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472 Cards in this Set
- Front
- Back
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What kind of chemical bond can produce drug-receptor interactions?
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Covalent, Ionic, hydrogen, hydrophobic, Van Der Waals
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Which of the types of chemical bonds are the strongest?
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Covalent
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Covalent bonds usually produce what kind of binding?
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noncompetitive
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What 4 things does a dose response curve show?
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1. affinity
2. efficacy 3. variability 4. slope |
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Efficacy means what?
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Can drug produce effect you want?
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Affinity means what?
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Will drug bind to a receptor?
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Pharmacokinetics is
A. prep and dispensing of drugs B. study of harmful effects of chemicals C. formulation and preparation of drugs D. study of absorption, distribution metabolism and excretion of drugs |
D.
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Pharmacognosy:
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Study of medicinal uses of naturally occurring compounds
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Pharmacodynamics is:
A. physiological and biochemical mechanism of action of drugs B. movement of drugs through body C. study of economic impact of drugs |
A. physiological and biochemical mechanism of action of drugs
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that play a critical role in drug response pharmacogenonmics:
A. genetic influences by and on drugs B. identifies discrete genetic differences among individuals |
B
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Pharmaceutics is:
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formulation and preparation of drugs
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Pharmacy is:
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preparation and dispensing of drugs
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What does antagonist do?
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It sits at the receptor and blocks the function of it-prevents it from doing wat it should do.
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Which stimulates the function that the receptor serves?
A. Antagonist B Agonitst |
B. Agonist
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What is the therapeutic index?
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LD50/ED50
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ED50 is the same as what other "dose"?
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MAC of gases
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What is the TD50?
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The dose that would be toxic in 50% of the population
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What is the index for drug dosage which can treat disease effectively while staying within the safety range?
A. Therapeutic index B. Therapeutic window |
B. Therapeutic window
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TD50/ED50:
A. Therapeutic index B. Therapeutic window |
B. Therapeutic window
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Give an example of a ligand-receptor relationship.
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Morphine is a ligand for opiate receptors
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Which of the types of chemical bonds is the strongest?
A. Hydrogen bonds B. Ionic C. Covalent D. Hydrophobic |
C. Covalent
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On a dose response curve, what does the slope show?
A. margin of safety B. efficacy C. affinity D. potency |
margin of safety
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Up regulation is what?
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Results from chronic admin of antagonist: number and sensitivity of receptors both increase because of the continual blockade.
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Tolerance develops as a result of which?
A. upregulation B. down-regulation C. Neither D. Both |
D. Both
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What is the ionization constant of a chemical compound?
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pKa
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Pka is defined as:
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pH at which 50% of a compound is ionized and 50% is non-ionized
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Antagonism is:
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action of one drug opposed the action of another (1+1=0)
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Synergism is defined as:
A. combined effect of two drugs is greather than either alone B. Combined effect of two drugs is equal to that expected by adding them together |
A 1+1=3
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The enhancement of the action of one drug by a second drug that has no detectable action of its own.
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Potentiation
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Alteration in the therapeutic action of a drug by concurrent admin of other chemicals
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Interaction
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A change in tissue sensitivity due to an adaptation is: (Choose all that apply)
A. pharmacokinetic tolerance B. functional tolerance C. pharmacodynamic tolerance D. dispositional tolerance |
B. functional tolerance
C. pharmacodynamic tolerance |
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which leads to reduced effects of a drug?
Enyyme induction or enzyme inhibition |
Enzyme induction
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The process that involves stimulation synthesis of drug-metabolizing enzymes is called?
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enzyme induction
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Which leads to faster metabolism of a drug: enzyme inhibition or enzyme induction?
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enzyme induction
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Which leads to an increase in a drugs effects?
Enzyme induction or enzyme inhibition? |
enzyme inhibition
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What does it mean when most of a drug is taken up in the liver before it ever gets to circulation?
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First pass metabolism
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Parasympathetic preganglionic neurotansmitter is:
A. ACH B. NE C. Dopamine |
A. ACH
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What kind of receptor is at the ganglia of the parasympathetic system?
A. muscarinic B. Nicotinic C. adrenergic |
B. nicotinic
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What kind of receptor is at the effector organ in the parasympathetic system?
A. Nicotinic. B. Muscarinic C. Adrenergic |
B. Muscarinic
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In the SNS, what is the preganglionic neurotransmitter?
A. ACH B. NE C. Dopamine |
A. ACH
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What kind of receptors are there in the ganglion of the sympathetic system?
A. Nicotinic Cholinergic B. Muscarinic Cholinergic C. Dopaminergic D. Adrenergic |
A. Nicotinic Cholinergic receptor
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The postganglionic neurotransmitter in the sympathetic system is what?
A. NE B. ACH C. epi |
A. NE
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What kind of receptor is on the effector organ of the sympathetic nervous system?
A. Muscarinic B. Nicotinic C. adrenergic d. Dopaminergic |
C. adrenergic
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Another word of "parasympathetic"?
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anticholinergic
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Blood-gas coefficient is a measure of what?
A. potency B. solubility C.speed D. concentration |
C. speed
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A lower blood-gas coefficient means
A. faster B. slower |
A. faster
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Liter flow and absortion into plastic are examples of what kind of issues regarding volatile anesthetics?
A. lungs B. machine C. Blood D. tissues |
B.machine
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List the volatile gases in order based on the speed of onset and offset. (slowest to fastest)
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Isoflurane
Sevo Nitrous Des |
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The lower the blood/gas coefficient the
A. faster B. slower the rise of the anesthetic in the lungs? |
A. faster
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Fa/Fi is a measure of what?
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How much anesthetic is in the lungs
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The faster you breathe, the
A. slower B. faster you go to sleep? |
B. faster
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"the more you give, the faster it works " is the definition for:
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The concentration effect
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A V/Q mismatch is important because:
A. it reduces oxygenation B. Causes increased partial pressure of nitrogen C. Slows delivery of all anesthetics D. allows nitrous to diffuse into lung |
C. slows delivery of all anesthetics
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Regarding V/Q mismatch:
are faster or slower agents affected more? |
faster
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Which kind of cases would NOT be appropriate choices to use nitrous?
(CHOOSE THREE) A. bowel obstruction B. thoracic surgeries ("one lung down" C. airway cases D. carotid endarterectomy E. inner ear surgeries |
A, D, E
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If a case is a high risk for air embolism, what agent should be avoided?
A. Des B. Sevo C. Nitrous D. isoflurane |
C. nitrous
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An increase in cardiac output has what effect on onset of anesthetic agents?
A. slows B. increases |
A. slows
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Which is the indicator of potency?
A. blood/gas coefficient B. Oil/gas coefficient C. MAC |
B. Oil/gas coefficient
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The more lipid soluble an anesthetic agent is the less potent it is: True or False
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False (more potent)
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The oil/gas coefficient is inversely proportional to MAC: True or False?
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True
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The indicator of speed of onset of an agent is measured by:
A. Oil/Gas coefficient B. Blood/Gas coefficient C. MAC |
B. Blood/gas coefficient
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Regarding metabolism of anesthetic agents:
A. Nitrous is highly metabolized B. Sevo is the most metabolized of the 4 agents C. Isoflurane is minimally metabolized |
B, C
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Which is the indicator of potency?
A. blood/gas coefficient B. Oil/gas coefficient C. MAC |
B. Oil/gas coefficient
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The more lipid soluble an anesthetic agent is the less potent it is: True or False
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False (more potent)
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"The greater the alveolar ventilation, the faster the pt achieves anesthesia " is
A. concentration effect B. ventilation effect C. Second gas effect |
B.
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"The higher the concentration of anesthetic delivered, the faster anesthesia is achieved" is the
A. ventilation effect B. concentration effect C. MAC D. Second gas effect |
B.
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what is the weakest kind of chemical bond that can produce a drug-receptor interaction?
A. Ionic B. Covalent C. VanDer Waals D. Hydrogen |
C. Van der Waals
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the types of chemical bonds that can produce a drug-receptor or interaction are?
List in increasing order of strength (weakest to strongest) |
Vander Waals
Hydrophobic Hydrogen ionic covalent |
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bioavailability is:
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How much of drug gets to blood (systemic circulation)
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a non ionized drug (will or will not) dissolve in water
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Will Not
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An ionized drug will or will not dissolve in water?
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will
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Which kind of drug in lipid sol?
A. Ionized B. Non ionized |
B
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which kind of drug will cross BBB?
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Non ionized ( because is lipid sol)
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pKa measures acid base status: true or false?
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False-measures extent of ionization
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acids in acid
or bases in basic are the above ionized or nonionized? |
nonionized
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acids in basic pH
and bases in acid pH: ionized or nonionized? |
ionized
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method for determining ionization:
pH-pKa= 0 means ionized/nonionized ratio is: |
50 percent
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method of determining ionization:
pH-pKa=0.5, then the ratio is: |
75/25
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method of determining ionization:
pH-pKa=1.0 or greater: the ratio is: |
99/1
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enzyme induction or inhibition is an example of:
(choose two) A. functional tolerance B. dispositional tolerance C. pharmacodynamic tolerance 'D. pharmacokinetic tolerance |
B, D
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Name an example of a drug that is an enzyme inducer:
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ETOH
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Name an example of a drug that is an enzyme inhibitor
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tagamet
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solubility of a drug is determined by:
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ionization %
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Stage one of anesthesia: lasts from_________ to _______
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awake to LOC
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Stage 2 of anesthesia lasts from _______ to ________
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loss of consciousness to onset of rythmicity of vitals
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Stage 3 of anesthesia lasts from __________ to ___________
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end of stage 2 to loss of respiration
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Oil/Gas coefficient is inversely proportional to MAC: T or F
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True
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Which volatile agent is the most highly metabolized?
A. Sevo B. Des C. Nitrous D. Isoflurane |
A. sevo
(which means "7" in latin-7% metabolized) |
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What effect will obesity have on an aneshtetic?
A. faster induction B. slower induction C. slower emergence D. faster emergence |
C
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Why do kids go to sleep faster than adults?
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Higher ventilatory rate and proportionally more vessel rich blood flow group
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Which will increase, decrease or not affect " the rate of rise in alveolar concentration (Fa/Fi) of an anesthetic gas during induction:
a) Lowering inspired concentration of gas. b) Increased ventilation c) Increased C.O. d) Hypoventilation |
a) Decrease
b) Increase c) Decrease d) Decrease |
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Which will increase, decrease or not affect " the rate of rise in alveolar concentration (Fa/Fi) of an anesthetic gas during induction:
a) V/Q defects b) co-administration of N2O c) Diffusion hypoxia d) Low B/G solubility |
a) Decrease
b) Increase c) No effect d) Increase |
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Which will increase, decrease or not affect " the rate of rise in alveolar concentration (Fa/Fi) of an anesthetic gas during induction
a) High B/G solubility b) second gas effect c) High O/G solubility d) Obesity |
a) Decrease
b) Increase c) No effect d) No effect |
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At what stage of Anesthesia do the following actions take place?
a) loose upper airway reflexes b) loose eyelid reflex c) excitement or delirium d) complete amnesia |
a) stage 3
b) stage 3 c) stage 2 d) stage 1 |
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At what stage of Anesthesia do the following actions take place
a) No BP or HR b) complete analgesia c) unconsciousness d) surgical anesthesia |
a) stage 4
b) stage 1 c) stage 1 d) stage 3 |
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At what stage of Anesthesia do the following actions take place
a) overdose b) lose corneal reflexes c) HTN, Tachycardia common d) lose tracheal reflexes |
a) stage 4
b) stage 3 c) stage 2 d) stage 3 |
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Ionized drugs are?
a. non-charged b. water soluble c. lipid soluble d. non-diffusable through biological membranes e. more than one of the above |
E
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A parasympatholytic drug blocks _______receptors?
a. dopamine b. beta c. muscarinic d. nicotinic |
C
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The O/G solubility coefficient is an indication of the ______of an anesthetic:
a. Potency b. Speed c. Ability to vaporize an agent d. Receptor affinity |
A
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Changes in C.O. will affect the uptake of which type of anesthetic agent the most?
a. soluble b. insoluble c. both types equally d. neither type is affected |
A
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Ventilator perfusion deficits will decrease the uptake of which type of anesthetic agent the most?
a. soluble b. insoluble c. both types equally d. neither type |
insoluble
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The MAC value of an agent is DEFINED as:
a. potency of an agent b. speed of induction + emerg. c. alveolar concentration where 50% of pt's do not respond to surgical stimuli. d. directly proportional to the B/G coefficient e. more than one of the above |
C
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The _______the MAC of an anesthetic agent the less potent that agent is:
a. lower b. higher |
higher
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A decrease in the # of receptors in a tissue in response to chronic agonist administration is referred to as?
a. acute tolerance b. up regulation c. down regulation d. sensitization |
down regulation
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How many 1/2 life's does it take to eliminate 75% of propofol?
a. 1 b. 2 c. 3 d. 4 |
2 half life's
(4 half life's = 12 hours) 12 hr - "don't count" 6 hr - 1st half life = 50% 3 hr - 2nd half life = 75% |
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Ketamine has a half life of 4 hours. How long would it take to be eliminated?
a. 5 hours b. 12 hours c. 16 hours |
16 hours
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Which drug increases ICP
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Ketamine
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Extrapyramidal side effects can be seen with which drug?
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Droperidol
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60 mg of a drug with a half life of 5 hours is given. How much remains after 15 hours.
a. 10mg b. 3 mg c. 7.5 mg d. 12 mg |
7.5mg
At zero hours: 60mg At 5 hours: 30mg = 1 half life At 10 hours: 15mg = 2 half life At 15 hours: 7.5mg = 3 half life At 20 hours: 3.75mg = 4 half life |
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Match the drug with it's appropriate receptor.
(gabamimetic; dopamine antagonist; NMDA antagonist; gaba antagonist) a. Etomidate b. Thiopental c. Versed d. propofol e. droperidol f. ketamine g. flumazenil |
Eomidate = gabamimetic
thiopental = gabamimetic versed = gabamimetic propofol = gabamimetic droperidol-dopamine antagonist Ketamine = NMDA antagonist Flumazenil = Gaba antagonist |
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What is the function of gamma-amino-butyric acid receptors?
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increase chloride ion influx into neuronal cells
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what is the drug with the longest elimination half life?
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thiopental
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What drug produces sympathomimetic effects?
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ketamine
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2 Meds are available which can relieve nausea in pregnant women. Which one will pass placental barrier more freely?
a. capsule which is an acid, with a PKA 6.3 b. IV solution of basic drug, with PKA 7.8 |
B
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your preparing an IV solution for injection of an acid drug, PKA 7.1 - in which diluent would it be more H2O soluble and dissolve more freely?
a. water solution pH 10 b. water solution pH 5 |
a
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You give a pt an oral capsule for preop HTN which is an acid with a PKA of 7.2. Is it likely you will achieve a significant blood level via this route?
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Yes
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Which of the following agents are NOT halogenated ethers?
A. Sevo B. Des C. Isoflurane D. N2O |
D
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Which of the following is an inorganic molecule?
A. N2O B. Sevo C.Isoflurane D. Des |
A
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How do the inhalational anesthetics reduce BP?
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1. CNS depression
2. direct cardiac depression 3. decreased SVR 4. baroreceptor depression 5. hormonal changes |
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Which of the inhlational anesthetics decrease BP?
A. Sevo B. N2O C. Des D. Isoflurane |
A, C, D
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Why does urine output decrease during anesthesia?
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decreased BP --decreased renal blood flow----decreased GFR, so decreased UOP
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Which agents can cause coughing during induction and maintenance due to irritant effects in the airway?
(CHOOSE 2) A. Sevo B. Des C. N2O D. isoflurane |
B, D
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Does N2O cause resp. depression?
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NO
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What is hypoxic pulmonary vasoconstriction? (HPV)
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vasoconstriction in pulmonary blood vessels in part of lung with least O2-(increases shunt)
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The longer the case, the (longer, shorter) time it takes to wake up?
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longer
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Does N2O trigger MH?
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No
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Which agents can trigger MH?
A. N2o B. Sevo C. Des D. Isoflurane |
B, C, D
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Which inhalational agent is preferred for kids due to "lack of stink"?
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Sevo
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Nitrous is contraindicated during delivery (OB). T or F
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F- contraindicated during pregnancy-delivery is different issue
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Which agents are contraindicated during pregnancy?
(choose all that apply) A. Sevo B. Des C. Nitrous D. Isoflurane |
C. Nitrous is teratogenic in animals
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The key factor in determining toxicity from sevo is:
A. absorber B. total exposure time C. FGF |
B. (p. 83)
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MAC goes up, BP does what?
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goes down
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MAC is directly proportional to vasodilation:
T or F |
T
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MAC is inversely proportional to SVR: T or F?
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T
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Which proteins are important when considering protein binding of drugs in the body?
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albumin, beta globulin and alpha2-acid glycoprotein (AAG)
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Albumin binds mostly which kind of drugs:
A. acid B. basic |
A acid
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AAG binds mostly which kind of drugs?
A. Acid B. basic |
B. basic
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Elimination 1/2 life is:
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Amount of time it takes an IV dose given to be reduced by 1/2
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How many 1/2 lives until drug is considered clinically gone?
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4
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Calculate the 1/2 life of propofol:
elimination 1/2 life 1-3 hours |
1-3 x 4 = 4-12 hours
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Why does a pt wake up after 5 to 10 minutes after injection of induction dose of a durg?
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REDISTRIBUTION to the tissues
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Is an induction dose of propofol gone in 8 minutes when the pt wakes up?
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NO- redistributed to the tissues
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Place the following tissues in order of peak drugs concentration:
A. muscles B. Brain C. fat |
B, A C
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Why does a pt go to sleep rapidly after an induction does of a drug?
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Distribution
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The free % of a drug is one that is able to .....
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go bind with receptor to illicit response
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The % of a drug bound to albumin is available to bind with a receptor: T or F?
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F
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What level of protein binding is considered clinically significant?
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90% or greater
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Which 4 categories of pts are at risk for increased elimination times due to protein binding?
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A. Malnutrition
B. liver dz C. renal dz D. last trimester of preg. |
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What ions are associated with GABA receptors?
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Chloride
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What is the MOA of GABA mimetics?
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control Cl-ions entering into nerve cell, which makes it harder for them to fire: inhibits nerve cell firing
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Which of the following drugs are antagonists?
A. Diazepam B. Propofol C. Ketamine D. pentothal |
C. Ketamine
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Ketamine acts on which receptor?
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NMDA
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NMDA is an inhibitory receptor: T or F
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F (excitatory receptor)
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Barbiturates, Benzos, Propofol and Etomidate are examples of
A. antagonists B. agonists |
B. Agonists
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A pt with a sulfa allergy should be monitored for an allergy to generic propofol: T or F?
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F: sulfa allergy is not the same as a sulfite allergy
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Sulfite allergy is an issue with which formulation of propofol?
A. fospropofol B. generic [propofol C. Diprivan ( trade drug) |
B. Generic propofol contains sulfites, others do not.
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What is responsible for burning on administration of any drug? (Choose 2)
A. alcohol B. egg emulsion C. propylene glycol D. water |
A, C
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An asthmatic pt should not receive which formulation of propofol?
A. Diprivan B. fospropofol C. generic |
C
(contains sulfites) |
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What is a prodrug?
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a drug that is administered in the inactive form and metabolized into the active drug once inside the body
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Which formulation of propofol is a prodrug?
A. generic B. Diprivan C. fospropofol |
C
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What class of drug has the best amnestic effects?
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BZDs
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the MOA for all IV induction drugs except ketamine is:
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GABA mimetic
(blocks chloride ion getting into nerve cell, which inhibits transmission) |
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Anterograde amnesia means?
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administer drug, pt can't remember what happens after that point
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retrograde amnesia is?
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Do something to pt and then administer drug, and pt can't remember what happened
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Induction dose of propofol?
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2mg/kg
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Induction dose of etomidate?
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0.3 mg/kg
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What is an example of excitatory activity associated with IV induction drugs?
A. nystagmus B. increased RR C. myoclonia D. laryngospasm |
C
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Which IV induction agents can cause excitatory activity?
A. Ketamine B. Etomidate C. BZDs D. barbs |
A, B
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Which of the following pts should ketamine not be used for?
A. abd surgery B. joint surgery C. head injured pt D. renal failure pt |
C head injured ( increases CMRO2)
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Induction dose of ketamine?
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1-2 mg/kg
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Which IV induction agent has the most profound cardiac effects?
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propofol
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Propofol maintains airway reflexes: T or F?
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F
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Which IV induction agent preserves airway reflexes?
A. Propofol B. Ketamine C. Thiopental |
B
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Which IV induction agent is the drug of choice for asthmatics or acitve wheezing?
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ketamine
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Which class of induction drug is contraindicated in asthmatics?
A. Propofol B. Ketamine C. BZDs D. barbs |
D. barbs ( histamine release)
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If propofol is supplied as a 1% solution, how many mls would be administered to a 70 kg pt for an induction dose?
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14 mls
(10 mg/cc, 2 mg/kg =140 mg, 14 ml) |
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Can most commonly used induction drugs cross the placental barrier?
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Yes- lipid sol drugs ( the ones that cross BB and put you to sleep) can also cross the placental barrier
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Pts with which of the following allergies should be given propofol with caution?
A. lecithin B. peanut C. soy D. milk |
A, B, C
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Which induction drug is the drug of choice for emergent surgery in an actively wheezing pt?
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ketamine
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Which of the following induction drugs is an indirect sympathomimetic?
A. thiopental B. Brevital C. ketamine D. propofol |
C. ketamine
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Which of the following induction drugs maintains airway reflexes?
A. Brevital B. ketamine C. propofol |
B. ketamine
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Your pt has prophyria. Which of the following drugs can be used for induction?
A. etomidate B. brevital C. thipental D. propofol |
D
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What is the rate limiting enzyme for prophyria?
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ALA synthetase
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Which induction drug causes greatest drop in BP?
|
propofol
|
|
|
Which induction drug causes drooling and increased resp. secretions?
A. propofol B. robinul C. ketamine D. brevital |
C. ketamine
|
|
|
Which induction drug has a high incidence of emergence delirium, hallucinations and nightmares?
A. propofol B. ketamine C. brevital D. etomidate |
B.
|
|
|
What can you administer to help with the emergence delirium associated with ketamine?
|
Coadminister versed if bp allows
|
|
|
Which of the following pts should NOT receive ketamine?
A. elevated ICP B. psychiatric pts C. CHF D. increased intraocular pressure E. all of the above |
E
|
|
|
Ketamine is often referred to as providing what kind of anesthesia?
|
dissociative anesthesia
|
|
|
Which enzyme is inhibited by etomidate?
|
11 beta-hydroxylase
|
|
|
Which induction drug can cause adrenal supression after as little as one dose?
A. ketamine B. etomidate C. brevital D. propofol |
B
|
|
|
Which drugs are not safe to give in a pt with prophyria?
A. barbs B. etomidate C.ketamine D. propofol E. A & B F. C & D |
E
|
|
|
which induction drug is LEAST likely to cause PONV?
A. ketamine B. etomidate C. propofol D. brevital |
C
|
|
|
wHICH INDUCTION DRUG IS LEAST LIKELY TO CAUSE HYPOTENSION?
a. ETOMIDATE b. KETAMINE c. BREVITAL d. PROPOFOL |
B
|
|
|
Which induction drug is most likely to cause PONV?
A. Etomidate B. propofol C. brevital D. versed |
A
|
|
|
Droperidol is contraindicated in what pts?
A. cardiac B. parkinsons C. seizure D. psychotic |
B Parkinsons
|
|
|
Droperidol can cause exacerbation of what kind of symptoms?
|
Parkinsons
|
|
|
A side effect of droperidol that earned it a black box warning from FDA is?
|
QT prolongation
|
|
|
Rank the following drugs in descending order for CV depression:
ketamine, propofol, brevital, etomidate |
1. propofol
2. brevital 3. etomidate 4. ketamine |
|
|
Dexmedetomidine is:
A. peripherally acting alpha 2 agonist B. centrally acting alpha 2 agonist C. sympatholytic D. GABA mimetic |
B, C
|
|
|
Dexmedetomidine produces which effects? (choose 2)
A. sedation B. amnesia C. loss of consciousness D.analgesia |
A, D
|
|
|
Which induction drug is best for a pt with elevated ICP?
A. etomidate B. ketamine C. propofol D. brevital |
C
|
|
|
Droperidol blocks which neurotransmitter?
A. norepinephrine B. dopamine C. ACH |
B. dopamine
|
|
|
For a pt in profound shock, which IV induction agent is best?
A. etomidate B. propofol C. brevital D. ketamine |
D ketamine
|
|
|
Induction dose of methohexital ( brevital)?
|
2 mg/kg
|
|
|
maintainence infusion rate for propofol?
|
100-200 mcg/kg/min
|
|
|
Which IV induction agents increase IOP? (choose 2)
A. propofol B. ketamine C. brevital D. sux |
B, D
|
|
|
Tactics to deal with Des induced tachycardia include:
(choose 2) A. use less than 1 MAC B. use ultrashort acting beta blocker (esmolol) C. raise concentration slowly D. Start with 2 MAC and decrease |
B, D
|
|
|
Which of the following drugs can be reversed with flumazenil?
A. morphine B. etomidate C. benzodiazepines D. ketamine |
C
|
|
|
Why will mazicon not reverse etomidate, propofol or ketamine?
|
Those drugs work on different receptors
|
|
|
Dosing regimen for flumazinil?
|
.2 mg increments, wait 45 sec between doses. Max 1 mg
|
|
|
Which has a longer half life: BZD's or flumazenil?
|
BZD's
|
|
|
If you administer flumazenil, you need to remember what?
|
the half life of flumazenil is shorter than the half life of BZD's, so pt can be resedated after flumazenil wears off.
|
|
|
Who has a higher chance of resedation:
A. Pt who received incremental flumazenil dosing regimen titrated to effect OR B. Pt who received single big does of flumazenil? |
b
|
|
|
The MAC of inhaled agents is inversely related to temperature. T or F?
|
F. The MAC of inhaled agents decreases as temp decreases.
|
|
|
The biggest cardiac effects of IV induction agents are seen in: (time frame)
|
the first minute (distribution)
|
|
|
The depth of anesthesia and the total amount of neuromuscular blockers needed are directly related. T or F?
|
T. The deeper you are, the less NMBs you need
|
|
|
CBF dos not increase until you hit above 1 MAC for an inhaled agent. T or F?
|
T
|
|
|
Which of the following agents have analgesic properties?
A. Ketamine B. Nitrous C. Precedex D. Propofol |
A, B, C
|
|
|
Name 2 other ways for saying MAC?
|
1.dose
2. ED50 |
|
|
OGPC is indicator for
A. speed B. potency |
B
|
|
|
BGPC indicator for:
A. speed B. potency |
A
|
|
|
which agents cause bronchodilation? (choose all that apply)
A. Sevo B. Des C. Nitrous D. Isoflurane |
A, B, D
|
|
|
CNS effects of gas anesthetics include:
A. decreased CMRO2 B. elevated IOP C. Increased ICP D. increased CBF |
A, C, D
|
|
|
Which agent is associated with free fluoride release?
A. Des B. Sevo C. NO D. iso |
B
|
|
|
One way to minimize elevated CBF/ICP associated with inhalational agents?
|
keep concentrations low
or hyperventilate down to low normal CO2 |
|
|
Which of the inhalational agents is metabolized the most?
A. Sevo B. Des C. NO D. Iso |
A
|
|
|
5 Ways inhalational agents drop BP?
|
1. Baroreceptor depression
2. CNS depression 3. cardiac depression 4. hormonal changes 5. decreased SVR |
|
|
regarding safe doses of epi:
No more than ____ ml in any ____minute period. |
10, 10
|
|
|
1:100,000 epi has how many mg/ml?
|
0.01 mg/ml
|
|
|
1:200000 epi has how many mg/ml?
|
0.005 mg/ml
|
|
|
What is the max amount of epi that can be used on a surgical field in one hour?
|
30 ml
|
|
|
which agent causes tachycardia during induction?
A. Des B. Sevo C. NO D. iso |
A
|
|
|
Which agent causes the least respiratory depression?
A. Sevo B. Des C. NO D. Iso |
C
|
|
|
Which of the following agents are metabolized only trace amounts?
A. NO B. Des C.Sevo |
A, B
|
|
|
Which agent is contraindicated during pregnancy?
A. Sevo B. Des C. NO E. Iso |
C
|
|
|
What is produced by degradation of Sevo in the CO2 granules?
|
compound A
|
|
|
Does NO cause a dose dependent drop in BP?
|
No
|
|
|
Which agents cause a dose dependent decrease in SVR (vasodilation)
A. Sevo B. Des C. Iso D. NO |
A,B, C
|
|
|
Does NO affect SVR?
|
NO
|
|
|
Which of the following can be attributed to NO?
A. vit. B12 inhibition B. Inhibition of beta hydroxylase C. Inhibition of methionine synthetase D. resp depression |
A, C
|
|
|
Which proteins do drugs prefer to bind to?
A. beta hydroxylase B. AAG C. albumin D. glutamine |
B,C
|
|
|
Which amino acid isassociated with NMDA receptors ( makes them excitatory)?
|
glutamine
|
|
|
What ion is associated with GABA receptors?
|
chloride
|
|
|
Mechanisms for decreasing BP include:
A. CNS depression B. decreased SVR C. chemoreceptor depression D. increased CMRO2 |
A, B
|
|
|
which agent causes adrenal suppression?
|
Etomidate
|
|
|
Why does etomidate cause adrenal suppression?
|
inhibition of 11 beta hydroxylase
|
|
|
which are effects of ketamine? (Choose all that apply)
A. bronchoconstriction B. nystagmus C. resp depression D. analgesic E. increase BP, P F. decreased muscle tone |
b, d, e,
|
|
|
Blocking dopamine in the brain can cause what kind of effects?
|
extrapyramidal
|
|
|
MAC's
1. Sevo..................a. 105 2. Des....................b. 2 3. Iso.....................c. 6 4. NO.....................d. 1.2 |
Sevo = 2
Des = 6 Iso = 1.2 NO = 105 |
|
|
B/G Coefficient's Matching
1. Sevo................a. 0.47 2. Iso...................b. 0.6 3. NO...................c. 0.42 4. Des..................d. 1.4 |
Sevo = 0.6
Iso = 1.4 NO = 0.47 Des = 0.42 |
|
|
O/G Coefficient's Matching
1. Sevo.................a. 99 2. Iso....................b. 18.7 3. NO....................c. 50 4. Des...................d. 1.4 |
Sevo = 50
Iso = 99 NO = 1.4 Des = 18.7 |
|
|
Which inhaled anesthetic is the only inorganic molecule?
|
NO
|
|
|
Which inhaled anesthetics are halogenated ethers
|
ISO, DES, SEVO
|
|
|
What is the MOA of inhaled anesthetics ( stimulation of what receptors)?
|
work by stimulating GABA receptors
|
|
|
What effects do Inhaled Anesthetics have on the CNS.
(Name 4) |
1. Dose dependent depression of the CNS & ANS
2. Decreased O2 consumption (CMRO2) 3. Decreased Intra-ocular pressure 4. Increased ICP (by increasing CBF) **therefore keep concentrations low and hyperventilate them down to a low normal PCO2** |
|
|
Name 5 reasons Inhaled Anesthetics cause the BP to go down
|
1. CNS depression
2. Direct Cardiac Depression 3. Decreased SVR (blood vessels depressed + dilate) 4. Baro-receptor depression 5. Hormonal changes such as decreased renin or vasopressin release |
|
|
All inhaled anesthetics exhibit all 5 mechanisms for decreasing BP except?
|
NO (not strong enough)
|
|
|
Surgeons are not aloud to concentrations of EPI that are stronger than what?
Which means they can use what two concentrations |
no stronger than 1:100,000
1:100,000 1:200,000 (larger surgical area) |
|
|
What is the total amount of EPI a surgeon can use in a 10 min period
|
No more than 10ml any 10 min period = (0.1mg)
|
|
|
What is the total amount of EPI a surgeon can use in a one hour time frame
|
30ml (0.3mg)
|
|
|
1: 1000 = __________
|
1:1000 = 1mg/ml
|
|
|
1: 10,000 = __________
|
1: 10,000 = 0.1mg/ml
|
|
|
1: 100,000 = ___________
|
1: 100,000 = 0.01mg/ml
|
|
|
1: 200,000 = _________
|
1: 200,000 = 0.005mg/ml
|
|
|
What two inhaled anesthetics produce tachy during initial induction
|
Desflurane and to a lesser extent Isoflurane...probably due to respiratory irritation
|
|
|
All inhaled anesthetics are both respiratory depressants and bronchodilators except?
|
NO
|
|
|
Depression of Vt before Respiratory rate
|
Inhaled anesthetics
|
|
|
Depression of Resp. Rate before Vt
|
Opiates
|
|
|
All inhaled anesthetics are metabolized in trace amts except for 1.
|
Sevo 5-8% or 5-7%
|
|
|
Which inhaled Anes. is teratogenic and contraindicated in pregnant women
|
NO
|
|
|
What inhaled anes. are absolutely contraindicated in a patient with malignant hyperthermia
|
They all are except Nitous
|
|
|
All anesthetics except NO are used DURING pregnancy. However, they depress and thus relax the uterus.
A drug that relaxes the uterus tends to.......... |
promote blood loss. So, you would use very low concentrations....i.e..1/2 MAC
|
|
|
What inhaled anes. can increase FREE FLUORIDE ION concentrations.
Which disease state would you want to avoid this in. |
SEVO
avoided in pt's with renal disease |
|
|
Compound A is produced by what inhaled drug
|
produced by Sevo in the CO2 granule canister
|
|
|
What inhaled anes. have a dose dependent decrease in BP
|
They all do......except Nitrous
|
|
|
What inhaled Anes. has the highest % in change of HR on induction
|
DES....
**all come back to normal around 2 MAC, that's why it's called transient tachycardia** |
|
|
What Inhaled drugs produce a dose dependent decrease in SVR
|
They all do....except Nitrous
|
|
|
What inhaled anes. are respiratory depressants, producing a dose dependent decrease in respiration leading to apnea
|
They all do.....except Nitrous
|
|
|
The following disadvantages are related to which Anesthetic.
Expansion of closed air spaces Requires high concentrations |
Nitrous Oxide
|
|
|
The following are disadvantages of which anesthetic.
Pungent odor Airway irritant |
Isoflurane
|
|
|
The following are disadvantages of which anesthetic
Airway irritant Low boiling point Sympathetic stimulation (tachy) Expensive |
Desflurane
|
|
|
The following are disadvantages of which anesthetic.
Susceptible to biotransformation reacts with soda lime increases serum fluoride concentration Expensive |
Sevoflurane
|
|
|
The following are advantages of which anesthetic.
Rapid uptake and elimination Nonpungent |
Sevo
|
|
|
The following are advantages of which anesthetic.
Rapid uptake and elimination stable molecules Minimal biotransformation |
Desflurane
|
|
|
The following are advantages of which anesthetic.
Good muscle relaxation decreases CMRO2 Minimal biotransformation Maintains cardiac output due to vasodilation |
Isoflurane
|
|
|
The following are advantages of which anesthetic
Analgesia Rapid uptake and elimination Little cardiac or respiratory depression Nonpungent Allows less potent anesthetic to be co-administered |
Nitrous Oxide
|
|
|
Using high doses of Nitrous with long term exposure will inhibit the function of which enzyme
|
Methionine synthase
|
|
|
NO causes immune suppression by inhibiting the function of methionine synthase by blocking what?
|
NO blocks Vitamin B-12 - thus inhibiting the function of methionine synthase
|
|
|
Which enzyme is inhibited by chronic administration of NO
|
methionine synthase
|
|
|
What are the two absolute contraindications to the use of Nitrous Oxide
|
Known deficiency of enzyme methionine synthase
toxicity from expansion of gas filled spaces |
|
|
What are the 3 chemical classes of Barbiturates
|
Thiobarbiturates
Oxybarbiturates N-Methyl Barbiturates |
|
|
What Barbiturate (s) are in the Thiobarbiturate class
|
Thiopental (pentothal)
|
|
|
What Barbiturate (s) are in the Oxybarbiturates class
|
Phenobarbital (luminal)
Pentobarbital (Nembutal) Secobarbital (Seconal) |
|
|
What Barbiturate (s) are in the N-Methyl barbiturates class
|
Methohexital (brevital)
|
|
|
Name 2 ultra short acting barbiturates
|
Thiopental (pentothal)
Methohexital (brevital) |
|
|
Name 2 short acting barbiturates
|
Pentobarbital (Nembutal)
Secobarbital (seconal) |
|
|
Name 1 long acting (24h) barbiturate
|
Phenobarbital (Luminal)
|
|
|
How long the effects of a drug work is known as?
|
Duration of action
|
|
|
How long the drug remains in the body is known as?
|
Half-life
|
|
|
Amt of time it takes to distribute from blood to tissues. "eventually equilibrates between blood ( 50%) and tissues (50%)
|
Distribution half-life
|
|
|
What drug has a fairly prolonged half life making it cause hangovers when you use it for IV induction.
|
Thiopental (pentothal)
has half-life of 10-12 hrs...all the rest are 2-3, 2-4 hrs. |
|
|
What anesthetic has the shortest half-life
|
propofol
|
|
|
Why does a patient wake up from the induction does of propofol
|
b/c of Redistribution
|
|
|
Why does a patient wake up from an induction dose of Pentothal
|
b/c of Redistribution
|
|
|
What induction drug has the longest half-life
|
Thiopental
|
|
|
Why do we care about protein binding
|
b/c there can be a potential for an exaggerated effect from a patient with a low plasma or tissue protein
|
|
|
What kinds of patients are we concerned with in regard to protein binding
|
1. severe liver dz
2. kidney disease 3. malnutrition 4. last trimester of Pregnacy |
|
|
The proteins in the body that drugs preferentially tend to bind to are?
|
Albumin and AAG
|
|
|
Protein binding greater than what % is potentially significant
|
>90%
|
|
|
What Ion is associated with GABBA receptors
|
CL-
|
|
|
All induction drugs except for Ketamine work on what "receptor"
|
Gabamimetic
|
|
|
Ketamine is an antagonist at what receptor?
|
NMDA (Glutamate receptor)
|
|
|
What ION is associated with GABA receptors that causes hyperpolarization
|
chlorine
|
|
|
What amino acid is associated with NMDA receptors that makes them excitatory
|
glutamine
|
|
|
What do GABA mimetics do the inhibitory response.
|
stimulates an inhibitory response
|
|
|
If someone is allergic to sulfites, be careful giving them sulfite containing drugs like?
|
generic propofol
|
|
|
You would avoid giving a patient ________if they have an egg or peanut allergy
|
propofol (diprivan)
|
|
|
Which drug; diprivan or generic propofol contain sulfites
|
generic propofol
|
|
|
What induction drugs decrease CBF, ICP, and CMRO2
|
they all do except Ketamine
|
|
|
What induction drugs increase CBF, ICP, CMRO2, HR and BP
|
Ketamine
|
|
|
Arrange the following drugs from most cardiac depressing to least cardiac depressing
Thiopental, Etomidate, Propofol |
1. Propofol (most)
2. Thiopental 3. Etomidate (least) |
|
|
Which induction drug is not cardiac depressing
|
Ketamine ( increases BP and HR)
|
|
|
What induction drug is a bronchodilator?
|
Ketamine
|
|
|
Statement:
Ketamine is a bronchodilator and the rest are neutral. Therefore, Ketamine is the agent of choice for a patient who is actively wheezing |
statement
|
|
|
What induction drugs are contraindicated in patients with "Porphyria" b/c of the induction of the enzyme ____________
|
Barbiturates and Etomidate
ALA synthetase |
|
|
what induction drug produces adrenocortical suppression b/c of inhibition of _____________
|
Etomidate
inhibition of "11 beta hydroxylase" |
|
|
What are the 11 clinical effects of Ketamine
Pneumonic: I pump in a Eii! (doesn't make sense) |
a. Increases CMR, CBF, ICP
b. Phencyclidine derivative c. Unconsciousness, amnesia "dissociative anesthesia" d. maintain resp. & airway reflexes e. potent bronchodialator f. increased BP & Pulse g. Nystagmus, IOP h. Analgesic I. emergence delirium j. Increases muscle tone k. Increases salivation/ secretions |
|
|
What drug is an Alpha 2 agonist
|
Dexmedetomidine (precidex)
|
|
|
what 3 effects does precidex produce
|
sedation, analgesia & hypnosis
|
|
|
__________is a known tranquilizer used as an antiemetic
|
Droperidol (inapsine)
|
|
|
What two side effects is droperidol known to cause
|
prolonging Q-T interval
arrhythmias |
|
|
What disease is Droperidol contraindicated in?
|
Parkinson's
|
|
|
Droperidol is contraindicated in Parkinson's disease b/c it can cause what S/E
|
Extrapyramidal side effects by blocking dopamine in the brain.
|
|
|
Which of the drugs that we give can cause salivation and respiratory secretions
|
Ketamine
|
|
|
What drug is the 1st and only IV anesthetic
|
Ketamine
|
|
|
What drug can you give in conjunction to Ketamine to reduce Emergence delirium
|
Versed
|
|
|
What is the only induction drug that is antiemetic
|
propofol
|
|
|
On emergence, what drug can cause hallucinations and emergence delirium
|
Ketamine
|
|
|
On emergence, what drug may cause a minimal hangover and possible euphoria
|
propofol
|
|
|
Precidex produces what type of effect on the brain
|
Sympatholytic
|
|
|
What are the only three drugs that have analgesic effects
|
Ketamine, Precidex, and Nitrous
|
|
|
What are two emetic drugs
What is one anti-emetic drug |
Etomidate & Ketamine
Propofol |
|
|
what are 3 drugs that can produce acute porphyrias
What drug is OK to give if a patient has prophyria |
Pentothal, Brevital, Etomidate
you can give propofol |
|
|
What enzyme do you not want to stimulate when dealing with porphyria
|
ALA synthetase
|
|
|
What 3 drugs can't you give to a patient who has porphyria
|
Pentothal, brevital, etomidate
|
|
|
What induction drug is commonly used in the elderly and pt's who are cardiovascularly compromised
|
Etomidate
(has minimal effect on the cardiovascular and respiratory systems.) |
|
|
What drug produces a biphasic effect on BP
|
Dexmedetomidine
|
|
|
These drugs are used primarily as premedicants for anxiolysis and amnesia
|
Benzo's
|
|
|
What is the most commonly used IV anesthetic
|
Propofol
|
|
|
Thiopental
|
Pentothal
|
|
|
Phenobarbital
|
Luminal
|
|
|
Pentobarbital
|
Nembutal
|
|
|
Secobarbital
|
Seconal
|
|
|
Methohexital
|
Brevital
|
|
|
Distribution half-life is known as?
|
Alpha Half-life
|
|
|
Elimination half-life is known as?
|
Beta half-life
|
|
|
Common S/E of Etomidate
|
Myoclonia
|
|
|
Propofol has been given as your induction agent. It's 30 min's into the case; at phase of redistribution will it be in the body.
a. brain b. muscle c. addipose |
Muscle
|
|
|
What receptor does ketamine work at, and is it an agonist or antagonist
|
NMDA receptor antagonism
|
|
|
What are two things a patient is at risk of with carbon monoxide build up in the CO2 absorber
|
Compound A
Carbon Dioxide |
|
|
60mg of Propofol was given ( 2 elimination half-life), 12 hours after the drug was given, how much drug remains in the body
a. 30 mg b. 15 mg c. 7.5 mg |
7.5mg.
12 hours would be 3 half lives. 60/2 = 30 (1st half-life) 30/2 = 15 ( 2nd half-life) 15/2 = 7.5 ( 3rd half-life) 7.5/2 = 3.75 ( 4th half-life) refer to pg 32 |
|
|
Where are the endogenous opioid peptides located in the body? (choose all that apply)
A. Brain B. spinal nerves C. spinal cord D. GI tract E. sympathetic nerves |
A, C, D
|
|
|
3 types of opiate receptors are: (choose 3)
A. kappa B. gamma C. delta D. Mu E. beta |
A, C, D
|
|
|
Analgesic properties and capacity to induce respiratory depression are inversely related: T or F?
|
F (they are directly related)
|
|
|
Which of the following are endogenous analgesic proteins?
A. enkephalins B. metakephalins C. dynorphins D. endorphins |
A, C, D
|
|
|
Wht is responsible for the transmission of the pain signal between neurons?
|
Substance P
|
|
|
Substance P is :
A. neurotransmitter B. endogenous analgesic C. inhibitor |
A
|
|
|
Opiate receptors are located where? (choose 2)
A. post synaptic neuron B. CNS C. presynaptic neuron D. PNS |
B, C
|
|
|
Opiates are:
A. antaonists B. agonists C. Inhibitory D. excitatory |
B
|
|
|
Name 3 types of opiate receptors
|
mu, kappa, delta
|
|
|
Which opiate receptor causes analgesia?
|
All do, but Mu is most
|
|
|
Analgesic property of a given opiate is directly proportional to its ability to cause respiratory depression. T or F?
|
T
|
|
|
Analgesic property of a given opiate is inversely related to its ability to cause addiction. T or F?
|
F ( directly proportional
|
|
|
Which opiate receptor causes euphoria?
A. Mu B. kappa C. delta |
A
|
|
|
which opiate receptorcauses resp. depression?
A. Delta B. kappa C. Mu |
C
|
|
|
Which opiate receptor causes miosis? (choose 2)
A. Mu B. delta C. kappa |
A, C
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Which opiate receptor is responsible for skeletal muscle rigidity?
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Mu
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Which opiate receptor has the least abuse potential?
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Kappa
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Which opiate receptor is responsible for development of physical dependence?
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Delta
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Which opiate receptor is responsible for biliary spasm?
A. Kappa B. Delta C. Mu |
C
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A pt allergic to morphine can safely receive which of the following?
A. Codeine B. Vicodin C. dilaudid D.Fentanyl |
D
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If a pt is allergic to one member of the phenanthrine class, they might be able to take a different member of the class. T or F
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F
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Two chemical classes of opiates are:
A. phenylpiperidines B. alkaloids C. Phenanthrenes D. esters |
A, C
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There is cross reactivity within the same chemcial class. T or F?
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T
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Why do we need to know chemical classes of opiates?
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There is cross reactivity within same class, not between different classes
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Which of the following are phenanthrenes? ( choose all that apply)
A. Morphine B. vicodin C. Fentayl D. dilaudid |
A, B, D
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Which of the following are phenylpiperidines?
A. methadone B. fentanyl C. meperidine D. oxycontin |
B, C
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Where are almost all opiates metabolized?
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Liver
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Which is the only opiate to not be metabolized in the liver?
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remifentanyl
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What is responsible for the metabolism of opiates? ( choose 2)
A. cytochrome enzymes B. Hoffman elimination C. Liver D. kidneys |
A, C
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What enzyme is responsible for metabolism of remi?
A. acetylcholinesterase B. non esterase dependent enzymes C. cytochrome enzymes |
B
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Which opiate has a neurotoxic metabolite?
A. meperidine B. morphine C. methadone D. dilaudid |
A
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What is the toxic metabolite of demerol?
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normeperidine
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What does the toxic metabolite normeperidine cause if levels accumulate?
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Sz
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What is the pathway called by which opiates cause miosis?
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Edinger-westphal nucleus
** board question** |
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Which routes of admin are most likely to result in pruritis? (choose 2)
A. intrathecal B. IV C. topical D. buccal |
A, D
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Which opiate receptor is responsible for the anti-shivering effect of demerol?
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kappa
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Pruritis is a sign of opiate allergy. T or F?
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F-naturally occuring side effect of drugs
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Treatment of pruritis cause by opiates include: (choose all that apply)
A. zofran B. reglan C. benadryl D. narcan |
A, C, D
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Which drugs can be used to treat opiate induced biliary spasm?
A. nitroglycerine B. narcan C. robinul D. glucagon |
All
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why do opiates cause PONV?
A. stimulate the CTZ B. increase gastric secretions C. activate the vomiting center D. both A& C |
D
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asthmatic pts should not receive: (choose 2)
A. morphine B. phenanthrines C. fentanyl D. phenylpiperidines |
a, b
(histamine release) |
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What narcotic is contraindicated in pts taking MAOIs?
A. morphine B. dilaudid C. meperidine D. fentanyl |
C
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What is the most potent opiate?
A. remifentanyl B. alfentanyl C. sufentanyl D. hydromorphone |
C
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Do opiates increase ICP?
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NO
(but increase CO2 from resp depression can increase ICP) |
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Which of the following are antipyretic?
A. ASA B. acetaminophen C. celebrex D. nonspecific NSADS |
a, b, c, d
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Which of the following are analgesic?
A. ASA B. acetaminophen C. celebrex D. non-specific NSAIDS |
all are
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Which of the following are antiinflammatory?
A. ASA B. acetaminophen C. celebrex D. non-specific NSAIDS |
A, C, D
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What are the 4 "endogenous opioid peptides in the body"
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Enkephalins
Endorphins Dynorphins Endomorphins |
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How do Opiates work?
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They are agonist at opiate receptors which which are presynaptic receptors decreasing pain, neurotransmitter release
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Both natural occuring & Semi synthetic Opioids are under which chemical classification
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Phenanthrene
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What are the two main chemical classifications of Opioids
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Phenanthrene's and Phenylpiperidine
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What are the naturally occurring drugs listed under the chemical classification of phenanthrene
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Morphine, Codeine, Thebaine
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What are the Semi Synthetic drugs listed under the chemical classification of phenanthrenes
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diacetylmorphine (heroin)
Hydrocodone ( vicoden) Hydromorphone (dilaudid) Oxycodone ( oxycotin) Oxymorphone |
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What drugs are classified as Phenylpiperidine derivatives
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Meperidine
Fentanyl Sufentanil Alfentanil Remifentanil |
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Statement:
There is no cross allergy between chemical classes. But there can be a cross allergy between drugs in one category! |
statement
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If someone is allergic to Morphine what other opioid can the have.
a. Codeine b. Vicoden c. Fentanyl d. oxycotin |
Fentanyl.
The other 3 are in the phenanthrene classification. Fentanyl is in the Phenylpiperidine class. |
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Which has the shortest elimination half-life of all Opioids
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Remifentanil
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How do you treat billiary spasm
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1. atropine or glycopyrrolate
2. nitroglycerine 3. glucagon 4. naloxone |
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What enzyme is responsible for Metabolism of Remifentanil
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nonesterase dependent enzymes
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All Narcotics except Remifentanil are metabolized where?
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in the liver
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What Opioid is Hydrolyzed in the plasma by nonesterase dependent enzymes
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remifentanil
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What Opioid gets metabolized to a metabolyte call normaperidine
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Demerol
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What are the effects of normaperidine (metabolyte) on the CNS and Renal system
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CNS toxic
mildly renal toxic |
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What are the acute effects of Opioids
|
Analgesia
Ventilatory depression Sedation Euphoria Vasodilation Bradycardia Cough suppression Miosis N/V Skeletal muscle rigidity Smooth muscle spasm Constipation Urinary retention Biliary spasm Pruritus, rash Antishivering (meperidine only) |
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What are the chronic effects of Opioids
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Tolerance
Physical dependence Constipation |
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What Opioid has an antishivering effect
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Meperidine
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What are the 3 subtypes of Opioid receptors
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MU, Kappa, Delta
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What opioids are classified as MU agonists
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Endorphins
Morphine Synthetic opioids |
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What opioids are classified as Kappa Agonists
|
Dynorphins
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What opioids are classified as Delta agonists
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Enkephanlins
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What are the 3 drugs classified as MU, Kappa, and Delta "Pure Antagonists"
|
Naloxone, Naltrexone, Nalmefene
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Which opioid receptor causes Dysphoria, sedation
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Kappa
|
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Which opioid receptor causes Minimal constipation (a)
Marked constipation (b) |
a. Delta
b. MU |
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Statement: With exception to Dysphoria and Minimal constipation, MU receptors cause all other effects....."so if you see a question on the exam related to effects of Opioid receptors, the answer will most likely be MU receptors.
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statement
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Produces a maximal biologic response (analgesia, resp. depression)
|
Full agonists
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Produces a submaximal response even at high doses
|
partial agonist
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what is the most potent opioid on the market
|
Sufentanil
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What opioid has to be given by continuous infusion (b/c of short half-life)
|
remifentanil
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What causes a greater stress response on the body...
a. intubation b. surgical incision |
Intubation
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CO2 response curves will shift in what direction when increasing the dose of narcotics in the blood
|
tend to shift to the right. Every time someone gets more narcotic, the curve shifts to the right requiring more minute ventilation to compensate for an elevated CO2
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The degree of respiratory depression caused by opioids is always equal to?
|
always equal to the Amt of drug given. ("POTENCY")
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Opioids produce respiratory depression by depressing....?
|
by depressing the respiratory centers sensitivity to CO2. So, it takes more CO2 to drive or make you breathe the same amt. as compared to before you received the drug!
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What opioids cause Miosis
|
They all do! "You never develop a tolerance to miosis....Pt's will always get pinpoint pupils......" the more pinpoint they are the more narcanized they are! (vagal effect on eye)
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Opioids abolish cortical inhibition of the ____________nucleus, thereby resulting in papillary constriction
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Edinger-Westphal (pathway that causes myosis)
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What receptor is suggested to mediate intrathecal morphine-induced itching
|
MU
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What drug reverses opioid-induced itching
|
Narcan
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GI effects:
Smooth muscle spasm is caused by the constriction of? |
Constriction of the spinchter of Oddi
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What effects do Opioids have on the common bile duct?
|
increase tone of the common bile duct...causing an increase in biliary pressure.
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What are the two main sites that produce N & V
|
CTZ & Vomiting center
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Which opioids produce N/V
|
they all do. (they are the most causative of all drugs)
|
|
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Does the Frequency of N/V increase or decrease with longer frequency of dosing
|
Frequency decrease the longer the patient is on opioids.
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Opioid induced N/V is more common in pt's who are lying down or ambulatory
|
ambulatory
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The vomiting center receives input from the CTZ as well as the peripheral sites via the ________ nerve
|
vagus
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Endorphins released into the pre-synaptic neuron decrease the amount of ___________ in return decreasing pain.
|
Sub P
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What cardiac effects do opioids have on a dehydrated person
|
they become a little hypotensive and to a greater extent cause the persons HR to decrease.
|
|
|
A common opioid that causes tachycardia
|
Demerol
|
|
|
Statement:
On a supine, well hydrated healthy person....The opioids have almost no effects on the CV system. |
statement
|
|
|
Which Opioids provide the best Antitussive effects.....List from best to least effects
|
1. heroin
2. fentanyl 3. Hydromorphine 4. Hydrocodone 5. Methadone 6. codeine 7. morphine 8. levorphanol 9. Meperidine |
|
|
Statement:
All Opioids stimulate the CTZ, but depresses the Vomiting Center. Clinically you get N+V with all doses, but the potential of N/V decreases with repeated doses b/c of the depression of the vomiting center. * More common in Ambulatory patients* |
Statement
|
|
|
Which class of Opioid drugs produce a histamine release?
|
Phenanthrene's
(synthetic & semi synthetic) |
|
|
Do the phenylpiperidine derivatives cause a histamine release?
|
No!! only phenanthrene's
|
|
|
If you have a patient who is on MAOI's, what drug can they "not" receive?
|
Demerol...
May cause Sz's |
|
|
What is the most potent Opioid in the World?
|
Sufentanil
|
|
|
What Narcotics have an effect on ICP?
|
None of them do!
|
|
|
T or F:
NSAIDS, Aspirin and Tylenol are all antipyretic, analgesic and anti-inflammatory |
False.
They all provide these effects except Tylenol. Tylenol does not have anti-inflammatory effects!! But it is antipyretic and analgesic! |
|
|
Which receptor Sub-type has the effect of Analgesia & Low abuse potential.
|
Mu
|
|
|
Do opioids stimulate or depress the CTZ
|
They stimulate
|
|
|
Do opioids stimulate of depress the vomiting center
|
They depress
|
|
|
What drug classification does Droperidol fall under?
|
Butyrophenone
|
