Pharmacology Fundamentals Flashcards

A PACU patient who received regional anesthesia develops sudden cardiovascular collapse. Lipid emulsion therapy is initiated. For which drug toxicity is this treatment indicated?

Answer: Local anesthetic systemic toxicity (LAST)

Intravenous lipid emulsion (Intralipid) acts as a 'lipid sink,' sequestering lipid-soluble local anesthetics like bupivacaine from cardiac and CNS tissue to treat LAST.

Which mechanism explains why succinylcholine causes a dangerous rise in serum potassium in burn or crush injury patients?

Answer: Upregulation of extrajunctional acetylcholine receptors causes exaggerated potassium efflux upon depolarization

After denervation or immobility, extrajunctional acetylcholine receptors proliferate across the muscle membrane, and succinylcholine-induced depolarization of all these receptors causes massive, potentially fatal potassium efflux.

A patient receives IV acetaminophen (Ofirmev) post-surgery. What is the maximum recommended daily dose for an adult weighing over 50 kg?

Answer: 4 g/day

The maximum recommended dose of IV or oral acetaminophen for adults over 50 kg is 4 g (4,000 mg) per day to prevent hepatotoxicity.

Droperidol was once widely used for PONV but carries an FDA black box warning. What is the concern?

Answer: QTc prolongation and risk of Torsades de Pointes

Droperidol received a black box warning due to reports of QTc prolongation and Torsades de Pointes, requiring ECG monitoring when doses exceed 2.5 mg.

Which adjunct analgesic drug class works by blocking sodium channels in peripheral nerves and is used as part of a multimodal analgesia plan to reduce opioid requirements?

Answer: Local anesthetics (e.g., IV lidocaine infusion)

IV lidocaine infusions provide systemic analgesia via sodium channel blockade and anti-inflammatory mechanisms, reducing opioid consumption in the perioperative period.

A PACU nurse notes a patient has bradycardia following reversal of neuromuscular blockade. Glycopyrrolate was used instead of atropine. What advantage does glycopyrrolate offer?

Answer: Does not cross the blood-brain barrier, avoiding CNS side effects like confusion

Glycopyrrolate is a quaternary ammonium compound that does not cross the blood-brain barrier, avoiding CNS anticholinergic effects such as confusion, sedation, or delirium seen with atropine.

A patient is prescribed transdermal fentanyl for chronic pain management. In the PACU, the nurse notes a slow respiratory rate. What factor about this formulation is most important to consider?

Answer: The depot in subcutaneous fat continues releasing fentanyl even after patch removal, prolonging effects

Transdermal fentanyl creates a subcutaneous depot that continues to release drug into systemic circulation for hours after patch removal, making overdose management prolonged.