A review of the material for pharm test 2. Includes: local anesthetics, antihypertensives, diuretics, vasodilators.
Most questions come directly from notes.
Esters
Ethers
Amides
Carboxylic Acids
Thiols
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
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
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
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.
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.
Cl , K
Na, Cl
Na, K
K, Na
Access to CSF
Increased fat stores
Increased blood flow
None of above
Procaine – pKa 8.9
Bupivacaine – pKa 8.1
Mepivacaine- pKa7.6
Ropivacaine- pKa 8.1
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
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
Precipitous Hypotension
Cardiac Dysrhythmias
AV Heart block
All the above
Hydralazine
Adenosine
Nipride
Nitric oxide
Pt receiving intercostal nerve block
Pt receiving caudal block
Pt receiving brachial plexus nerve block
Pt receiving sub-q local anesthetic
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
Mannitol 30g IV
Furosemide 40 mg IV
Aldactone 250mg PO
Enalapril 2.5 mg IV
Lidocaine
Chloroprocaine
Cocaine
Mepivicaine
Prilocaine
Lipophilic, hydrophilic
Hydrophilic, lipophilic
Ionized, unionized
None of above
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.
Hydrochlorothiazide
Urea
Spironolactone
Acetazolamide
By blocking passage of sodium ions into nerve cells
Through beta1 agonistic effects
Through vasoconstriction and decreasing vascular absorption
All the above
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.
Subcutaneous
Sciatic
Caudal
Epidural
Angiotensin I
Angiotensin II
Angiotensin converting enzyme
Renin
Lungs
Kidneys
Liver
Coronary Vessels
True
False
Lidocaine
Chloroprocaine
Cocaine
Mepivicaine
Prilocaine
CGMP
Prusside
Nitric Oxide
Cyandie
Causes Spincter of Oddi spasms
Uses special tubing when administered
May cause headaches
Decreases left end diastolic pressure
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Hydralizine
Trimethapan
Ephedrine
Nimotop
By hydrolysis via pseudocholinesterase
Via hepatic enzymes P450
Via proteins present within CSF
Via renal metabolism and excretion
Push Methlene blue 1-2mg/kg of 1% solution over 5 min
Stop the Nipride infusion and administer 100% O2
Give Thiosulfate 150 mg/kg over 15 min
Titrate Nipride until effective dose is reached
By hydrolysis via pseudocholinesterase
Via hepatic enzymes P450
Via proteins present within CSF
Via renal metabolism and excretion
Procaine – pKa 8.9
Lidocaine – pKa 7.7
Chloroprocaine – pKa 9.1
Bupivacaine – pKa 8.1
Inhibits reabsorption of sodium and chloride ions in the medullary portion of the ascending loop of Henle
Blocks the conversion of angiotensin I to angiotensin II to prevent vasoconstriction
Inhibits reabsorption of sodium and chloride ions in the cortical portion of the ascending loop of Henle
Increases the osmolarity of the renal tubular fluid and prevents reabsorption of water
True
False
Degree of protein binding
Lipid Solubility
Degree of Ionization
Size of Molecule
Degree of protein binding
Lipid Solubility
Degree of Ionization
Size of Molecule
Captopril
Enalapril
Losartan
Hydrochlorothiazide
Administer local anesthesia with Bupivacaine
This has no effect on local anesthetics, only on succinylcholine.
Administer local anesthesia with Procaine
Patient may not receive any local anesthetics
Hyperoxygenate, Lipid rescue
Intubate the pt and wait it out, no treatment available
Tx seizures with benzos
Give Bretylium 20 mg/kg IV
180 mg
150 mg
300 mg
90 mg
May cause left ventricular hypertrophy to decrease
Delay progression of diabetic renal disease
First line treatment for HTN and mitral regurge
Commonly used to treat renal stenosis
Lidocaine
Prilocaine
Bupivacaine
Cocaine
Bolus dose of 2 mcg/kg
Pt on IV Nipride 3 mcg/kg/min for past 12 hours
Pt on IV Nipride 11 mcg/kg/min for past 4 hours
All the above are safe doses
Hydralizine
Trimethapan
Sodium nitroprusside
Nimotop
Epinephrine
Metoprolol
Phenylephrine
Ephedrine
Hypokalemia
Metabolic Alkalosis
Skeletal muscle weakness
Hemodilution
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