A review of the material for pharm test 2. Includes: local anesthetics, alpha and beta antagonists, antihypertensives, diuretics.
Most questions come directly from notes.
Hydrochlorothiazide
Urea
Spironolactone
Acetazolamide
Greater degree of protein binding and thus longer duration
No effect at all
Decreased lipid solubility resulting in decreased potency
Increased unionized drug causing more rapid onset
Acetycholine
Serotonin
Glutamate
Norepinephrine
Access to CSF
Increased fat stores
Increased blood flow
None of above
Esters
Ethers
Amides
Carboxylic Acids
Thiols
Bradycardia
Bronchospasm
Chronic Cough
Hypokalemia
Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
Inhibits reabsorption of sodium and chloride ions in the loop of Henle
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
Inhibits reabsorption of sodium and chloride ions in the loop of Henle
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
By blocking passage of sodium ions into nerve cells
Through beta1 agonistic effects
Through vasoconstriction and decreasing vascular absorption
All the above
Precipitous Hypotension
Cardiac Dysrhythmias
AV Heart block
All the above
Cl , K
Na, Cl
Na, K
K, Na
The technique must have been wrong, try again.
The acidic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.
The basic environment of the foot cause a greater concentration of ionized anesthetic, which can not cross cell membrane.
Pt must have a tolerance to local anesthetics, try again using a larger dose.
Mannitol 30g IV
Furosemide 40 mg IV
Aldactone 250mg PO
Enalapril 2.5 mg IV
By hydrolysis via pseudocholinesterase
Via hepatic enzymes P450
Via proteins present within CSF
Via renal metabolism and excretion
Degree of protein binding
Lipid Solubility
Degree of Ionization
Size of Molecule
Blocks the vasoconstrictor and aldosterone-secretion effects of Angiotensin II to the AT1 receptors in the smooth muscles
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
Inhibits reabsorption of sodium and chloride ions in the loop of Henle
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
Increased HR
Decreased urine secretion
Secretion of norepi
Increased Saliva and mucus production
Hydrochlorothiazide
Furosemide
Triamterene
Ethacrynic Acid
Procaine – pKa 8.9
Lidocaine – pKa 7.7
Chloroprocaine – pKa 9.1
Bupivacaine – pKa 8.1
Subcutaneous
Sciatic
Caudal
Epidural
Alpha 1 receptor blockers
Beta 2 receptor Blockers
Beta 1 receptor blockers
All the above will cause bronchoconstriction
Labetolol
Phenoxybenzamine
Atenolol
Esmolol
Lipophilic aromatic group
Esther linkage
Amide Linkage
Hydrophilic amine group
Slow down your rate of injection, and then administer rest of anesthetic.
Immediately notify MD and prepare pt for cardiac bypass, your plasma concentration is most likely too high now.
Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.
Comfort the patient that this is normal to experience and deliver rest of anesthetic quickly.
Ha ha!!
Kind of a catchy tune...
I love the looks on their faces!
All the above
Mimics acetylcholinesterase to Cause sustained depolarization rendering the NMJ unable to conduct further impulses=Muscle relaxation
Produces skeletal muscle relaxation by a direct action on excitation-contraction coupling, presumably by decreasing the amount of calcium released from the sarcoplasmic reticulum
Dependent upon type of anesthetic as ester and amides have different MOA’s
Prevents passage of sodium ions through ion selective channels in nerve membranes to block nerve conduction.
Acetycholine
Serotonin
Glutamate
Norepinephrine
By hydrolysis via pseudocholinesterase
Via hepatic enzymes P450
Via proteins present within CSF
Via renal metabolism and excretion
True
False
Pt receiving intercostal nerve block
Pt receiving caudal block
Pt receiving brachial plexus nerve block
Pt receiving sub-q local anesthetic
True
False
Absorption from tissues during nerve blocks
Inadvertent intravascular injection
Inadvertent administration of epidural dose into subdural space
Drug interactions between pt meds and LA’s
Prepare for the patient to be placed on cardiac bypass due to arrhythmias.
Intubate the patient and wait it out.
Deliver neo and glyco to reverse the paralysis.
Begin delivering pain medication to counteract the headache.
Lungs
Kidneys
Liver
Coronary Vessels
Lipophilic, hydrophilic
Hydrophilic, lipophilic
Ionized, unionized
None of above
Potassium sparing diuretics
Aldosterone Antagonists
Osmotic Diuretics
Thiazide Diuretics
Chronic Cough
Orthostatic hypotension
Bronchospasm
Heart block
Bronchodilation
Glycogenolysis/gluconeogenesis
Activation of Na/K pump
Vasoconstriction
Lidocaine
Chloroprocaine
Cocaine
Mepivicaine
Prilocaine
Procaine – pKa 8.9
Bupivacaine – pKa 8.1
Mepivacaine- pKa7.6
Ropivacaine- pKa 8.1
Phenoxybenzamine
Prazosin
Esmolol
Labetolol
Brochodilation
Increase heart rate
Increase contractility
All the above result from Beta 1 stimulation
Use Tetracaine instead, since this is a different class of anesthetic
This pt may not receive any spinal anesthetics and will need to have GA
Cancel procedure for today and reschedule for a later time.
Use Ropivacaine instead, since this is a different class of anesthetic
Degree of protein binding
Lipid Solubility
Degree of Ionization
Size of Molecule
CHF
Renal Failure
Increased ICP
COPD
Dihydroxyphenylalanine
Norepinephrine
Epinephrine
N-methyltransferase
Lidocaine
Prilocaine
Bupivacaine
Cocaine
Tyrosine
DOPA
Epinephrine
Hydroxylase
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