Otterbein/Grant CRNA Pharm Final Review

Metoclopramide is a centrally acting dopamine antagonist that stimulates cholinergic receptors in the gastrointestinal (GI) tract. It increases the tension of the lower esophageal sphincter (LES) and fundal smooth muscles, which helps prevent reflux. It also increases the motility of the gastric and small intestine, aiding in digestion. Additionally, metoclopramide relaxes the pylorus and duodenum during contraction, allowing for the smooth passage of food through the GI tract.

The statement is true because hypotension, bradycardia, dysrhythmias, and akathisia are indeed common side effects of Reglan. Hypotension refers to low blood pressure, bradycardia is a slow heart rate, dysrhythmias are abnormal heart rhythms, and akathisia is a condition characterized by restlessness or uneasiness. These side effects can occur when taking Reglan, a medication commonly used to treat gastrointestinal issues such as acid reflux and gastroparesis. It is important for patients to be aware of these potential side effects and discuss them with their healthcare provider.

Ancef is indeed an example of a cephalosporin that is commonly used. It is known for its broad spectrum coverage, meaning that it can effectively treat a wide range of bacterial infections. Additionally, it is also relatively inexpensive, making it a cost-effective choice for many healthcare providers. Therefore, the statement that Ancef offers broad spectrum coverage and is inexpensive is true.

Serotonin is a neurotransmitter that is involved in various physiological processes, including the regulation of blood vessels. As an endogenous vasoactive autocoid, it means that serotonin is produced within the body and acts as a signaling molecule to regulate blood vessel constriction and dilation. This helps in maintaining blood pressure and blood flow to different tissues and organs. Therefore, the statement that serotonin is an endogenous vasoactive autocoid is true.

Aldosterone secretion causes the reabsorption of Na+ and the loss of hydrogen ions. This hormone also stimulates the reabsorption of potassium ions (K+) in the kidneys. Therefore, the correct answer is K+.

Prostaglandins are lipid compounds that play a role in various physiological processes. They are known to cause bronchial muscle relaxation, which helps in widening the airways and facilitating breathing. Prostaglandins also stimulate uterine contractions during labor and delivery. Additionally, they inhibit gastric acid secretion, which can help in reducing stomach acid levels and preventing gastric ulcers. Lastly, prostaglandins prevent platelet aggregation, which is important for maintaining normal blood flow and preventing the formation of blood clots. Therefore, the statement is true as prostaglandins do indeed cause all of these effects.

The explanation for the given correct answer is that fat soluble vitamins are only absorbed and stored in the body with the help of dietary fat. A, D, E, and K are the only vitamins that fall under this category. Since all other vitamins are not fat soluble, they must be water soluble, meaning they can dissolve in water and are easily absorbed and excreted by the body. Therefore, the statement is true.

Mnemonic=In Time I Can Please Everyone But Susie & Sally

Parkinson's disease is characterized by a deficiency of dopamine in the brain. Dopaminergic drugs are used to increase the levels of dopamine in the brain, which helps to alleviate the symptoms of the disease. These drugs work by either replacing dopamine or by stimulating the dopamine receptors in the brain. Therefore, the use of dopaminergic drugs is a crucial part of the treatment for Parkinson's disease.

Cocaine is indeed special because it has vasoconstrictive properties. This means that it can narrow or constrict blood vessels, leading to a decrease in blood flow. This property is related to its ability to block the reuptake of norepinephrine, a neurotransmitter involved in regulating blood vessel size. By blocking the reuptake of norepinephrine, cocaine increases its levels in the body, causing vasoconstriction and various physiological effects. Therefore, the statement "Cocaine is special because it has vasoconstrictive properties related to its ability to block the reuptake of norepinephrine" is true.

Levodopa, a medication commonly used for the treatment of Parkinson's disease, is indeed associated with various side effects. GI dysfunction refers to gastrointestinal problems such as nausea, vomiting, and constipation. Hypotension refers to low blood pressure, which can lead to dizziness and fainting. Dyskinesias are abnormal involuntary movements that can occur as a side effect of levodopa treatment. Lastly, psychosis, which includes symptoms such as hallucinations and delusions, can also be a potential side effect of levodopa therapy. Therefore, the statement "Levodopa for Parkinson's treatment is associated with GI dysfunction, hypotension, dyskinesias, and psychosis" is true.

The given answer is true because angiotensin II is indeed considered to be one of the most potent vasoconstrictors. It is a hormone that constricts blood vessels, leading to an increase in blood pressure. Angiotensin II plays a crucial role in regulating blood pressure and fluid balance in the body.

Angiotensin converting enzyme (ACE) is responsible for the production of angiotensin II, which is a vasoconstrictor. ACE inhibitors work by blocking the action of ACE, thereby preventing the production of angiotensin II. This leads to vasodilation, or the widening of blood vessels, which helps to lower blood pressure. Additionally, ACE is also responsible for the destruction of bradykinin, which is a vasodilator. By inhibiting ACE, ACE inhibitors also increase the amount of circulating bradykinin, further promoting vasodilation. Therefore, the statement that ACE inhibitors prevent the production of angiotensin II and increase the amount of circulating bradykinin causing vasodilation is true.

Kayexelate is indicated for hyperkalemia, a condition characterized by high levels of potassium in the blood. It works by binding with potassium in exchange for sodium or calcium ions, which helps to lower the potassium levels in the body. Once bound, it is excreted through the stool, thereby aiding in the removal of excess potassium from the body.

When redosing an induction agent, it is recommended to use 10% of the original dose that was given. This is because the initial dose of the induction agent is usually higher to achieve the desired effect quickly. Redosing with a smaller amount helps maintain the desired level of sedation or anesthesia without overdosing the patient. Using a smaller dose also allows for better control and adjustment of the medication as needed. Therefore, the statement "When redosing an induction agent you should use 10% of the original dose you gave" is true.

Beta blockers are medications that can block the effects of adrenaline, which can cause bronchial constriction and narrowing of the airways. This can be particularly dangerous for individuals with asthma, as it can potentially trigger severe asthma attacks. Therefore, it is generally recommended to avoid using beta blockers in asthmatics to minimize the risk of exacerbating their condition.

Atropine is able to cross the blood-brain barrier (BBB), allowing it to exert its effects on the central nervous system. This is due to its lipophilic nature, which enables it to pass through the lipid-rich barrier. On the other hand, glycopyrrolate is a quaternary ammonium compound, which means it carries a positive charge and is therefore unable to cross the BBB. Hence, atropine is the correct answer as it is the antimuscarinic that can penetrate the BBB.

Increases CPP, CMRO2, ICP, and IOP

Sodium nitroprusside, when administered at high doses, can cause cyanide toxicity. Cyanide is a highly toxic substance that inhibits cellular respiration by binding to cytochrome oxidase, preventing the utilization of oxygen by cells. Symptoms of cyanide toxicity include headache, confusion, dizziness, seizures, respiratory distress, and cardiac arrest. Prompt recognition and treatment are essential in managing cyanide toxicity.

An allergy to penicillins implies an 8% likelihood of an allergy to cephalosporins (ancef). This means that there is a relatively high chance of cross-reactivity between penicillins and cephalosporins, as both are beta-lactam antibiotics and have a similar chemical structure. However, there is no significant evidence to suggest a similar cross-reactivity with aminoglycosides, antivirals, or vancomycin. Therefore, the correct answer is cephalosporins (ancef).

Dexamethasone is commonly used to treat cerebral edema. It is a steroid that helps reduce inflammation and swelling in the brain, which can occur in conditions such as brain tumors, infections, or traumatic brain injury. Dexamethasone works by suppressing the immune response and reducing the release of substances that cause inflammation. This helps to alleviate the symptoms of cerebral edema and improve the patient's condition.

Gabapentin was originally advertised as an antiepileptic medication but is now commonly used to manage neuropathic pain. It works by reducing the abnormal electrical activity in the brain that can cause seizures, and also helps to relieve nerve pain by affecting certain chemicals in the brain and nerves that are involved in pain signals.

Antiretrovirals, which are used to treat HIV, can indeed cause pancreatitis, lactic acidosis, and inhibition of cytochrome P-450 enzymes. Pancreatitis is inflammation of the pancreas, lactic acidosis is a buildup of lactic acid in the body, and inhibition of cytochrome P-450 enzymes can affect the metabolism of other drugs. Therefore, the statement is true.

Epinephrine increases myocardial oxygen demand. Epinephrine is a hormone that is released during times of stress or excitement. It acts on the heart by increasing heart rate and contractility, which in turn increases the amount of oxygen that the heart muscle needs to function properly. This increased demand for oxygen can be beneficial in certain situations, such as during exercise when the body needs more oxygen to meet the increased energy demands. However, in individuals with heart disease or other cardiac conditions, this increased demand for oxygen can be detrimental and may lead to chest pain or heart attack.

Methyldopa, clonidine, and dexmedetomidine are all alpha 2 agonists. Alpha 2 agonists work by stimulating alpha 2 adrenergic receptors in the body, leading to a decrease in sympathetic outflow from the central nervous system. This results in a decrease in sympathetic activity and a reduction in blood pressure. These drugs are considered sympatholytic because they inhibit the release of norepinephrine, which is responsible for activating the sympathetic nervous system. Abrupt discontinuation of alpha 2 agonists can cause acute withdrawal syndrome, which can lead to a sudden increase in sympathetic activity and hypertensive crisis.

Phenylephrine is a non-catecholamine that primarily acts as an agonist on alpha1 adrenergic receptors. This means that it stimulates these receptors, leading to vasoconstriction and increased blood pressure. Alpha1 agonists are commonly used to treat conditions such as nasal congestion, hypotension, and shock.

Ropivacaine is mentioned in the ppt to have less cardiotoxicity than bupivacaine - it is "the propyl analogue of, bupivacaine having a butyl group in the same position."

NE is in abundance - will cause htn crisis

Deficiencies in folic acid can lead to neural tube defects in the developing fetus. Folic acid is crucial for the proper development of the neural tube, which eventually becomes the brain and spinal cord. Insufficient levels of folic acid during pregnancy can result in incomplete closure of the neural tube, leading to conditions such as spina bifida or anencephaly. It is therefore important for pregnant women to ensure an adequate intake of folic acid through diet or supplements to prevent these defects.

With epinephrine added, the maximum dose of lidocaine and mepivacaine is both 7 mg/kg.

HITT stands for heparin induced thrombocytopenia and thrombosis caused by drug induced platelet aggregation. Heparin is a medication commonly used as an anticoagulant to prevent blood clots. However, in some individuals, heparin can cause an immune response that leads to a decrease in platelet count (thrombocytopenia) and the formation of blood clots (thrombosis). This condition is known as HITT. It is important to identify and manage HITT promptly to prevent serious complications.

Decreased renal perfusion refers to a reduction in blood flow to the kidneys. When the kidneys sense a decrease in blood flow, they release renin, an enzyme that plays a crucial role in regulating blood pressure. Renin acts on angiotensinogen to convert it into angiotensin I, which is further converted to angiotensin II. Angiotensin II causes vasoconstriction and stimulates the release of aldosterone, leading to increased blood volume and blood pressure. Therefore, decreased renal perfusion stimulates renin secretion as a compensatory mechanism to restore blood pressure.

H2 receptors are found in the bronchial smooth muscles, and when these receptors are activated by H2 antagonists, they cause relaxation of the muscles. This relaxation can lead to bronchial constriction, which is a narrowing of the airways. Therefore, patients on H2 antagonists are indeed at an increased risk for bronchial constriction.

The addition of epinephrine to a local anesthetic leads to vessel vasoconstriction, which means that the blood vessels in the area constrict or narrow. This constriction reduces blood flow to the area, resulting in less absorption and metabolism of the local anesthetic. As a result, the anesthetic stays in the area for a longer duration, providing prolonged pain relief.

Local anesthetics that are more lipid soluble tend to have a higher degree of protein binding. In this case, the correct answer is Alpha 1-acid glycoproteins. This means that local anesthetics with higher lipid solubility have a greater affinity for binding to Alpha 1-acid glycoproteins rather than albumin.

Local anesthetics that exhibit the greatest protein binding and highest lipid solubility have a longer duration of action. This is because these properties allow the anesthetic to stay bound to proteins and remain within the lipid-rich environment for a longer period of time, resulting in a slower release and metabolism of the drug. As a result, the effects of the anesthetic are prolonged, leading to a longer duration of action.

Many antiepileptic drugs work by enhancing GABA-mediated neuronal inhibition. GABA is an inhibitory neurotransmitter in the brain, meaning it helps to reduce neuronal activity. By enhancing the effects of GABA, these drugs can further suppress the excessive neuronal activity that occurs during seizures, helping to prevent or reduce the frequency and severity of epileptic episodes.

Etomidate is associated with adrenal corticoid suppression and should be used cautiously or avoided with patients on chronic steroids/Addison's disease. This is because etomidate inhibits the production of cortisol, a hormone produced by the adrenal glands. Patients with chronic steroid use or Addison's disease already have compromised adrenal function, and the use of etomidate can further suppress cortisol production, leading to adrenal insufficiency. Therefore, it is important to exercise caution and consider alternative induction agents in these patients to prevent adrenal crisis.

NSAID-induced bronchospasms appear to be caused by the inhibition of cyclooxygenase-1 (Cox-1); this in turn activates the lipoxygenase pathway, which eventually increases the release of cysteinyl leukotrienes (Cys-LTs) that induces bronchospasm and nasal obstruction.

The statement is true because aldosterone, desoxycorticosterone, cortisol (hydrocortisone), corticosterone, and cortisone are indeed endogenous corticosteroids. These hormones are produced naturally in the body by the adrenal glands and play important roles in regulating various physiological processes, including salt and water balance, metabolism, and immune responses.