Spring 2020 - pharm exam 1 Flashcards
The sodium/potassium pump is responsible for? (choose 2)
A. Maintains oncotic equilibrium
B. Creates sodium gradient
Which of the following are true of halothane? (Choose 2)
a. high potency, quick onset and recovery
b. vapor malfunction caused by thymol
slide 89 of gas ppt
Plasma fluoride concentration is higher after administration of sevoflurane than enflurane, but exposure of renal tubules to fluoride is limited because most elimination is through the:
Lungs
Which of the following are true of Sevoflurane? (choose 2)
A. Though controversial, 2 L/min of fresh gas flow prevents the breakdown of compound A
B. CO2 absorbents react with sevoflurane to eliminate hydrogen fluoride
Though controversial, 2 L/min of fresh gas flow prevents the breakdown of compound A with the use of which gas?
sevo
CO2 absorbents react with which gas to eliminate hydrogen fluoride
sevoflurane
Maintains oncotic equilibrium
sodium /potassium pump
what creates sodium gradiant?
sodium /potassium pump
which gas has a high potency, quick onset and recovery?
halothane
which gas is associated with a vapor malfunction caused by thymol
halothane
the ratio b/w the LD50 and ED50?
Therapeutic Index (TI)
The time required to change the amount of drug in the body by 1/2 during elimination (or during a constant infusion) represented by:
0.7 x Vd/Cl
0.7 x Vd/Cl =
The time required to change the amount of drug in the body by 1/2 during elimination (or during a constant infusion) represented by:
Propofol classification
GABA Agonist
MOA of Malignant hyperthermia:
constant leak of Ca through ryanodine receptors
List volatile anesthetics from greatest to least HEPATIC effects:
Halothane > Enflurance >Isoflurane > Desflurane
Which is true regarding properties of inhaled anesthetics?
The higher the concentration of gas, the quicker the effects take place
The higher the concentration of gas….
the quicker the effects take place
True or False?
The higher the concentration of gas, the quicker the effects take place
True
How do inhaled anesthetics work? What do they act on?
choose 2
- GABA receptor
- Influx of Cl- ions into the cell to hyperpolarize cells
most soluable anesthetic gas in blood?
sevoflurane (was only choice that was most soluble)
What is the Boiling point for Desflurane?
BP = 22.8
What is the vapor pressure for Desflurane?
VP = 669
Blood gas solubility of Sevo:
0.69
Pharmacokinetics does NOT include:
Bioavailability
Hydrolysis does not involve
P450
What is broken down in the plasma by hydrolysis?
succ
What is the exchange ratio of the Na Atpase Pump?
3Na IN
2K OUT
Chronic alcoholics require more anesthetic gases, why?
chronic alcoholism causes increased metabolism due to enzymes that break down the drug faster.
What is the order of potency for morphine (compared to sufentanil, dillaudid, fentanyl)
Sufentanil> fentanyl> hydromorphone> morphine
Which drug has the least protein binding?
Procaine (ester)
exogenous epi dose:
6mcg/kg
Which volatile agent causes transient increase in HR?
Desflurane
Malignant hyperthermia is caused from? (choose two)
- ) succinylcholine
2. ) continuous release of ca from the ryanodine receptor
Malignant hyperthermia results from the continuous release of….
ca from the ryanodine receptor
what is the process of allowing temporary per-op myocardial ischemia to prepare a pt for surgery?
Ischemic perconditioning
which of the following gases has a blood gas solubility that allows for a rapid rise to equilibrium?
Desflurane
which gas is used as the first gas of the second gas effect?
Nitrous Oxide
gas that enters the mouth, pharynx, and trachea but does not reach the alveoli is referred to as:
anatomical dead space
what gas is not stable in sode lime?
sevoflurane
Graph with A B C D choices.
Which one does the CRNA want?
C - line between LD1, ED99
??
LD1, ED99 describes the need for:
vigilance
which of the following best describes the need for vigilance?
LD1, ED99
Therapeutic index is not optimal. What is a more effective ratio for anesthesia?
LD1, ED99
What is the therapeutic index? (ratio)
LD 50, ED 50
A drug infused at a constant rate reached 94% of steady state after how many half lifes?
4
What is involved in Phase 1 metabolism? (choose 2)
- cytochrome P450 enzymes
2. yields water soluble metabolites
An 80 year old patient with liver disease is expected to have: (choose 2)
- Increase in volume of distribution
2. Decrease in plasma protein
Which of the following is descriptive of fetal ion trapping (choose 3):
- fetal pH lower than the mother
- drug converting from non-ionized to ionized form in fetus
- drugged becoming trapped in fetus leading to toxicity.
Which of the following is an ester?
Tetracaine
“i” esters
which of the following is associated with fetal ion trapping (choose 2):
- fetus being more acidic than the mother
2. specific amides
definition of peak concentration:
rate of absorption = rate of elimination
definition of a prodrug:
inactive until metabolized
Chloroprocaine has no protein binding, what are two things you can assume about it?
- short duration of action
2. dissociates from Na channels with ease
choose/name three characteristics of LIPID soluble drugs that help them spread:
- can pass through the BBB
- high protein binding
- because of Vd, it does not get cleared out of the body as quickly
what are the correct definitions for efficacy and potency?
Efficacy is max effect a drug can produce.
Potency is amount of drug needed for a given effect.
Efficacy is
max effect a drug can produce.
Potency is
amount of drug needed for a given effect.
What describes liver metabolism before the drug enters circulation?
First pass effect
First pass effect is:
the metabolism by the liver before the drug enters circulation
Receptor theory, those that are responsible for no action at the receptor side (2):
- Non-competitive antagonist
- competitive antagonist
Responsible for moving morphine out of the CNS?
P-glycoprotein
Most ions are insoluble or soluble to the cell membrane?
Insoluble
Most ions cross cell membrane through:
Protein channels
Na/K pump is responsible for: (choose 2)
Na/K transport
Transmembrane electrical potential
Glucose moves across cell membrane by: (2)
- sodium cotransport system
2. insulin
O2 and CO2 move into the cell by:
simple diffusion
What are the two most abundant constituents in the cell membrane?
- protein
2. phospholipids
Cholesterol provides ___ and ____ to the cell membrane.
- Flexibility
- Stability
What provides SPECIFICITY to the cell membrane?
Protein(s)
How many liters of plasma do we have?
3Liters
Constituent are identical but quantities vary:
- plasma
- interstitial fluid
- intracellular fluid
Total body weight is composed of:
65% water
35% non-water
What coefficient parallels anesthetic requirement?
Oil : gas partition
Oil : gas partition parallels what?
anesthetic requirement
negative middle ear pressures may develop after d/c of Nitrous Oxide leading to:
serous otitis
Conjugation is not part of (metabolism) Phase :
Phase 1
All of the following are a part of phase I metabolism except:
Conjugation
Tissue uptake is determined by:
pH
Biotransformation occurs primarily in the :
Liver
Context sensitive half time (2):
- time it takes for the plasma concentration to decrease by 50%
- depends on the duration of the infusion
Half time elimination (2):
- Directly proportional to volume of distribution
2. inversely proportional to clearance
time it takes for the plasma concentration to decrease by 50% (defines)
context sensitive half time
the duration of the infusion influences
context sensitive half time
what is directly proportional to volume of distribution?
half time elimination
what is inversely proportional to clearance?
half time elimination
Half time elimination is directly proportional to:
volume of distribution
Half time elimination is inversely proportional to:
clearance
What is the term for when two drugs produce the same effect are given together and one enhances the effect of the other?
synergistic
When two drugs are present in a mixture of 50/50 they are referred to as:
racemic mixture
What LA has no protein binding?
Procaine?
What generally decreases membrane fluidity and permeability?
Cholesterol
a patient has a hx of seizures. What gas would the CRNA avoid?
Enflurane
The most potent inhaled anesthetic:
insoflurane
osmotic pressure (flow of fluid)
hypotonic to hypertonic
Signs of diffusion hypoxia with decreased respiration’s (hypoventilation). Use of what gas could cause this?
Nitrous Oxide
Which stage of anesthesia do you want your patient in?
Stage 3
Induction (partial pressure equilibrate order):
PA –>Pa –> Pbr
Patient has divergent gaze and breath holding. What stage of GA is pt in?
Stage 2
100% MAC =
N2O
What is the equation for Minute ventilation?
tidal vol x breaths/min
Vapor pressure of Sevoflurane:
170
Gas coefficient of Sevoflurane:
0.69
Not stable in soda lime:
sevoflurane (and halothane)
