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115 Cards in this Set

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prop of Halothane as anesthetic
high lipid and blood solubility (high potency, slow induction, slow recovery time)
prop of N2O as anesthetic
low blood and lipid solubility--fast induction, low potency
SE inhaled anesthetics
cardiac, respir depression, N/V, increase cerbral BF
toxicity of inhaled anesthetics
halothane=hepatic
methoxyflurane=kidney
enflurane=sz
malignant hyperthermia (rare)
name inhaled anesthetics (6)
halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, N2O
how determine potency (formula) for anesthetics
1/MAC
general prop and use thiopental
IV anesthetic=hi lipid solubility, used induction and short procedures. terminated by redistribution from brain. decr cerbral BF
benzodiazepine used in anesthesia
midazolam (IV anesthetic)
midazolam use, prop
(IV anesthetic, benzodiazepine) commonly for endo, adjunctively with gaseous anesthesias and narcotics. severe postop respir depression and amnesia
midazolam toxicities
severe postop respir depression and amnesia
(a benzo used in endoscopy)
ketamine, type Rx, use
a PCP analog, IV dissociative anesthetic.
SE ketamine
cardio stim, increase cerebral BF,
-disorientation, hallucination, bad dreams
propofol use
IV anesthetic, for rapid induction and short procedures, less post op N than thiopental
Name depolarizing NM blockers
Succinyl choline
stages reversal of depolarizing NM blockers
(succinyl choline)
1. prolonged depolar-no antidote, block is + by - CE
2. repolarized, blocked-use - CE (ie neostigmine)
name nondepolarizing NM block (5)
tubocurarine, atracurium, mivacurium, pancuronium, vecuronium
(-curonium, -curium)
reversal atracurium
(a non depol NM block)
an - CE (ie neostigmine, edrophonium)
dantrolene, mech, use (2)
tx malignant hyperthermia (caused by inhaled anesthet exc N2O and succinylcholine).
tx neuroleptic malign syndrome
mech: prevent Ca rel from SR skel mscl
name local anesthetics
esters=procaine, cocaine, tetracaine
amides=lidocaine, bupivicaine
mech local anesthetics
block Na channel to binding to specif R on inner portion channel. tertiary amines penetrate mem uncharged, then bind as charged
order of nerve blocked w local anesthetics
small>large diameter, myelyinated>nonmyelinated
small unmyelinated>sm myelinated>large myelinate
loss of sensations w nerve blockade
pain (lose first)>temperature>touch>pressure
SE local anesth, general, 2 specific Rx
bupivicaine=severe cardiac tox
cocaine=arrhyth
HTN
opoiod analges R
act at opoiod receptors
mu=morphine
delta=enkephalin
kappa=dynorphin
dextramethorphan
an opoiod used for cough suppression
loperamide
opoiod used for diarrhea
diphenoxylate
opoiod used for diarrhea
generally opoiods used for 2 things
1) pain
2) acute pul edema
methadone
an opoiod used in maintenance for addicts
toxicity of opoiods
addiction, respir depression, constipation, miosis (pinpoint), additive CNS depression
tx of opoiod OD
naloxone, naltrexone (opoiod R antagonist)
name NSAIDs
ibuprofen, naproxen, indomethacin
2 effects of NSAIDs
1) reversibly inhibi COX1,2
2) block PG synthesis
toxicity of NSAIDs
renal damage, aplastic anemia, GI distress, ulcers
tx of opoiod OD
naloxone, naltrexone (opoiod R antagonist)
name NSAIDs
ibuprofen, naproxen, indomethacin
2 mech effects of NSAIDs
1) reversibly inhibi COX1,2
2) block PG synthesis
toxicity of NSAIDs
renal damage, aplastic anemia, GI distress, ulcers
NSAIDs used for
anti-pyretic, analgesic, anti-inflamm (indomethacin to close PDA)
acetaminophen, how difft NSAID
-rev inhibits COX mostly in CNS (inactiv peripher)
-anti-pyretic, analgesic, no anti-inflamm
toxicity acetaminophen, mech , how tx
hepatic necrosis (depletes glutathione and forms toxic NADQI
(N acetylcysteine antidote)
mechanism of class I anti arrhyth
local anesthetics, decr conduction, esp depolarized. decr slope 4 depolar, increase threshold in abnormal pace
T/F class I antiarrhythm good for fast tachycardias
yes, bc they are state dependent (they selectively depress tissue freq depolarized)
class IA arrhytmics
quinidine, amiodarone, procainamide, disopyramide
class IB arrhytmics
lidocaine, mexiletene, tocainide
mexiletene
class IB arrhytmic
prop of IA arrhyth
increase AP, incr ERP, incr QT
effect both atrial and ventricle
toxicity quinidine
cinchonism
HA, tinnitus, thrombocytopenia, torsades de pointes
toxicity procainamide
(IA) reseversible SLE-like
prop IB arrhyth
decr AP, affect ischaemia or depol Purknje and ventricular
IB used for
acute ventricular (esp s/p MI) and digitalis-induced
pneu for IB Rx
"IB Sancho (Na), I like mex taco"
IB Na, Lidocaine, mexiletene, toacainide
toxicity IB
CNS stim/depress, cardiovas depression
IC arrhyth
flecainide, ecainide, propafenone
propafenone
IC arrhyth
flecainide
IC arrhyth
prop/use IC
no affect AP, useful in VT that ->VF or intractable SVT.
toxicity IC arrhyth
proarrhyth (esp s/p MI)
summary AP duration class I
IA- increase
IB- decrease
IC- no change
what type Rx are II arrhyth?
beta blockers
mech II arrhyth
decr cAMP, decr Ca, suppress abnl by decr slope ph 4. AV node esp sensitive
increase PR interval
how II arrhyth affect intervals
incr PR (as do class IV)
drugs that decr slope ph 4
class I, II arrhyth
name class II arrhyth Rx
propanolol, esmolol (short t1/2), metoprolol, atenolol, timolol
(P MEAT)
toxicity II arrhyth
same as SE beta blockers-impotence, exacerb asthma, CV (bradycardia, AV block, CHF), CNS (sedate, sleep). May mask hypoglycemia
what type Rx III arrhyth
K channel blockers
name III arrhyth
sotalol, ibutilide, bretylium, amiodarone, dofetilide "K IS BAD"
dofetilide
III arrhyth
sotalol
III arrhyth (NOT b blocker!)
amiodarone
both IA and III
prop of III arrhyth
incr AP duration, incr ERP, incr QT. used when others FAIL
which incr QT
IA, III
toxicity sotalol
torsades de pointes, excessive block
toxicity ibtuilide
t de pointes
toxicity bretylium
new arrhythmia, hypotension
toxicity amiodarone
pul fibrosis, hepatotoxic, change thyroid
also corneal deposit, photodermatitis, neuro, constipation, CVS
type Rx is IV arrhyth
Ca blockers
name IV arrhyth
verapamil, diltiazem
prop IV arrhyth
mostly affect AV node, decr conduction, incr ERP, incr PR.
used in prevention nodal arrhythmias
toxicity IV arrhyth
constipation, flushing, edema, CV (CHF, AV block, sinus node depression)
adenosine use arrhyth
diagnose/abolishing AV nodal arrhyth
K+ in arrhyth, mech
depress ectopic pacemakers, esp for digoxin toxicity
Mg use in arrhyth
t de pointes, digoxin toxicity
effect statins
much decr LDL, small decr tg, small incr HDL
problems with statins
expensive, reversible incr LFTs, myositis
effect niacin on lipid
decr LDL, incr HDL, sl decr TG
problems with niacin
red, flushed face which decr w longtime use
names bile acid resins
cholestyramine, colestipol
effect of cholestyramine
decr LDL, slight incr tg
(a bile resin)
problems w bile resins
pts hate-tastes bad, GI discomfort
ezetimibe
cholesterol absorption blocker
effect ezetimibe
decr LDL
toxicity ezetimibe
rare incr LFTs
colestipol
a bile resin
gemfibrozil
a fibrate
effect of fibrates
decr LDL, incr HDL, big decr tg
problem w fibrates
myositis, incr LFTs
mech fibrates
stimulate LPL
what step niacin inhibit
cholesterol being secreted as VLDL
name sulfonylurea
tolbutamide, chlorpropamide, 2nd gen: glyburide, glipizide
mech sulfonylureas
stimulate ins release, closes K channel on beta-cell membrane incr Ca influx
toxicities sulfonylurea
hypoglycemia (more common with gly and glip)
disulfiram-like effects (not with gly and glip)
tolbutamide
sulfonylurea
chlorpropamide
sulfonylurea
mech metformin
inhib gluconeo and incr glycolysis
use of metformin
both DMII, and DMI (doesn't require islet fxn)
SE metformin
lactic acidosis
glitazones, name II
pioglitazone, rosiglitazone
mech glitazone
incr target cell response to insulin (for DMII)
SE glitazone
weight gain, hepatotoxic (troglitazone)
miglitol
a glucosidase inhibitor
mech a-glucosidase inhib
inhibits brush border alpha glucosidases causing delay of hydrolysis, decr postprandial glu
toxicity a-glucosidase inhib
GI disturbance
mech insulin R, effect?
R has tyrosine kinase activity.
mscl-stim glycogen and protein syn
adipose-incr tg storage
toxicity insulin, 2nd use
hypoglycemia (rare hypersensit),
also used for hyperkalemia