset the decreased TV)
  • overall decreased minute ventilation
  • (therefore) mild increase in PaCO2
150
Q

What is the maximum dose of bupivicaine with 1:200,000 epinephrine for a 70 kg patient? Tetracaine? Lidocaine? Mepivicaine? Etidocaine? Prilocaine?

A 
Bupivicaine = 225 mg
Tetracaine = 200 mg
Lidocaine and Mepivicaine = 500 mg
Etidocaine = 400 mg
Prilocaine = 600 mg
151
Q

Name cardioselective beta-1 antagonists

A

Atenolol
Betaxolol
Esmolol
Metoprolol

152
Q

Name a nonselective beta antagonist

A

Propranolol

153
Q

What volatile anesthetic will NOT cause an increase in heart rate and has minimal effects on SVR?

A

Halothane

154
Q

What opioid causes decreased myocardial contractility when given in large doses?

A

Meperidine, possibly due to its anticholinergic properties

155
Q

What organ can be effected by long term therapy with cyclosporine?

A

Kidneys

156
Q

How does ketorolac effect the bladder?

A

It has been shown to effectively reduce the incidence and severity of bladder spasms and urinary retention after GU pediatric surgery

157
Q

What drugs increase serum lithium levels?

A 
ACE inhibitors
Angiotensin II receptor antagonists (ARBS)
NSAIDS
Thiazide diuretics
Tetracycline
Metronidazole
Cox-2 inhibitors
158
Q

What drugs may decrease serum lithium levels?

A 
Aminophylline
Theophylline
Acetazolamide
Mannitol
Sodium bicarbonate

[Spironolactone and furosemide have NO significant effect on serum lithium concentrations]

159
Q

What is the MOA of Tramadol? What is its potency?

A

It is a weak opioid agonist at the mu receptor but also has properties of inhibition of NE and serotonin reuptake

It is one-tenth as potent an analgesic as morphine and has fewer respiratory effects.

Associated with seizure activity in those with a history of alcohol abuse

160
Q

What is Nitric oxide’s MOA

A

Inhibition of cGMP resulting in dilation of pulmonary vascular beds.

161
Q

What is the MOA of baclofen

A

It is a GABA-B receptor agonist, binding to presynaptic GABA receptors in the dorsal horn of the spinal cord, thereby decreasing the excitatory neurotransmitters

162
Q

What is the duration of sulfur hexafluoride in the vitreous? vs. air

A

10 days vs. only 5 days with air

163
Q

MOA of promethazine

A

A first-generation antihistamine of the phenothiazine family.

It is primarily a H1 antagonist with moderate Ach receptor antagonistic properties. It also has weak to moderate affinity for the 5-HT, D2, and alpha 1 receptors as an antagonist.

Another notable use is as a local anesthetic, by blockade sodium channels

164
Q

In patients with PCN allergies, what cephalosporin can be given safely?

A

2nd (i.e. Cefuroxime), 3rd (i.e. Ceftriaxone), and 4th (i.e. Cefipime) generation cephalsporins are less likely to cross-react with PCNs.

[1st generation cephalosporins (i.e. Cefazolin) are the most likely class of abx to exhibit cross-reactivity)

165
Q

What is the brain time constant? What is it for Sevoflurane?

A

It is 2 times the blood brain coefficient for the brain. It is also defined as capacity of a tissue to hold the volatile agent relative to the actual tissue blood flow.

For Sevoflurane: the brain/blood partition coefficient is 1.7, therefore twice that value would be 3.4 min.

166
Q

What is the proposed mechanism for cardiac arrest from local anesthetic toxicity?

A

Local anesthetics REVERSIBLY bind to voltage gated sodium channels rendering them unable to generate and propagate an action potential

167
Q

What effect does nitrous oxide have on muscle tone?

A

It, unlike other inhalational anesthetics, can cause an increase in muscle tone.

168
Q

Why is mask induction with nitrous oxide faster than desflurane induction?

A

Despite nitrous oxide having a higher blood-gas solubility compared to desflurane…..

Due to the concentration effect, wherin the rate of rise of FA/FI is quicker because:

  • nitrous oxide can be administered at much higher concentrations than desflurane and other gases —> the inspired partial pressure (FI) becomes so high that it causes the alveolar concentration (FA) of the gas to rise rapidly.
  • higher inspired concentrations offset its diffusion into the blood, resulting in faster induction.
169
Q

Vapor pressures of volatile anesthetics

A 
N2O = 38,770
Desflurane = 670 (669)
Halothane = 240 (243)
Isoflurane = 240 (238)
Sevoflurane = 160 (157)
Enflurane = 170 (172)
170
Q

What volume of vapor does 1 mL of most volatile anesthetics produce?

A

200 mL of vapor at 20 degrees Celsius

171
Q

What is the MOA of Demeclocycline? Its use?

A

Demeclocycline is a tetracycline antibiotic that interferes with the action of ADH. By blocking ADH at its receptor, it impairs the ability of the kidneys to concentrate urine., which will worsen HYPERnatremia.

Utilized (off label) in treating SIADH

172
Q

How are aminoglycosides metabolized?

A

They are minimally metabolized

[They are antibiotics that are NOT metabolized by CYP3A]

173
Q

Name a selective beta-1 blocker?

A

Acebutolol (good to use in patients with asthma)

174
Q

In comparison to fentanyl, alfentanil, sufentanil, and methadone, Morphine’s peak onset is Faster or Slower?

A

Slower

*compared to synthetic opioids, morphine is relatively hydrophobic and crosses the blood brain barrier much more slowly. The onset of all the other opioids is relatively fast (< 10 mins to peak effect). By contrast, morphine peak effect takes approx. 1 hr.

175
Q

Hydroxyethyl starch is described as 2 numbers (e.g. 130/0.42, 670/0.75, etc.) What do these 2 numbers mean?

A

Average molecular weight/ molar substitution

176
Q

What is the effect of 1 MAC of Sevoflurane on the cardiovascular system?

A

At 1 MAC, sevoflurane results in an increase in the QT interval, which usually does not lead to any clinical significance.

Cardiac output is maintained (a decrease in SVR is compensated by an increase in HR)

177
Q

What are the common side effects of anticancer drugs such as Bleomycin, Doxorubicin, Cisplatin, and Vincristine?

A

Bleomycin —> pulmonary fibrosis
Doxorubicin —> cardiotoxicity
Cisplatin —> renal toxicity
Vincristine —> neurotoxicity (specifically peripheral neuropathy and vocal cord palsy)

178
Q

What is the best test to monitor the activity of LMWH?

A

LMWH (enoxaparin) has a longer plasma half-life and more reliable efficacy than unfractionated heparin due to its smaller size and decreased peripheral protein binding.

The Anti-Xa Assay peaks at 4 hours (the advised time to conduct monitoring assays).

179
Q

What advantages does cisatracurium have over atracurium?

A
  • time to maximum block is slightly shorter, greater potency
  • it is more cardiac stable because it lacks histamine release
  • it has the same duration of action as atracurium
180
Q

What level of CO2 is produced from the components of TPN (carbohydrates vs. proteins vs. fats) in regards to the RQ?

A

The respiratory quotient (RQ) is defined as the ratio of the amount of CO2 produced relative to the amount of oxygen consume (VCO2/VO2)

The RQ changes with the type of caloric intake.

Carbohydrates (sugars) have an RQ of 1
Proteins have an RQ of 0.8 - 0.9
Lipids have an RQ closer to 0.7

A higher RQ reflects greater CO2 production

Anesthesia Written Board Questions (13 decks)

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