Pharmacology Flashcards
What is one potential “cross reaction” of fentanyl patches?
They can melt with heating pads and release too much fentanyl.
Side effects of isoniazid include ______________.
seizures, acidosis, and glove-and-stocking neuropathy (if B6 is not given)
What is the mechanism of TXA?
It is a lysine derivative that reduces the conversion of plasminogen to plasmin by displacing plasminogen from fibrin.
What are the duration of actions of lorazepam and midazolam?
Lorazepam: 6+ hours
Midazolam: 1-2 hours
What is the onset of action of IM Haldol?
15-30 minutes
What is the onset of action of IM lorazepam?
20 minutes
Compare the onset times of IM and IV ketamine.
IM: 3-10 minutes
IV: 1-2 minutes
What are the doses of IM and IV ketamine for sedation?
IM: 2-5 mg/kg
IV: 1-2 mg/kg
A prehospital study showed that IM ketamine led to higher risks of what upon hospital arrival?
Intubation
As many as 49% of patients given 5 mg/kg of ketamine by EMS were intubated.
Note, another trial showed 2 mg/kg IM ketamine led to fewer safety events.
Why is succinylcholine contraindicated in those with neuromuscular disorders?
Succinylcholine depolarizes the neuromuscular membrane which raises the serum potassium 0.5 - 1.0 mEq/L. Those with neuromuscular disorders can have upregulation of nicotinic acetylcholine receptors (due to insufficient stimulation). Thus, succinylcholine has an exaggerated effect and can raise potassium to life-threatening levels.
Which of the paralytics is non-depolarizing and is degraded in the serum (i.e., not dependent on liver or kidney)?
Cisatracurium
Thus, if you know someone has severe kidney and liver disease and you don’t want prolonged paralysis (like for repeated neuro exams) then consider this.
The rash of red man syndrome most commonly affects which parts of the body?
Head, face, neck, and upper torso
What are the phenanthrene and non-phenanthrene opioids?
- Phenanthrene: oxycodone, morphine, hydrocodone, hydromorphone
- Non-phenanthrene: fentanyl, meperidine, methadone
Patients who have side effects or allergic reactions to one group will likely be ok receiving another group.
What patient population can’t get acetazolamide?
Sickle cell (because of the acidosis)
Medication percent means what?
grams per 100 mL
So D50 is 50 grams per 100 mL (which is why a 50 mL amp is 25 grams of sugar).
Likewise, 1% lidocaine is 1 gram per 100 mL or 1000 mg per 100 mL (which equals 10 mg/mL)
What class of medicine is Tamiflu?
Neuraminidase inhibitor
Sumatriptans should be avoided in patients with which comorbidities?
CAD, uncontrolled HTN, CVA
What is the deal with droperidol and torsades?
There was a concern based on a small number of case reports. In more recent years studies have shown this risk to be extremely small and thus the medicine is now back on the market.
What is the dose and administration guidelines for analgesic ketamine?
0.2 - 0.5 mg/kg IV over 15 minutes
What medication can cause hiccups?
Glucocorticoids
1:1,000 means what?
How many g in mL
So 1:1,000 is 1000 mg in 1000 mL or 1 mg/mL.
What are the 4th- and 5th-generation cephalosporins?
4th: cefepime
5th: ceftaroline
True or false: cefuroxime is a 3rd-generation cephalosporin.
False
It’s a 2nd.
True or false: cetazidime covers PsA.
True
What is the oral-to-IV conversion of morphine?
1:3
What is the conversion of IV morphine to IV Dilaudid?
1:6.5
So 2 mg IV Dilaudid is equivalent to 13 mg IV morphine
True or false: DRESS usually spares the mucous membranes early in the disease.
True
It usually presents with fever, exanthem, and internal organ involvement.
What is the reason IV phenytoin can’t be given as a bolus?
It contains propylene glycol that can cause cardiovascular collapse if given too fast.
Why is meperidine not routinely used in the ER?
It has a half-life of 48 hours.
What medication can cause PRES?
Tacrolimus
Which beta blocker is renally cleared?
Atenolol
By what mechanism does octreotide suppress insulin release?
It blocks calcium intake into islet cells, which decreases endogenous insulin release.
Propofol dosing…
Procedural sedation: 0.5 - 1.0 mg/kg with follow up boluses 0.2 - 0.5 mg/kg
RSI: 1.5 - 2.0 mg/kg
Sedation (gtt): usual is 40-100 mcg/kg/min
Which common condition is a contraindication to tramadol?
Seizures
How do neuraminidase inhibitors work?
They prevent release of virion from infected cells.
What common medication increases the concentration of apixaban?
Diltiazem
Other than antipsychotics, ___________ can also cause neuroleptic malignant syndrome.
antiemetics (Reglan and Phenergan)
What antibiotics are the most common culprits of drug-induced neutropenia?
Cephalosporins, penicillins, and macrolides
True or false: acetazolamide causes metabolic alkalosis.
False
It causes a non-anion gap metabolic acidosis. Inhibiting carbonic anhydrase induces increased urination of HCO.
True or false: according to the boards it is ok to give cephalosporins to someone with confirmed beta-lactam anaphylaxis.
False
Which muscle relaxer is not on the Beers criteria?
Cyclobenzaprine
How do macrolides effect cyp?
They inhibit it.
What chemotherapy can cause cholinergic toxicity?
Etoposide
What are the mechanisms of sirolimus and tacrolimus?
Tacrolimus: calcineurin inhibitor (like cyclosporine)
Sirolimus: mTOR inhibitor
At what level INR do you begin oral vitamin K in asymptomatic people?
Greater than 10
In which patients should you not give diltiazem (for pharmacological reasons)?
Those taking drugs metabolized by cyp450.
True or false: any degree of CKD is a contraindication to colchicine.
False
Those with GFRs greater than 30 (CKD 1-3) can receive normal dose colchicine. CKD 4 can get a dose adjustment.
Other than PUD, what GI complication can long-term steroid use cause?
Pancreatitis
Which antiemetic carries a risk of digital necrosis when given IV?
Promethazine
Which NSAID does not cause gastric bleeding?
Celebrex (celecoxib)
Celecoxib is a COX-2 selective inhibitor.
The others NSAIDs – meloxicam, ibuprofen, aspirin, naproxen – are nonselective COX-2 and COX-1 inhibitors.
