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Summer Pharm > Test 1 > Flashcards

Test 1 Flashcards

1
Q

This can be given to treat muscle rigidity from opioids

A

NDMRs

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2
Q

What should you do if you see a localized reaction at the site of morphine injection?

A

DON’T PANIC

Morphine causes histamine release, so this is a common reaction

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3
Q

These meds can be used to relieve sphincter of oddi spasm

A

Glucagon, nubain, and NTG

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4
Q

Opioids are weak (acids/bases)

A

Bases

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5
Q

Vd is related to

A

Lipid solubility and protein binding

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6
Q

A large Vd will equate to a long or short DOA?

A

Long

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7
Q

Do opioids produce amnesia?

A

NO

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8
Q

How do opioids produce bradycardia?

A

Vagal stimulation and inhibition of the SA node

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9
Q

The bradycardia and ventilatory depression caused by opioids are

A

dose dependent

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10
Q

Where do agonists/antogonists work?

A

They are Mu antagonists and full or partial kappa agonists

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11
Q

Do benzos provide enough muscle relaxation for surgery?

A

NO. Give the normal amount of muscle relaxant you would normally give.

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12
Q

Should you decrease the amount of muscle relaxant you give for a case if you have given a benzo?

A

NO

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13
Q

Do benzos or barbiturates induce enzymes?

A

Only barbiturates

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14
Q

Benzos have a (large/small) margin of error

A

Large

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15
Q

Which do we typically give for pre-medication and MAC sedation? Benzos vs. barbs

A

Benzos. These have essentially replaced barbs for these purposes.

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16
Q

How do benzos act at the GABA receptor?

A

They FACILITATE the actions of GABA at the receptor (increases it’s affinity and potency)

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17
Q

Where are GABAa receptors found?

A

On POST-synaptic neurons in the CNS

There are barely any GABA receptors outside the CNS

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18
Q

Why is there a ceiling effect with benzos?

A

Because all it can do is assist GABA to open the Cl- channels. After that, it can’t do anything else to achieve any effects.

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19
Q

If given in subtherapeutic doses, this type of medication can cause a person to enter Stage 2 (excitatory) Anesthesia, and result in bronchospasm or laryngospasm

A

Barbiturates

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20
Q

What does it mean if a drug has a short effect site equilibration time?

A

It means that the effects on the brain occur promptly after IV administration

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21
Q

The reversal for dexmedetomidine is

A

Atipamezole

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22
Q

The two preservatives used in propofol are

A

EDTA and sodium metabisulfite

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23
Q

How is the pharmacologic activity of barbiturates terminated?

A

Side chain oxidation at carbon 5, converting it to carboxylic acid

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24
Q

These medications are prepared as racemic mixtures

A

1) Ketamine (R and S, the S has more analgesic potency, undergoes faster metabolism, and has less incidence of emergence delirium)
2) Barbiturates (L and D, the L enantiomer has 2x the potency of D)

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25
Q

Effect of barbiturates on pain

A

Small doses can lower the pain threshold

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26
Q

If your patient’s seizure disorder has been treated with a barbiturate, such as phenobarbital, you can expect that they will metabolize your drugs about ___x as rapidly

A

2 (this is especially evident in muscle relaxants)

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27
Q

Do patients develop tolerance to barbs?

A

Yes, they induce their own metabolism and cause tolerance!

28
Q

How is diazepam prepared?

A

In benzyl alcohol and propylene glycol. pH of 6.6-6.9.

29
Q

Flumazenil is a _______ derivative

A

Imidazobenzodiazepine derivative

30
Q

What’s unique about NMDA receptors?

A

They are both ligand and voltage-gated

31
Q

The clearance of this medication is dependent of hepatic blood flow

A

Ketamine

32
Q

How common are emergence reactions with ketamine?

A

10-30%

33
Q

Why should ketamine be avoided with MAOIs and TCAs?

A

Because ketamine prevents the re-uptake of NE

34
Q

MOA of propofol

A

Binds to the B1 subunit of GABA and inhibits NMDA

35
Q

What converts fospropofol into propofol?

A

Endothelial cell alkaline phosphatases

36
Q

What effect does sulfuration of barbituric acid have?

A

Makes it more lipid soluble

37
Q

What is the structure of benzodiazepines?

A

A benzene ring fused with a seven-membered diazepine ring

38
Q

The effects of benzos binding with GABA-A is thought to cause these effects

A

Sedation, anxiolysis, anticonvusant, and muscle relaxant. (everything but amnesia)

39
Q

Where can GABA-A receptors be found?

A

Almost exclusively on post-synaptic membranes in the CNS

40
Q

Which medication class causes a flattening of the CO2 response curve?

A

Benzodiazepines

41
Q

Effect of midazolam on the CV system.

A

None at small doses. At induction doses, there is a drop in SVR and BP, but CO is unchanged.

42
Q

Effect of diazepam on the CV system

A

Decrease in SVR, BP, and CO by 20%

43
Q

Ativan has this as a solvent

A

Propylene glycol

44
Q

How does flumazenil work?

A

It’s a competative benzodiazepine antagonist

45
Q

Benefits of flumazenil

A

Reverses the sedation and respiratory depression. Also, it’s post-op use is not associated with any anxiety provoking or neuroendocrine response (increased BP, HR, , etc), as opposed to narcan.

46
Q

A suboptimal dose of this medication can cause a patient to enter Stage 2 Anesthesia

A

TPL

47
Q

Effect of TPL on pain

A

Small doses can decrease the pain threshold. It can act as an “anti-analgesic”

48
Q

(TPL/Methohexital) can cause myoclonus and hiccups

A

Methohexital (the methyl radical causes convulsant activity)

49
Q

Allergy to TPL

A

Rare (1:30,000), but if it happens, it causes SEVERE anaphylaxis.

50
Q

If hepatic enzymes are induced, you can expect these medications to be metabolized faster

A

Oral anticoagulants, vitamine K, corticosteroids, TCAs, and phenytoin.

51
Q

TPL should not be mixed with these meds

A

Overall, avoid mixing with opioids, catecholamines, and NDMBs, because these are all acidic in solution

Vecuronium
Atracurium
Pancuronium

Sufentanil
LR
Alfentanil
Midazolam

52
Q

IBW calculation

A

Men:
105 + 6lbs for every inch over 5 feet

Women
100 + 5lbs for every inch over 5 feet

53
Q

Relationship of pKa of the opioids and their ionization

A

Lower the pKa, the more non-ionized. Alfentanil has the lowest pKa of the bunch, 6.5, and has the highest % non-ionized (90%), and thus the fastest rate of onset.

54
Q

This pain medication is contraindicated if

A

Meperidine (Demerol)

55
Q

Unlike most opioids, this one can cause tachycardia and myocardial depression

A

Meperidine (Demerol). This is because structurally, it resembles atropine.

56
Q

Effects of accumulation of normeperidine

A

Confusions, hallucinations, myoclonus, seizures

57
Q

How does meperidine act to reduce post-op shivering?

A

Works on kappa and alpha-2 receptors

58
Q

Compared with morphine, fentanyl has a (longer/shorter) onset and DOA

A

Shorter

59
Q

Why is does ketamine has sympathomimetic effects

A

1) NMDA activity in the nucleus tractus solitarius***
2) Antagonist at muscarinic receptors
3) Inhibits the reuptake of NE

60
Q

This medication is cerebroprotective and resembles vitamin E in structure

A

Propofol

61
Q

This is a common premed we give that can inhibit the CYP450 system

A

Cimetidine

62
Q

These medications are myocardial depressants

A
  • Ketamine
  • Propofol
  • Meperidine
63
Q

These medications have propylene glycol as a solvent

A

Diazepam, lorazepam, and etomidate.

64
Q

These medications flatten the CO2 response curve

A

Benos
Barbs
Etomidate Propofol

65
Q

These medications shift the CO2 response curve down/to the right

A

Opioids

66
Q

These medications are water soluble

A
  • Midazolam
  • Dexmedetomidine
  • Fospropofol
  • Ketamine (both water and fat soluble)

Summer Pharm (7 decks)

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