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104 Cards in this Set

  • Front
  • Back
Carbamazepine is used for
a) ETOH withdrawal
b) Partial tonic/clonic seizures
c) neuralgia
d) Parkinsons
ETOH withdrawal
Partial tonic/clonic seizures
neuralgia
GABA excitatory/inhibitory
Glutamate excitatory/inhibitory
GABA Inhibitory

Glutamate Excitatory
CNS Depressants
a) highly protein bound
b) CYP inducers/inhibitors
c) increase requirement of MAC, Opioids, NDMR's, STP, Propofol
d) narrow therapeutic window
highly protein bound
CYP inducers/inhibitors
increase requirement of MAC, Opioids, NDMR's, STP, Propofol
narrow therapeutic window
Carbamazepine
a) induces it's own CYP
b) Na channel blocker
c) causes SIADH
d) causes sedation, vertigo, ataxia
Induces it's own CYP (active metabolites)
Na channel blocker
causes SIADH
causes sedation, vertigo, ataxia
PONV Risk factors (4)
Female
Nonsmoker
Hx of PONV/motion sickness
Opioids
Key Neurotransmitters in Vomiting center
a) Substance P
b) Histamine
c) Serotonin
d) ACh
e) Dopamine
Substance P (NK1)
Histamine (H1)
Serotonin (5 HT 3)
ACh (muscarinic)
Dopamine (D2)
1st signal in PONV pathway
a) GI tract via vagus nerve (serotonin)
b) CNS (ACh, Histamine)
c) CTZ ( serotonin, dopamine)
CNS (ACh, Histamine)
2nd signal in PONV pathway
a) GI tract via vagus nerve (serotonin)
b) CNS (ACh, Histamine)
c) CTZ ( serotonin, dopamine)
GI tract via vagus nerve (serotonin)
3rd signal in PONV pathway
a) GI tract via vagus nerve (serotonin)
b) CNS (ACh, Histamine)
c) CTZ ( serotonin, dopamine)
CTZ ( serotonin, dopamine)
D2 antagonists
a) prochloroperazine
b) dolasetron
c) Promethazine
d) metoclopramide
prochloroperazine & metoclopramide
also droperidol
Which class of PONV drugs can cause Extrapyramidal effects?
D2 antagonists
Of the following which one is the least efficacious for PONV
a) Ondansetron
b) Scopolamine
c) Dexamethasone
d) metoclopramide
metoclopramide
How does oxygen work to decrease PONV?
increases O2 in GI tract which increases Serotonin
Arrests growth & replication, limits spread allows immune system to destroy pathogens
a) Bacteriostatic
b) Bactericidal
Bacteriostatic
Lowest concentration that will inhibit growth
a) Minimum inhibitory concentration
b) Minimum bactericidal concentration
Minimum inhibitory concentration
Lowest concentration that will kill 99.9% of organisms
a) Minimum inhibitory concentration
b) Minimum bactericidal concentration
Minimum bactericidal concentration

can take up to 48 hours
Concentration dependent drugs
a) Cillins
b) Cephalosporins
c) Aminoglycosides
d) Carbapenems
Aminoglycosides
Carbapenems

also fluroquinolones
Time dependent drugs
a) Cillins
b) Cephalosporins
c) Aminoglycosides
d) Carbapenems
Cillins
Cephalosporins
(beta lactams)
Narrow spectrum antibx
a) effective against gram + & -
b) effective on single or limited # of organisms
c) effective against a variety of organisms
effective on single or limited # of organisms
Extended Spectrum antibx
a) effective against gram + & -
b) effective on single or limited # of organisms
c) effective against a variety of organisms
effective against gram + & -
Carbamazepine is used for
a) ETOH withdrawal
b) Partial tonic/clonic seizures
c) neuralgia
d) Parkinsons
ETOH withdrawal
Partial tonic/clonic seizures
neuralgia
GABA excitatory/inhibitory
Glutamate excitatory/inhibitory
GABA Inhibitory

Glutamate Excitatory
CNS Depressants
a) highly protein bound
b) CYP inducers/inhibitors
c) increase requirement of MAC, Opioids, NDMR's, STP, Propofol
d) narrow therapeutic window
highly protein bound
CYP inducers/inhibitors
increase requirement of MAC, Opioids, NDMR's, STP, Propofol
narrow therapeutic window
Carbamazepine
a) induces it's own CYP
b) Na channel blocker
c) causes SIADH
d) causes sedation, vertigo, ataxia
Induces it's own CYP (active metabolites)
Na channel blocker
causes SIADH
causes sedation, vertigo, ataxia
Key Neurotransmitters in Vomiting center
a) Substance P
b) Histamine
c) Serotonin
d) ACh
e) Dopamine
Substance P (NK1)
Histamine (H1)
Serotonin (5 HT 3)
ACh (muscarinic)
Dopamine (D2)
D2 antagonists
a) prochloroperazine
b) dolasetron
c) Promethazine
d) metoclopramide
prochloroperazine & metoclopramide
also droperidol
Arrests growth & replication, limits spread allows immune system to destroy pathogens
a) Bacteriostatic
b) Bactericidal
Bacteriostatic
Lowest concentration that will inhibit growth
a) Minimum inhibitory concentration
b) Minimum bactericidal concentration
Minimum inhibitory concentration
Lowest concentration that will kill 99.9% of organisms
a) Minimum inhibitory concentration
b) Minimum bactericidal concentration
Minimum bactericidal concentration

can take up to 48 hours
Concentration dependent drugs
a) Cillins
b) Cephalosporins
c) Aminoglycosides
d) Carbapenems
Aminoglycosides
Carbapenems

also fluroquinolones
Time dependent drugs
a) Cillins
b) Cephalosporins
c) Aminoglycosides
d) Carbapenems
Cillins
Cephalosporins
(beta lactams)
Narrow spectrum antibx
a) effective against gram + & -
b) effective on single or limited # of organisms
c) effective against a variety of organisms
effective on single or limited # of organisms
Extended Spectrum antibx
a) effective against gram + & -
b) effective on single or limited # of organisms
c) effective against a variety of organisms
effective against gram + & -
Broad Spectrum antibx
a) effective against gram + & -
b) effective on single or limited # of organisms
c) effective against a variety of organisms
effective against a variety of organisms (including normal flora)
Delivery to BBB, Prostate depend on
a) lipid solubility
b) molecule size
c) protein binding
d) all of the above
lipid solubility
molecule size
protein binding
Prophyllactic antibx are given to
a) Bowel, GYN, ENT surgeries
b) Joints, cardiovascular
c) Dental proceed. in pt with prosthetic devices
d) all OR cases (at least one dose)
Bowel, GYN, ENT surgeries
Joints, cardiovascular
Dental proceed. in pt with prosthetic devices
Bowel, GYN, ENT surgeries are covered with
a) 1st generation cephalosporins
b) 2nd or 3rd generation cephalosporins
c) aminoglycosides
2nd or 3rd generation cephalosporins

Cefoxitin or Ceftriaxone
Cell Wall Synthesis Inhibitors
a) Tetracyclines
b) Cillins
c) Cephalosporins
d) aminoglycosides
Cillins
Cephalosporins (these are Beta Lactam antibx)
Vancomycin is also a Cell Wall drug
Protein Synthesis Inhibitors
a) Cillins
b) Clindamycin
c) Aminoglycosides
d) Tetracylines
Clindamycin
Aminoglycosides
Tetracylines
as well as Macrolides & Chloramphenicol
Folate Synthesis Inhibitors
a) Vancomycin
b) Sulfonamides
c) Tetracyclines
d) Cephalosporins
Sulfonamides
as well as Trimethoprim
What is the MOA of Isoniazid used to treat TB
a) Inhibits Synthesis of Mycolic Acid
b) Blocks RNA Synthesis
c) Creates Holes in cell wall
d) Inhibits cell growth
Inhibits Synthesis of Mycolic Acid

Rifampin is also used to treat but it blocks RNA synthesis
What is MOA of amphotericin
a) Inhibits Synthesis of Mycolic Acid
b) Blocks RNA Synthesis
c) Creates Holes in fungal cell wall
d) Inhibits cell growth
Creates Holes in fungal cell wall
Describe the side effects of Amphotericin
Infusion fever shakes, N/V
pretreat with antipyretics, antihistamines, steroids, & demerol
Metronidazole
a) AntiViral
b) AntiProtozoal
c) Herpes simplex
d) Antifungal
AntiProtozoal
Oseltamivir, Zanamivir, Amantidine, Rimatidine
a) HIV drugs
b) AntiViral drugs
c) AntiProtozoal drugs
d) AntiFungal drugs
AntiViral drugs
Oseltamivir, Zanamivir
a) Neuramidase Inhibitors
b) Inhibitors of Viral coating
c) AntiFluenza drugs
Neuramidase Inhibitors

AntiFluenza drugs
Amantidine, Rimatidine
a) Neuramidase Inhibitors
b) Inhibitors of Viral coating
c) AntiFluenza drugs
Inhibitors of Viral coating
AntiFluenza drugs
A MANtidine RIMatidine
(A man's coat has a Rim)
Acyclovir
a) Tx Herpes Simplex, Varicella Zoster
b) AntiFungal
c) Inhibits DNA Synthesis
d) forms a "fake guanosine"
Tx Herpes Simplex, Varicella Zoster
Inhibits DNA Synthesis
forms a "fake guanosine"
Nucleoside Reverse Transcriptase Inhibitors (NRTI)
a) Zidovudine (AZT)
b) interfere with DNA Synthesis
c) Prevent Assembly of Virion
d) Block fusion of virus on Host membrane
Zidovudine (AZT)
interfere with DNA Synthesis
Protease Inhibitors
a) used in combo with other drugs
b) Prevent Assembly of Virion
c) Interfere with DNA Synthesis
d) Enfuvirtide
used in combo with other drugs
Prevent Assembly of Virion
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
a) Interfere with DNA Synthesis
b) Prevent Assembly of Virion
c) Delaviridine
d) Elavirenz
e) Nevirapine
Interfere with DNA Synthesis
Delaviridine
Elavirenz
Nevirapine
Viral Fusion Inhibitors
a) Prevent Assembly of Virion
b) Block Fusion of virus to host membrane
c) Enfuvirtide
d) Elavirenz
Block Fusion of virus to host membrane (FUsion)

Enfuvirtide (enFUviritide)
Chronic use of Amphetamines, QAT, St. John's Wort
a) increase anesthetic requirement
b) decrease anesthetic requirement
c) labile BP
d) decreased response with indirect vasopressors
decrease anesthetic requirement
labile BP
decreased response with indirect vasopressors
Acute use of Amphetamines, QAT, St. John's Wort, Cocaine
a) increase anesthetic requirement
b) decrease anesthetic requirement
c) labile BP
d) decreased response with indirect vasopressors
increase anesthetic requirement
Caffiene
a) increased catechol release
b) used to prevent apnea in preemies
c) Tx for PDPH
d) increases CSF production
a) increased catechol release
b) used to prevent apnea in preemies
c) Tx for PDPH
d) increases CSF production
Acute use of ETOH
a) increases anesthetic need
b) decreases anesthetic need
decreases anesthetic need
Chronic use of ETOH
a) increases anesthetic need
b) decreases anesthetic need
increases anesthetic need
T/F Vitamin B12 deficiency can be caused by long OR cases using N2O and then lead to Neurologic syndrome
True, parasthesias and weakness
CNS demyelination
(this is real Dr. Coyle took care of someone with this)
can also cause anemia
T/F 5-Flurouracil (chemo drug) decreases plasma cholinesterase
True
Most important anesthetic concern in someone who has received Chemo is
a) Immunosuppression
b) Friability of tissues
c) bleeding
d) nutrition
Immunosuppression
With Chemo drugs
a) less barbiturates
b) more barbiturates
c) less NMBD
d) more NMBD
less barbiturates

more NMBD
Alkylating Chemo Drugs
a) Antimetabolites
b) Interfere with DNA Synthesis
c) high incidence PONV
d) Pulmonary Fibrosis
Antimetabolites
Interfere with DNA Synthesis
high incidence PONV
Pulmonary Fibrosis

Nucleic Acid Synthesis Inhib. cause Fibrosis also
Bleomycin
a) Pulmonary Fibrosis
b) Antibx
c) Fibrosis can worsen 6 -12 mths later
d) made worse with high flow O2 & hypervolemia
Pulmonary Fibrosis
Antibx
Fibrosis can worsen 6 -12 mths later
made worse with high flow O2 & hypervolemia
DNA Topoisomerase Inhibitors
a) Pulmonary Fibrosis
b) Cardiac ischemia
c) SIADH
d) CNS effects
Cardiac ischemia

CNS effects
Microtubule Inhibitors
a) Pulmonary Edema
b) Cardiac myopathy
c) SIADH, Ortho. HOTN
d) Vincristine
SIADH
Ortho. HOTN
Vincristine (Chemo)
Heparin
a) binds to Factor X
b) binds to Antithrombin III
c) binds to Antithrombin II
d) Blocks Intrinsic Pathway
Factor X
Antithrombin III
Blocks Intrinsic Pathway
LMWH
a) binds to Factor X
b) mol. wt 6000 - 8000
c) Prolongs PTT
d) has no effect on PTT
binds to Factor X
mol. wt 6000 - 8000
has no effect on PTT
Warfarin
a) Blocks Extrinsic Pathway
b) Interferes with Vit K Synthesis
c) Many drug interactions
d) monitored with PT/INR
Blocks Extrinsic Pathway
Interferes with Vit K Synthesis
Many drug interactions
monitored with PT/INR
Warfarin has it's biggest effect on
a) Antithrombin II
b) Antithrombin III
c) Antithrombin VII
d) Factor X
Antithrombin II but also has an effect VII, IX, X
Protamine
a) binds to heparin 1:1 (1mg/100units)
b) heparin reversal
c) can cause myocardial depression
d) anaphyllaxis
a) binds to heparin 1:1 (1mg/100units)
b) heparin reversal
c) can cause myocardial depression
d) anaphyllaxis
Heparin Protamine Complex
a) noted at end of infusion
b) noted at start of infusion
c) an anaphyllactic reaction
noted at start of infusion
an anaphyllactic reaction

Tx with steroids, H1 & H2 blockers, fluids
Why would Protamine cause myocardial depression?
D/t the amount of free protamine circulating after all heparin is bound

Tx alpha adrenergics & Ca
Reversal of Warfarin
a) Vit K
b) Protamine
c) FFP
d) Warfarin is irreverisbly bound & the body must build new factors (like ASA and platelets)
Vit K (takes about 24 hours)

FFP (4-6 units be wary of hypervolemia with higher number of units)
Parkinson's Disease
a) loss of dopamine receptors /dopamine
b) increase in dopamine
c) loss of ACh
d) treat with dopamine
loss of dopamine receptors /dopamine

receptors are found in Substantia Nigra, dopamine controls motor movement. When there is enough dopamine ACh is kept in "check" when there isn't ACh rules and causes muscle rigidity and inc. tone
Causes of Parkinson's Disease
a) Encephalitis
b) CVA's
c) Ideopathic
d) all of the above
Encephalitis
CVA's
Ideopathic
Levodopa
a) must be given with Carbidopa
b) crosses BBB
c) converted to dopamine once in BBB
d) causes Nausea d/t stimulation of CTZ
must be given with Carbidopa
crosses BBB
converted to dopamine once in BBB
causes Nausea d/t stimulation of CTZ
Why must Levidopa be given with Carbidopa
a) Levodopa doesn't cross BBB & Carbidopa will bind with it and help it across
b) Levodopa is absorbed in the GI tract, but Carbidopa will decrease absorption of Levodopa allowing it to cross BBB
c) Carbidopa stops the breakdown of Levodopa by COMT
Levodopa is absorbed in the GI tract, but Carbidopa will decrease absorption of Levodopa allowing it to cross BBB
Selegiline
a) COMT inhibitor
b) MAO Type B Inhibitor
c) Precursor of Dopamine
d) Prevents breakdown of dopamine
MAO Type B Inhibitor

Prevents breakdown of dopamine
(this enhances the effect of Levodopa)
Side effects of Selegiline
a) HOTN
b) HTN
c) metabolite is amphetamine
d) insomnia
HTN (in high doses will effect MAO type A which increase NE)
metabolite is amphetamine
insomnia (caused by the amphetamine)
COMT Inhibitors
a) Entacapone
b) enhance dopamine availability
c) prevents breakdown of dopamine
d) Rasagiline
Entacapone
enhance dopamine availability
prevents breakdown of dopamine
Anesthetic Considerations r/t Parkinson's
a) lack of airway tone
b) Labile BP
c) NMBD's may be unpredictable
c) No Reglan
lack of airway tone
Labile BP (r/t Levodopa)
NMBD's may be unpredictable (may have decreased # of receptors)
No Reglan (dopaminergic antagonist)
Sleep aid drugs
a) short duration
b) long duration
c) GABA receptor
short duration

GABA receptor
Reversal of Benzo's
a) Flumazenil
b) Aminophylline
c) Physostigmine
d) a only
Flumazenil
Aminophylline
Physostigmine
Of the following drugs which has NO effect on Norepi re-uptake
a) Venlafaxine
b) Imipramine
c) Fluoxetine
d) Trazadone
Fluoxetine
Selective Seretonin Re-uptake Inhibitor

Trazadone (atypical antidepressant)
Of the following which have effect on both Norepi & Seretonin Re-uptake
a) Venlafaxine
b) Imipramine
c) Fluoxetine
d) Duloxetine
Venlafaxine
Imipramine
Duloxetine
Bupropion
a) Seretonin, Norepi, & dopamine re-uptake inhibitor
b) anti-depressant
c) smoking cessation
d) seizures with high doses
Seretonin, Norepi, & dopamine re-uptake inhibitor
anti-depressant
smoking cessation
seizures with high doses
With long term use of SSRI's & SNRI's
a) inhibitory receptors are upregulated
b) inhibitory receptors are downregulated
c) increased neurotransmitter in synaptic cleft
d) decreased neurotransmitter in synaptic cleft
inhibitory receptors are downregulated

increased neurotransmitter in synaptic cleft
SNRI's
a) Venlafaxine
b) Duloxetine
c) Mirtazapine
d) Doxepin
VenlafaXine
DuloXetine
Tricyclic Antidepressants
a) amitriptylline
b) imipramine
c) block Norepi & Seretonin re-uptake
d) block Norepi, Dopamine & Seretonin re-uptake
amitriptylline
imipramine
block Norepi & Seretonin re-uptake
Acute administration of TCA's
a) increased SNS response
b) decrease in catechol stores
c) exaggerated response to direct acting drugs
d) exaggerated response to indirect acting drugs
increased SNS response

exaggerated response to indirect acting drugs (unpredictable response)

( A Cute little TCA likes SNS & exaggerates INDIRECTly)
Chronic use of TCA's
a) increased SNS response
b) decrease in catechol stores
c) may require higher dose of direct acting drugs
d) exaggerated response to indirect acting drugs
DECREASE in catechol STORES

may require HIGHER dose of DIRECT acting drugs (decreased receptor function)
T/F TCA's have increased incidence of cardiac dysrhythmias esp. with halogenated anesth. gases
True
T/F TCA's can cause increased anticholinergic delirium
True
Monamine Oxidase
a) acts as a safety valve to get rid of extra catchols (NE, Dop. Seret)
b) can be inhibited by Phenelizine
c) both of the above
acts as a safety valve to get rid of extra catchols (NE, Dop. Seret)

can be inhibited by Phenelizine
also Tranylcypromine, Selegiline
MAOI's for treatment of depression
a) Phenelizine
b) Tranylcypromine
c) Selegiline
d) Fluoxetine
Phenelizine
Tranylcypromine
Selegiline (also used in the treatment of Parkinson's because it increases amount of dopamine)
MAOI's
a) competitively bind with MAO
b) irreversibly bind with MAO
c) require avoidance of tyramine containing foods
irreversibly bind with MAO

require avoidance of tyramine containing foods
Which of the following drugs can cause both an excitatory and depressive response when given with MAOI's
a) Morphine
b) Demerol
c) Dilaudid
d) all of the above
Demerol b/c it inhibits seretonin uptake (fentanyl, sufenta, alfenta may have the same effect)
type I excitatory = H/A, agitation, high temp, muscle rigidity (seretonin syndrome)
type 2 depressive = HOTN, dec. ventilation, coma
MAOI's
a) Exaggerated response to catecholamines esp. w/ indirect acting drugs
b) require avoidance or dec. dosing of epi. in epidurals
c) cause excessive response to surgical stimuli
d) all of the above
Exaggerated response to catecholamines esp. w/ indirect acting drugs
require avoidance or dec. dosing of epi. in epidurals
cause excessive response to surgical stimuli
Of the following neurotransmitters which one is the only one that is both excitatory and inhibitory
a) Norepinephrine
b) Dopamine
c) Seretonin
d) Substance P
Seretonin
Which of the following neuroleptic drugs have the highest potential for causing extrapyramidal effects
a) Haloperidol
b) Fluphenazine
c) Thioridazine
d) Clozapine
Haloperidol
Fluphenazine
Thioridazine
These drugs are all Typical neuroleptic drugs
Typical Neuroleptics
a) treat positive symptoms (thought disorders, delusions, agitation)
b) treat negative symptoms ( social withdrawal, blunted emotions)
c) cause extrapyramidal effects
d) low potential for extrapyramidal effects
treat positive symptoms (thought disorders, delusions, agitation)

cause extrapyramidal effects
Atypical Neuroleptics
a) treat positive symptoms (thought disorders, delusions, agitation)
b) treat negative symptoms ( social withdrawal, blunted emotions)
c) cause weight gain
d) low potential for extrapyramidal effects
treat negative symptoms ( social withdrawal, blunted emotions)
cause weight gain
low potential for extrapyramidal effects
T/F Neuroleptic Drugs can cause Neurolept Malignant Hyperthermia
True
Rigidity, fever, rhabdomyolysis, coma
Can be treated with Dantrolene & Bromocryptine (dopaminergic agonist)
Atypical Neuroleptics
a) Clozapine
b) Haloperidol
c) Aripiprazole
d) Risperidone
Clozapine
Aripiprazole
Risperidone