Term
| Tolvaptan works to treat symptoms of congestive heart failure related to hyponatremia, hypervolemia by |
|
Definition
| acting as a competitive vasopressin II antagonist. It assists in diuretic therapy and is not associated with hypokalemia or hypotension! And with no kidney dysfunction. Avoid in liver disease patients. |
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Term
| An agonist action on the kappa receptor will result in what Sx |
|
Definition
1. dyphoria
2. Negative regulation against ADH
3. resp depression
4. meoisis
5. hallucinations
6. constipation |
|
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Term
| describe the occupancy theory about receptors |
|
Definition
| t is based on mass-action kinetics and attempts to link the action of a drug to the proportion of receptors occupied by that drug at equilibrium.[9][10] In particular, the magnitude of the response is directly proportional to the amount of drug bound, and the maximum response would be elicited once all receptors were occupied at equilibrium |
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Term
| benefits of etomidate at induction are |
|
Definition
1. maintenance of cerebral perfusion pressure while also decreasing CBF and decrease CRMO2
2. Minimal ventilatory depression
3. Minimal hemodynamic changes
4. No histamine release
5. Short acting and fast onset |
|
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Term
| what are the benefits of clevidipine |
|
Definition
1. highly selective to vascular smooth muscle
2. Near NO effect on cardiac myocyte and does not cause coronary steal syndrome
3. Almost entirely metabolized by blood esterases so can be safe in liver and renal failure patinets
4. IV only
5. E1/2 1 minute |
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Term
| which local anesthetics have intrinsic abilities to produce vasoconstriction |
|
Definition
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Term
| What is vasoplegic syndrome and what kind of patients may you see this the most |
|
Definition
| A massive drop in SVR with high CO and BP that is refractory to any pressors. Seen most commonly in cardiac surgery patients but also SEEN WITH PTS ON ACE-I. |
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Term
| the normal blood pressure is maintained by what three systems in the body |
|
Definition
1. Sympathetic nervous system
2. Renin-Angiotensinogen & aldosterone System
3. vasopressinergic system |
|
|
Term
| refractory hypotension can be treated with what dose of vasopressin.. then start an iv gtt at a rate of? |
|
Definition
| Bolus 0.5 units of vaso then start a gtt at 0.03 units/min |
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|
Term
| primary means of roc elminiation is via |
|
Definition
| biliary elimination of unchanged drug |
|
|
Term
| plasma cholinesterase will metabolize what three drugs we commonly use |
|
Definition
1. sux
2. mivatracurium
3. chloroprocaine |
|
|
Term
| explain the effects of opioids on endocrine function in the body long term |
|
Definition
1. increase TSH
2. Decrease Prolactin
3. Decrease Gonadtropin relaeasing hormone. |
|
|
Term
|
Definition
| Alpha 2 agonist in the locus coernelus produces sedation and analgesia is achieved in the dorsal horn of the spinal cord to modulate release of substance p |
|
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Term
| what is fospropofol and how does it work |
|
Definition
| it is a prodrug converted to propofol by alkaline phosphatases. |
|
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Term
| The route of administration associated with the lowest degree of bioavailability |
|
Definition
intrathecal
By definition, intravenous administration is associated with 100% bioavailability. Intramuscular and sublingual administration is associated with 60 - 100% bioavailability. Intrathecal administration circumvents the blood-brain barrier, but is associated with very low overall bioavailability. |
|
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Term
| what antiarrythmic is associated with respiratory insufficiency |
|
Definition
Respiratory insufficiency has been associated with the administration of: amiodarone
Pulmonary disease from amiodarone occurs with 5 - 15% prevalence and takes the form of chronic interstitial pneumonitis, organizing pneumonia, ARDS or a solitary mass of fibrosis. |
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Term
| The central nervous system effects of nitrous oxide include |
|
Definition
The central nervous system effects of nitrous oxide include: a decrease in cerebrovascular tone, an uncoupling of CBF and (CMRO2)
Nitrous oxide decreases cerebral vascular tone significantly and increases CMRO2. Since the increase in CMRO2 exceeds the elevation in CBF there is an uncoupling of these parameters. Mild hyperventilation can attenuate the increase in CBF that accompanies the use of nitrous oxide. |
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Term
| Actions produced by opiate agonistic action on the kappa receptor include |
|
Definition
| Actions produced by opiate agonistic action on the kappa receptor include: (Select 3) analgesia, inhibition of ADH release, antishivering |
|
|
Term
| risk factors for propofol infusion syndrome (PRIS) |
|
Definition
| Risk factors include young age, doses greater than 4 - 5 mg/kg/hr, critical illness and an infusion duration greater than 48 hours. |
|
|
Term
| propofol infusion syndrome Symptoms include |
|
Definition
| propofol infusion syndrome Symptoms include severe metabolic acidosis, bradycardia and refractory heart failure. |
|
|
Term
| The propofol infusion syndrome (PRIS) results in damamge where |
|
Definition
| The propofol infusion syndrome (PRIS): results in cardiac and peripheral muscle necrosis |
|
|
Term
| the primary mechanism of action of nitroglycerin is |
|
Definition
Relief of anginal pain by nitroglycerine is primarily the result of: decreased preload and cardiac work
Nitroglycerine causes venodilation and a resultant decrease in preload. Its primary mechanism of action in the relief of angina is a decrease in preload and cardiac work. |
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Term
| Drug X is quickly distributed to the total body water of a 70 Kg patient. The estimated volume of distribution (Vd) is drug X is: |
|
Definition
Drug X is quickly distributed to the total body water of a 70 Kg patient. The estimated volume of distribution (Vd) is drug X is:
(Enter numerical answer in box below. Click 'Next' when completed.): 0.6 L/Kg
The typical Vd, normalized for the body weight of a 70 Kg adult, would be the quantity of total body water (42 L) divided by the body weight (70 kg). This results in a Vd of 0.6 L/Kg. |
|
|
Term
| Stimulation of opioid receptors has been shown to do what intracellularly via its receptor |
|
Definition
Stimulation of opioid receptors has been shown to: inhibit adenylate cyclase in the cell
Opioid receptors are GPCRs and inhibit the activity of adenylate cyclase inside cells. This causes in a decrease in intracellular cAMP, which decreases conductance of the voltage-gated calcium channels and open potassium channels, resulting in decreased neuronal activity. |
|
|
Term
| Pharmacokinetic and pharmacodynamic properties of etomidate include: |
|
Definition
| hydrolysis by plasma esterases, minimal hemodynamic changes with induction, adrenocortical suppression with induction doses |
|
|
Term
| describe etomidate propertieis |
|
Definition
| Etomidate is rapidly metabolized by hepatic microsomal enzymes and plasma esterases. However, rapid redistribution accounts for its extremely short duration of action. The primary clinical advantage of etomidate is the hemodynamic stability upon induction. Adrenal hormone levels decrease for up to 24 hours after etomidate administration, largely as a result of 11β-hydroxylase inhibition. |
|
|
Term
| The graded dose-response curve has a ___ shape |
|
Definition
| The graded dose-response curve has a: hyperbolic shape |
|
|
Term
| local anesthetics with vasoconstrictive include 3x |
|
Definition
| Vasoconstrictive properties are associate with use of: (Select 3) cocaine, lidocaine, ropivacaine |
|
|
Term
| A 23-year-old man is undergoing a thoracotomy for resection of blebs. He is currently has a 500 mL pneumothorax present. If the patient is anesthetized with an anesthetic of desflurane with nitrous oxide and oxygen in a 2:1 ratio, the resultant volume of the pneumothorax will approach: |
|
Definition
1500 mL
VF/VO = 1/ (1-F N20) |
|
|
Term
| The chemical interaction of sevoflurane with desiccated soda lime has been associated with |
|
Definition
| The chemical interaction of sevoflurane with desiccated soda lime has been associated with: anesthesia machine fires |
|
|
Term
| Causes of increased pseudocholinesterase activity include |
|
Definition
1. Thyroid disease
2. nephrotic syndrome
3. obesity
4. cognitively impaired children. |
|
|
Term
| Characteristically, drugs with large volumes of distribution are |
|
Definition
Characteristically, drugs with large volumes of distribution are: lipid soluble with little protein binding
Drugs that are free, unbound to plasma proteins and lipid soluble easily cross membranes to tissues and therefore have large calculated volumes of distribution with low plasma concentrations. |
|
|
Term
| repetivie dosing of demerol can cause seizures due to |
|
Definition
Its neurotoxic active metabolite called normeperidine. Repetitive dosing of meperidine can cause accumulation of normeperidine, which may precipitate tremulousness, myoclonus, and seizures.
pg. 1621 |
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Term
|
Definition
| Ketamine noncompetitively inhibits the NMDA receptor in the brain producing amnesia and a profound analgesic state. It inhibits tumor necrosis factor-alpha and interleukin-6, accounting for its antiinflammatory action. Ketamine is metabolized by hepatic microsomal enzymes. It increases CMRO2, CBF and ICP. Ketamine causes a centrally-mediated increase in sympathetic tone with an increase in heart rate and blood pressure. It increases pulmonary compliance in patients with bronchospastic disease. |
|
|
Term
| explain vasoplegic syndrome |
|
Definition
| Vasoplegic syndrome (VS) is defined as unexpected refractory hypotension resulting from low systemic vascular resistance. The incidence of VS in surgical patients may be as high as 50% in persons receiving renin-angiotensin system antagonists. |
|
|
Term
| The therapeutic safety margin of a drug is defined as the: |
|
Definition
The therapeutic safety margin of a drug is defined as the: lethal dose in 1% divided by the effective dose in 99% of the population
The effective dose 99% (ED99) and lethal dose 1% (LD1) identify the therapeutic safety margin of a drug. The lower the margin of safety of a drug, the more likely toxic effects will be seen. |
|
|
Term
absoprtion of local anestehtics generally occurs in order from greatest to least with the following...
1. intercostal block
2. sciatic femoral block
3. brachial plexus block
4. epidural block
5. caudal block
6. interp leural block
7. subcutaneous block |
|
Definition
| Excluding blocks of the airway, the absorption of local anesthetics generally occurs in the following order of rapidity: interpleural block > intercostal block > caudal block > epidural block > brachial plexus block > sciatic-femoral block > subcutaneous blocks. |
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|
Term
| The greatest degree of inhaled anesthetic metabolism is seen with the use of which agent |
|
Definition
The greatest degree of anesthetic metabolism is seen with the use of: sevoflurane
Although approximately 5% of sevoflurane is metabolized, the release of free fluoride anion does not seem to cause any clinically significant toxicity. |
|
|
Term
| The primary means of rocuronium elimination is |
|
Definition
The primary means of rocuronium elimination is: biliary elimination of unchanged drug
Biliary elimination of rocuronium is the primary means of elimination. Approximately one-third undergoes renal excretion. As a result, prolonged neuromuscular blockade can be expected in patients with significant hepatic or renal disease |
|
|
Term
| In the two-compartment drug distribution curve shown below, the α-phase is largely the result of: |
|
Definition
| In the two-compartment drug distribution curve shown below, the α-phase is largely the result of: dispersal of the drug into the tissue compartments |
|
|
Term
| All opiate agonists produce a dose-dependent depression of respirations via effects on what opioid receptors |
|
Definition
| All opiate agonists produce a dose-dependent depression of respirations via effects on mu and delta receptors. |
|
|
Term
| Pharmacodynamic properties of isoproterenol include |
|
Definition
Pharmacodynamic properties of isoproterenol include: (Select 2): bronchodilation, increased heart rate
The profound β1 stimulation of isoproterenol results in both positive inotropic and chronotropic effects and causes a dramatic increase in myocardial oxygen consumption. Isoproterenol is also a potent bronchial dilator and pulmonary vasodilator |
|
|
Term
| The benzodiazepine with the longest elimination half-life is: |
|
Definition
| he benzodiazepine with the longest elimination half-life is: diazepam |
|
|
Term
| Entacapone and tolcapone are used for the treatment of Parkinson's disease. They are are selective and reversible inhibitors of ? |
|
Definition
| Entacapone and tolcapone are used for the treatment of Parkinson's disease. They are are selective and reversible inhibitors of COMT |
|
|
Term
| what is Chemical antagonism |
|
Definition
| Chemical antagonism occurs when a drug's action is blocked by the antagonist's chemical binding of the drug. This occurs in the case of positively charged protamine forming an ionic bond with heparin or the chemical binding of rocuronium by γ-cyclodextrin. |
|
|
Term
| MAC is decreased by how much as we age |
|
Definition
| The MAC of inhalational agents is decreased by 4% per decade of age over 40 years |
|
|
Term
| the mac for a 80 year old iS? |
|
Definition
The MAC of inhalational agents is decreased by 4% per decade of age over 40 years
80 year old mac is 0.84. |
|
|
Term
| MAC for a 60 year old is? |
|
Definition
The MAC of inhalational agents is decreased by 4% per decade of age over 40 years
0.92 |
|
|
Term
| Electroencephalographic evidence of seizure activity has been associated with the administration of what inhaled anesthetic |
|
Definition
Electroencephalographic evidence of seizure activity has been associated with the administration of: sevoflurane
Sevoflurane, unlike desflurane, isoflurane or nitrous oxide can predispose patients to epileptic activity.
pp. 90, 97 |
|
|
Term
| how is atracurium metabolized compared to cisatracurium |
|
Definition
ATracurium: hoffmans, nonspecific esterases
Cisatracurium: hoffman. NO ESTERASE INVOLVEMENT, liver metabolism too. |
|
|
Term
| what drugs undergo ester hydrolysis compared to what drugs under go pseudocholinesterase metabolism |
|
Definition
| Pseudocholinestease metabolism 1. sux 2. cocaine 3. procaine 4. chloroprocaine 5. tetracaine 6. neostigmine 7. pyridostigmine Nonspecific esterases 1. remifentanil 2. atracurium 3. esmolol 4. clevidipine 5. etomidate |
|
|
Term
| endocrine effects of opiate administration during surgery include: 6x |
|
Definition
Endocrine effects of opiate administration during surgery include
1. increase release of Vasopressin
2. immunosuppresion
3. reduced stress response
4. inhibition of corticotropin
5. inhibition of gonadotropin
6. inhibition of release of thyrotropin |
|
|
Term
|
Definition
| Milrinone is a phosphodiesterase type-3 inhibitor, which produces positive inotropic action and vasodilation without producing tachycardia. In smooth muscle, milrinone causes an efflux of calcium with resultant relaxation and vasodilation. |
|
|
Term
| The primary antidysrhythmic effect of adenosine |
|
Definition
The primary antidysrhythmic effect of adenosine: is to interrupt reentrant AV nodal tachycardia
The primary antidysrhythmic effect of adenosine is to interrupt reentrant AV nodal tachycardia, which most likely relates to its K+ current rather than Ca2+ current effects. |
|
|
Term
| Maximum dosage guidelines for the infiltrative injection of local anesthetic state that the maximum cumulative (per procedure) dose of lidocaine with and without epi |
|
Definition
| The maximum cumulative dose of lidocaine per procedure is: 4.5 mg/kg; not to exceed 300 mg dose. If epinephrine is added to the lidocaine, the dose can be increased to: 7 mg/kg; not to exceed 400 mg dose. |
|
|
Term
| The anesthetic effect of volatile agents is greatly attenuated or lost if what changes in its chemistry function? |
|
Definition
The anesthetic effect of volatile agents is greatly attenuated or lost if: the length of the agent's molecules exceeds 5 carbon atoms
The length of anesthetic molecules is significant in that immobility (anesthetic effect) is attenuated or lost if carbon atom chain length exceeds a distance of 5 - 6 carbon atoms. |
|
|
Term
| Awakening after an induction dose of propofol is a result of: |
|
Definition
| Awakening after an induction dose of propofol is a result of: redistribution of the drug to the peripheral compartment |
|
|
Term
|
Definition
| Dexmedetomidine is an α2-receptor agonist, which produces sedation with central sympatholysis. This results in a reduction in blood pressure and heart rate. dexmedetomidine does not interfere with neurologic monitoring or cause significant ventilatory depression. |
|
|
Term
| describe the pk/pd of ritonavir |
|
Definition
| Ritonavir is a protease inhibitor used in the treatment of HIV infection. Ritonavir can cause changes in the function of the cytochrome system and may reduce fentanyl clearance and increase its half-life. |
|
|
Term
| ocal anesthetics that have been associated with the production of methemoglobin include: |
|
Definition
| Two local anesthetics, benzocaine and prilocaine, can cause methemoglobin formation. Prilocaine can produce methemoglobin as a result of the hemoglobin oxidizing effect one of its metabolites, o-toluidine. |
|
|
Term
| Propofol is prepared in a 1% lipid emulsion because of its |
|
Definition
high pKa
Propofol is prepared in a lipid emulsion as a result of its lack of solubility in water, as reflected by its high pKa of 11.high pKa
Propofol is prepared in a lipid emulsion as a result of its lack of solubility in water, as reflected by its high pKa of 11. |
|
|
Term
| Concerning the pharmacokinetics of neuromuscular blockers in elderly patients and onset and recovery |
|
Definition
Concerning the pharmacokinetics of neuromuscular blockers in elderly patients: (Select 2) onset or relaxation is delayed, recovery is delayed
The onset times of the NMBAs are generally delayed in the elderly due to slower circulation times. Changes in hepatic and renal clearance and an increased volume of distribution account for the increased duration. |
|
|
Term
| purpose of phase II drug metabolism reactions |
|
Definition
| Phase II reactions are also referred to as synthetic reactions in which the body actually synthesizes a new compound by donating a functional group. The products of Phase II reactions have little or no biologic activity and are more polar compounds that are more highly ionized and easily extractible by the kidneys. |
|
|
Term
| Prazocin, doxazosin and terazosin are what type of drugs? Used to treat? |
|
Definition
| Prazocin, doxazosin and terazosin are selective α1-receptor antagonists used the the treatment of hypertension. |
|
|
Term
| Concerning the action of local anesthetics, a phasic block refers to |
|
Definition
a faster onset of block in nerves repetitively depolarized
Local anesthetics work faster as the sodium channels are repetitively depolarized. This is termed as use-dependent or phasic block. |
|
|
Term
| If the absolute value of the pKa - pH of a drug is less than 1, then the drug will be |
|
Definition
If the absolute value of the pKa - pH of a drug is less than 1, then the drug will be: partially ionized and partially nonionized
If the absolute value of the pKa - pH is less than 1, regardless of whether the pH is lower or higher than the pKa, the drug will be partially ionized (hydrophilic) and partially nonionized (lipophilic). |
|
|
Term
| Fospropofol is converted to propofol through the action of |
|
Definition
| Fospropofol is converted to propofol through the action of: alkaline phosphatase |
|
|
Term
| The elimination half-life is the time necessary for the plasma content of a drug to drop to half of its prevailing concentration. Clinically a drug is regarded as being fully eliminated when approximately ___% or more has been eliminated. |
|
Definition
| The elimination half-life is the time necessary for the plasma content of a drug to drop to half of its prevailing concentration. Clinically a drug is regarded as being fully eliminated when approximately 95% or more has been eliminated. |
|
|
Term
| For practical purposes, drugs undergoing first-order elimination are regarded as being fully eliminated after 5 half-lives have past. At this point, the amount of drug remaining is approximately___ |
|
Definition
For practical purposes, drugs undergoing first-order elimination are regarded as being fully eliminated after 5 half-lives have past. At this point, the amount of drug remaining is approximately: 3.125%
(0.5)^5 = 0.03125 |
|
|
Term
| The rapid termination of effect after the discontinuation of an esmolol infusion is a result of |
|
Definition
| Esmolol has an onset time of 2 minutes and an elimination half-life of approximately 9 minutes. Esmolol is metabolized by nonspecific esterases found in the cytosol of red blood cells. |
|
|
Term
| Bosentan reduces pulmonary artery pressure by |
|
Definition
Bosentan reduces pulmonary artery pressure by: inhibiting endothelin
Bosentan is the best studied of the endothelin antagonists and through this action induces pulmonary vasodilation. |
|
|
Term
| The protein binding of acidic drugs is largely with which protein |
|
Definition
The protein binding of acidic drugs is largely with: albumin
In the binding of drugs to plasma proteins, albumin is the most important. Plasma albumin binds, for the most part, acidic drugs, while basic drugs may be bound by β-globulin and α1-acid glycoprotein. |
|
|
Term
|
Definition
| Propofol administration is associated with a decrease in CMRO2,CBF and ICP. Propofol can produce myoclonia; however, it does not cause epileptiform activity on the EEG. Propofol causes a decrease in BP, heart rate and SVR. It does not cause histamine release and is a preferred agent for induction in asthmatic patients. |
|
|
Term
| Diuresis, through the competitive inhibition of aldosterone, can be achieved with the administration of: |
|
Definition
Diuresis, through the competitive inhibition of aldosterone, can be achieved with the administration of: spironolactone
By blocking the action of aldosterone, which normally stimulates Na+ reabsorption and K+ excretion by the collecting duct, spironolactone causes sodium and water loss with potassium retention. |
|
|
Term
| In general, when nitroprusside is administered faster than ___, cyanide is generated faster than the patient can eliminate it. |
|
Definition
| n general, when nitroprusside is administered faster than 2 μg/kg/min, cyanide is generated faster than the patient can eliminate it. |
|
|
Term
| Methods of drug delivery that bypass the portal system's first-pass effect include: |
|
Definition
| Methods of drug delivery that bypass the portal system's first-pass effect include: (Select 3): intravenous, sublingual, distal rectal placement |
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|
