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Test > Pharmacology Review > Flashcards

Pharmacology Review Flashcards

1
Q

Which inhaled gas provides analgesia?

A

Nitrous Oxide

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2
Q

What are the two actions of volatile anesthetics?

A
  • Produce immobility (↓ muscle tone)
  • Produce amnesia
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3
Q

What inhaled gas increases skeletal muscle tone?

A

Nitrous Oxide

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4
Q

Inhaled anesthetics produce immobility via actions on the __________.

A

Spinal Cord

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5
Q

What is Minimum Alveolar Concentration (MAC)?

A

Alveolar concentration at which 50% of patients will not show a motor response to surgical incision.

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6
Q

Nitrous Oxide Effect on
BP:
HR:
SVR:
CO:

A

Nitrous Oxide Effect on
BP: N/C
HR: N/C
SVR: N/C
CO: N/C

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7
Q

Isoflurane Effect on
BP:
HR:
SVR:
CO:

A

Isoflurane Effect on
BP: ↓ ↓
HR: ↑
SVR: ↓ ↓
CO: N/C

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8
Q

Desflurane Effect on
BP:
HR:
SVR:
CO:

A

Desflurane Effect on
BP: ↓ ↓
HR: N/C or ↑
SVR: ↓ ↓
CO: N/C or ↓

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9
Q

Sevoflurane Effect on
BP:
HR:
SVR:
CO:

A

Sevoflurane Effect on
BP: ↓
HR: N/C
SVR: ↓
CO: ↓

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10
Q

Nitrous Oxide Effect on
TV:
RR:
Resting PaCO2:
Challenge PaCO2:

A

Nitrous Oxide Effect on
TV: ↓
RR: ↑
Resting PaCO2: N/C
Challenge PaCO2: ↑

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11
Q

Isoflurane Effect on
TV:
RR:
Resting PaCO2:
Challenge PaCO2:

A

Isoflurane Effect on
TV: ↓ ↓
RR: ↑
Resting PaCO2: ↑
Challenge PaCO2: ↑

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12
Q

Desflurane Effect on
TV:
RR:
Resting PaCO2:
Challenge PaCO2:

A

Desflurane Effect on
TV: ↓
RR: ↑
Resting PaCO2: ↑ ↑
Challenge PaCO2: ↑ ↑

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13
Q

Sevoflurane Effect on
TV:
RR:
Resting PaCO2:
Challenge PaCO2:

A

Sevoflurane Effect on
TV: ↓
RR: ↑
Resting PaCO2: ↑
Challenge PaCO2: ↑

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14
Q

Nitrous Oxide Effect on
Cerebral Blood Flow:
ICP:
Cerebral Metabolic Rate:
Seizures:

A

Nitrous Oxide Effect on
Cerebral Blood Flow: ↑
ICP: ↑
Cerebral Metabolic Rate: ↑
Seizures: ↓

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15
Q

Isoflurane Effect on
Cerebral Blood Flow:
ICP:
Cerebral Metabolic Rate:
Seizures:

A

Isoflurane Effect on
Cerebral Blood Flow: ↑
ICP: ↑
Cerebral Metabolic Rate: ↓ ↓
Seizures: ↓

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16
Q

Desflurane Effect on
Cerebral Blood Flow:
ICP:
Cerebral Metabolic Rate:
Seizures:

A

Desflurane Effect on
Cerebral Blood Flow: ↑
ICP: ↑
Cerebral Metabolic Rate: ↓ ↓
Seizures: ↓

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17
Q

Sevoflurane Effect on
Cerebral Blood Flow:
ICP:
Cerebral Metabolic Rate:
Seizures:

A

Sevoflurane Effect on
Cerebral Blood Flow: ↑
ICP: ↑
Cerebral Metabolic Rate: ↓ ↓
Seizures: ↓

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18
Q

Nitrous Oxide Effect on Nondepolarizing blockade

A

↑

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19
Q

Isoflurane Effect on Nondepolarizing blockade

A

↑ ↑ ↑

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20
Q

Desflurane Effect on Nondepolarizing blockade

A

↑ ↑ ↑

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21
Q

Sevoflurane Effect on Nondepolarizing blockade

A

↑ ↑

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22
Q

Nitrous Oxide Effect on
Renal Blood Flow:
GFR:
U/O:

A

Nitrous Oxide Effect on
Renal Blood Flow: ↓ ↓
GFR: ↓ ↓
U/O: ↓ ↓

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23
Q

Isoflurane Effect on
Renal Blood Flow:
GFR:
U/O:

A

Isoflurane Effect on
Renal Blood Flow: ↓ ↓
GFR: ↓ ↓
U/O: ↓ ↓

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24
Q

Desflurane Effect on
Renal Blood Flow:
GFR:
U/O:

A

Desflurane Effect on
Renal Blood Flow: ↓
GFR: ↓
U/O: ↓

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25
Q

Sevoflurane Effect on
Renal Blood Flow:
GFR:
U/O:

A

Sevoflurane Effect on
Renal Blood Flow: ↓
GFR: ↓
U/O: ↓

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26
Q

All inhaled anesthetics will have this effect on hepatic blood flow.

A

Decrease hepatic blood flow.

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27
Q

Describe key characteristics of Desflurane

A
  • Airway irritant (Smells funny, stinks) - don’t use on pt with asthma or smokers
  • Cause ↑ HR if titrated up quickly
  • Very low solubility (fast onset, fast off)
  • Needs a special heated vaporizer
  • Very $$$
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28
Q

Describe key characteristics of Sevoflurane

A
  • Nice smell, great for pediatric induction, non-irritable
  • Can cause emergence delirium in kids
  • Has been indicated to cause nephrotoxicity in rats → Compound A
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29
Q

Describe key characteristics of Isoflurane

A
  • Most lipid-soluble of the inhaled anesthetics (longer emergence)
  • Very suitable in longer cases or sick patients expected to stay on the vent
  • Cheap
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30
Q

Describe key characteristics of Nitrous

A
  • Not a solo anesthetic gas, used as an adjunct
  • Only inhaled anesthetic to provide analgesia
  • N/V in high doses
  • Do not use in neuro or bowel cases (nitrous air will diffuse out and increase pressure in enclosed space)
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31
Q

At what age will the highest MAC be used for an infant?

A

Highest MAC is used at 6 months.

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32
Q

Factors that increase anesthetic requirements

A
  • Chronic EtOH use
  • Infants
  • Red hair
  • Hypernatremia
  • Hyperthermia
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33
Q

Factors that decrease anesthetic requirements

A
  • Acute EtOH use
  • Old Pts
  • Hyponatremia
  • Hypothermia
  • Anemia (Hgb < 5 g/dL)
  • Hypercarbia
  • Hypoxia
  • Pregnancy
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34
Q

Why use anesthetic gases?

A
  • Speed of onset
  • Titratable
  • Potent (narrow therapeutic window)
  • Little/ no metabolism: gas in/gas out
  • Available measures: watching what pt breathes in and out tells us what is in the pt’s brain
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35
Q

Dose of Propofol for
Induction:
Sedation:
TIVA:

A

Induction: 2mg/kg IV
Sedation: 25-100 mcg/kg/min
TIVA: 100-3000 mcg/kg/min

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36
Q

What is used to mitigate the pain of propofol IV push during induction?

A
  • 1-2% Lidocaine
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37
Q

Benefits of propofol

A
  • Patient can wake up very quickly
  • ↓ PONV, anti-emetic
  • Dose rarely needs to be changed for renal or liver disease
  • Bronchodilator
  • Suppresses SNS response to laryngoscopy, best drug to blunt larynx
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38
Q

What patient population do you want to avoid propofol in?

A
  • Avoid propofol in cardiac and CAD pts
  • Propofol reduces arterial blood pressure, heart rate, and myocardial contraction significantly
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39
Q

Problems with long-term (>58 hours) and high-dose propofol infusion (5 mg/kg/hr)

A
  • Lipidemia
  • Fatty infiltrates of the liver
  • Enlarged liver
  • Metabolic acidosis
  • Rhabdomylosis
  • Myoglobinuria
  • Propofol Infusion Syndrome (PRIS)
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40
Q

What induction drug is used for cardiovascular stability?

A
  • Etomidate
  • Best used in patients with poor cardiac status
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41
Q

What is the adverse effect of etomidate?

A
  • Seizures
  • Adrenocortical Suppression (prolonged hypotension - give 100 mg hydrocortisone)
  • PONV in 30% of patients (vomit-date)
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42
Q

Etomidate Preparation

A

0.2% solution (2mg/mL)

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43
Q

Etomidate induction dose

A

0.3 mg/kg

Like propofol, there will be pain on injection

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44
Q

What is the mechanism action of ketamine?

A
  • Noncompetitive NMDAR antagonist
  • Dissociative anesthesia, not a hypnotic
  • Depresses neuronal function of the cortex and thalamus
  • Activates opioid receptors and subcortical neurons in the spinal tract → Intense analgesia and amnesia
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45
Q

Use of Ketamine

A
  • Dissociative anesthesia
  • Pain relief acute/chronic
  • Adjunct to decrease other anesthesia drugs
  • ↓ Narcotic use
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46
Q

The most common ketamine preparation

A
  • 5% solution (50 mg/mL)
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47
Q

Dose of Ketamine for
Adult Induction
Intense Analgesia
Pediatric Induction

A

Adult Induction: 1.5 mg/kg IV
Intense Analgesia: 0.2-0.5 mg/kg IV
Pediatric Induction: 4-8 mg/kg IM

Unlike propofol and etomiate, ketamine does not cause pain on injection

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48
Q

What is contraindicated when using ketamine

A
  • MAOI’s
  • ↑ Epinephrine (↑ HR, ↑ BP)
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49
Q

High doses of ketamine (4-5 mg/kg) will have this effect on pts.

A

Emergence Delirium (treat with benzos)

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50
Q

Cardiovascular Effects of Ketamine

A
  • ↑ SVR
  • ↑ PVR
  • ↑ CO
  • ↑ SNS outflow
  • ↑ Epi and NorEpi (inhibit reuptake)
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51
Q

Ketamine’s effect on respiratory tract

A
  • Intense bronchodilator can treat status asthmaticus
  • Airway tone remains intact
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52
Q

What does ketamine do to salivary secretions?

A
  • ↑ Salivary secretions
  • Pre-treat with Robinol 0.1 mg (anti-sialagogue) or Benadryl
53
Q

Mechanism of dexmedetomidine

A

Stimulation of alpha-2 receptors causes pre-synaptic inhibition (turns down SNS).

54
Q

Dexmedetomidine’s effect on α2A receptor.

A
  • Sedation
  • Hypnosis
  • Sympatholysis
55
Q

Dexmedetomidine’s effect on α2B receptor.

A
  • Vasoconstriction
  • Anti-shivering
  • Analgesia
56
Q

Dexmedetomidine’s effect on α2C receptor.

A
  • Learning
  • Startled Response
57
Q

Preparation of precedex

A
  • 2 mL vials
  • 100 mcg/ mL
  • Reconstitute with 50 mL to get 4 mcg/mL
58
Q

What is the loading dose of precedex?

A

0.5 -1.0 mcg/kg over 10 minutes

59
Q

What is the infusion rate of precedex?

A

0.2-0.7 mcg/kg/hr

60
Q

What happens if precedex is given too fast?

A
  • Transient hypertension and bradycardia
61
Q

Respiratory effects of precedex

A
  • Minimal respiratory depressant (respiratory sparing)
  • Anti-sialagogue
  • Normal ABG, no change in TV or RR
  • Caution in pt w/ OSA
62
Q

Besides the sedative effects, what are 4 other benefits of using precedex?

A
  • Widens thermoregulation/ Anti-shivering
  • Decrease muscle rigidity seen with high-dose opioids
  • Drug addicts and EtOH withdrawal are offset
  • Chronic pain pts become extremely tolerant
63
Q

Methohexital Uses

A
  • Rapid non-painful procedures
  • ECT therapy
  • Cardioversion
  • Mapping seizure focus - helps pts to continually seize
64
Q

Methohexital adult dosing

A

1.5 mg/kg

65
Q

Adverse side effects of Methohexital

A
  • Myoclonus/Seizures at low doses (used to treat seizures at high doses)
  • Hiccups
  • Airway irritability
66
Q

What is the post-op pain dose for morphine?

A

5-20 mg IV titrated

67
Q

Morphine consideration for intrathecal catheter administration

A

Potential for delayed respiratory depression up to 24 hours or longer after intrathecal catheter administration

68
Q

Morphine will cause dose-dependent _________ release.

A

histamine

Morphine will not be a good choice for someon who is already hypotensive

69
Q

What is the active metabolite for morphine?

A

morphine-6- glucuronide

70
Q

What pt population will have a prolonged morphine half-life?

A
  • Elderly
  • Liver failure pt
  • Renal failure pt
71
Q

Hydromorphone/Dilaudid is how many times more potent than morphine?

A

7 times more potent, but less histamine release

72
Q

Which narcotic is favored by many anesthetic providers toward the end of the surgery?

A
  • Hydromorphone (Dilaudid)
  • 2-4 hour duration
  • Works very slow, 15 minute onset
73
Q

What is the dosing of fentanyl (sublimaze) during the first hour of surgery?

A

1-5 mcg/kg

74
Q

What is the infusion rate of fentanyl (sublimaze) during surgery?

A

3-6 mcg/kg/hour

Turn off one hour before breathing.

75
Q

Fentanyl should be dosed by what kind of weight?

A

Ideal Body Weight

76
Q

Meperidine (Demerol) has an affinity for which opioid receptors?

A
  • Mu
  • Kappa
  • Delta
77
Q

Dose of Meperidine for post-op shivering.

A
  • 12.5 mg IV
78
Q

The active metabolite for meperidine can cause this effect.

A
  • Seizures
79
Q

Meperidine is contraindicated with which drug?

A
  • MAOI’s
  • Meperidine blocks the reuptake of serotonin
80
Q

What is the induction dose of Sufentanil (Sufenta)?

A
  • 0.3 - 1 mcg/kg
81
Q

What is the infusion dose of Sufentanil (Sufenta)?

A
  • 0.5 - 1 mcg/kg/hr
  • If surgery is < 2 hours, turn infusion off 30 mins before breathing
  • If surgery is > 2 hours, turn infusion off 45 mins before breathing
82
Q

Benefits of using sufentanil

A
  • CV Stable
  • Good for infusion
  • Good for post-op pain control after infusion (stays in the system longer than remifentanil)
83
Q

What is the loading dose of Remifentanil (Ultiva)?

A

0.5 - 1.0 mcg over 1 minute

84
Q

What is the infusion dose of Remifentanil (Ultiva)?

A

0.125 - 0.375 mcg/kg/min

Turn off the infusion 6 minutes before breathing.

85
Q

How is Remifentanil metabolized?

A

Plasma esterase (independent of organ function)

86
Q

Remifentanil can have a ___-% reduction of MAC when used as an infusion.

A

70%

87
Q

Use of Remifentanil

A
  • Neuro
  • Carotid endarterectomy
  • Eye blocks
  • TIVA
88
Q

Considerations for using Remifentanil

A
  • MUST cover post-op pain with another drug (quick on and off)
  • Quick respiratory depression (can substitute for Sch for induction)
  • Bradycardia
  • Expensive
89
Q

What is the most common PO opioid used?

A

Oxycodone and Tramadol

90
Q

What can be used to treat pruritis without reversing analgesia?

A

Partial agonist/antagonist narcotics (methadone, nubaine, stadol, buprenex)

91
Q

What is the dose of Naloxone (Narcan) for respiratory depression reversal?

A

40-80 mcg IV

Comes in 400 mcg/mL vial

92
Q

Adverse effects of Naloxone (Narcan)

A
  • Potential for flash pulmonary edema
  • Cardiac stimulation r/t abrupt reversal of analgesia
  • Can wear off before narcotic, might need administration
93
Q

Besides opioid reversal, what can Narcan treat?

A
  • Pruritis
  • Urinary Retention
  • Muscle Rigidity
  • Biliary Spasm (Oddi spasm)
94
Q

What are the pharmacology effects of benzodiazepam?

A
  • Sedation
  • Anxiolysis
  • Hypnotic
  • Anticonvulsant
  • Mediate skeletal muscle relaxation
95
Q

Rank the three most potent benzos.

A
  1. Lorazepam (5x more than Midazolam)
  2. Midazolam (5x more than Diazepam)
  3. Diazepam
96
Q

CV effects of Benzos

A
  • Minimal effect with sedative dose
  • May get a small drop in BP with sedation (minimal)
97
Q

Respiratory effects of Benzos

A
  • Dose-dependent respiratory depression
  • Depresses airway reflex and ability to swallow (high doses)
  • Hypoxic drive to breathe is DEPRESSED
98
Q

Typically, CO2 drives our breathing. However, what patient population uses oxygen/hypoxia to trigger breathing?

A
  1. Chronic COPD
  2. Sleep Apnea
  3. Morbid Obesity
99
Q

Dose for Benzo Reversal, Flumazenil (Ramazicon)

A

0.2 mg
Repeat 0/1 mg IV every minute to a total of 1 mg in the first hour and 3 mg maximum dose.

100
Q

An overdose of Flumazenil can cause what adverse effects?

A

Seizures

101
Q

Which N/V agent has anti-inflammatory properties and is long-acting?

A
  • Decadron
102
Q

This N/V agent is very safe, difficult to overdose and very effective. Just watch for prolonged QT interval on the EKG.

A
  • Zofran
103
Q

This N/V agent is not used as much anymore. Watch the QT interval, and can cause sedation/confusion

A
  • Droperidol
104
Q

This N/V agent works on the dopamine receptor. Can cause forward GI motility, can cause anxiety, and EPS side effects.

A
  • Metoclopramide (Reglan)
105
Q

This N/V agent is a potent antihistamine.

A
  • Benadryl
106
Q

These are very effective for those with motion sickness.

A
  • Scopolamine patches
107
Q

This is an H2 blocker that can decrease stomach acid but can reduce N/V.

FDA-approved for morning sickness

A
  • Pepcid
108
Q

N/V agent used as a rescue drug, sedation qualities, and extravasation can result in limb loss

A
  • Phenergan
109
Q

This drug has anti-emetic properties and can be used as a last-ditch rescue.

Can also be used in TIVA and avoid gas to ↓ N/V in high risk pt.

A
  • Propofol
110
Q

Newer, $$$ drug, for use in very high-risk pts.
NK-1 Receptor Antagonist.

A
  • Emend (Aprepitant)
111
Q

Describe how Succinylcholine works as a depolarizing NMB.

A
  • Succinylcholine is composed of 2 ACh molecules bound together.
  • It binds to the ACh-R at the NMJ and mimics ACh
  • Succinylcholine opens the channel and allows depolarization of the motor endplates
  • Channel stays open and does not reset, causing paralysis
112
Q

Considerations for using Succinylcholine

A
  • MH Trigger
  • Dangerous to use in burn patients (↑K+)
  • Renal patients (↑K+)
113
Q

Compared to Atricurium, Cisatracurium does not cause _______-

A

Histamine release

114
Q

This NMBD is the drug of choice for renal patients as it is metabolized in the blood (organ-independent).

A
  • Cisatracurium (Nimbex)
115
Q

What is the advantage of using vecuronium over rocuronium?

A

Vecuronium is a lot more predictable.

116
Q

Describe the metabolism of rocuronium.

A
  • Minimal to no metabolism
  • No active metabolite
  • Excreted unchanged in the kidneys
  • Excreted unchanged in the bile
117
Q

Describe the metabolism of vecuronium.

A
  • 30-40% hepatic metabolism
  • Active metabolite- 80% potency of the parent compound
  • May accumulate in renal failure
118
Q

What neuromuscular reversal agent is used in pediatrics?

A
  • Edrophonium
119
Q

How do Acetylcholinesterase inhibitors (Neostigmine) work to reverse non-depolarizing paralytics?

A

Neostigmine binds to acetylcholine esterase at the NMJ and ↑ the concentration of ACh.

120
Q

What is the adverse effect of the neuromuscular reversal agent?

A

Bradycardia

Use anticholinergic agent (robinul) to counter this effect

121
Q

What is the effect of glycopyrrolate when paired with neostigmine?

A
  • Tachycardia
  • Bronchodilation
  • Antisialagogue

Robinul does not cross the BBB, no sedative effect

Give glycopyrrolate first before neostigmine or just mix the two together.

122
Q

Sugammadex dose for shallow/medium blockade

A

2 mg/kg

123
Q

Sugammadex dose for deep blockade

A

4 mg/kg

124
Q

Sugammadex dose for immediate reversal after 1.2 mg/kg rocuronium after 3 minutes.

A

16 mg/kg

125
Q

What is the best drug of choice to treat a patient who is just tachycardic and normotensive?

A
  • Esmolol (Beta 1)
126
Q

What is the best drug of choice to treat a patient who is tachycardic and hypertensive?

A
  • Labetalol (Nonselective Beta)
127
Q

What is the best drug of choice to treat a patient who is bradycardiac and hypertensive?

A
  • Hydralazine
128
Q

What is Propofol Infusion Syndrome?

A

Sudden onset of bradycardia that progresses to asystole and is resistant to treatment

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