p.1
Morphine Dosage and Administration
What is morphine?
A naturally occurring opiate.
p.1
Morphine Dosage and Administration
What are the available forms of morphine?
Tablets, syrup, suppository, and solution.
p.22
Morphine Dosage and Administration
What are the available forms of Prochlorperazine?
Tablets (3/5/25 mg), Syrup (1 mg/mL), Suppositories (5/25 mg), Solution (IM) (12.5 mg/mL).
p.1
Mechanism of Action of Opioids
What is the mechanism of action of morphine?
Agonist at MOP and KOP G-protein coupled opioid receptors.
What is the mechanism of action of metoclopramide?
It is a D2 receptor antagonist that stimulates muscarinic, 5-HT3, and 5-HT4 receptors, leading to increased gastric motility and relaxation of the pyloric sphincter.
p.3
Opioid Metabolism and Excretion
How is alfentanil metabolized?
It undergoes hepatic metabolism mostly by N-dealkylation to noralfentanil.
p.20
Opioid Metabolism and Excretion
How is Metoclopramide metabolized and excreted?
It undergoes hepatic metabolism, with metabolites and unchanged drug excreted in urine.
p.27
Antiarrhythmic Drug Classification
What are the critical effects at levels greater than 10 μg/mL?
AV block, refractory hypotension, and cardiac arrest.
p.13
Anti-emetic Pharmacology
Which area is closely associated with the chemoreceptor trigger zone (CTZ)?
The area postrema on the floor of the fourth ventricle.
p.25
Antiarrhythmic Drug Classification
How do Class II antiarrhythmic drugs exert their effects?
They are β-blockers that decrease sympathetic tone on the heart, reducing the slope of Phase 4 of the action potential.
p.13
Anti-emetic Pharmacology
What is the significance of the CTZ's location outside the blood-brain barrier?
It is well placed to detect blood-borne toxins.
p.11
Local Anesthetics Classification
What are examples of ester local anesthetics?
Cocaine, amethocaine, and procaine.
What is the chemical classification of Diamorphine?
It is a synthetic diacetylated morphine derivative and a prodrug.
p.9
Opioid Metabolism and Excretion
How is Naloxone metabolized?
Hepatic metabolism by glucuronidation.
p.22
Clinical Uses of Opioids
What are some common uses of Prochlorperazine?
Nausea and vomiting, vertigo and motion sickness, psychosis, and premedication.
p.23
Antiarrhythmic Drug Classification
What is a limitation of the Vaughn–Williams classification system?
Many drugs are not included and some fit into more than one category.
p.25
Antiarrhythmic Drug Classification
How do Class IV antiarrhythmic drugs exert their effects?
They block L-type Ca2+ channels, decreasing the slope of Phase 0 of the action potential, which reduces heart rate and cardiac conduction velocity.
p.7
Clinical Uses of Opioids
What is a common respiratory effect of opioids?
Antitussive effects and mild depression.
p.20
Clinical Uses of Opioids
What are the gastrointestinal effects of Metoclopramide?
Increases the tone of the lower esophageal sphincter and decreases the tone of the pyloric sphincter.
How does the potency of alfentanil compare to morphine?
Alfentanil is 10–20 times as potent as morphine.
p.17
Anti-emetic Pharmacology
What type of receptors does cyclizine act as a competitive antagonist?
H1 and muscarinic receptors.
p.26
Side Effects of Opioids
What are some cardiovascular effects of Quinidine?
Can cause arrhythmias, hypotension, long PR, wide QRS, long QT, and torsades de pointes.
p.24
Antiarrhythmic Drug Classification
Which drugs are classified as Class Ib antiarrhythmics?
Lignocaine, phenytoin, mexiletine.
p.25
Antiarrhythmic Drug Classification
What is the effect of blocking β-adrenoceptors in cardiac tissues?
It decreases Ca2+ flux into cells, reducing the slope of Phase 0 of the action potential, leading to decreased heart rate and contractility.
p.1
Opioid Metabolism and Excretion
What are the metabolic products of morphine?
Morphine-3-glucuronide (inactive) and morphine-6-glucuronide (active).
p.11
Local Anesthetics Classification
How do ester local anesthetics undergo hydrolysis?
By pseudocholinesterases found principally in plasma.
What is the potency of Pethidine compared to Morphine?
Pethidine has 1/10th the potency of Morphine.
p.27
Antiarrhythmic Drug Classification
What type of drug is lignocaine?
An amide local anesthetic and Class 1b antiarrhythmic.
p.26
Side Effects of Opioids
What central nervous system effects can Quinidine cause?
Cinchonism, including tinnitus, blurred vision, hearing loss, headache, and confusion.
p.13
Anti-emetic Pharmacology
What is the incidence range of postoperative nausea and vomiting (PONV)?
12% to 38%, depending on risk factors.
p.21
Mechanism of Action of Opioids
What is the mechanism of action of Ondansetron?
It antagonizes peripheral and central 5-HT3 receptors.
p.19
Mechanism of Action of Local Anesthetics
Why does Domperidone have fewer extrapyramidal side effects?
It does not cross the blood-brain barrier (BBB).
p.1
Clinical Uses of Opioids
What are the common uses of morphine?
Analgesia, sedation on ITU, palliative care, and CCF.
p.9
Morphine Dosage and Administration
What is the typical dosage range for Naloxone?
0.1–2 mg, titrate to effect.
What is the potency of tramadol compared to morphine?
Tramadol has 1/10th the potency of morphine.
p.3
Mechanism of Action of Opioids
What is the mechanism of action (MOA) of alfentanil?
It is a highly selective MOP opioid receptor agonist.
What are the available forms of Metoclopramide?
Tablets/slow release capsules (10/15 mg), syrup (1 mg/mL), and solution (5 mg/mL).
What are the chemical properties of alfentanil?
It is a synthetic phenylpiperidine derivative with a pKa of 6.5, making it 87% un-ionized at pH 7.4.
p.9
Morphine Dosage and Administration
What is the onset time and duration of action for Naloxone?
Onset time is 2 minutes, duration is 20 minutes.
p.19
Mechanism of Action of Local Anesthetics
What is the mechanism of action (MOA) of Domperidone?
Antagonises D2 receptors.
p.8
Mechanism of Action of Opioids
What is the mechanism of action of tramadol?
Weak agonist at all opiate receptors with increased affinity for MOP; inhibits reuptake of noradrenaline and 5-HT.
p.24
Antiarrhythmic Drug Classification
What is the primary action of Class II antiarrhythmics?
β-adrenoreceptor blockade.
p.11
Side Effects of Opioids
What is a significant breakdown product of ester local anesthetics that can cause hypersensitivity reactions?
p-aminobenzoic acid (PABA).
p.6
Side Effects of Opioids
What cardiovascular effects can Pethidine cause?
Orthostatic hypotension and tachycardia secondary to anticholinergic effects.
p.13
Anti-emetic Pharmacology
How can pre-hydration help reduce PONV?
Oral carbohydrate solutions given 2 hours pre-operatively reduce PONV.
p.18
Opioid Metabolism and Excretion
How is Chlorpromazine metabolized and excreted?
Hepatic metabolism; excreted in urine and bile.
p.26
Opioid Metabolism and Excretion
How is Quinidine metabolized and excreted?
Hepatic metabolism and excreted in urine.
p.1
Side Effects of Opioids
What are the central nervous system effects of morphine?
Analgesia, sedation, euphoria, hallucinations, and seizures at high doses.
p.8
Side Effects of Opioids
What are the respiratory effects of tramadol compared to morphine?
Tramadol causes less respiratory depression than morphine.
p.2
Morphine Dosage and Administration
What are the available forms of Diamorphine?
Tablets (10 mg) and powder (5/10/30/100/500 mg vials).
p.8
Side Effects of Opioids
Why is tramadol relatively contraindicated in epileptics?
Because it lowers the seizure threshold.
p.9
Mechanism of Action of Opioids
What is the mechanism of action (MOA) of Naloxone?
Competitive antagonist at opioid receptors, with the highest affinity for MOP.
p.2
Mechanism of Action of Opioids
What is the mechanism of action of Diamorphine?
Metabolites act at MOP or KOP receptors; Diamorphine itself has no affinity for opioid receptors.
p.21
Anti-emetic Pharmacology
What is the pediatric dosing for Ondansetron?
100 μg/kg every 8 hours for children over 2 years old.
p.6
Clinical Uses of Opioids
What are the primary uses of Pethidine?
Analgesia in labor, antispasmodic in renal and biliary colic, and treatment of post-operative shivering.
p.5
Mechanism of Action of Opioids
What happens to the effects of Remifentanil after discontinuation?
The effect is gone within 10 minutes, with no residual analgesia.
p.10
Local Anesthetics Classification
What is the role of α1-acid glycoprotein and albumin in relation to amide local anaesthetics?
Amide local anaesthetics are extensively bound to α1-acid glycoprotein and albumin in the plasma.
p.24
Antiarrhythmic Drug Classification
Which drugs are included in Class III antiarrhythmics?
Amiodarone, sotalol, bretylium.
p.13
Anti-emetic Pharmacology
What is a recommended strategy to minimize starvation times before surgery?
Using peri-operative intravenous fluid hydration.
p.15
Side Effects of Opioids
What are some side effects of butyrophenones like droperidol?
Extrapyramidal symptoms, neuroleptic malignant syndrome, altered temperature regulation, hypotension, tachycardia, arrhythmias, and endocrine effects.
p.11
Mechanism of Action of Local Anesthetics
What is 'state-dependent blockade' in local anesthetics?
Local anesthetics bind more avidly to inactivated or open sodium channels, affecting rapidly firing nerves preferentially.
p.9
Side Effects of Opioids
What are the cardiovascular effects of opioids?
Hypertension and ventricular arrhythmias.
p.20
Mechanism of Action of Opioids
What is the primary mechanism of action of Metoclopramide?
It antagonizes D2 receptors at the chemoreceptor-trigger zone (CTZ) and 5-HT3 receptors, and acts as an agonist at muscarinic receptors to increase gut motility.
p.13
Anti-emetic Pharmacology
What types of receptors are involved in the stimulation of vomiting?
Histamine (H1), muscarinic (mAchR), dopaminergic (D2), serotonergic (5-HT3), opioid, α1 and α2 adrenoceptors.
p.24
Antiarrhythmic Drug Classification
What effect do Class Ic antiarrhythmics have on the refractory period?
No effect on refractory period.
p.16
Clinical Uses of Opioids
What are the clinical uses of metoclopramide?
It is used in ICU for the treatment of gastric stasis and ileus.
p.28
Antiarrhythmic Drug Classification
What are the available forms and dosages of Flecainide?
Tablets: 50/100 mg; Solution: 10 mg/mL.
p.15
Anti-emetic Pharmacology
What is the primary use of domperidone?
It is used in the treatment of nausea and vomiting associated with cytotoxic therapy.
p.11
Mechanism of Action of Local Anesthetics
How do local anesthetics exert their effects?
By blocking sodium channels.
p.10
Local Anesthetics Classification
What is the metabolic pathway for amide local anaesthetics?
They undergo hepatic metabolism by hepatic amidases.
p.29
Mechanism of Action of Antiarrhythmic Drugs
What is the mechanism of action of Amiodarone?
Blocks K+ channels, slows depolarization, increases action potential duration and refractory period.
p.25
Antiarrhythmic Drug Classification
What conditions can nifedipine be used to treat?
Arterial spasm in coronary angiography, Raynaud's phenomenon, hypertension, and angina.
p.27
Antiarrhythmic Drug Classification
What is the maximum IV dose of lignocaine?
3 mg/kg or 7 mg/kg if in combination with adrenaline.
p.9
Clinical Uses of Opioids
What is the primary use of Naloxone?
Reversal of opioid overdose.
p.24
Antiarrhythmic Drug Classification
What is the mechanism of Class Ia antiarrhythmics?
Blocks fast Na+ channels in cardiac myocytes, increasing the refractory period.
p.10
Local Anesthetics Classification
How are local anaesthetics classified?
They are classified as either esters or amides based on the nature of the link between the aromatic group and the amine group.
p.29
Antiarrhythmic Drug Classification
What class of antiarrhythmic is Amiodarone?
Class III antiarrhythmic.
p.23
Antiarrhythmic Drug Classification
How are antiarrhythmic drugs traditionally classified?
According to the Vaughn–Williams system.
p.25
Antiarrhythmic Drug Classification
What do Class III antiarrhythmic drugs do?
They block K+ channels, decreasing K+ flux out of cells, which delays repolarization and increases the refractory period.
p.2
Opioid Metabolism and Excretion
How is Diamorphine metabolized?
Hydrolyzed by plasma enzymes and RBCs to 6-O-acetylmorphine, which is then glucuronidated to morphine.
p.5
Mechanism of Action of Opioids
What is the mechanism of action of Remifentanil?
It is a pure MOP opioid receptor agonist.
p.23
Antiarrhythmic Drug Classification
What is recommended when answering questions on antiarrhythmics?
Draw the graph of the nodal and myocyte action potentials.
p.21
Clinical Uses of Opioids
What are the primary uses of Ondansetron?
As an antiemetic, effective in PONV and chemotherapy-induced nausea and vomiting (CINV).
p.6
Mechanism of Action of Opioids
What is the mechanism of action of Pethidine?
Agonist at MOP and KOP opioid receptors, and it is not reversed by naloxone.
p.14
Anti-emetic Pharmacology
What should be avoided in high-risk patients during the intra-operative period?
Nitrous oxide and, if feasible, inhalation agents.
p.15
Anti-emetic Pharmacology
What is the role of 5-HT3 receptor antagonists in antiemetic therapy?
They are effective in the treatment and prevention of nausea and vomiting associated with chemotherapy.
p.16
Mechanism of Action of Opioids
How do antimuscarinic agents affect gastric motility?
They antagonize muscarinic M3 receptors, decreasing gastrointestinal motility, saliva production, and gastric secretions.
p.1
Side Effects of Opioids
What is the effect of morphine on the urinary system?
Increased tone in uterus, bladder detrusor, and sphincter muscles, potentially causing retention.
p.21
Anti-emetic Pharmacology
What are the available forms of Ondansetron?
Tablets (4/8 mg) and solution (2 mg/mL).
How is fentanyl absorbed in the body?
Orally, from the small intestine.
p.27
Antiarrhythmic Drug Classification
What are the signs of toxicity for antiarrhythmic drugs at levels greater than 4 μg/mL?
Perioral tingling, dizziness, tinnitus, and paresthesia.
p.27
Antiarrhythmic Drug Classification
What severe symptoms occur at antiarrhythmic drug levels greater than 5 μg/mL?
Altered consciousness, coma, and seizures.
What are the available forms of Chlorpromazine?
Tablets (10/25/50/100 mg), Syrup (5 mg/mL), Suppositories (100 mg), Solution (IM) (25 mg/mL).
p.26
Clinical Uses of Opioids
What caution should be taken when using Quinidine?
It displaces digoxin from binding sites, causing toxicity, and has vagolytic effects that can increase SA nodal rate and AV nodal conduction.
p.10
Local Anesthetics Classification
How does pH affect the binding of amide local anaesthetics?
Binding decreases with a reduction in pH, which can lead to toxicity in conditions like hypoxia and acidosis.
p.16
Clinical Uses of Opioids
What is the role of erythromycin in gastric motility?
Erythromycin acts as an agonist at motilin receptors, increasing gastric emptying and is used for short-term treatment of gastroparesis.
What effect does fentanyl have on histamine release?
It causes less histamine release compared to morphine.
What is a notable cardiovascular effect of fentanyl?
Associated with bradycardia.
p.12
Local Anesthetics Classification
What are the side effects of cocaine?
Hypertension, hallucinations, seizures, and coronary ischaemia.
p.25
Antiarrhythmic Drug Classification
Which drug groups can be used to treat VTs?
Drugs from groups Ic, III, and IV.
p.8
Side Effects of Opioids
How does tramadol affect constipation compared to morphine?
Tramadol causes less constipation than morphine.
p.26
Mechanism of Action of Opioids
What is the mechanism of action of Quinidine?
Blocks fast Na+ channels, prolongs phase 0 of action potential, increases refractory period, and decreases vagal tone.
p.22
Morphine Dosage and Administration
What is the typical dosage range for Prochlorperazine?
5–20 mg every 8–12 hours.
p.10
Local Anesthetics Classification
What characterizes amide local anaesthetics?
Amides contain an 'i' in the drug name followed by 'caine', e.g., lignocaine, bupivacaine.
p.12
Local Anesthetics Classification
What is the main feature of levobupivacaine compared to bupivacaine?
Less cardiotoxic in overdose.
p.7
Side Effects of Opioids
What cardiovascular effect can IV opioids cause?
Profound hypotension secondary to histamine release.
p.21
Opioid Metabolism and Excretion
How is Ondansetron metabolized?
Hepatic metabolism; dose should be decreased in liver failure.
p.22
Side Effects of Opioids
What are some central nervous system effects of Prochlorperazine?
Extrapyramidal symptoms, acute dystonias, akathisia in young patients, and mild sedation.
p.29
Amiodarone Dosage and Administration
What are the oral dosing instructions for Amiodarone?
200 mg t.d.s. for 1 week, reducing to BD for 1 week, then to od thereafter.
p.25
Antiarrhythmic Drug Classification
What is the main difference between verapamil and nifedipine?
Verapamil affects the SA and AV nodes, slowing conduction and decreasing heart rate, while nifedipine primarily decreases arterial tone with little effect on the nodes.
What is the effect of neostigmine on gastrointestinal motility?
Neostigmine increases the availability of acetylcholine at the myenteric plexus, enhancing gut motility, salivation, and gastric secretions.
p.7
Side Effects of Opioids
What are common gastrointestinal side effects of opioids?
Constipation, nausea, and vomiting.
p.5
Side Effects of Opioids
How does the potency of Remifentanil compare to morphine?
It is 50–80 times as potent.
p.23
Mechanism of Action of Antiarrhythmic Drugs
What happens during Phase 1 of the cardiac myocyte action potential?
Early repolarization with K+ outflow and Cl− influx.
p.14
Anti-emetic Pharmacology
How does the duration of anaesthesia affect the incidence of PONV?
As the duration of anaesthesia increases, so does the incidence of PONV.
p.18
Side Effects of Opioids
What central nervous system effects can Chlorpromazine cause?
Sedation, extrapyramidal side effects, neuroleptic malignant syndrome (rare), increased growth hormone, and increased prolactin.
p.7
Opioid Metabolism and Excretion
How is codeine metabolized?
10% is metabolized to morphine, with the rest undergoing glucuronidation, N-demethylation, and O-demethylation.
p.22
Mechanism of Action of Opioids
What is the primary mechanism of action of Prochlorperazine?
It antagonizes D2 receptors.
p.12
Local Anesthetics Classification
What is the onset time and protein binding percentage of lignocaine?
Fast onset (pKa 7.9) and 70% protein bound.
p.22
Opioid Metabolism and Excretion
How is Prochlorperazine metabolized and excreted?
It undergoes hepatic metabolism and is excreted in bile and urine.
p.29
Amiodarone Dosage and Administration
What is the IV loading dose of Amiodarone?
5 mg/kg over 1 hour, into a large vein.
p.13
Anti-emetic Pharmacology
What pre-operative measure can reduce anxiety and PONV?
Benzodiazepine premedication.
p.19
Anti-emetic Pharmacology
What are the common forms of Domperidone available?
Tablets (10 mg), Suspension (1 mg/mL), Suppositories (30 mg), Solution (IM) (12.5 mg/mL).
p.18
Mechanism of Action of Opioids
What receptors does Chlorpromazine antagonize?
D2, Muscarinic, α1, α2, H1, and 5-HT receptors.
p.6
Side Effects of Opioids
What respiratory effects are associated with Pethidine?
Respiratory depression, decreased tidal volume, decreased respiratory rate, and reduced response to pCO2 and pO2.
p.12
Local Anesthetics Classification
What is the main characteristic of cocaine as a local anesthetic?
Profound vasoconstriction.
p.19
Side Effects of Opioids
What effect does Domperidone have on the gastrointestinal (GI) system?
Increases the tone of the lower oesophageal sphincter.
p.19
Side Effects of Opioids
What is a notable side effect of Domperidone related to prolactin?
Increased prolactin secretion causing gynaecomastia and galactorrhoea.
p.4
Opioid Dosage and Administration
What are the common forms of fentanyl administration?
Patches, lozenges/lollypops, and patient-controlled transdermal systems.
p.11
Mechanism of Action of Local Anesthetics
What effect does adding bicarbonate to epidural solutions have?
It raises the pH, making the local anesthetic more un-ionised for faster onset.
p.14
Anti-emetic Pharmacology
What is the rule of one-third in relation to anti-emetic agents?
Each additional anti-emetic agent can reduce the risk of PONV by 30%.
p.14
Anti-emetic Pharmacology
What do dopaminergic receptor antagonists primarily target?
Dopaminergic receptors at the chemoreceptor trigger zone (CTZ) and muscarinic receptors at the vomiting centre.
How does domperidone differ from metoclopramide?
Domperidone is primarily an antiemetic that increases gastrointestinal motility but does not cross the blood-brain barrier, resulting in minimal central side effects.
p.3
Clinical Uses of Opioids
What are the primary uses of alfentanil?
It is used as a short-acting analgesic, to obtund hypertensive response to airway manipulation, and for sedation.
p.17
Clinical Uses of Opioids
What are the primary uses of cyclizine?
As an antiemetic and for Ménière’s disease.
p.27
Antiarrhythmic Drug Classification
What are the routes of administration for lignocaine?
Topical, infiltration, intrathecally, and epidurally.
p.2
Clinical Uses of Opioids
What are the clinical uses of Diamorphine?
Analgesia, sedation on ITU, palliative care, and treatment for congestive cardiac failure (CCF).
p.28
Flecainide Dosage and Administration
What is the loading dose for IV administration of Flecainide?
2 mg/kg over 30 min (max 150 mg).
p.24
Mechanism of Action of Antiarrhythmics
How do Class I drugs affect cardiac myocytes?
By blocking fast Na+ channels, reducing Na+ influx, and increasing the time to reach threshold potential.
p.16
Side Effects of Opioids
What are the side effects associated with cisapride?
Cisapride can cause long QT syndrome, ventricular tachycardia, ventricular fibrillation, and torsades de pointes.
p.6
Opioid Metabolism and Excretion
How is Pethidine metabolized?
Hepatic metabolism by N-demethylation to norpethidine, then hydrolyzed to pethidinic acid.
p.5
Side Effects of Opioids
What is a notable side effect of Remifentanil?
Bradycardia, which may be profound, especially following a bolus.
p.6
Opioid Metabolism and Excretion
What is the oral bioavailability of Pethidine?
50%, subject to first-pass metabolism.
p.11
Local Anesthetics Classification
What factors influence the duration of action of local anesthetics?
Protein binding and the addition of vasoconstrictors.
p.29
Side Effects of Opioids
What skin effect can Amiodarone cause?
Photosensitivity and 'slate-grey' skin.
p.28
Clinical Uses of Opioids
What cardiovascular effects can Flecainide have?
May precipitate conduction disorders and is a negative inotrope.
p.14
Anti-emetic Pharmacology
How can regional anaesthetic techniques help during surgery?
They can reduce opioid and volatile agent requirements.
p.28
Clinical Uses of Opioids
What conditions is Flecainide used to treat?
Termination of SVT, VT, and WPW.
p.14
Anti-emetic Pharmacology
What serious side effects are associated with chlorpromazine?
Extrapyramidal symptoms, sedation, impaired temperature regulation, and agranulocytosis.
p.5
Opioid Metabolism and Excretion
How is Remifentanil metabolized?
Undergoes rapid ester hydrolysis by non-specific plasma/tissue esterases.
How does codeine's potency compare to morphine?
Codeine is 10 times less potent than morphine.
p.5
Clinical Uses of Opioids
What are the clinical uses of Remifentanil?
Analgesia during general anesthesia, hypotensive anesthesia, and sedation in ICU.
p.22
Side Effects of Opioids
What are some other potential side effects of Prochlorperazine?
Haematological abnormalities, skin sensitivity, increased prolactin, neuroleptic malignant syndrome, and pruritis.
p.29
Opioid Metabolism and Excretion
How is Amiodarone metabolized and excreted?
Hepatic metabolism; excreted by biliary tract, lacrimal glands, and skin.
p.21
Side Effects of Opioids
What are some common side effects of Ondansetron?
Constipation, headache, bradycardia, and flushing.
p.27
Mechanism of Action of Antiarrhythmic Drugs
What is the mechanism of action of lignocaine?
Blocks fast Na+ channels, decreases the slope of Phase 0 action potential, decreases refractory period, and decreases vagal tone.
p.20
Side Effects of Opioids
What rare cardiovascular side effects can occur with Metoclopramide?
Hypotension and tachycardia.
p.24
Antiarrhythmic Drug Classification
How are Class I antiarrhythmics further classified?
According to their effects on the refractory period of the myocyte.
p.4
Opioid Dosage and Administration
What is the typical dose of fentanyl for pain relief?
1 μg/kg, repeat as needed.
p.27
Clinical Uses of Opioids
What are the primary uses of lignocaine?
As a local anesthetic and for the termination of ventricular tachycardias (VTs).
p.7
Clinical Uses of Opioids
Why has codeine been withdrawn from use in certain populations?
Due to unpredictable metabolism and risk of respiratory depression.
p.15
Anti-emetic Pharmacology
What is the potential role of neurokinin-1 receptor antagonists?
They may represent the final common pathway in the stimulation of the vomiting reflex.
p.14
Anti-emetic Pharmacology
What are the side effects of metoclopramide?
Acute dystonic reactions, sedation, diarrhoea, and neuroleptic malignant syndrome.
p.1
Side Effects of Opioids
What cardiovascular effects can morphine have?
No direct effects; may cause hypotension if histamine release occurs.
p.10
Local Anesthetics Classification
What should be avoided in local anaesthetic preparations for subarachnoid injection?
Preparations containing sodium metabisulphite or methyl parahydroxybenzoate should be avoided due to the risk of arachnoiditis.
p.13
Anti-emetic Pharmacology
What approach is suggested for greater antiemetic efficacy?
A multimodal approach using a combination of drugs acting at different receptors.
p.25
Antiarrhythmic Drug Classification
Which drug groups can be used to treat SVTs?
Drugs from groups Ia, Ib, Ic, and III (but not bretylium).
p.1
Side Effects of Opioids
What gastrointestinal effects does morphine have?
Decreased motility and secretion, nausea, and vomiting.
p.21
Side Effects of Opioids
What caution should be taken with Ondansetron regarding cardiac health?
Caution in patients with risk factors for prolonged QT interval and cardiac arrhythmias.
p.12
Local Anesthetics Classification
What is the unique feature of prilocaine in terms of its use?
Used in intravenous regional anaesthesia (Bier's block).
p.18
Side Effects of Opioids
What are some gastrointestinal effects of Chlorpromazine?
Antiemetic effects and increased weight.
p.6
Side Effects of Opioids
What is a significant caution when using high doses of Pethidine?
Norpethidine is proconvulsant, requiring caution in high doses.
p.15
Anti-emetic Pharmacology
Why is domperidone relatively free of side effects?
Because it does not cross the blood-brain barrier.
p.20
Side Effects of Opioids
What central nervous system side effects can Metoclopramide cause?
Extrapyramidal side effects, oculogyric crisis, sedation, and agitation.
p.19
Clinical Uses of Opioids
What are the primary uses of Domperidone?
Nausea and vomiting, especially following chemotherapy.
p.23
Mechanism of Action of Antiarrhythmic Drugs
What occurs during Phase 0 of the cardiac myocyte action potential?
Fast depolarization due to Na+ influx.
p.26
Clinical Uses of Opioids
What are the clinical uses of Quinidine?
Termination of SVTs including AF/flutter and termination of ventricular arrhythmias.
p.7
Morphine Dosage and Administration
What are the available forms of codeine?
Tablets (15/30/60 mg), syrup (5 mg/mL), and solution for injection (60 mg/mL).
p.11
Local Anesthetics Classification
What governs the potency of a local anesthetic?
The lipid solubility of the drug.
p.27
Opioid Metabolism and Excretion
How is lignocaine metabolized and excreted?
Hepatic metabolism and excreted in urine (<10% unchanged).
What is the effect of opioids on gastric motility?
Opioids agonize mu-opioid receptors, leading to reduced stomach emptying, decreased gut motility, and increased intestinal transit time.
p.23
Mechanism of Action of Antiarrhythmic Drugs
What occurs during Phase 3 of the cardiac myocyte action potential?
Rapid repolarization with K+ outflow.
p.6
Side Effects of Opioids
What are the potential effects of Pethidine on the gastrointestinal system?
Gastric stasis and less constipating than morphine.
p.28
Side Effects of Opioids
What are some common side effects of Flecainide?
Dizziness, paresthesia, headache.
p.7
Mechanism of Action of Opioids
What is the mechanism of action of codeine?
Acts via MOP and KOP opioid receptors, with antitussive effects through specific codeine receptors.
p.14
Anti-emetic Pharmacology
What is metoclopramide's mechanism of action?
It is a dopamine antagonist at the CTZ and increases gastric motility.
p.2
Side Effects of Opioids
What are the side effects of Diamorphine compared to morphine?
Thought to cause less nausea, vomiting, and constipation than morphine.
p.28
Mechanism of Action of Antiarrhythmic Drugs
What is the mechanism of action of Flecainide?
Blocks fast Na+ channels and prolongs phase 0 of action potential.
p.29
Side Effects of Opioids
What are the cardiovascular effects of Amiodarone?
Prolonged QT, hypotension, bradycardia.
p.24
Mechanism of Action of Antiarrhythmics
What is the effect of Class I drugs on the slope of Phase 0 of the action potential?
They decrease the slope of Phase 0 and decrease cardiac conduction velocity.
p.29
Side Effects of Opioids
What respiratory side effect is associated with Amiodarone?
Pneumonitis, affecting 10% after 3 years.
p.19
Opioid Metabolism and Excretion
How is Domperidone metabolized and excreted?
Hepatic metabolism; excreted in faeces and urine.
p.16
Side Effects of Opioids
What common side effects do opioids cause?
Opioids commonly cause constipation, nausea, and vomiting.
p.18
Clinical Uses of Opioids
What are the primary uses of Chlorpromazine?
Treatment of nausea and vomiting (especially in terminally ill), treatment of hiccoughs, and as an antipsychotic.
p.14
Anti-emetic Pharmacology
What are common side effects of antihistamines?
Dry mouth, urinary retention, blurred vision, and sedation.
p.20
Side Effects of Opioids
What endocrine effects can Metoclopramide have?
Increases prolactin levels, causing gynaecomastia and galactorrhoea.
p.10
Local Anesthetics Classification
What is the shelf-life of local anaesthetic solutions?
They have a shelf-life of approximately two years.
p.4
Mechanism of Action of Opioids
What is the mechanism of action (MOA) of fentanyl?
Potent agonist at MOP receptors.
p.28
Opioid Metabolism and Excretion
How is Flecainide metabolized and excreted?
Hepatic metabolism; active metabolites and unchanged drug excreted in urine.
p.15
Side Effects of Opioids
What are common side effects of 5-HT3 receptor antagonists?
Headache, flushing, diarrhoea, constipation, drowsiness, tachycardia, bradycardia, and ECG changes.
p.15
Anti-emetic Pharmacology
How does propofol exhibit antiemetic properties?
When given at sub-hypnotic doses at the end of surgery and during anaesthesia induction and maintenance.
p.11
Local Anesthetics Classification
How does the site of injection affect the rate of systemic vascular absorption of local anesthetics?
The rate varies by site, with intercostal space having the highest absorption and subcutaneous the lowest.
p.14
Anti-emetic Pharmacology
What are the side effects of muscarinic receptor antagonists?
Dry mouth, blurred vision, urinary retention, tachycardia, and sedation.
p.22
Opioid Metabolism and Excretion
What is a notable characteristic of Prochlorperazine's absorption?
It has variable oral absorption and significant first-pass metabolism, resulting in low oral bioavailability.
p.18
Side Effects of Opioids
What are some cardiovascular effects of Chlorpromazine?
Vasodilation and hypotension.
p.23
Mechanism of Action of Antiarrhythmic Drugs
What is the role of L-type Ca2+ channels in Phase 2?
They open to allow calcium influx.
p.6
Morphine Dosage and Administration
What are the dosing recommendations for adults taking Pethidine?
Oral: 50–150 mg every 4 hours; IM: 25–150 mg every 4 hours; IV: 25–100 mg every 4 hours; Epidural: 25 mg.
p.24
Mechanism of Action of Antiarrhythmics
What role do K+ channels play in the action potential of cardiac myocytes?
They are responsible for Phase 3 repolarization.
p.15
Anti-emetic Pharmacology
What properties does lorazepam have?
Sedative, amnesic, and antiemetic properties.
p.15
Anti-emetic Pharmacology
How can acupuncture help with nausea?
Acupuncture at point P6 can reduce the incidence of post-operative nausea and vomiting (PONV).
p.14
Anti-emetic Pharmacology
What technique is associated with a reduction in PONV rates?
Total intravenous anaesthetic techniques using propofol.
p.15
Anti-emetic Pharmacology
What is the effectiveness of high doses of dexamethasone?
They are effective in treating nausea caused by cytotoxic agents and in preventing post-operative nausea and vomiting (PONV).
What drug interactions should be avoided with Amiodarone?
Other drugs that prolong QT, such as tricyclics and thiazides.
p.14
Anti-emetic Pharmacology
What type of receptors do antihistamines act on for their antiemetic action?
H1 receptors within the CNS.
p.11
Mechanism of Action of Local Anesthetics
How does pKa affect the speed of onset of local anesthetics?
Lower pKa results in a higher un-ionised fraction, leading to faster onset.
p.29
Side Effects of Opioids
What thyroid-related effects can Amiodarone have?
Hypo/hyperthyroidism and affects iodide absorption.
p.4
Clinical Uses of Opioids
What are the uses of fentanyl in clinical practice?
Perioperative analgesia, opioid-based anesthesia, and chronic pain management.
p.15
Anti-emetic Pharmacology
What is nabilone used for?
It is approved for the treatment of chemotherapy-induced nausea and vomiting and as an analgesic adjunct for neuropathic pain.
p.14
Anti-emetic Pharmacology
What is imperative for reducing PONV during the peri-operative period?
Good peri-operative analgesia.
p.18
Side Effects of Opioids
What are some serious side effects associated with Chlorpromazine?
Agranulocytosis, hemolytic anemia, leucopenia, cholestatic jaundice.
p.14
Anti-emetic Pharmacology
What is the primary action of muscarinic receptor antagonists?
They act as competitive antagonists of muscarinic receptors at the vomiting centre and in the gastrointestinal tract.
