BT GS 1.36 Describe the PK of neuromuscular blocking agents

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Regarding rocuronium:

It is a more potent agent than vecuronium   T/F

If you drank it, it would paralyse you eventually         T/F

Its duration of action is dependent on what time of the day you administer it    T/F

It commonly causes stinging when injected*    T/F

It is presented as a racemic mixture                 T/F

 

*Read this paper for a description of what it feels like to have rocuronium and suxamethonium injected when you are wide awake.  Response of the bispectral index to neuromuscular block in awake volunteers. P Schuller et al. British Journal of Anaesthesia 2015; 115(Supp 1): i95-103.

Reading any clinical paper about rocuronium should allow you to answer the third question. Unfortunately, reading any of the recommended texts for the exam won’t be enlightening about this particular property of rocuronium.

BTGS 1.30 and 1.31 Describe and compare the PK/PD of sedative/ induction agents

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Regarding midazolam:

It can sting on administration because it has a high pKa   T/F

It has very poor bioavailability   T/F

It can induce anaesthesia when used as a sole agent    T/F

It tastes nice hence its popularity as a paediatric premed   T/F

It has an active metabolite   T/F

Despite what the practice of many trainees may suggest, the t1/2 keo of midazolam is significantly more than about thirty seconds.

BT GS 1.29 Describe the physical properties of sedative/ hypnotic agents

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Regarding a propofol ampoule:

It contains egg products so shouldn’t be given to patients with an egg allergy   T/F

The contents are white because it contains soya bean oil$       T/F

It costs more than an ampoule of thiopentone               T/F

It contains antimicrobial preservative                            T/F

If you drank a 100ml ampoule it would make you quite sleepy*     T/F

$ Ask yourself what colour most oils are and what colour mayonnaise is and why they aren’t the same…

*In the trial of Michael Jackson’s cardiologist come ‘anesthesiologist’, Conrad Murray, an expert witness for the defence suggested that Jackson swigged a whole lot of propofol. This hypothesis was strongly refuted by the expert witness for the prosecution who happened to be none other than Steve Shafer. Who was correct?

Mineraloglucoaldosticosteroids

BT_PO 1.90

Describe the pharmacology of * insulin preparations *oral hypoglycaemic *corticosteroid drugs.

Intravenous dexamethasone has a slow onset of action. TRUE/FALSE

Prednisone and dexamethasone are synthetic corticosteroids with predominantly mineralocorticoid effects. TRUE/FALSE

The anti-inflammatory response of corticosteroids is a mineralocorticoid effect. TRUE/FALSE

Mineralocorticoid effects of synthetic corticosteroids are less than the natural hormones. TRUE/FALSE

Dexamethasone lacks mineralocorticoid effects. TRUE/FALSE

 

 

Bleedy McBleedster

BT_PO 1.121

Describe methods to reverse the effect of warfarin

BT_PO 1.120

Describe the pharmacology of warfarin and other anticoagulant drugs

The metabolic clearance of warfarin is inhibited by amiodarone. TRUE/FALSE

Third generation cephalosporins reduce the anticoagulant effect of warfarin. TRUE/FALSE

Intravenous vitamin K should return the prothrombin time to a normal range within 1 hour. TRUE/FALSE

Skin necrosis is a side effect of warfarin therapy. TRUE/FALSE

Warfarin can be reversed with recombinant factor VIIa TRUE/FALSE

BT_PO 1.41 Nitric Oxide

Staying on a vaguely respiratory topic….

This little molecule is actually mentioned in two LOs, so double bang for your buck today.

Amix-Nutrition-Nitric-Oxide-120-kapslí

But perhaps Nitric Oxide itself will give you the most bang!!

BT_PO 1.41 Outline the pharmacology of drugs used to treat pulmonary hypertension including nitric oxide

BT_PO 1.58 Describe the pharmacology of anti-hypertensive agents and their clinical application, including the following agents:

  • nitric oxide
  • plus lots of others….

 

Nitric oxide is synthesised from l -arginine                                   TRUE/FALSE

Nitric oxide for inhalation is stored in cylinders diluted with nitrogen   TRUE/FALSE

Nitric oxide inhibits platelet activation                                           TRUE/FALSE

Inhaled nitric oxide improves oxygenation by reducing V/Q mismatch   TRUE/FALSE

Effects of NO on the immune system are beneficial                     TRUE/FALSE

 

Heparin

BT_PO 1.118 Describe the pharmacology of heparin and low molecular weight heparins including their side-effects

T/F All modern drugs now are produced by recombinant DNA technology.

Bull
Actually Heparin is still made from mammalian sources. Beginning in the 1940s heparin was manufactured from bovine lung and pig intestinal mucosa. Because of the BSE crisis, bovine heparin was voluntarily removed. This meant that most of the world’s supply of heparin came from pigs intestines from slaughterhouses in China.

In 2007 there was a crisis in which heparin was adulterated, which illustrated the problem of relying on a single source for a drug. There is now a suggestion that bovine heparin should be re-introduced into clinical practice.

 

 

T/F Both fractionated and unfractionated heparin require anti-thrombin as a cofactor

T/F Heparin exhibits a 4 fold variation in sensitivity and 3 fold variation in its rate of metabolism between patients

T/F The half life of heparin is 1-2 hours and varies directly with the total dose

T/F Heparin induced thrombocytopaenia is the result of a non-specific immune reaction

T/F Heparin is cleared from the circulation by hepatic mechanisms alone

Antibiotics

BT_PO 1.3 Describe the adverse effects of antimicrobial agents Discuss the role of antibiotic prophylaxis in preventing infection and the identification of patients requiring it.

I remember listening to a radio program a few years ago about the development of streptomycin. During WWII Sulfanilamide and (later) Penicillin were available, but there was no treatment for gram negative infections, which were obviously common after gunshot wounds to the abdomen. Selman Waksman was looking for such a drug amongst soil microbes, and found Streptomycin in 1943.

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Here is a picture of someone making Streptomycin at a Merck Plant.

We don’t use streptomycin much now, but it sobering to think that it wasn’t that long ago that we couldn’t treat these infections at all.

 

 

 

 

 

 

T/F Antimicrobial effect of gentamicin is related to the area under the concentration time curve

T/F Clindamicin is effective against anaerobes

T/F Aminoglycoside ototoxicity is a dose dependent phenomenon

T/F If a patient has an anaphylactic reaction to penicillin there is a 15% chance they will also react to cefazolin

T/F Cefazolin is effective against most oral anaerobes

BT_PO 1.132 Antiseptics and disinfectants, clinical uses and risks

This is perhaps not one of the most obvious topics to study, but when you think about it, every patient having surgery, and hence being looked after by us, will be exposed to one of these creatures. Probably a good idea to know something about them, especially their hazards….

There is a reasonable section on this topic in both  Katzung Ch50 and Stoelting’s book Ch41 (until recently unavailable on the ANZCA site – but it is there now, yay!)

For some “clean” is a highly overrated concept….

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BT_PO 1.132 Outline the pharmacology of antiseptics and disinfectants, their clinical use and associated risks

Chlorhexidine can cause sensorineural hearing loss if instilled in the middle ear TRUE/FALSE

Povidone-iodine 10% aqueous solution is the only antiseptic which is non toxic to the cornea  TRUE/FALSE

Antiseptics are disinfectants which are safe to use on skin, wounds and mucous membranes    TRUE/FALSE

Providone-iodine is more likely to cause hypersensitivity than tincture of iodine TRUE/FALSE

It is essential to allow chlorhexidine skin preparation to dry before performing spinal anaesthesia   TRUE/FALSE

BT_PO 1.54 Pharmacology of beta receptor blocking agents

jan 2006 156

I asked about these drugs in the recent in exams and was fascinated (read horrified and astounded) that only one person had a plausible explanation as to how these little chaps cause hypotension…..

These drugs are actually mentioned in 5 LOs BT_PO 1.54 and BT_PO 1.57-1.60

We see a lot of patients on these drugs, partly because they have been shown to confer a survival advantage in people with heart failure, so it is probably a good idea to know a bit about them…

BT_PO 1.54 Describe the pharmacology of commonly used alpha and beta receptor blocking agents, their clinical use, adverse effects and use in the perioperative period

 

Metoprolol is metabolised by the CPY2D6, and hence prone to large inter individual variation in response   TRUE/FALSE

Beta1 selective blockers produce a significant reduction in blood pressure when given to normotensive individuals     TRUE/FALSE

Hypotension with beta blockers is mediated by the dilation of vessels in skeletal smooth muscle   TRUE/FALSE

Beta blockers cause a reduction in the release of renin TRUE/FALSE

Some beta blockers have an alpha agonist effect TRUE/FALSE