Spring 2020 - pharm exam 3 Flashcards
CCB may increase the plasma concentration of:
Digoxin
Digoxin plasma concentration may be increased by:
CCB’s
Which effects of propranolol are most important?
- Decreased HR
- Decreased contractility
If a patient is saying their ears are ringing; what might you anticipate their plasma concentration of Lidocaine to be?
5MCG/ml
what medication would you avoid with Raynaud’s Syndrome?
Propranolol
What drug decreases the plasma CLEARANCE of lidocaine and bupivacaine?
Propranolol
Q: Which of the following is Ture:
Answers are: (finish them)
- Epinephrine is…
- Phenylephrine is…
- Dobutamine is…
- Epi (Direct general agonist)
- Neo (pure alpha agonist), A1>A2)
- Dobutamine (Beta 1 > beta 2)
Drug with greatest potential to produce ventricular arrhythmias:
Dopamine
Which is associated with active metabolites? (beta blockers)
Propranolol
LA prevent the transmission of nerve impulses by inhibiting what specific voltage gated channels?
sodium
Large IV bolus of Precedex leads to:
HTN
Bradycardia
What LA has the greatest protein binding?
Levobupivacaine
Is tetany a SE of CCB?
No
What are SE of CCBs?
hypotension H/A Flushing Edema Constipation?
What drug can cause reflex bradycardia?
Phenylephrine
What is the regional dose of lidocaine with epinephrine?
7mg/kg
Name two things that are true regarding Diltiazem?
- First line tx for SVT
- Minimal vasodilating properties; intermediate b/w verapamil and dihydrophyridines
- ) Diltiazem has minimal cardiodepressant effects and Is unlikely to interact with beta blocking drugs
- tx WPW
Ephedrine indirectly or directly stimulates…. (receptors)
indirectly
alpha and beta
What amide LA undergoes the slowest metabolism:
bupivacaine
List CCB least to greatest for AV/SA node effect & Vasodilation properties
verapamil , diltiazem, dihydrophyridines (nicardipine, etc)
List the amides in order of slowest to fastest metabolism:
fastest -to slowest : Prilocaine, Lido/mepiv, etio, bupivacaine=ropivacaine
SLOWEST -ropivacaine -bupivacaine -mepivacaine -Lidocaine -Prilocaine FASTEST
Which of the sympatholytics can be administered orally?
Ephedrine
Which of the following has very little beta stimulation?
phenylephrine
*epi, norepi, ephedrine and dobutamine definitely do
Name a rapid onset selective beta 1 antagonist:
Esmolol
Which LA is 35 times more lipid soluble and has a potency and DOA 3-4 times that of mepivacaine:
bupivicaine
Principle difference in pharmacokinetecs b/w all the beta blockers is:
elimination Half-time
Dobutamine leads to an increase in
cAMP
Clearance comparison between Ropivacaine and bupivacaine:
Bupivacaine half time is LONGER
*ropivacaine lipid solubility is less than bupivicaine; and has a shorter half time
what pharmacological effects of propranolol are most important? (2)
- decreased HR
- decreased contractility
Protein binding of Beta Blockers from greatest to least:
Propranolol > Metoprolol > atenolol
** add "PENAMA" Propranolol esmolol nadolol acebutolol Metoprolol Atenolol
Which LA class is likely to cause an allergic reaction?
Esters
*Tetracaine
Prazosin is a (2):
- sympatholytic
- vasodilator
What type of patients will have a marked decrease in psudocholinesterase activity but normal enzyme?
- Hep C
- 30 Yo late stage of pregnancy
What LA are extracted by the lungs?
Lidocaine
Prilocaine
Bupivacaine
*all amides so Tetracaine is not!
What are significant applications of Verapamil?
- Negative chronotropy on SA node
- moderate vasodilating effect on CA and systemic arteries
BB with highest protein binding:
Propanolol
Which drug has an alpha 2 preference of 1600:1
dexmedetomidine
precedex
Labatelol therapy includes:
all of the following
- selective alpha 1 antagonist
- direct vasodilation
*(also beta 1and 2)
Which of the following is not a beta blocker:
isoproterenol
What BB has:
- less lipid solubility
- decreased entrance into the CNS
Atenolol
during pregnancy there is a faster onset of
LA blockade
Principle contraindication of administration of esmolol is: (2)
- AV Block
- HF not induced by tachycardia
Dibucaine is an amide that inhibits: (2)
- Typical plasmacholinesterase
- Typical P CH E
Lidocaine, diazepam, and propranolol can increase the pharmacologicallya ctive, unbound portion of which drug?
Verapamil
high dose IV push Metoprolol does: (2)
- antagonize Beta 2
- antagonize receptor Beta 1 selectively
PDI produce:
- increased contractility and
- dilates arteries and veins
Chiral LA drugs that have S&R:
Bupivacaine
Mepivacaine
Elimination half time of Esmolol is due to :
hydrolysis
Which drug(s) should be used with caution when given with Dantrolene?
Verapamil & Nifedipine
*CCB’s
due to Verapamil’s dextroisomer , it has:
no slow calcium channel activity
Benzocaine is unique because:
it is a weak acid
Most alph 2 receptors are found in:
locus cerelus
Timolol is effective for glaucoma tx b/c it decreases production of:
aqueous humor
L-type channel antagonized by CCB works on which receptor:
Alpha 1
What drug should be avoided in asthmatic patients?
Labetalol
Initiation of labetalol does what action through Alpha 1 blockade and Beta blockade:
- decreases SVR by A1 blockade
- attenuates tachy by beta blockade
what is stored in postganglionic sympathetic nerve endings?
Norepi
Prototype of sympathomimetics:
epinephrine
What LA’s are racemic mixtures?
mepivacaine
bupivacaine
CCB should be used with caution in patient with:
- hypovolemia
- LV dysfunction
Amide metabolism from Rapid to slow:
Prilocaine>Mepivicaine > Etido = Ropivacaine
Which of the following LA is 10xmore potent and more lipid soluble (than procaine)
Tetracaine
Unique aspect of nadolol:
daily administration d/t long elimination half tie
Drug you would use with caution in RV failure:
Norepi
and dopamine “DN.R”
Drug that has the greatest effect on metabolim:
epinephrine
Potent activator of alpha, but also activates beta 1 and 2:
epinephrine
Which drug does not produce an interaction with digoxin:
Clonidine
Drug of choice for prehospital managment of pheochromocytoma is:
Phenoxybenzamine
What can be added to LA to increase DOA?
epinephrine
Verapamil is given for all of the following situations except:
acute myocardial ischemia
is verapamil (CCB’s) given for management of acute MI?
no
Dibucaine number that inhibits succinlchoine?
30
Physiological effects of Calcium is seen in:
freely diffusible ionized Ca
Substituting a butyl group for the amine group on the benzene ring of procaine results in
tetracaine
Labetalol lowers systemic bp by
decreasing SVR and reflex tachycardia triggered by vasodilation is attenuated by simulatneous beta blockade
reflex tachycardia triggered by vasodilation is attenuated by
beta blockade (labetalol would do this)
What describes best how the action potential and relationship b/w locals
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.
