Pharm-3C

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atmu
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206829
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Pharm-3C
Updated:
2013-03-12 19:26:30
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Pharm 3C
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Pharm-3C
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  1. Lidocaine toxicity
    -without epinephrine, max safe does is 4mg/kg

    -with epinephrine, max safe does is 7mg/kg
  2. Stages of anesthesia (4)
    Stage I: analgesia

    Stage II: delirium or excitement with increase resp. rate and BP

    Stage III: surgical anesthesia - unconscious w/ muscle relaxation and decreased response to pain

    Stage IV: medullary paralysis --> vasomotor and respiratory centers cease --> death
  3. MOA of IV anesthetics
    • -act predominantly at GABA receptors
    • -inhibit neurotransmitter --> depresses CNS function

    -ketamine is exception because it inhibits NMDA receptors
  4. Most common used general anesthetic
    -Propofol

    -most commonly used because faster recovery, rapid onset, and little emesis
  5. Most potentially life-threatening adverse effect of general anesthesia
    -malignant hyperthermia
  6. General MOA and use (4) of local anesthetics
    • MOA:
    • -inhibit nerve conduction by inhibiting Na+ channels on neuronal membrane --> prevents conduction of nerve impulses

    • Use:
    • 1. infiltration anesthesia
    • 2. nerve blocks
    • 3. spinal anesthesia
    • 4. epidural anesthesia
  7. Dose dependent effects of local anesthesia on nerve function (e.g. sensory, motor, autonomic, etc...)
    Pain --> Sensory (deep pressure later) --> motor neurons

    small unmyelinated fibers that conduct pain > temp > autonomic function and touch are affected first
  8. Why do we add epi to lidocaine? which areas cannot get lidocaine with epi?
    Epinephrine is vasoconstrictor, which inhibits distribution of lidocaine away from injection site --> prolongs effects of lidocaine

    -this allows for smaller doses

    -can NOT use in fingers, nose, penis, or toes to avoid ischemia and tissue loss
  9. Most commonly used intermediate-acting local
    anesthetic used for infiltration and topical anesthesia
    • Topical:
    • 1. tetracaine
    • 2. lidocaine
    • 3. EMLA cream
    • 4. benzocaine (oragel)

    • Infiltration:
    • 1. lidocaine
    • 2. provocaine (novacaine)
  10. Complications and difference between epidural and spinal anesthesia
    • Spinal:
    • -injected into lumbar space into CSF
    • -for surgery 
    • -complications: postdural HA

    • Epidural:
    • -injected into epidural space
    • -used for obstetrics during labor
    • -more absorption into blood than sipnal
  11. Which antiviral used for severe RSV?
    Ribavirin
  12. Mechanism of action of antivirals such as acyclovir, which are effective against herpes viruses - other antiherpes antivirals
    Inhibit viral DNA synthesis via inhibiting viral DNA polymerase
  13. Anti CMV drugs- foscarnet and gancyclovir - major AE and MOA
    • Foscarnet
    • MOA: inhibits nucleic acid synthesis by direct interaction w/ viral DNA polymerase and HIV

    • reverse transcriptase
    • AE: Nephrotoxicity, hypocalcemia

    • Gancyclovir
    • MOA: inhibits viral DNA synthesis
    • AE:
    • -myelosuppression is frequent and reversible; monitor CBC regularly
    • -N/V/D, rash, and HA
  14. The oral drug of choice that covers influenza A, influenza B and H1N1 influenza is which of the following
    Oseltamivir (Tamiflu)
  15. Treatment of Hep C virus (2)
    interferon and ribavirin = Rebetron
  16. Major drugs used for Hep B virus
    • 1. Adefovir dipivoxil (Hepsera)
    • 2. Lamivudine (3TC)
    • 3. Entecavir (new for chronic)
    • 4. Telbivudine (Tyzeka) - newest
  17. Basic classes of Antiarrhythmics
    Class I: Sodium channel blockade; increases threshold and decrease velocity

    Class II: Beta-adrenergic blockade (propanolol, esmolol, acebutolol); decrease velocity, prolongs refractory period

    Class III: Prolong repolarization (K+ channel blockade); powerful and most useful but very toxic

    Class IV: Calcium channel blockade (verapamil, diltiazam, bepridil)
  18. Lidocaine- uses and toxicity
    Type IB antiarrhythmic

    -useful for acute therapy of ventricular arrhythmias; not for atrial

    • AE: most neurologic
    • -seizures in high doses
    • -hypotension, AV blocks, and other arrhythmias
    • -tremor, dysarthria, and ALOC
  19. Antiarrhythmics that prolong the action potential and prolong the QT interval and torsades de pointes
    • 1. Quinidine and other Class IA drugs
    • 2. Sotalol and other class III
  20. Verapamil- effects as an antiarrhythmics (CCB)
    Class IV calcium channel blockade

    • -blocks slow Ca+ channels in SA and AV nodes
    • -slows conduction and prolong refractory period, slows impulses to ventricles

    -effective for automatic and reentry tachycardias (SVTs) and to slow ventricular response to atrial fib

    -can increase serum digoxin concentrations
  21. Drugs is/are used to slow ventricular rate in patients with rapid atrial fibrillation
    • 1. Digitalis (Digoxin/Lanoxin)
    • 2. Verapamil
    • 3. Diltiazem
    • 4. Beta blockers
  22. Amiodarone - MOA and major indications, major AE/toxicity
    Class III - K+ channel blocker

    -affects K+, Ca++, Na_ channels to prolong AP, increase refractory period of all cardiac fibers

    • -first line for ventricular arrhythmias during resuscitation
    • -orally for resistant and sustained V-tach and V-fib

    DI: warfarin and digoxin levels are increased

    AE: prolong QT, Long term=pulmonary toxicity (fibrosis), smurf syndrome

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