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Questions and Answers
Which drug combination may lead to reduced cardiac output?
Which drug combination may lead to reduced cardiac output?
Which of the following can lead to increased idiosyncratic reactions?
Which of the following can lead to increased idiosyncratic reactions?
What effect do volatile anesthetics have on cardiac output?
What effect do volatile anesthetics have on cardiac output?
What is an example of plasma protein binding interaction?
What is an example of plasma protein binding interaction?
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What is the consequence of altered urinary pH on drug metabolism?
What is the consequence of altered urinary pH on drug metabolism?
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What effect does sodium bicarbonate have on bupivacaine?
What effect does sodium bicarbonate have on bupivacaine?
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How does neostigmine affect ester local anesthetics?
How does neostigmine affect ester local anesthetics?
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Which compound inhibits 17 α hydroxylase and 11 β hydroxylase?
Which compound inhibits 17 α hydroxylase and 11 β hydroxylase?
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What toxic compound can be formed when halogenated agents are combined with Baralyme?
What toxic compound can be formed when halogenated agents are combined with Baralyme?
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What is a possible consequence of MAO inhibitors interacting with tyramine?
What is a possible consequence of MAO inhibitors interacting with tyramine?
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Which of the following is an example of an enzyme inducer?
Which of the following is an example of an enzyme inducer?
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Which substance reduces the absorption of digoxin due to drug interaction?
Which substance reduces the absorption of digoxin due to drug interaction?
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What effect do enzyme inhibitors have on drug metabolism?
What effect do enzyme inhibitors have on drug metabolism?
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What effect does adding adrenaline have on local anesthetic absorption?
What effect does adding adrenaline have on local anesthetic absorption?
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What is a potential consequence of pharmacokinetic interactions in drug absorption?
What is a potential consequence of pharmacokinetic interactions in drug absorption?
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What is one consequence of meperidine interaction with MAO inhibitors?
What is one consequence of meperidine interaction with MAO inhibitors?
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What is the effect of acidic urine on phenobarbital excretion?
What is the effect of acidic urine on phenobarbital excretion?
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Which group of agents can activate the production of Sevo-olefin?
Which group of agents can activate the production of Sevo-olefin?
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What risk is associated with the combination of nitric oxide and oxygen?
What risk is associated with the combination of nitric oxide and oxygen?
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Which of the following is NOT a mechanism of pharmacokinetic drug interactions?
Which of the following is NOT a mechanism of pharmacokinetic drug interactions?
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Which antacid components can inactivate oral tetracycline?
Which antacid components can inactivate oral tetracycline?
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Which drug is an example of a drug with a high extraction ratio?
Which drug is an example of a drug with a high extraction ratio?
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What is the primary rate limiting factor for drugs with a high extraction ratio?
What is the primary rate limiting factor for drugs with a high extraction ratio?
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Which interaction occurs when drugs with similar mechanisms of action are combined?
Which interaction occurs when drugs with similar mechanisms of action are combined?
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Which of the following combinations exemplifies an additive interaction?
Which of the following combinations exemplifies an additive interaction?
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Which drug is known to inhibit CYP3A4 and reduce clearance of midazolam?
Which drug is known to inhibit CYP3A4 and reduce clearance of midazolam?
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What is the effect of competitive inhibitors like midazolam and fentanyl?
What is the effect of competitive inhibitors like midazolam and fentanyl?
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Which of the following is an example of a drug with a low extraction ratio?
Which of the following is an example of a drug with a low extraction ratio?
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Which interaction involves small doses of two drugs producing larger effects?
Which interaction involves small doses of two drugs producing larger effects?
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What is a risk factor for hyperkalemia?
What is a risk factor for hyperkalemia?
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Which condition is associated with hyperlipidemia?
Which condition is associated with hyperlipidemia?
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Which of the following is an early marker of potential complications?
Which of the following is an early marker of potential complications?
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Which of the following can help prevent hyperkalemia?
Which of the following can help prevent hyperkalemia?
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What is a possible treatment step for hyperkalemia?
What is a possible treatment step for hyperkalemia?
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Which electrolyte imbalance is indicated by elevated creatinine kinase?
Which electrolyte imbalance is indicated by elevated creatinine kinase?
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Which demographic group is more commonly affected by hyperkalemia?
Which demographic group is more commonly affected by hyperkalemia?
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What condition can contribute to the development of skeletal myopathy?
What condition can contribute to the development of skeletal myopathy?
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Which of the following strategies is essential to maintain hemodynamic stability during hyperkalemia treatment?
Which of the following strategies is essential to maintain hemodynamic stability during hyperkalemia treatment?
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Which laboratory investigation is used for diagnosing metabolic acidosis?
Which laboratory investigation is used for diagnosing metabolic acidosis?
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What is a common symptom of cardiac complications due to hyperkalemia?
What is a common symptom of cardiac complications due to hyperkalemia?
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Which of the following treatments should be avoided to manage hyperlipidemia?
Which of the following treatments should be avoided to manage hyperlipidemia?
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What effect does ketamine have on muscarinic receptors?
What effect does ketamine have on muscarinic receptors?
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What is the role of IV crystalloids in hyperkalemia treatment?
What is the role of IV crystalloids in hyperkalemia treatment?
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Which mechanism is NOT associated with hyperkalemia?
Which mechanism is NOT associated with hyperkalemia?
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What is the primary mechanism of action of midazolam?
What is the primary mechanism of action of midazolam?
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Which of the following is a common adverse effect associated with midazolam?
Which of the following is a common adverse effect associated with midazolam?
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What is the typical induction dose of midazolam for adults?
What is the typical induction dose of midazolam for adults?
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Which of the following routes of administration has an oral bioavailability of approximately 50%?
Which of the following routes of administration has an oral bioavailability of approximately 50%?
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What property of midazolam contributes to its short duration of action?
What property of midazolam contributes to its short duration of action?
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In which situation is midazolam typically contraindicated?
In which situation is midazolam typically contraindicated?
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What effect does midazolam have on the cardiovascular system?
What effect does midazolam have on the cardiovascular system?
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Which of the following is a potential drug interaction with midazolam?
Which of the following is a potential drug interaction with midazolam?
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Midazolam can be used effectively in which of the following scenarios?
Midazolam can be used effectively in which of the following scenarios?
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Which statement best describes midazolam's effect on respiratory function?
Which statement best describes midazolam's effect on respiratory function?
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What is one of the metabolites of midazolam after hepatic metabolism?
What is one of the metabolites of midazolam after hepatic metabolism?
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How does midazolam affect cerebral blood flow?
How does midazolam affect cerebral blood flow?
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What dosing preparation is available for midazolam in syrup form?
What dosing preparation is available for midazolam in syrup form?
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What is a characteristic effect of benzodiazepines such as midazolam?
What is a characteristic effect of benzodiazepines such as midazolam?
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Study Notes
Anesthetic Pharmacology - Drug Interactions
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Toxic Compound Formation: Halogenated anesthetics (e.g., sevoflurane) mixed with Baralyme produces toxic compounds like CO and sevo-olefin. NO reacting with O2 forms toxic NO2.
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Pharmacokinetic Interactions:
- Absorption: Oral absorption of certain drugs (e.g., tetracycline) can be affected by antacids. Some anti-diarrheals can bind and reduce absorption of other drugs. Reduced regional perfusion can also lower anesthetic absorption.
- Distribution: Cardiac output changes alter drug distribution. Volatile anesthetics impact cardiac output and affect the CNS. Ion trapping and plasma protein binding alter drug distribution; for example, displacement of warfarin by other drugs can alter its effect.
- Metabolism: High extraction ratio (ER ≥ 0.7) drugs (e.g., lidocaine) have liver blood flow as the rate limiting step, thus concentration in the blood increases. Low ER drugs (e.g., diazepam), are limited by enzyme induction affecting metabolism.
- Elimination: Altered urinary pH affects renal clearance of drugs. Probenecid inhibits penicillin secretion.
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Pharmacodynamic Interactions:
- Additive: Combining drugs with similar mechanisms of action (e.g., roc/vecuronium, volatile anesthetics/N2O) leads to an additive effect.
- Antagonistic: Some drugs oppose each other's effect (e.g., SCH/NDMR, neostigmine/NDMR, flumazenil/benzodiazepines, naloxone/opioid).
- Synergistic: Small doses of different drugs can create a larger effect (e.g., opioid/NSAIDS, NDMR/volatile anesthetics).
- Hyperkalemia/other Adverse Effects: Drug interactions can cause various adverse effects, including but not limited to, hyperkalemia, hyperlipidemia, bradycardia, skeletal myopathy, and acute renal failure.
Anesthetic Pharmacology - Propofol
- Problems Due to Drug Interactions: Interactions can lead to drug antagonism, toxicity, reduced therapeutic index, unidentified drug effects, and idiosyncratic reactions.
- Risk Factors for Problems: Factors like pediatric age, cumulative dose, infusion duration, and severe illnesses.
- Early Markers of Propofol Associated Toxicity: Unexplained metabolic acidosis, elevated serum lactate, elevated creatine kinase, myoglobin levels, hyperlipidemia, and ECG changes
- Prevention/Treatment: Infusion minimization, alternative sedatives, supportive treatment (IV fluids, vasopressors), nutritional support (carbohydrate use), and renal support (dialysis).
Ketamine
- Introduction: A phencyclidine derivative, used for induction, cardioversion, and percutaneous interventions.
- Mechanism of Action: Primarily acts through GABA receptors, kappa opioid agonists, and monoaminergic receptors.
- Dosage: 0.2–0.6 mg/kg IV for induction, 0.04–0.05 mg/kg/hr infusion, mapping procedure.
- Adverse Effects: Emergence delirium, pain on injection, nausea/vomiting, myoclonus (can be mitigated by pre-medication).
Midazolam
- Introduction: Used for premedication, sedation, and induction.
- Mechanism of Action: Primarily acts via benzodiazepine receptors, influencing GABA receptor function. Includes kappa opioid agonist effects.
- Dosage: Wide range depending on usage (e.g., induction, sedation, post-op).
- Routes of Administration: Oral, IM, IV, intrathecal, epidural.
- Pharmacokinetics: Well absorbed from multiple routes, high lipid solubility leading to quick redistribution. Metabolism via cytochrome P450 with CYP3A4 being a key enzyme.
- Adverse Effects: Ventilatory depression, apnea, paradoxical vocal cord motion (causing upper airway obstruction), and possible cognitive decline.
- Drug Interactions: Affected by antacids, food, and other drugs inhibiting metabolism (like cimetidine, erythromycin).
Validation
- Corticus Trial: A trial evaluating corticosteroid therapy for septic shock, where some participants received etomidate..
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Description
This quiz covers the complex drug interactions within anesthetic pharmacology. It focuses on toxic compound formation, pharmacokinetic interactions including absorption, distribution, and metabolism. Understand how these factors can influence the efficacy and safety of anesthetic agents.
