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A. Spring Quiz/Exam Comp > Spring 2020 - pharm exam 3 > Flashcards

Spring 2020 - pharm exam 3 Flashcards

1
Q

CCB may increase the plasma concentration of:

A

Digoxin

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2
Q

Digoxin plasma concentration may be increased by:

A

CCB’s

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3
Q

Which effects of propranolol are most important?

A
  • Decreased HR

- Decreased contractility

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4
Q

If a patient is saying their ears are ringing; what might you anticipate their plasma concentration of Lidocaine to be?

A

5MCG/ml

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5
Q

what medication would you avoid with Raynaud’s Syndrome?

A

Propranolol

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6
Q

What drug decreases the plasma CLEARANCE of lidocaine and bupivacaine?

A

Propranolol

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7
Q

Q: Which of the following is Ture:

Answers are: (finish them)

  • Epinephrine is…
  • Phenylephrine is…
  • Dobutamine is…
A
  • Epi (Direct general agonist)
  • Neo (pure alpha agonist), A1>A2)
  • Dobutamine (Beta 1 > beta 2)
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8
Q

Drug with greatest potential to produce ventricular arrhythmias:

A

Dopamine

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9
Q

Which is associated with active metabolites? (beta blockers)

A

Propranolol

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10
Q

LA prevent the transmission of nerve impulses by inhibiting what specific voltage gated channels?

A

sodium

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11
Q

Large IV bolus of Precedex leads to:

A

HTN

Bradycardia

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12
Q

What LA has the greatest protein binding?

A

Levobupivacaine

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13
Q

Is tetany a SE of CCB?

A

No

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14
Q

What are SE of CCBs?

A 
hypotension
H/A
Flushing
Edema
Constipation?
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15
Q

What drug can cause reflex bradycardia?

A

Phenylephrine

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16
Q

What is the regional dose of lidocaine with epinephrine?

A

7mg/kg

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17
Q

Name two things that are true regarding Diltiazem?

A
  1. First line tx for SVT
  2. Minimal vasodilating properties; intermediate b/w verapamil and dihydrophyridines
  3. ) Diltiazem has minimal cardiodepressant effects and Is unlikely to interact with beta blocking drugs
    - tx WPW
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18
Q

Ephedrine indirectly or directly stimulates…. (receptors)

A

indirectly

alpha and beta

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19
Q

What amide LA undergoes the slowest metabolism:

A

bupivacaine

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20
Q

List CCB least to greatest for AV/SA node effect & Vasodilation properties

A

verapamil , diltiazem, dihydrophyridines (nicardipine, etc)

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21
Q

List the amides in order of slowest to fastest metabolism:

A

fastest -to slowest : Prilocaine, Lido/mepiv, etio, bupivacaine=ropivacaine

SLOWEST
-ropivacaine
-bupivacaine
-mepivacaine
-Lidocaine
-Prilocaine
FASTEST
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22
Q

Which of the sympatholytics can be administered orally?

A

Ephedrine

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23
Q

Which of the following has very little beta stimulation?

A

phenylephrine

*epi, norepi, ephedrine and dobutamine definitely do

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24
Q

Name a rapid onset selective beta 1 antagonist:

A

Esmolol

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25
Q

Which LA is 35 times more lipid soluble and has a potency and DOA 3-4 times that of mepivacaine:

A

bupivicaine

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26
Q

Principle difference in pharmacokinetecs b/w all the beta blockers is:

A

elimination Half-time

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27
Q

Dobutamine leads to an increase in

A

cAMP

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28
Q

Clearance comparison between Ropivacaine and bupivacaine:

A

Bupivacaine half time is LONGER

*ropivacaine lipid solubility is less than bupivicaine; and has a shorter half time

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29
Q

what pharmacological effects of propranolol are most important? (2)

A
  • decreased HR

- decreased contractility

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30
Q

Protein binding of Beta Blockers from greatest to least:

A

Propranolol > Metoprolol > atenolol

** add
"PENAMA"
Propranolol
esmolol
nadolol
acebutolol
Metoprolol
Atenolol
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31
Q

Which LA class is likely to cause an allergic reaction?

A

Esters

*Tetracaine

32
Q

Prazosin is a (2):

A
  • sympatholytic

- vasodilator

33
Q

What type of patients will have a marked decrease in psudocholinesterase activity but normal enzyme?

A
  • Hep C

- 30 Yo late stage of pregnancy

34
Q

What LA are extracted by the lungs?

A

Lidocaine
Prilocaine
Bupivacaine

*all amides so Tetracaine is not!

35
Q

What are significant applications of Verapamil?

A
  • Negative chronotropy on SA node

- moderate vasodilating effect on CA and systemic arteries

36
Q

BB with highest protein binding:

A

Propanolol

37
Q

Which drug has an alpha 2 preference of 1600:1

A

dexmedetomidine

precedex

38
Q

Labatelol therapy includes:

all of the following

A
  • selective alpha 1 antagonist
  • direct vasodilation

*(also beta 1and 2)

39
Q

Which of the following is not a beta blocker:

A

isoproterenol

40
Q

What BB has:

  • less lipid solubility
  • decreased entrance into the CNS
A

Atenolol

41
Q

during pregnancy there is a faster onset of

A

LA blockade

42
Q

Principle contraindication of administration of esmolol is: (2)

A
  • AV Block

- HF not induced by tachycardia

43
Q

Dibucaine is an amide that inhibits: (2)

A
  • Typical plasmacholinesterase

- Typical P CH E

44
Q

Lidocaine, diazepam, and propranolol can increase the pharmacologicallya ctive, unbound portion of which drug?

A

Verapamil

45
Q

high dose IV push Metoprolol does: (2)

A
  • antagonize Beta 2

- antagonize receptor Beta 1 selectively

46
Q

PDI produce:

A
  • increased contractility and

- dilates arteries and veins

47
Q

Chiral LA drugs that have S&R:

A

Bupivacaine

Mepivacaine

48
Q

Elimination half time of Esmolol is due to :

A

hydrolysis

49
Q

Which drug(s) should be used with caution when given with Dantrolene?

A

Verapamil & Nifedipine

*CCB’s

50
Q

due to Verapamil’s dextroisomer , it has:

A

no slow calcium channel activity

51
Q

Benzocaine is unique because:

A

it is a weak acid

52
Q

Most alph 2 receptors are found in:

A

locus cerelus

53
Q

Timolol is effective for glaucoma tx b/c it decreases production of:

A

aqueous humor

54
Q

L-type channel antagonized by CCB works on which receptor:

A

Alpha 1

55
Q

What drug should be avoided in asthmatic patients?

A

Labetalol

56
Q

Initiation of labetalol does what action through Alpha 1 blockade and Beta blockade:

A
  • decreases SVR by A1 blockade

- attenuates tachy by beta blockade

57
Q

what is stored in postganglionic sympathetic nerve endings?

A

Norepi

58
Q

Prototype of sympathomimetics:

A

epinephrine

59
Q

What LA’s are racemic mixtures?

A

mepivacaine

bupivacaine

60
Q

CCB should be used with caution in patient with:

A
  • hypovolemia

- LV dysfunction

61
Q

Amide metabolism from Rapid to slow:

A

Prilocaine>Mepivicaine > Etido = Ropivacaine

62
Q

Which of the following LA is 10xmore potent and more lipid soluble (than procaine)

A

Tetracaine

63
Q

Unique aspect of nadolol:

A

daily administration d/t long elimination half tie

64
Q

Drug you would use with caution in RV failure:

A

Norepi

and dopamine “DN.R”

65
Q

Drug that has the greatest effect on metabolim:

A

epinephrine

66
Q

Potent activator of alpha, but also activates beta 1 and 2:

A

epinephrine

67
Q

Which drug does not produce an interaction with digoxin:

A

Clonidine

68
Q

Drug of choice for prehospital managment of pheochromocytoma is:

A

Phenoxybenzamine

69
Q

What can be added to LA to increase DOA?

A

epinephrine

70
Q

Verapamil is given for all of the following situations except:

A

acute myocardial ischemia

71
Q

is verapamil (CCB’s) given for management of acute MI?

A

no

72
Q

Dibucaine number that inhibits succinlchoine?

A

30

73
Q

Physiological effects of Calcium is seen in:

A

freely diffusible ionized Ca

74
Q

Substituting a butyl group for the amine group on the benzene ring of procaine results in

A

tetracaine

75
Q

Labetalol lowers systemic bp by

A

decreasing SVR and reflex tachycardia triggered by vasodilation is attenuated by simulatneous beta blockade

76
Q

reflex tachycardia triggered by vasodilation is attenuated by

A 
beta blockade
(labetalol would do this)
77
Q

What describes best how the action potential and relationship b/w locals

A

Failure of sodium channel permeability to increase slows the rate of depolarization such that threshold potential is not reached and thus an action potential is not propagated.

A. Spring Quiz/Exam Comp (9 decks)

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