Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
136 Cards in this Set
- Front
- Back
- 3rd side (hint)
Used for Cushing's syndrome (increased corticosteroid)
|
Dexamethasone suppression test
|
|
|
Antifungal agent used for inhibition of all gonadal and adrenal steroids
|
Ketoconazole
|
|
|
Diuretic used to antagonize aldosterone receptors
|
Spironolactone
|
|
|
Common SE of spironolactone
|
Gynecomastia and hyperkalemia
|
|
|
Slightly increased risk of breast cancer, endometrial cancer, heart disease (questionable), has beneficial effects on bone loss
|
Estrogen
|
|
|
Antiestrogen drugs used for fertility and breast cancer respectively
|
Clomiphene and tamoxifen
|
|
|
Common SE of tamoxifen and raloxifene
|
Hot flashes
|
|
|
Selective estrogen receptor modulator (SERM) used for prevention of osteoporosis and prophylaxis in women with risk factors for breast cancer
|
Raloxifene
|
|
|
Non-steroidal estrogen agonist causes clear cell adenocarcinoma of the vagina in daughters of women who used it during pregnancy
|
Diethylstilbestrol (DES)
|
|
|
Estrogen mostly used in oral contraceptives (OC)
|
Ethinyl estradiol and mestranol
|
|
|
Anti-progesterone used as abortifacient
|
Mifepristone (RU-486)
|
|
|
Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 days are sugar pills or iron prep)
|
Combination oral contraceptives (OC)
|
|
|
Oral contraceptive available in a transdermal patch
|
Ortho-Evra
|
|
|
Converted to more active form DHT by 5 alpha-reductase
|
Testosterone
|
|
|
5 alpha-reductase inhibitor used for benign prostatic hyperplasia (BPH) and male pattern baldness
|
Finasteride (Proscar and Propecia respectively)
|
|
|
Anabolic steroid that has potential for abuse
|
Nandrolone, oxymetholone, and oxandrolone
|
|
|
Anti-androgen used for hirsutism in females
|
Cyproterone acetate
|
|
|
Drug is used with testosterone for male fertility
|
Leuprolide
|
|
|
Constant proportion of cell population killed rather than a constant number
|
Log-Killed hypothesis
|
|
|
Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously
|
Pulse Therapy
|
|
|
Toxic effect of anticancer drug lessened by rescue agents
|
Rescue Therapy
|
|
|
Drug used concurrently with toxic anticancer agents to reduce renal precipitations of urates
|
Allopurinol
|
|
|
Pyrimidine analog that causes Thiamine-less death given with leucovorin rescue
|
5 FU
|
|
|
Drug used in cancer therapy causes Cushing-like symptoms
|
Prednisone
|
|
|
Side Effect of Mitomycin
|
SEVERE Myelosuppression
|
|
|
MOA of cisplatin
|
DNA alkylating
|
|
|
Common toxicities of cisplatin
|
Nephro and ototoxicity
|
|
|
Analog of hypoxanthine, needs HGPRTase for activation
|
6-Mercaptopurine 6-MP
|
|
|
Interaction with this drug requires dose reduction of 6-MP
|
Allopurinol
|
|
|
May protect against doxorubicin toxicity by scavenging free radicals
|
Dexrazoxane
|
|
|
Blows DNA breaks DNA strands, limiting SE is pulmonary fibrosis
|
Bleomycin
|
|
|
Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm
|
Testicular cancer
|
|
|
MOPP regiment used in Hodgkin's disease
|
Mechlorethamine+oncovorin(vincristine)+procarbazine, and prednisone
|
|
|
ABVD regimen used for HD, but appears less likely to cause sterility and secondary malignancies than MOPP
|
Adriamycin( doxorubicin) + bleomycin, vinblastine + dacarbazine
|
|
|
Regimen used for non-Hodgkin's lymphoma
|
COP ( cyclophosphamide, oncovin (vincristine) and predisone
|
|
|
Regimen used for breast cancer
|
CMF ( cyclophosphamise, methotrexate, and flurouracil and tamoxifen if ER+)
|
|
|
Alkylating agent, vesicant that causes tissue damage with extravasation
|
Mechlorethamine
|
|
|
Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis
|
Cyclophosphamide
|
|
|
Prevention of cyclophosphamide induced hemorrhagic cystitis
|
Hydration and mercaptoethanesulfonate, MESNA
|
|
|
Microtubule inhibitor that causes peripheral neuropahty foot drop( eg ataxia), and pins and needles sensation
|
Vincristine
|
|
|
Interact with microtubules ( but unlike vinca which prevent disassembly of tubules), it stabilizes tubulin and cells remain frozen in metaphase
|
Paclitaxel (taxol)
|
|
|
Toxicities include nephrotoxicity and ototoxicity, leading to a severe interaction with aminoglycosides
|
Cisplatin
|
|
|
Agent similar to cisplatin, less nephrotoxic, but greater myleosuppression
|
Carboplatin
|
|
|
Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA ( asparagine)
|
L-asparagine
|
|
|
Used in hairy cell leukemia; it stimulates NK cells
|
Interferon alpha
|
|
|
Anti-androgen used for prostate cancer
|
Flutamide (Eulexin)
|
|
|
Anti-estrogen used for estrogen receptor + breast cancer
|
Tamoxifen
|
|
|
Newer estrogen receptor antagonist used in advanced breast cancer
|
Toremifene (Fareston)
|
|
|
Some cell cycle specific anti-cancer drugs
|
Bleomycin, vinca alkaloids, antimetabolites ( eg 5-FU, 6-MP, methotrexate, etoposide)
|
|
|
Some cell cycle non-specific drugs
|
Alkylating agents (eg mechlorethamine, cyclophosphamide), antobiotics ( doxorubicin, daunorubicin), cisplatin, nitrosurea
|
|
|
Anti-emetics used in association with anti-cancer drugs that are 5-HT3 ( serotonin receptor subtype) antagonist
|
Odansetron, granisetron
|
|
|
Nitrosources with high lipophilicity, used in brain tumors
|
Carmustine (BCNU) and Lomustine (CCNU)
|
|
|
Produces disulfiram-like reaction with ethanol
|
Procarbazine
|
|
|
Agent with zero order kinetics
|
Ethanol
|
|
|
Rate limiting step of Alcohol metabolism
|
Aldehyde Dehydrogenase
|
|
|
Agents that inhibit alcohol dehydrongenase
|
Disulfiram, metronidazole, certain sulfonylureas and cephalosporins
|
|
|
Agent that is metabolized by alcohol dehydrogenase and MEOS
|
Ethanol
|
|
|
Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension
|
Disulfiram
|
|
|
System that increases in activity with chronic ethanol exposure and may contribute to tolerance
|
MEOS
|
|
|
The most common neurologic abnormality in chronic alcoholics
|
Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)
|
|
|
Agent that is teratogen and causes a fetal syndrome
|
Ethanol
|
|
|
Agent that is the antidote for methanol overdose
|
Ethanol, fomepizol
|
|
|
Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure
|
Fomepizole
|
|
|
MOA of general anesthetics
|
Most are thought to act at GABA-A receptor - chloride channel
|
|
|
Inhaled anesthetic with a low blood/gas partition coefficient
|
Nitrous oxide
|
|
|
Inversely related to potency of anesthetics
|
Minimum alveolar anesthetic concentration (MAC)
|
|
|
Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents
|
Halothane and methoxyflurane
|
|
|
Most inhaled anesthetics SE
|
Decrease arterial blood pressure
|
|
|
Inhaled anesthetics are myocardial depressants
|
Enflurane and halothane
|
|
|
Inhaled anesthetic causes peripheral vasodilation
|
Isoflurane
|
|
|
Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis
|
Halothane
|
|
|
Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect on respiration
|
Nitrous oxide
|
|
|
Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency
|
Methoxyflurane
|
|
|
Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia
|
Nitrous oxide
|
|
|
Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm
|
Desflurane
|
|
|
DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics
|
Dantrolene
|
|
|
IV barbiturate used as a pre-op anesthetic
|
Thiopental
|
|
|
Benzodiazepine used adjunctively in anesthesia
|
Midazolam
|
|
|
Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose
|
Flumazenil
|
|
|
This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery
|
Ketamine
|
|
|
Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetia
|
Fentanyl
|
|
|
State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide
|
Neuroleptanesthesia
|
|
|
Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension
|
Propofol
|
|
|
What are the four stages of anesthesia?
|
Stage 1: Analgesia
Stage 2: Disinhibition Stage 3: Surgical anesthesia Stage 4: Medullary depression |
|
|
A patient has decreased awareness of pain with/without amnesia. Counsciousness may be impaired but not lost
|
Stage 1 Analgesia
|
|
|
A patient appears to be delirious and excited. Amensia occurs, reflexes enhanced, respiration it typically irregular.
|
Stage 2 Disinhibition
|
|
|
A patient is unconscious, has no pain reflexes, respiration is regular, and BP normal
|
Stage 3 surgical anesthesia
|
|
|
A patient has severe respiratory and CV depression and requires mechanical and pharm support.
|
Stage 4 Medullary depression
|
|
|
What is the general protocol for anesthesia in major surgery?
|
IV drugs to induce anesthetic state
Inhaled anesthetics to maintain Neuromuscular blockade |
|
|
What is the possible MOA of general anesthetics?
|
Increase threshold firing of CNS neurons
|
|
|
A drug that has a higher solubility will have what type of blood:gas partition coefficient?
|
A larger/ wider Blood:Gas partition coefficient
|
|
|
Drugs with a low blood gas:partition coefficient do what?
|
equilibrate more rapidly and enter the brain
|
|
|
The speed of induction of an anesthetic depends on several factors:
|
1: solubility
2. Inspired gas partial pressure 3: Ventilation Rate 4: Pulmonary Blood Flow 5: Arteriovenous concentration gradient |
|
|
How does inspired gas partial pressure effect the speed of conduction of anesthesia?
|
A high partial pressure in the lungs = a higher level in the blood
|
|
|
How does ventilation rate affect the speed of induction of anesthesia?
|
The more rapid the vent, the more rapid the rise in alveolar and blood and then eventually brain
|
|
|
How does pulmonary blood flow affect the speed of conduction?
|
A high pulmonary blood flow slows the partial pressure and thus the speed of onset
|
|
|
How does arteriovenous concentration gradient affect the speed of conduction of anesthesia?
|
?
|
|
|
Describe the process of termination of anesthesia?
|
Redistribution of the drug form the brain to the blood and elimination of the drug thru the lungs
|
|
|
The rate of recovery is faster with
|
Agents of low blood:gas partition
|
|
|
Inhaled anesthetics metabolized by the liver
|
Halothane and methoxyflurane
|
|
|
What are the MAC values for older people and infants?
|
Lower
|
|
|
How can inhaled anesthetics lead to an increase in intracranial pressure?
|
B/c they decrease brain metabolic rate
Reduce vascular resistance and increase cerebral blood flow |
|
|
This drug may cause spike and wave activity and muscle twitching
|
Enflurane
|
|
|
This drug has a high MAC value and causes marked analgesia and amnesia
|
Nitrous Oxide
|
|
|
These inhaled anesthetics cause myocardial depression which decrease cardiac output
|
Enflurane and Halothane
|
|
|
These inhaled anesthetics cause peripheral vasodilation
|
Isoflurane
|
|
|
This inhaled anesthetic may sensitize myocardium to arrhythmogenic effects of cathecolamines
|
Halothane
|
|
|
This drug is less likely to lower blood pressure
|
Nitrous Oxide
|
|
|
What affect does inhaled anesthetics have on respiratory system?
|
Increase in rate of respiration
TV and minute ventilation are decreased LEADS to INCREASE in CO2 |
|
|
Which drug has the least effect on respiration?
|
Nitrous Oxide
|
|
|
This drug causes postoperative hepatitis during shock or severe stress.
|
Halothane
|
|
|
Prolonged exposure of this drug decreases methionine synthase activity and causes megaloblastic anemia
|
Nitrous oxide
|
|
|
This drug may cause renal insufficiency after prolong exposure
|
Methoxyflurane and Fluoride
|
|
|
Uncontrolled release of calcium by the SR of skeletal muscle leads to muscle spasm, hyperthermia, autonomic liability
|
Malignant Hyperthermia
|
|
|
Which drugs can cause malignant hyperthermia?
|
Halogenated anesthetics
|
|
|
Drug used in the treatment of malignant hypertermia
|
Dantrolene
|
|
|
These agents are used for the induction of anesthetics and short surgical procedures
|
Barbiturates
|
|
|
Barbiturates are eliminated via
|
hepatic metabolism
|
|
|
These IV anesthetics can be used due decrease intracranial pressure
|
Barbiturates
|
|
|
IV BZ drug used for induction that has slower onset and longer duration of action
|
Midazolam (BZ)
|
|
|
BZ drug that causes severe postoperative respiratory depression
|
Midazolam
|
|
|
Antagonist used in the tx of severe respiratory depression
|
Flumazenil
|
|
|
Associated with dissociated disorder
|
Ketamine
|
|
|
MOA of Ketamine
|
antagonist of glutamic acid, blocking the NMDA receptor
|
|
|
This IV drug is a cardiovascular stimulant and lead to increase intracranial pressure
|
ketamine
|
|
|
Emergence reactions, disorientation, excitation, and hallucinations that occur with recovery
|
Ketamine
|
|
|
Class of drugs used to treat Ketamine post-operative effects
|
BZ
|
|
|
Class of IV anesthetics that cause chest wall rigidity and impair ventilation
|
Morphine and fentanyl
|
|
|
Reversal of respiratory depression caused by opioids
|
Naloxone
|
|
|
Neuroleptanesthesia
|
Fentanyl+droperidol+Nitrous oxide
|
a state of quiescence, altered awareness, and analgesia produced by a combination of an opioid analgesic and a neuroleptic.
|
|
Opioids used in the induction of anesthesia
|
Alfentanil and remifentanil
|
|
|
Opioid that has rapid recovery b/c of blood and tissue esterases
|
Remifentanil
|
|
|
Produces anesthesia similar to barbiturates but rapid recovery
|
Propofol
|
|
|
Has antiemetic actions and recovery is not delayed after prolonged use
|
Propofol
|
|
|
This drug is used in outpatient surgery as a balanced anesthetic
|
Propofol
|
|
|
Can cause marked hypotension thru decreased peripheral resistance
|
Propofol
|
|