Pharmacology Final-Anesthesia, Smoke Cessation, Steroids – Flashcards
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Ideal characteristics of anesthesia
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quick, few AE, rapidly reversible
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Oldest anesthetic
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Chloroform
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Objectives of Anesthesia- the anesthetic triad
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hypnosis, paralysis, analgesia
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T/F: most anesthetic drugs can accomplish the triad alone
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False; objective accomplished by multiple drugs. Single drugs would require high doses, increased AE
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Conscious sedation
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Hypnosis with intact airway (usually an ultra short acting benzo)-Midazolam
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Pre procedure:
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Antiolysis-rare Hold any inappropriate meds
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Pre op period drugs
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Inductionagents, antacids/prokinetics/H2RA/PPI, drying agents
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Induction of anasthesia
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opiod (fentanyl) followed by propofol Paralytic for intubation maintenance; volatile gas plus O2, additional bolus of opioid/NMB, alternative: propofol with opioid $$
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Monitor during anesthesia:
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BP, HR, RR
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Post op:
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reverse paralysis-stigmine/sugammadex Extubation Relief of pain, n/v
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T/F; Decreased MAC=Increased Potency
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True
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T/F Generally as you decrease the lipophillicity of an anesthetic you increase the potency
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False: lipophillicity increases potency
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Anesthetic agents act on which parts of the brain
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The RAS-midbrain
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MAC=
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Minimum alveolar concentration required to prevent movement in response to a standard surgical incision in 50% of test subjects.
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Malignant hyperthermia
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-rare, life threatening AE of anesthetics. associated with gasses can occur at any point in anesthesia sudden release of calcium-muscle contractions and rhabdo, hypermetabolic state with hyperkalemia
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Treatment of malignant hyperthermia
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Dantrolene plus insulin and D5W future anesthesia -IV agents only
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Gasses:
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Nitrous oxide=laughing gas Isoflurane Sevoflurane Enflurane Desflurane Halothane
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Gas with a sweetish smell, non flammable, non explosive, produces light anesthesia
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Nitrous Oxide
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Gas with rapid induction and recovery with strong analgesic properties, always mixed with oxygen
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Nitrous oxide
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Volatile, colorless liquid with a pungent odor, may cause coronary steal
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Isoflurane
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Vasodilation of coronary arteries
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coronary steal
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Parenteral anesthetic
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Propofol
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Difference between thiopental and propofol
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Thiopental can accumulate in the tissueswith prolonged exposure
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Induction with propofol occurs in ~
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30s
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T/F ; propofol reduces vascular tone?
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True
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What anesthetic is a lipid based emulsion
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Propofol
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Calories in propfol
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1cal/ml
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First drug used for lethal injection
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Thiopental
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These drugs potentiate NMB
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aminoglycosides
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Anesthetic can be potentiated by this electrolyte imbalance
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hypokalemia
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One of the earliest prescribed local anesthetics
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cocaine
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Ideal properties of local anesthetic
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water soluble, sterilized by heat, rapid on/off, nontoxic in systemic absorption
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MOA of local anesthetic
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prevent the initiation and propagation of nerve impulses
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how to prolong a local anesthetic
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add a vasoconstrictor (EPI)
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Most local anesthetics take about ____minutes for onset and _______ to wear off.
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5 min 1-1.5 hours
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WHere should you not use a local anesthetic with Epi
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Fingers, toes, nose, penis, earlobes
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EMLA
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eutectic mixture of local anesthetic (prilocaine and lidocaine)
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Most every local anesthetic can have these effects ifabsorbed systemically
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arrhythmia
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Uses of LA
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nerve block Epidural
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Preferred local agent; few AE
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lidocaine
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Local anesthetics
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Stays where you put it; Lidocaine, Prilocaine, Bupivicaine
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____ years after smoking cessation your risk of coronary disease is back to that of nonsmoker:
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15 years
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Nicotine is second to __________ as the mose widely used CNS stimulant
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Caffeine
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This receptor is responsible for 90% of nicotine binding
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alpha 4 beta 2
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What NT causes the reinforcing effects of nicotine stimulation
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Dopamine
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T/F Chronic nicotine use creates tolerance by downregulating nicotinic cholinergic receptors
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True** Note packet wrong via Romanelli
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T/F Nicotine cessation results in a subnormal amount of DA release
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True
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Decreased dopamine results in these constitutional effects
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State of mailaise and inability to experience pleasure
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T/F a single cigarette can return to compulsive tobacco use
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True
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Tachypylaxis:
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Down regulation of receptors- tolerance
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T/F: pts cannot smoke when they are taking nicotine replacement therapy.
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True
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Nicotine gum available in what doseage amounts
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2mg and 4mg
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Nicotine Patch strengths
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21, 14, 7mg per 24 hours
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T/F Nicotine patch is slow on/slow off
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True
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Side effects of nicotine patch
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Skin reactions, insomnia (remove at bedtime)
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T/F nicotine patch can cause vivid dreams
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True
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Strength of Nicotine losenges
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2mg and 4mg
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Losenges placed in buccal cavity every:
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1-2 hours as needed
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Weaning agents for smoking cessation
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Buproprion and Varnicline (chantix)
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MOA of Buproprion:
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Weak NE and DA reuptake inhibitor, some nicotinic cholinergic receptor activity
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Starting dose of Buproprion
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150mg twice daily x3 days
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T/F Nicotine is a sympatholytic drug
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False, sympathomimetic
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When should patient stop smoking if using buproprion for smoke cessation?
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1 week after starting the drug
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If buproprion is not effective by day _____ it will likely not be effective
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7
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SE of buproprion
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dry mouth, sweating, tremor, seizure
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Which smoking cessation-weaning agent has high affinity and selectivity for alpha 4 beta 2 receptors?
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Varenicline (Chantix)
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MOA of Varenicline (Chantix)
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Partial agonist (binds and prevents others (nicotine) from binding.
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Varenicline (Chantix) duration of therapy?
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3 months, with an additional 3 month option
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The only FDA approved combination therapy for smoking cessation:
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Buproprion and Nicotine Patch
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T/F: second line smoking cessation therapies are FDA approved
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False
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Examples of second line smoking cessation agents
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Nortriptyline (TCA), Clonidine,
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ACTH was first available in ______ (year)
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1948
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MOA of steroids
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Act to suppress the DNA synthesis of LTs, PGs, and cytokines
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SE of glucocortocoids
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gluconeogenesis with decreased glucose utilization catabolism Osteoporosis Delayed growth in children Fat deposition (cushing syndrome) reduced healing
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Live Vaccines:
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MMR Vericella Zoster Intra-nasal flu vaccine
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Don't give live vaccines to patients who have been on ______mg of Prednisone for ______ weeks or the equivalent of.
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20mg for 2 weeks Can suppress the HPA axis
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Why must steroids be tapered?
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to prevent acute adrenocortical insufficiency from deactivation of the HPA axis
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Steroids are more commonly higher in the ----- hours.
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morning
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Stressed dosed steroids:
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additional steroids given to a patient on chronic steroid therapy that has undergone trauma/physical/mental stress.
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Avg daily dose of HC
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10mg/d
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The one medication that may allow topical/inhaled steroids to reach systemic HPA suppression levels in the body:
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Ritonavir
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T/F: Hydrocortisone is short on/short off
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True
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Hydrocortisone in blood bound to:
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Cortisol binding globulin
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T/F: IV formulation of predisone does not act faster than the PO formulation
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True
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T/F: Prednisone wastes potassium
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True
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T/F Prednisone causes left shift of WBCs
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False, it causes demarginalization
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AE of Prednisone
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Osteopenia, reduced gastric mucous, fat redistribution, hyperglycemia, depression, psychosis, weight gain, hypokalemia Rarer: avascular necrosis, tendon rupture, cataracts, menstrual disorders, thromboembolism
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what is Medrol dos-pak?
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Oral methylprednisone, six days, taper
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Intra-articular steroid of choice:
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triamcinolone
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Example of inhaled only steroids:
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Fluticasone Beclomethasone
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Steroids in pregnancy?:
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Maintain lowest possible dose, avoid fluorinated agents
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Medications used to treat Cushing's disease:
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1. Aminoglutethimide 2. Metyrapone 3.Ketoconazole 4. finasteride
