Term
| What is the most common cause of chronic anemia? |
|
Definition
|
|
Term
| What are the common symptoms of iron deficiency? |
|
Definition
| Pallor, fatigue, dizziness and DOE. |
|
|
Term
| Which form of iron has the highest bioavailability? Moderate? Mild? |
|
Definition
Highest = Ferrous fumarate (organic iron).
Moderate = Ferrous gluconate (organic iron).
Mild = Ferrous sulfate (inorganic iron). |
|
|
Term
| Where does iron absorption occur? |
|
Definition
| Duodenum and upper jejunum of the SI. |
|
|
Term
| What percentage of iron is stored in hemoglobin? What about the liver/spleen/bone marrow? |
|
Definition
Hemoglobin = 60%.
Liver/spleen/bone marrow = 30%. |
|
|
Term
| How is iron eliminated from the body? |
|
Definition
| There is no mechanism for excretion but small amounts are lost in feces, bile, urine, sweat and breast milk. |
|
|
Term
| What is the most common etiology of iron deficiency in adults? |
|
Definition
| Heavy menstrual cycles and GI bleeds. |
|
|
Term
| What form of iron is given to those with absorption dysfunction (IBD, post-gastrectomy, etc) or very severe anemia and how is it given? Why is it important to give a test dose first? |
|
Definition
Iron dextran, given IM or IV (IV is more common.
Can also give iron sucrose complex or iron sodium gluconate IV as well.
Give a test dose first to check for potential AEs of bronchospasm or urticaria bc full dose could lead to anaphlaxis. |
|
|
Term
| Will activated charcoal reverse iron toxicity? How do you reverse it? |
|
Definition
| Activated charcoal does not bind iron so no, use a potent iron chelating compound (Deferoxamine or Deferasirox) and do a whole bowl irrigation. |
|
|
Term
| How do you treat hemochromatosis? |
|
Definition
| Intermittent phlebotomy and iron chelation (Deferoxamine or Deferasirox). |
|
|
Term
| What oral agents (food + meds) can interfere with iron absorption? |
|
Definition
| Coffee, tea, milk, eggs, antacids, proton pump inhibitors, cimetidine and WelChol (cholesterol med). |
|
|
Term
| What medications have reduced absorption if taken with iron? |
|
Definition
| Tetracyclines, Methyldopa, Quinolones and Levothyroxine. |
|
|
Term
| What is pernicious anemia? What does it look like on MCV? How do you treat it? |
|
Definition
It is a vitamin B12 deficiency anemia that appears megaloblastic on MCV.
Treat with Cyanocobalmin or Hydroxocobalmin. |
|
|
Term
| What is the function of vitamin B12 in the body? |
|
Definition
| Essential for cell growth and replication of myelin sheath. |
|
|
Term
| What is required for absorption of Vitamin B12? What foods are high in B12? |
|
Definition
| Intrinsic Factor is necessary for Vit B12 absorption. Common foods = meat, eggs and dairy. |
|
|
Term
| What are the S&S for Vitamin B12 deficiency anemia? |
|
Definition
| S&S = paresthesias, weakness in peripheral nerves, spasticity and ataxia. |
|
|
Term
| How will someone with folic acid deficiency present? |
|
Definition
| Megaloblastic anemia similar to Vitamin B12 deficiency but they will NOT have neurological symptoms. |
|
|
Term
| What must you do if you have megaloblastic anemia before you administer folic acid? |
|
Definition
| Must check for neurological symptoms, if they are present then it is Vitamin B12 deficiency NOT folic acid deficiency. You DO NOT give folic acid for megaloblastic anemia of unknown cause bc it can mask B12 deficiency. |
|
|
Term
| What is the MOA and indication for EPO (Erythropoietin/Darbepoetin)? Most common adverse effect? |
|
Definition
MOA - Stimulate RBC production and reticulocyte release from the bone marrow.
Indication - chronic renal failure and aplastic anemias (Darbepoetin only treats CRF bc of its delayed onset of action).
AE - HTN and thrombotic complications. |
|
|
Term
| What is the TCA: Anafranil (clomipramine) the drug of choice for? |
|
Definition
|
|
Term
| :Often referred to as “antimanic” drug but in many parts of the world known as “mood-stabilizing” agent, former drug of choice for treatment of mania & manic episodes of bipolar disorders (replaced due to its slow onset of action), prevents mood swings and depression in bipolar affective (manic-depressive) disorder |
|
Definition
| Eskalith (lithium carbonate) |
|
|
Term
| What is the MOA for lithium? |
|
Definition
| It decreases NE and Dopamine turnover. Also affects Serotonin. |
|
|
Term
| Which neuroleptics (antipsychotics) can be combined with lithium without exhibiting more severe extrapyramidal symptoms? |
|
Definition
| Clozapine and other atypical antipsychotics. |
|
|
Term
| What are some adverse effects and effected organs seen with lithium use? |
|
Definition
AEs = tremor, chorea, edema and mental confusion.
Organ effects = decreased thyroid function, decreased renal function, sick-sinus-syndrome. |
|
|
Term
| How do you treat a lithium OD? |
|
Definition
| Hemodialysis until the plasma concentration falls into the therapeutic range. |
|
|
Term
| What are the uses of the typical antipsychotic: Haldol (haloperidol)? MOA? |
|
Definition
It is a typical antipsychotic used to treat chorea movements, dystonia and is the most effective drug to treat Tics (Treats positive symptoms of psychosis).
MOA = D2 receptor antagonist. |
|
|
Term
| What is the indication of the TCA: Amitriptyline? |
|
Definition
| Typical TCA indications (treat depression, anxiety, certain sleep disorders and chronic pain). It may be useful with treating depression with Parkinson's disease as well. |
|
|
Term
| What patients do you absolutely NOT want to use the TCA: Amitriptyline? |
|
Definition
| Patients with BPH or glaucoma. |
|
|
Term
| What is a Heterocyclic antidepressant? What are the uses and MOA of the Heterocyclic antidepressant: Nefazodone? |
|
Definition
Antidepressant that is neither TCA or SSRI.
Nefazodone uses = major depressive disorder.
MOA = It inhibits NE and Serotonin reuptake and antagonizes serotonin receptors. |
|
|
Term
| What are the uses of the Heterocyclic antidepressant: Wellbutrin/Zyban (bupropion)? |
|
Definition
| Sold as Zyban for smoking cessation. |
|
|
Term
| What are the uses of the Heterocyclic Antidepressant: Cymbalta (duloxetine)? MOA? SEs? What patients do you want to avoid giving this to? |
|
Definition
Uses = major depressive disorder and anxiety.
MOA = Decreases the re-uptake of serotonin and NE.
SEs = n/v/d, dry mouth, constipation, insomnia, sexual dysfunction and dizziness. Avoid giving to hepatic and renal insufficiency (metabolized in liver and eliminated via kidney). |
|
|
Term
What is the indication for the Heterocyclic Antidepressant: Trazodone?
What is different with this drug from other heterocyclic antidepressants regarding dosage? |
|
Definition
Use - Major depressive disorder.
It has a short half live so it needs frequent dosing throughout the day. |
|
|
Term
| What are the indications and MOA for the Heterocyclic Antidepressant: Effexor (venlafexine)? What is different with this drug from other heterocyclic antidepressants regarding dosage? |
|
Definition
MOA - blocks serotonin and NE reuptake.
Indications - Major depressive disorder and anxiety.
It is offered ER and regular but it has a short half live so it will require frequent dosing throughout the day. |
|
|
Term
| What is the MOA for MAOIs? Therapeutic uses? What are 2 potentially dangerous complications of OD? |
|
Definition
MOA = inhibit the degradation of serotonin and NE by the MAO enzyme.
Uses = MDD and anxiety.
OD = MAOIs block the deamination of dietary tyramine (which releases NE) leading to a dramatic and often fatal increase in BP, it can also lead to serotonin syndrome. |
|
|
Term
| Which class of drugs has been linked to a precipitation of mania, with more rapid cycling of mood swings with bipolar? Which class is less likely to induce mania? |
|
Definition
| TCAs are more likely to cause mania, SSRIs are less likely. |
|
|
Term
| What class of drug was the first generation of antidpressants? |
|
Definition
|
|
Term
| What is the MOA of TCAs? Uses? How long does it typically take to see effects? |
|
Definition
MOA = Inhibit serotonin and NE reuptake transporters into presynaptic terminals, and they have alpha-adrenergic and antihistamine properties.
Uses = MDD, anxiety, certain sleep disorders and chronic pain.
Typically takes 2-4 weeks to see effects. |
|
|
Term
| What are some common toxicities seen with TCA overdose? Common side effects? |
|
Definition
Toxicity = cardiac arrhythmias, hypotension, sinus tachycardia, sedation and seizures.
SEs = antimuscarinic effects (blurred vision, dry mouth, constipation, urinary hesitancy and confusion)." |
|
|
Term
| Why do you not combine MAOIs with TCAs? |
|
Definition
| Because of interactions that lead to hyperpyrexia, convulsions and coma. |
|
|
Term
| How do you treat TCA poisoning? |
|
Definition
| Activated charcoal or gastric lavage and physostigmine. |
|
|
Term
| What is the drug class of choice for treating depression and anxiety? Why? MOA? What do they have interactions with? |
|
Definition
SSRIs bc they have the fewest side effects and are much safer in OD.
MOA = selectively block serotonin reuptake transporter.
Interactions seen with cytochrome P450. |
|
|
Term
| What are some other clinical uses of SSRIs other than depression and anxiety? |
|
Definition
| OCD, panic disorder and bulimia nervosa. |
|
|
Term
| What is special about the SSRI: Paxil (paroxetine)? |
|
Definition
| It is an SSRI but it has similar pharmacokinetics to TCAs (serotonin AND NE reuptake inhibition). |
|
|
Term
| What is the treatment of choice for control of the manic phase of bipolar affective disorder? |
|
Definition
| Atypical antipsychotics (olanzapine), used to be lithium but the atypicals work faster and have an FDA indication for manic-bipolar disorder. |
|
|
Term
| What drug is used in combination therapy with antipsychotics when bipolar combo therapy does not work with TCAs or SSRIs? |
|
Definition
| Valproic acid (PO) or Valproate (IV). |
|
|
Term
| Which atypical antipsychotic has been approved for monotherapy in the acute phase treatment of the manic phase of bipolar affective disorder? |
|
Definition
|
|
Term
| What drug should an individual taking typical antipsychotics that is experienceing prolactin increases switch to? |
|
Definition
| The atypical antipsychotic: Olanzapine |
|
|
Term
| Why should the atypical antipsychotic: Olanzapine, not be routinely used in the treatment of psychosis in patients with Parkinson's disease? |
|
Definition
| SEs of worsening motor function and weight gain. |
|
|
Term
| Why should the atypical antipsychotic: Olanzapine, not be routinely used in the treatment of psychosis in patients with dementia-related psychosis? |
|
Definition
| Increased risk of cardiovascular or infectious death. |
|
|
Term
| What is the class and MOA of Tegretol (carbamazapine)? Which movement disorders is it used to treat? |
|
Definition
| It is an anti-convulsant that stabilizes the inactivated state of sodium channels in the brain, making the brain cells less excitable. It can be used to treat dystonia and tics. |
|
|
Term
| How do you treat tardive dyskinesia? What causes it? |
|
Definition
Dopamine depletion (reserpine) or dopamine receptor blockade can treat it.
It is caused by long term use of antipsychotic drugs, especially in combination with antimuscarinic drugs. |
|
|
Term
| What is the primary treatment option for Parkinson's Disease? |
|
Definition
| Sinemet (carbidopa-levodopa), replace the lost dopamine. |
|
|
Term
| What is the "On-Off" syndrome of Sinemet (carbidopa-levodopa) treatment of Parkinson's Disease? |
|
Definition
| It is difficult to predict when the medication will have a response period (on) or an non-response period (off). During the on there may be too much effect of L-dopa and lead to dyskinesia (chorea). During the off there may not be enough L-dopa and they will get motor fluctuations. |
|
|
Term
| How do you treat the "off" symptoms of Sinemet treatment of Parkinson's Disease? |
|
Definition
| Give a COMT inhibitor (prevent the degredation of dopamine), MAO-BI or a dopamine agonist. |
|
|
Term
| What are the advantages and dysadvantages to using a dopamine agonist vs L-dopa to treat Parkinson's Disease? |
|
Definition
| Dopamine agonist advantage is that it leads to less motor complications but it is only 50% as effective as L-dopa. |
|
|
Term
| What drug can improve the dyskinesia and motor fluctuations seen with L-dopa treatment of AD? |
|
Definition
| Amantadine (NMDA blocker) |
|
|
Term
| How may vitamin C supplementation affect levodopa? |
|
Definition
| It may increase the levels of L-dopa. |
|
|
Term
| When are dopamine agonists effective in treating PD? |
|
Definition
| They are effective in early PD. |
|
|
Term
| How does Levodopa affect restless leg syndrome? |
|
Definition
| It can be used to treat it. |
|
|
Term
| What is the indication for the Cholinesterase inhibitor: Exelon (Rivastigmine) in the treatment of Parkinson's Disease or DLB (dementia w/ Lewy Bodies)? |
|
Definition
| It can be used to treat the dementia associated with PD or DLB and can improve cognitive function. |
|
|
Term
| What movement disorders can be treated with the Benzodiazepine: Klonopin (clonazepam)? |
|
Definition
| Tics and restless leg syndrome |
|
|
Term
| What drug is a BZD antagonist and can be used to reverse BZD overdose? |
|
Definition
|
|
Term
| What are the uses of the BZD: Valium (diazepam)? |
|
Definition
| It can be used as an IV anesthetic, to provide relief from muscle spasm (tardive dyskinesia, dystonia, etc) and in restless leg syndrome. |
|
|
Term
| What are synthetic Opioid: Fentanyl lozenges used for? |
|
Definition
| Treatment of cancer pain, only in patients that still have pain with narcotics. |
|
|
Term
| Describe the analgesic properties of the synthetic Opioid: Fentanyl. What is the principle use? |
|
Definition
100x the analgesic properties of morphine.
Principle use is in anesthesia. |
|
|
Term
| Describe the rate of onset and duration of action for the synthetic Opioid: Fentanyl, when compared to other IV anesthetics. What is the rate and duration of action when compared to other opioids? What drug can you give to reverse its effects? |
|
Definition
It has a slow onset and recovery when compared to other IV anesthetics. It has a rapid onset and short duration of action compared to other opioids.
Give Narcan (naloxone) to reverse its effects bc it is an opioid receptor antagonist. |
|
|
Term
| What is the use for the semisynthetic morphine derivative Opioid: Oxycodone? What is it commonly combined with and what does it make when they are combined? |
|
Definition
| Used to treat moderate to severe pain. Can be combined with aspirin or acetaminophen (Tylenol) to make Percocet(acetaminophen) or Perdodan(ASA). |
|
|
Term
| What is the use of the Opioid: Dilaudid (hydromorphone)? |
|
Definition
| It is an opioid that is used to control moderate to severe pain. |
|
|
Term
Describe the potency of the synthetic Opioid: Demerol (meperidine). Common use?
SEs? |
|
Definition
It is about 1/8 as potent as morphine.
It is used for any type of severe pain relief and is commonly used in obstetrics because it does not affect uterine smooth muscle.
SEs = smooth muscle spasm (including bronchospasm), dry mouth and blurred vision. |
|
|
Term
| What conditions may cause an accumulation of the active metabolite of the synthetic Opioid: Demerol (meperidine), leading to adverse effects? |
|
Definition
| Renal failure, liver disease or high doses could all lead to accumulation. |
|
|
Term
| What is the purpose of mixed agonist-antagonist Opioids? What is an example? |
|
Definition
| The agonist component relieves pain and the antagonist component decreases the risk of toxicity and dependence. Example is Nalbuphine. |
|
|
Term
| What class of drug is hydrocodone? Indications? |
|
Definition
It is an opioid drug that is often used in combo with other drugs such as ibuprofen, acetaminophen or anti-tussive agents.
Indications = It is used for pain relief and also as an anti-tussive (cough) medication. |
|
|
Term
| What is the use of Lidocaine? MOA? |
|
Definition
It is widely used as a local anesthetic.
MOA - Sodium channel blocker. |
|
|
Term
| What is the purpose of using lidocaine with epinephrine? Where shouldn't you use them? |
|
Definition
Lidocaine with epinephrine cause vasoconstriction, leading to less bleeding and a longer duration of action.
Do not use on the fingers, toes, ears, nose or penis. |
|
|
Term
| Is Lidocaine short acting, intermediate or long acting in regards to its half life and expected need? Is Lidocaine more or less neurotoxic than other local anesthetics? |
|
Definition
Intermediate.
Lidocaine is more neurotoxic than other local anesthetics. |
|
|
Term
| Why is it important that the local anesthetic: Novacaine (procaine) is water soluble? |
|
Definition
| BC it causes it to be short acting. |
|
|
Term
| What is the MOA and end result of cocaine use? Therapeutic uses? SEs? Can cocaine cross the placenta? |
|
Definition
MOA = blocks the reuptake of serotonin, NE and dopamine, leading to euphoria.
Therapeutic uses = topical and local anesthetic.
SEs = tachycardia, HTN, fever and seizures.
Cocaine can cross the placenta and lead to abortion or abnormalities. |
|
|
Term
| What is the only FDA indicated drug to treat the chorea associated with Huntington's disease? |
|
Definition
| Xenazine (tetrabenazine). |
|
|
Term
| What is the use, SEs and contraindications of Xenazine (tetrabenazine)? |
|
Definition
Use = treat the chorea movements associated with Huntington's disease.
SEs = somnolence, parkinsonism, insomnia, fatigue, akathisia (inner restlessness) and a prolonged QT interval.
C/I = suicidal, MAOI use, reserpine use or hepatic disease. |
|
|
Term
| What are the indications for the atypical antipsychotic: Risperdal (risperdone)? |
|
Definition
| Indication = treatment of psychosis in individuals taking typical antipsychotics that are having SEs, and it can treat the psychosis with PD in nonemergency situations. |
|
|
Term
| What are the uses of the Acetylcholine receptor antagonist: Cogentin (benztropine)? |
|
Definition
| It treats drug induced parkinsonism and Parkinson's Disease. |
|
|
Term
| Which drug reverses the effects of opioids (morphine, heroin, etc)? |
|
Definition
|
|
Term
| Which drug is the major analgesic drug found in crude opium and is the prototype strong agonist? |
|
Definition
|
|
Term
| What is the MOA for the Opioid: Morphine? |
|
Definition
| It decreases the release of substance P and inhibits release of excitatory transmitters from nociceptive (painful) stimuli. |
|
|
Term
| What are the actions of morphine on: (pulmonary, cough, GI, CV, hormonal, and labor)? |
|
Definition
Pulmonary = respiratory supresssion and bronchconstriction.
Cough = it is anti-tussive.
GI = causes emesis and constipation.
CV = causes hypotension and bradycardia.
Hormonal = Inhibits GnRH and CRH, stimulates GH, prolactin and ADH.
Labor = decreases strength, duration and frequency of uterine contractions. |
|
|
Term
| Can morphine be used as an analgesic during labor? Can it be used as an IV anesthetic? |
|
Definition
No, it can cross the placenta.
Yes, it is used as an IV anesthetic. |
|
|
Term
| Which opioid is the least lipophilic and thus, least likely to cross the BBB? |
|
Definition
|
|
Term
| What is heroin converted to in the body? |
|
Definition
| It does not occur naturally and it is converted to morphine in the body. |
|
|
Term
| What are the therapeutic uses of the Opioid: Methadone? |
|
Definition
| Uses = Analgesia and suppression of withdrawal symptoms in morphine and heroin addicts due to its ability to satisfy the craving for heroine/morphine without producing euphoria. |
|
|
Term
| What is tylenol(acetaminophen) with codeine? |
|
Definition
| Tylenol(acetaminophen) with codeine is Tylenol #3/#4. |
|
|
Term
| What is Codeine? What are its uses? |
|
Definition
Codein is a "prodrug" that is converted to morphine.
Uses = analgesic and antitussive effects. |
|
|
Term
| Which class of drugs has analgesic and anti-tussive effects? |
|
Definition
|
|
Term
| Which Opioid drug is used to manage moderate to moderately severe pain and has less respiratory-depressant activity than morphine? |
|
Definition
|
|
Term
What are the therapeutic uses of Naloxone?
What is the dosing regimen and route for Naloxone? Max dose? |
|
Definition
Use = reverses the effects of Opioid (morphine, heroin, Fentanyl) OD in minutes and also used in labor to minimize neonatal respiratory suppression.
Dose = 0.4-2.0mg IV q 2-3 minutes until alert.
Max = 10mg. |
|
|
Term
What are the therapeutic uses for the Opioid receptor antagonist: Naltrexone?
What is the dosing regimen and route for Naltrexone? |
|
Definition
It has twice the potency and 3 times the duration of action as Naloxone so it is used in the management of opioid and alcohol dependence.
Dose = 50mg/day PO. |
|
|
Term
| What are the medical uses of the Cannabinoid: Marijuana (dronabinol)? |
|
Definition
| Uses = increase appetite, attenuation of nausea, decrease IOP and relief of chronic pain. |
|
|
Term
| What is the therapeutic use of Ketamine (PCP)? What are the SEs? What interesting SE of Ketamine makes it a useful drug for patients needing in CV shock? |
|
Definition
Use = General anesthetic.
SEs = hallucinations, HTN and impaired memory.
It is the only anesthetic that actually causes an increase in cardiovascular performance. |
|
|
Term
| What is the MOA and SEs of LSD (Lysergic acid diethylamide)? |
|
Definition
MOA = serotonin agonist.
SEs = color hallucinations, n/v, muscle weakness and psychosis. |
|
|
Term
| Describe Ecstasy (MDMA). Previous therapeutic use? Main effect? SEs? |
|
Definition
It is an amphetamine derivative that was previously used in psychotherapy to induce feelings of intimacy and empathy.
SEs = hyperthermia, dehydration and serotonin syndrome. |
|
|
Term
| What is the MOA for amphetamines? What are the therapeutic uses of amphetamines? How do you treat an amphetamine OD? |
|
Definition
MOA = block the reuptake of catecholamines.
Uses = ADHD, Narcolepsy and weight control.
Treat OD by acidification of the urine to increase the excretion. |
|
|
Term
| Describe Schedule I controlled substances (examples). |
|
Definition
No accepted medical use in the USA and have a high abuse potential, cannot be prescribed.
Ex = Heroin and MDMA. |
|
|
Term
| Describe Schedule II controlled substances (examples). |
|
Definition
High abuse potential with severe physical dependence and no refills can be prescribed. Prescription must be written except in an emergency where it still needs to be confirmed within 72 hours.
Ex = Cocaine, dextroamphetamine, Ritalin and hydromorphone. |
|
|
Term
| Describe Schedule III controlled substances. |
|
Definition
| Abuse potential is less than schedule I and II and prescriptions can be oral or written and up to 5 renewals are permitted within 6 months. |
|
|
Term
| Describe Schedule IV controlled substances. |
|
Definition
| Less abuse potential than schedules I,II and III, prescriptions can be oral or written and they are allowed up to 5 renewals within 6 months. |
|
|
Term
| Describe Schedule V controlled substances. |
|
Definition
| Abuse potential less than those in schedule I, II, III and IV. May or not require a prescription and usually contain very limited quantities of narcotics mainly used for anti-tussive and anti-diarrheal purposes. |
|
|
Term
| What is the use for Halothane? What is the rate of onset and recovery? What is its effect on the bronchial smooth muscle? What is the major SE? |
|
Definition
It is a potent inhaled anesthetic agent with a medium rate of onset and recovery. It is a bronchodilator.
SE = It is hepatotoxic. |
|
|
Term
| What is the use of Isoflurane and how is it delivered? Why has it replaced halothane? What is its rate of onset and recovery? How does it affect the heart rate and respiratory system? |
|
Definition
It is a volatile liquid that is used as an inhaled anesthetic.
It has replaced halothane because it offers a faster induction and awakening and does not have the organ toxicity (liver) of halothane.
Rate of onset and recovery are both medium.
It increases HR and depresses the respiratory system more than any other anesthetic (possible mechanical ventilation). |
|
|
Term
| What is the route of administration and use of Nitrous oxide? What is the rate of onset and recovery? What are the SEs? What are the Contraindications? |
|
Definition
It is an inhaled gas anesthetic commonly used for dental procedures.
It has a rapid onset and recovery.
SEs = nausea, vomiting, increase BP and decrease CO.
Contraindicated with pregnancy, immunosuppression and anemia. |
|
|
Term
| What is the route of administration and use of Propofol? What makes this drug so good? Adverse effects? |
|
Definition
It is the most popular IV anesthetic.
It is good because it has a fast onset and recovery, a reduction in post-operative nausea/vomiting and an increased clarity of mental status upon recovery.
AEs = elevated serum lipid and it has negative inotropic effects. |
|
|
Term
| What is Prilocaine? What field is it typically used in and how is it adminstered? What is special about this drug? What is the half-life and expected need? What are the AEs seen with large doses of prilocaine? |
|
Definition
It is a local/topical anesthetic commonly used in dentistry and can be topical or injection. It is the most water soluble and therefore has the largest volume of distribution.
Half-life and expected need are intermediate.
Large doses can lead to an accumulation of methemoglobin and decompensation of preexisting pulmonary or cardiac disease. |
|
|
Term
| What is the use and route of administration for mepivacaine? What field is it typically used in? Describe the half-life and expected need. |
|
Definition
It is a local anesthetic that is given as an injection and is used in dentistry.
The half-life and expected need are intermediate. |
|
|
Term
| Describe the water solubility, half life, route of administration and field of use for bupivacaine. What is the major downside with bupivacaine? |
|
Definition
It is the least water soluble local anesthetic so it has a long half life. It is given as an injection and is used in dentistry.
Major downside is that it is the most cardiotoxic local anesthetic leading to bradycardia, hypotension and a wide QRS. |
|
|
Term
| Describe the water solubility, half life and use of ropivacaine. |
|
Definition
| It is not very water soluble and therefore has a long half life and it is a local anesthetic. |
|
|
Term
| Describe the rate of distribution and elimination seen with non-depolarizing neuromuscular blockers (skeletal muscle relaxants). |
|
Definition
| They have rapid distribution and slower elimination. |
|
|
Term
| What is Succinylcholine? Use? |
|
Definition
| It is the fastest depolarizing NMB (muscle relaxant) and is used for emergency tracheal intubation. |
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Term
| What conditions inhibit NMB (muscle relaxants)? |
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Definition
| Tissue edema, burns and certain drugs (phenytoin, lithium, carbamazepine and corticosteroids). |
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Term
| What is the action of Benzodiazepines on skeletal muscle? |
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Definition
| They are spasmolytic drugs (provide relief from spasm). |
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Term
| What is the MOA of spasmolytic drugs? |
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Definition
| They increase the stretch reflex to decrease the spasm. |
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Term
| What is the drug class of choice for severe or chronic malignant pain? |
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Definition
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Term
| What are the common uses of Opioids (small and large doses)? |
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Definition
| Relieve intense pain, relieve anxiety prior to anesthesia, antitussive (cough) and to control diarrhea. |
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Term
| What are some common drug interactions seen with Opioids? |
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Definition
| Alcohol, sedatives, hypnotics, anesthetics, TCAs, warfarin, phenytoin, rifampin, etc. |
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Term
| What are the typical physical withdrawal signs of opioid dependence? |
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Definition
| Rhinorrhea, hyperventilation and anxiety. |
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Term
| What are the 2 main MOAs for anesthetics? |
|
Definition
| Sodium channel and action potential inhibition. |
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Term
| How does lipophylicity relate to rate of onset and potency in regards to local anesthetics. |
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Definition
| The more lipophilic the faster onset and more potent the drug. |
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Term
| What can you add to topical anesthetics to increase their duration of action? |
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Definition
|
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Term
| Describe stages I-IV for general anesthesia. |
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Definition
I - just analgesia at first and then analgesia and amnesia, but no LOC.
II - Excitation, patient appears delirious.
III - Pt is unconscious and has no pain reflexes.
IV - Severe depression of vasomotor center in medulla and respiratory center, pt needs respiratory and circulatory support. |
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Term
| How do you assess whether or not you are at the surgical anesthesia stage? |
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Definition
| Trapezius muscle squeeze (loss of responsiveness to noxious stimuli). |
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Term
| What is the most common method of monitoring the depth of anesthesia? |
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Definition
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Term
| When are inhaled anesthetics typically used? |
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Definition
| Primarily for maintenance of anesthesia after IV agent given |
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Term
| What are the effects seen with an inhaled anesthetic that has a low PC (gas partition coefficient)? |
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Definition
| It has low blood solubility so it goes into the brain quickly, has a rapid onset of action and then leaves the system rapidly. |
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Term
| Describe the onset of efficacy of antidepressants drugs. |
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Definition
| All antidepressants have a slow onset of efficacy (3-6 weeks). |
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Term
| What neurotransmitter do many anti-seizure drugs target? Why? |
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Definition
| GABA because it is the major inhibitory neurotransmitter in the CNS. |
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Term
| What neurotransmitter do many anti-stroke drugs target? Why? |
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Definition
| Glutamate because it is the major excitatory neurotransmitter in the CNS. |
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Term
| What kind of disturbances can be seen with decreased levels of Dopamine production in the brain? |
|
Definition
| Psychiatric disorders, major mood disorders and movement disorders. |
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Term
| What can result from disturbances in serotonin production? |
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Definition
| Obsessive-compulsive disorder, depression, anxiety, addictive behavior, and some psychotic disorders. |
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Term
| How is norepinephrine inactivated? |
|
Definition
| Inactivated by MAO (Monoamine Oxidase) and aldehyde oxidase and COMT (Catechol-O-methyltransferase). |
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Term
| What is the MOA for Anxiolytics and sedative/hypnotics? |
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Definition
| Enhance GABAa receptor activity. |
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|
Term
| What is the most common mechanism for antipsychotic medications? |
|
Definition
| block dopamine receptors (D2) |
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|
Term
| What is the most common MOA for antidepressants? |
|
Definition
| Block the reuptake of serotonin or norepinephrine. |
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|
Term
| What are the most common MOAs for Parkinsonism drugs? |
|
Definition
| Dopamine replacement and/or anticholinergic drugs. |
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Term
| What are the therapeutic uses of MAOIs? What are some SEs seen with MOAIs? |
|
Definition
Uses = Major Depressive Disorder and anxiety disorder.
SEs = Hyperthermia, muscle rigidity, headache, nausea, HTN, cardiac arrhythmia and stroke. |
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