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Advanced Pharm Final > REVIEW > Flashcards

REVIEW Flashcards

22 questions: neuropsych(3), herbal (3), antiarryth(3), pharmdyn/kin(2), MH(2), resp(2), abx(2), hemdynam(2), math(2), Essay(1)

1
Q

The volume of distribution (Vd) is the relationship between:

A

Administered dose and plasma concentration

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2
Q

a drug that is lipophilic has a ______ volume of distribution, requiring a ______ dose

A

larger, higher

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3
Q

a drug that is hydrophilic has a ______ volume of distribution, requiring a ______ dose

A

smaller, smaller

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4
Q

to maintain steady state in plasma the ______ must equal the rate of clearance

A

infusion rate/interval dosing

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5
Q

how many half-times are required to reach a steady state? what can decrease this?

A

5, administering a loading dose

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6
Q

which kinetic model describes the process that metabolizes a constant amount of drug per unit time

A

Zero order

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7
Q

which kinetic model describes the process that metabolizes a constant fraction of a drug per unit time?

A

first order

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8
Q

what occurs in phase 1?

A

Modification: oxidation, reduction, hydrolysis, de methylation

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9
Q

what occurs in phase II?

A

Conjugation

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10
Q

what occurs in phase 3?

A

Excretion

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11
Q

4 parts of pharmacokinetics

A
  1. Absorption
  2. Distribution
  3. Metabolism
  4. Excretion
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12
Q

What is down regulation?

A

When you’re on a medication for a long time, desensitizes/enzyme removal of protein molecule

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13
Q

What are the three phases of the multi compartment model?

A

Rapid distribution
Slow distribution
Terminal phase

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14
Q

Which medications are metabolized by zero order effects?

A

Aspire in, ethanol, phenytoin

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15
Q

what is the curve for medications of high efficacy?

A

Up and to the LEFT

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16
Q

What does the slope tell us in the dose-response curve?

A

number of receptors that are occupied to produce a clinical effect

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17
Q

Continuous administration of an agonist may cause ______ of the target receptors

A

down regulation

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18
Q

What is a partial agonist?

A

binds to and activates receptor but no as much as a full agonist/low efficacy

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19
Q

What is an inverse agonist?

A

binds at the same site as an agonist but produces an opposite effect (turns off receptor)

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20
Q

what’s the difference between clean-contaminated and contaminated?

A

major break in sterility, spillage/acute inflammation

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21
Q

What bacteria do beta lactams target?

A

gram positive and gram negative

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22
Q

What antibiotic is commonly prescribed for dental prophylaxis?

A

Penicillin

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23
Q

What antibiotic class can penetrate into joints and cross the placenta?

A

cephalosporins

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24
Q

what first generation cephalosporin is the best choice for preventing SSI?

A

Cefazolin

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25
Q

What generation of Cephalosporins treat MRSA?

A

5th

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26
Q

What antibiotic is frequently given for prostate biopsy?

A

Cefoxitin

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27
Q

What antibiotic class is best at treating ventilator associated pneumonia?

A

Carbapenems

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28
Q

What drug can penetrate CSF to treat meningitis?

A

Ceftriaxone

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29
Q

Why should carbapenems never be users for simple prophylaxis?

A

they’re the “heavy hitters” last antibiotic option to treat resistant bacteria

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30
Q

What is the antibiotic of choice for colorectal surgery?

A

cefazolin and metronidazole

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31
Q

What is the antibiotic of choice for appendectomy?

A

Cefotetan or Cefoxitin

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32
Q

Dosage for Cefazolin:

A

2 grams, >120 kg 3 grams

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33
Q

(T/F) Vanomycin is good for gram negative

A

FALSE (best for treating MRSA)

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34
Q

What is the target bacteria for flagyl?

A

Anaerobic gram negative

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35
Q

What antibiotic class has unique anti inflammatory effects?

A

Macrolides

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36
Q

Vancomycin dosage:

A

15-20mg/kg: 1 g, 1.5 g, 2g

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37
Q

what is an indication for a glycopeptide (vancomycin)?

A

BL allergy or MRSA outbreak

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38
Q

What antibiotic class has the highest occurance of resistance?

A

Macrolides

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39
Q

What is the antibiotic of choice in BL allergy?

A

Clindamycin/ vancomycin ONLY in MRSA

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40
Q

Clindamycin dosage:

A

900mg

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41
Q

what cannot be given with sulfonamides?

A

anticoagulants, methotrexate, sulfonylurea, and thizides

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42
Q

metronidazole dosage:

A

500mg

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43
Q

What bacteria does metronidazole treat?

A

Anaerobic gram negative and clostridium

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44
Q

Dosing for Gentamicin:

A

5mg/kg

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45
Q

Dosing for piperacillin-tazobactam (zosyn):

A

3.375

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46
Q

IM epinephrine dosage for anaphylaxis

A

0.01mg/kg OR 0.5mg max Q5-15min
1:1,000

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47
Q

IV Epinephrine Dose for Anaphylaxis:

A

50-100mcg over 1-10 minutes
1:10,000

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48
Q

What are the antibiotics of choice for urinary procedures?

A

cefazolin and cipro

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49
Q

What antibiotics are safe in pregnancy?

A

PCN and cephalosporins

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50
Q

What would happen if you gave succinylcholine to an individual with Muscular dystrophy?

A

Rhabdomyolysis and hyperkalemia

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51
Q

What two drug classes cause MH?

A

Halogenated anesthetics
depolarizing neuromuscular blockers

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52
Q

Dantrolene dosage:

A

2.5mg/kg Q5-10mins

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53
Q

What is Trismus?

A

a tight jaw that can still be opened. normal response to succinylcholine

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54
Q

Which drug is contraindicated in the management of MH?

A

Verapamil- CCB could lead to hyperkalemia when administered with dantrolene

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55
Q

dantrolene classification

A

muscle relaxant

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56
Q

Dantrolene side effects:

A

muscle weakness, venous irritation

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57
Q

What are dantrolenes 2 mechanisms of action?

A

reduces calcium release from the RyR1 receptor in skeletal myocyte
prevents calcium entry into the myocyte- reducing the stimulus for calcium-induced calcium release

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58
Q

When should Dantrolene administration STOP?

A

when hypermetabolic state stops.
if pt requires more than 20mg/kg reconsider diagnosis

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59
Q

What should dantrolene be reconstituted with?

A

60 mL sterile water

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60
Q

How much dantrolene is in each bottle?

A

20mg

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61
Q

How much bicarb should be given to correct metabolic acidosis r/t MH?

A

1-2 mEq/kg IV

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62
Q

What is the max dantrolene dosage?

A

10mg/kg

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63
Q

what is the half life of dantrolene?

A

6-8 hours/ metabolized into active form in liver then excreted by kidneys

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64
Q

what is the half life of dantrolene?

A

6-8 hours/ metabolized into active form in liver then excreted by kidneys

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65
Q

how do we maintain UOP during an MH crisis?

A
  1. iv fluids
  2. mannitol 0.25g/kg
  3. furosemide 1mg/kg
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66
Q

what is calcium dosage for MH?

A

Ca Cl: 0.5-1g
Calcium Gluc: 1.3-5g

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67
Q

How long should dantrolene be continued after an MH crisis?

A

1mg/kg Q4-6H for 24H

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68
Q

Which three IV anesthetics have a favorable influence on bronchomotor tone?

A

propofol
ketamine
midazolam

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69
Q

Which two volatile anesthetics do NOT reduce bronchomotor tone?

A

desflurane and nitrous oxide

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70
Q

which three volatile anesthetics have a favorable effect on bronchomotor tone?

A

isoflurane
sevoflurane
halothane

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71
Q

What occurs when M3 receptors are activated?

A

bronchoconstriction

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72
Q

How long do short acting beta 2 agonists last? (according to stoelting)

A

4-6 hours

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73
Q

T/F long acting beta agonists should be prescribed if short acting beta agonists are used greater than twice a week

A

TRUE

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74
Q

how does a beta agonist work?

A

causes stimulators G protein to activate adenylate cyclades converting adenosine triphophate into cyclic adenosine mono phosphate (cAMP) which decreased calcium and leads to smooth muscle relaxation

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75
Q

what are the most common side effects of a beta 2 agonist?

A

tremors, tachycardia, hyperglycemia, hypokalemia, and hypomagnesmia

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76
Q

What is ipratropium?

A

short acting anti cholinergic commonly used as maintenance therapy for COPD

77
Q

What is tiotropium?

A

the ONLY long acting anti cholinergic available for COPD (M3 receptor)

78
Q

What are common side effects of anti cholinergics?

A

dry mouth, urinary retention, constipation, pupillary dilation, and blurred vision
can’t see, can’t pee, can’t spit, can’t shit

79
Q

What is fluticasone?

A

inhaled corticosteroid

80
Q

what is montlukast?

A

leukotriene modifiers

81
Q

What is cromolyn?

A

mast cell stabilizer

82
Q

What is theophylline?

A

methylxanthine

83
Q

What is an additional measure that can be taken, last resort to cause broncodialation?

A

Magnesium

84
Q

What is an undesired side effect of ketamine?

A

increase in salivation

85
Q

How does nitric oxide work?

A

non cholinergic PNS nerves release onto airway smooth muscle which causes relaxation; thus, broncodilation

86
Q

copd treatment:

A

education/smoking cessation
short acting bronchodialators
long acting bronchodialators
rehab
inhaled steroids
oxygen
surgery

87
Q

clinical manifestations of asthma:

A

expiratory wheezing, dyspnea, non productive cough, prolonged expiration, tachycardia, tachypnea

88
Q

An asthma attack can lead to:

A

status asthmaticus which is a bronchospasm not reversed by usual measures

89
Q

What are the 4 histamine releasing medications that should be avoided in patients with bronchoconstricting diseases?

A

atracurium, succs, morphine, merderidine

90
Q

What is the beta blocker of CHOICE for individuals with lung disease?

A

Esmolol (beta1 selective)

91
Q

asthma management:

A

SABA
ICS
LABA
Theophylline
daily systemic steroid

92
Q

How do inhaled steroids work?

A

stabilize mast cells by preventing degranulation + production of cytokines

93
Q

Albuteral dose:

A

nebulized 2.5mg OR 90mcg/puff 2-3 puff

94
Q

When should inhalers be d/c’ed and continued after surgery?

A

they should be continued the morning of and be restarted immediately

95
Q

What is the LABA black box warning?

A

can cause fatal or near fatal asthma attacks when NOT used in conjunction with a SABA

96
Q

when should methylxanthine be discontinued prior to surgery?

A

the evening before

97
Q

What is an anesthesia specific consideration for methylxanthine?

A

check a serum level

98
Q

Methylxanthine side effects:

A

> 20mcg/ml: n/v, diarrhea, headache, sleep disturbances
30mcg/ml: seizures, tachy dysrhythmias, CHF

99
Q

Ipratropium dose:

A

200unit/inhal 2 puffs QID

100
Q

Which surgery necessitates pretreating with anticholinergics?

A

Gi surgery: large amount of vagal stimulation

101
Q

What is the MOA of leukotriene modifiers?

A

inhibits 5-lipoxygenase enzyme- decrease leukotriene synthesis which decreases bronchospasm, vasoconstriction, eosinophil recruitment

102
Q

T/F montelukast is used in the management of acute bronchospasm

A

FALSE

103
Q

When should we stop giving albuterol when pt has ETT present?

A

when tachycardia occurs

104
Q

What is our first step to breaking a bronchospasm?

A

increase volatile gas bc it is PNS innervation

105
Q

When should supplements be discontinued prior to surgery?

A

at least two weeks

106
Q

What herbal supplement most commonly causes coagulopathies?

A

Gingko

107
Q

What are the effects of Dong quai on platlets?

A

decreases activation

108
Q

What is echinachea used for?

A

Treats viral, bacterial, and fungal URIs by modulating cytokine signaling and stimulation of macrophages and NK cells
Treats chronic wounds and arthritis
Long term use: acute rejection due to immunesupp

109
Q

What can occur with ephedra use in combination with an MAOI?

A

life threatening hypertension, hyperpyrexia, and coma

110
Q

Can feverfew be taken by an individual also taking warfarin?

A

no, it inhibits platelet activity

111
Q

What is the indication for Gingko biloba?

A

neuroprotective: treats alzheimers, memory loss, and multi infarct dementia
Peripheral vascular disease- decreases blood viscosity

112
Q

What two drugs interact with gingko?

A

NSAIDs, and anticoagulants

113
Q

How does long term kava use affect anesthetic dose?

A

increases dose requirement

114
Q

What are adverse effects of kava?

A

increase effects of ETOH, barbiturates, and other drugs
can prolong anesthetic agents
kava dermopathy- scaly cutaneous lesions

115
Q

How does St. Johns wort affect anesthesia?

A

can delay emergence

116
Q

What is valerian root?

A

herb used for anxiolytic, restlessness, and sleep aids
Gi upset, headache, tremor, cardiac disturbances
Can potentiate effects of benzos

117
Q

What type of drug interacts with turmeric?

A

antacid medications such as PPIs and H2A

118
Q

What supplements are hepatotoxic?

A

Echinacea, ephedra, saw palmetto, garcinia

119
Q

immunosuppressive vs immunostimulating

A

echinacea (long term use suppresses)
echinacea, garlic, st john wort, ginseng, garcinia

120
Q

Which 5 supplements can cause delayed emergence?

A

St. John wort, Valerian root, Kava, ginger, saw palmetto

121
Q

What 3 supplements DO NOT increase bleeding risk? all other supplements do

A

increase clotting: St. John’s wort, garcinia
no effect: ephedra

122
Q

What is the first drug given for an initial seizure intraoperatively?

A

Benzodiazepine

123
Q

After seizure has stopped, what drug is most commonly given after a Benzodiazepine?

A

Keppra 1000-3000mg

124
Q

T/F gabapentin should be discontinued a week prior to surgery

A

False, should be continued until preoperative setting
(if d/c indicated, should do 1 week taper due to potential for withdrawal)

125
Q

Should ANY seizure medications be d/c’ed prior to surgery?

A

NO, could cause a seizure to occur

126
Q

What are indications for Keppra?

A

epilepsy, seizures, neurosurgery- brain tumor removals

127
Q

Which AEDs cause the need for higher doses of anesthetic drugs?

A

Tegretol, Phenytoin

128
Q

Does phenytoin undergo first order or zero order kinetics?

A

first at <10mcg/mL
zero at >10mcg/mL

129
Q

What AED causes upregulation of acetylcholine receptors and what does that cause?

A

Phenytoin, effects NDMB and DMB: can cause release of high levels of potassium or greater response to succs

130
Q

What is the dose for midazolam?

A

2.5-5mg/IV (up to 15mg for status epilepticus)

131
Q

How should status epilepticus be managed?

A

upper airway management, O2
IV access, benzo, AED drug

132
Q

Do ketamine and propofol increase or decrease the risk of seizure?

A

increase, can actually mimic seizure like phenomenon

133
Q

What are the effects of benzos and barbs on AEDs?

A

interactive, decreasing metabolism

134
Q

How does ethanol affect volatile agents?

A

volatiles must compete with the same GABA receptors as ethanol, competitive inhibition

135
Q

Serotonin: head, red, fed

A

Head: satisfaction, sociality, migraine, decreased anxiety, impulsivity, sex
Red: inhibits platelets and bleeding
Fed: Gi motility, naused

136
Q

How long do SSRIs take to work?

A

4-6 weeks
d/c causes brain zap

137
Q
A
138
Q

What are the cardiac symptoms that occur with TCA’s?

A

Wide QRS complex

139
Q

What is the DOPAMINE mnemonic?

A

Drive
psychOsis
Parkinsonism
Attention
Motor
Inhibition of prolactin
Narcotics
Extrapyramidal

140
Q

_____ generation antipsychotics normally have _____ side effects while _____ generations normally have _____ side effects

A

first, neurological; second, metabolic

141
Q

What is given to treat acute muscular dystonia from antipsychotics?

A

Benadryl 50mg

142
Q

What is Neuroleptic Malignant Syndrome and the S/S associated with it?

A

Occurs with recent antipsychotic use: can mimic MH
S/S: confusion
agitation
hyperthermia
muscular rigidity
seizures
TX: dantrolene

143
Q

What antipsychotic can cause Diabetes insipidus?

A

lithium

144
Q

What drug increases requirement of non-depolarizing paralytic doses?

A

keppra, levetiracetam

145
Q

What drugs should be avoided in patients taking cocaine or amphetamines?

A

ketamine, ephedrine, and catecholamines

146
Q

What is the one thing that isnt present in patients with SS and NMS?

A

no CO2 changes

147
Q

What are the effects of acute and chronic alcohol use on anesthesia requirements?

A

acute caused inhibition which decreases the need of medications
chronic causes induction which increases the amount of medication needed

148
Q

What order kinetics with alcohol associated with?

A

zero order kinetics- high risk of toxicity

149
Q

What drugs should not be given to individuals who use cannabis?

A

ketamine, atropine, epinephrine

150
Q

What are major anesthesia considerations of Cannabis ?

A

Coronary artery spasm with CAD, increased airway reactivity

151
Q

What are some anesthesia considerations for patients on antipsychotics?

A

post op confusion
hypotension
impaired temp regulation

152
Q

What drugs should not be given to an individual taking MAOIs or TCAs?

A

no ephedrine or ketamine
only low doses of direct acting sympathomimetics to prevent a hypertensive crisis event

153
Q

What psych meds cause a risk for developing serotonin syndrome when combined with opioids?

A

high risk: MAOIs OR previous serotonin toxicity
low/intermediate risk: SSRIs, SNRIs, TCAs, St John wort, lithium

154
Q

Which opioids can cause development of serotonin syndrome in patients taking some psych meds?

A

low risk: morphine, codeine, oxycodone, hydromorphone, oxymorphone, and buprenorphine
medium risk: fentanyl, tapentadol, and methadone
high risk: tramadol, meperidine, dextromethorphan

155
Q

What are the two neuro syndromes that can look like MH?

A

Serotonin syndrome and neurological malignant syndrome

156
Q

When before surgery should MAOIs be stopped?

A

2 weeks (irreversible) - 1 day (reversible)

157
Q

What is second line therapy for seizures?

A

levetiracetam (keppra) 1000-3000mg
phenytoin
valproic acid
first line = benzos

158
Q

Should mood stabilizers be d/ced prior to surgery in individuals with hx of suicidal ideations?

A

gray area… it would be best to…. but what if the attempted suicide due to that? some people recommend continuing the med and using major caution in the anesthetic plan.
stopped 24H prior to surgery

159
Q

What 2 Na channel blockers lengthens AP?

A

procanimide
flecinide

160
Q

What NA. channel blocker shortens AP?

A

Lidocaine

161
Q

How do Class 1 antiarrythmic medications work? (lidocaine, procanimide, flecainide)

A

lengthens AP and Phase 0 depolarization to decrease conduction speed (lidocaine shortens AP)

162
Q

Sympathomimetics:

A

Natural catecholamines:
Epinephrine
Norepinephrine
Dopamine
Synthetic catecholamines:
Isoproterenol
Dobutamine
synthetic noncatecholamines:
Ephedrine
Phenylephrine

163
Q

What antiarrythmic increases pacemaker capture threshold?

A

Flecainide

164
Q

What is the beta blocker of choice to treat tachycardia perioperatively?

A

esmolol OR labetalol for tachycardia & HYPERTENSION

165
Q

What are the three mechanisms that remove neurotransmitters from the synaptic cleft?

A
  1. Uptake into presynaptic terminals
  2. Extraneural uptake
  3. Diffusion
166
Q

What is the dose of isoproterenol and what is it best at treating?

A

1-5mcg/min Heart block

167
Q

What are the effects of ephedrine?

A

direct: binds to alpha and beta receptors
indirect: inhibits neuronal norepinephrine reuptake and displaces more norepinephrine from storage vesicles

168
Q

How does phenylephrine work and what is the dosage?

A

alpha1 receptors, primarily venoconstriction 50-200mcg bolus
reflex bradycardia

169
Q

What occurs in phase 0 of the cardiac cycle?

A

NA channels lead to depolarization of the cell

170
Q

How do NON dihydropyridine CCBs work?

A

block calcium channels in heart muscle, reduce Ca in cardiac cells, leading to a decrease in the heart rate and contractions DILTIAZAM

171
Q

How do dihyrdopyridine CCBs work?

A

bind to calcium channels on vascular smooth muscle, promoting vasodilation NICARDIPINE

172
Q

What three things cause arrhythmias to occur?

A
  1. reentry
  2. enhanced automaticity
  3. triggered
173
Q

how to potassium channel blockers work?

A

prolong repolarization and duration of the AP/refractory period

174
Q

What cardiac phase do class I antiarrythmics work on?

A

phase 0 depolarization
+ lidocaine phase 4

175
Q

what classes of antiarrythmics treat wide complex tachycardias?

A

IC and III

176
Q

What does flecainide treat?

A

ventricular and atrial/reenty arrythmias such as WPWS

177
Q

What antiarrythmic class prevents the risk of sudden cardiac dealth?

A

Beta blockers

178
Q

What cardiac phase do class IV antiarrythmias work in?

A

Phase 2 contraction

179
Q

What drug should never be given to a patient with WPWS and why?

A

Diltiazem, enhances conduction of accessory pathways

180
Q

What antiarrythmic can alter thyroid function and why?

A

amiodarone, high percentage of iodine in the molecule

181
Q

What is the pneumotic that helps us remember antiarrythmic classes?

A

Some (sodium blockers)
block (beta blockers)
Potassium (potassium blockers)
Channels (calcium blockers)

182
Q

Calcium channel blockers are a ________ inotrope and should not be used in patients with ______ heart failure

A

negative, systolic

183
Q

What is the preferred treatment for WPWS?

A

procanimide

184
Q

What is the preferred treatment for WPWS?

A

procanimide

185
Q

What phases of the cardiac cycle are effected by class III antiarrythmics?

A

Phase 1 and 3

186
Q

Where do class IV antiarrythmics work in the cardiac cycle?

A

mostly phase 2
phase 4 in pacemaker cells

187
Q

where do class II antiarrythmics work in the cardiac cell?

A

Phase 4, pacemaker
phase 2, myocyte

188
Q

What phase of the cardiac cycle do class 1 antiarrythmics work on?

A

Phase 0 in nonpacemaker

189
Q

How does lidocaine work since it shortens AP while other sodium channel blockers lengthen the AP?

A

works on the conduction by decreasing conduction in the SA node to allow AV node to become the primary pacemaker at a lower rate

Advanced Pharm Final (5 decks)

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