Nagelhout Pharmacology 2 Exam 2
How is the spread of epidural and spinal anesthesia different in pregnant women? - ANSWER-the spread and depth is greater; the fetus is pushing back so you have decreased epidural space
How does pregnancy change the dosage of LA given? - ANSWER-give decreased dose; they are more sensitive to LA d/t increased hormone (progesterone) levels
Lidocaine for tumescent anesthesia - ANSWER-they use large amounts of diluted LA for liposuction; doses from 35-55mg/kg (if not lipo 28mg/kg)
What is Hyaluronidase - ANSWER-an enzyme that helps break down tissue matrix; breaks down hyaluronic acid so fluids can go further; *helps spread LA* this also increases the risk of toxicity
Synthesis of catecholamines - ANSWER-phenylalanine--> tyrosine (tyrosine hydroxylase)--> dopa--> dopamine--> NE--> Epi increased NE will inhibit the change from tyrosine to dopa (tyrosine hydroxylase)
What does mixing LAs do to your toxic doses? - ANSWER-decreases them; the toxicity is additive so if you have used 50% of your lidocaine dose and watch to switch to bu pivacaine- you can only give 50% of your toxic bupivacaine dose
increased catecholamines - ANSWER-sympathomimetic
decreased catecholamines - ANSWER-sympatholytic
- enzymes that break down catecholamines - ANSWER-MOA- stored in nerves
COMT- stored in synapse
PNS preganglionic and postganglionic NTs - ANSWER-pre: nACh
post mACh
SNS preganglionic and postganglionic NTs - ANSWER-pre: nACh
post: NE (adrenergic)
pre-synaptic alpha 2 agonists: sympathomimetic/sympatholytic? - ANSWER-
sympatholytic; activates the negative feedback so nerve does not release any more catecholamine 1 / 2
post-synaptic alpha2 agonists: sympathomimetic/sympatholytic? - ANSWER-
sympathomimetic; it reached its destination so it will cause the effects
MOA: interference with synthesis of neurotransmitter: sympathomimetic/sympatholytic?
- ANSWER-sympatholytic
MOA: metabolic transformation by same pathway as precursor of transmitter: sympathomimetic/sympatholytic? - ANSWER-sympatholytic
MOA: blockade of transport system at nerve terminal membrane: sympathomimetic/sympatholytic? - ANSWER-sympathomimetic; block reuptake
MOA: blockade of transport system of storage vesicles - ANSWER-sympatholytic; not safely in vesicle so more will be broken down my MAO or COMP
MOA: promotion of exocytosis or displacement of transmitter from axonal terminal: sympathomimetic/sympatholytic? - ANSWER-sympathomimetic
MOA: prevention of release of transmitter: sympathomimetic/sympatholytic? - ANSWER-sympatholytic
MOA: mimicry of transmitter at post junctional sites: sympathomimetic/sympatholytic? -
ANSWER-sympathomimetic; aka: direct agonist
MOA: blockade of postsynaptic receptor: sympathomimetic/sympatholytic? - ANSWER- sympatholytic; aka direct antagonist
MOA: inhibition of enzymatic breakdown of transmitter: sympathomimetic/sympatholytic? - ANSWER-parasympathomimetic
MOA: interference with second messenger system: sympathomimetic/sympatholytic? - ANSWER-sympathomimetic; prevents breakdown of second messenger--> increased catecholamines
MOA: interference with synthesis of transmitter: cholinergic and adrenergic agents - ANSWER-sympatholytic
cholinergic: choline acetyl transferase inhibitors
adrenergic: a-methyl tyrosine
MOA: metabolic transformation by same pathway as precursor: adrenergic agents - ANSWER-sympatholytic
adrenergic: methyldopa
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