Pharmacology and Pain

Question 1

What antibiotics are notoriously known as needing dose adjustments if used in a patient with renal injury?

Answer 1

Aminoglycosides

Gentamicin

Question 2

What medications can result in decrease in efficacy of birth control pills if taken? (6-PPCRG)

Answer 2

1. Phenytoin
2. Carbamazepine
3. Primadone
4. Phenobarbital
5. Rifampin
6. Grisofulvin

Question 3

What causes the adverse drug reaction between Warfarin and Diclofenac?

Answer 3

Diclofenac displaces protein bound warfarin

leads to increased warfarin levels and bleeding risk

Question 4

How many half-lives of a therapeutic dose of a medication does it take to reach steady state?

Answer 4

5

Question 5

What is a contraindication of Propofol for sedation?

Answer 5

Soy or egg allergy

Question 6

What is a potential complication of using dexmedetomidine (Precedex) as a sedation agent? (2)

Answer 6

1. Bradycardia (if on meds that slow conduction via AV node like digoxin)
2. Profound hypotension (if on nifedipine)

Question 7

Why is oral naloxone less effective compared to IV naloxone?

Answer 7

1st pass effect (decreased concentration as filtered through liver first)

Question 8

What are contraindications for the use of Ketamine?

Answer 8

1. less than 3 months of age (relatively less than 1 year of age)
2. history of psychosis (due to psychiatric and hallucinogenic after-effects)

Question 9

What medications require an acidic environment for absorption and are best absorbed if taken before meals?

Answer 9

1. Azole antifungals (fluconazole)
2. Iron
3. Thyroid hormone

Question 10

What class of medications can result in decreased renal clearance of lithium if taken together?

Answer 10

NSAIDs (ibuprofen)

Question 11

What level of sedation is described as loss of orientation to environment, preservation of protective airway reflexes and requires continuous monitoring?

Answer 11

Moderate sedation

Question 12

What is the mechanism by which overdoses lead to higher than expected concentrations and lengthen of half-life of the medication?

Answer 12

saturation of metabolic pathways leading to zero order kinetics

Question 13

What is the first step in managing a pt who develops apnea with decreased oxygen saturation during propofol sedation?

Answer 13

Ensure proper airway positioning with chin lift/ jaw thrust

may need to intubate

Question 14

What is characteristic must be the same for 2 drugs to be considered bioequivalent?

Answer 14

rate of absorption