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293 Cards in this Set
- Front
- Back
|
Name of NMB w/ very short DOA?
|
Succinylcholine
|
|
Which NMBs are eliminated by plasma cholinesterase?
|
Succinylcholine
Mivacurium |
|
Which NMBs are eliminated by biliary route?
|
Vecuronium
Rocuronium |
|
Which NMBs are metabolized by Hoffman elimination?
|
Cisatracurium
Atracurium |
|
Which NMBs elicit the release of histamine?
|
Metocurine
Mivacurium Atracurium Succinylcholine dTubocurarine |
|
Which NMBs produce bradycardia and why?
|
Succinylcholine
Mimicks Ach, directly stimulates muscarinic receptors of SA node |
|
Which NMBs produce Tachycardia? Why?
|
metocurine
dTubocurarine Atracurium =reflex tachycardia Pancuronium gallamine =direct vagolytic |
|
Which NMBs produce significant HTN?
|
gallamine
pancuronium |
|
SEs of Succ include?
|
Hypotension
bradycardia histamine release |
|
SEs of mivacurium include?
|
histamine release
|
|
Which muscle relaxants produce autonomic blockade?
|
dTubocurarine
metocurine |
|
SEs of dTubocurarine include?
|
histamine release
autonomic ganglia blockade reflex tachycardia hypotension |
|
SEs of metocurine include?
|
histamine release
autonomic ganglia blockade reflex tachycardia hypotension |
|
What 2 NMBs cause: autonomic blockade, histamine release, reflex tachycardia, and hypotension?
|
d-tubocurarine
metocurine |
|
SEs of pancuronium include?
|
tachycardia-direct vagolytic
HTN |
|
SEs of Gallamine include?
|
tachycardia-direct vagolytic
HTN |
|
What 2 NMBs cause tachycardia and HTN?
|
Pancuronium
Gallamine |
|
How much may Succ raise plasma K+ levels?
|
0.5 mEq/L in normal pt.
5-10mEq/L in burn, trauma or head injury pts. |
|
In which pts are you concerned w/ Hyperkalemia after Succ admin?
|
Burns
Paraplegia or hemiplegia Skeletal muscle trauma upper motor neuron injury (head injury, CVA, Parkinsons) |
|
NDNMB is unchanged by?
|
Cephalasporins
PCN Chloramphenicol IV corticosteroids |
|
Where are muscarinic receptors located?
|
tissues innervated by the PNS
exception: sweat gland=postganglionic sympathetic nerves release Ach. |
|
Where are adrenergic receptors located?
|
tissues innervated by the SNS
except sweat gland=postganglionic sympathetic nerves release Ach, has muscarinic receptors |
|
Sympathetic and parasympathetic preganglionic neurons are what type of fiber?
|
B fibers
|
|
Postganglionic sympathetic neurons are what fiber type?
|
C fibers
|
|
S/S of Horners Syndrome (due to stellate ganglion blockade) are?
|
Ipsilateral: miosis
ptosis enopthalamos flushing increased skin temp anhydrosis nasal congestion |
|
List the steps in the synthesis of norepi.
|
tyrosine -->dopa
dopa-->dopamine dopamine-->norepi |
|
Which electrolyte concentrations are higher in the cell?
|
K
Mag Phosphate |
|
What electrolyte abnormalities cause increased neurotransmitter release?
|
Hypercalcemia
Hypo mag |
|
Which drugs are Beta agonists?
|
Tertbutaline
Albuteral Metoproterenol Isoethrine Dobutamine (B1) Ritodrine Isoproterenol (B1, B2) Salmeterol |
|
What effect does stimulation of Beta 1 receptors lead to?
|
Increased contractility and HR--> increased CO and BP
|
|
What effect does stimulation of Beta 2 receptors lead to?
|
Dilates skeletal muscle blood vessels --> decreased SVR
Promotes bronchodilation relaxes pregnant uterus stimulates the NaK pump |
|
Which drugs are alpha and beta agonists?
|
Epi (adrenaline)
Norepi (Levophed)-no B2 action |
|
Which drugs work at Dopa receptors?
|
Fenoldapam
Metoclopramide Dopamine |
|
What drug has some action at Alpha, Beta and dopaminergic receptors?
|
Dopamine
|
|
Phenylephrine primarily stimulates _____ receptors.
|
A1
|
|
Alpha 1 receptor stimulation leads to?
|
arterial and venous constriction-->increased BP
|
|
Clonidine primarily stimulates ____ receptors.
|
A2
|
|
Stimulation of alpha 2 receptors leads to?
|
Decreased synthesis and release of norepi (negative feedback)
in brainstem-inhibits outflow of SNS in substantia gelatinosa-promotes analgesia |
|
Isoproterenol primarily stimulates _____ receptors.
|
B1 and B2
|
|
Dobutamine primarily stimulates ______ receptors.
|
B1
|
|
Ritodrine (Yutopar) primarily works at ____ receptors.
|
B2 with minimal B1
|
|
Ephedrine primarily stimulates _______ receptors.
|
A1 A2 B1 B2 (indirect agent)
|
|
Isoproterenol is used to?
|
tx complete heart block-chemical pacemaker
1-5mcg/kg/min infusion (B1 B2) |
|
Dobutamine is used to?
|
Increase CO secondary to increased contractility in CHF, especially if HR and SVR are increased
|
|
Name of NMB w/ short DOA?
|
Mivacurium
|
|
SEs of Atracurium include?
|
histamine release
reflex tachycardia |
|
Terbutaline primarily affects _____ receptors.
|
B2 w/ minimal B1
|
|
Yohimbine is _____. Is used to _____.
|
selective alpha 2 antagonist
used to tx impotence |
|
Which adrenergic receptor antagonist should generally be avoided in pt. w/ irritable airway?
|
non-selective Beta2 blocker like propanolol
|
|
Opiod agonist drug names include?
|
Morphine
Fentanyl Sufentanil Alfentanil Remifentanil Codiene Meperidine Hydromorphone |
|
Which opiod is metabolized by plasma esterase?
|
Remifentanil (Ultiva)
|
|
Drug names of competitive opiod antagonists include?
|
Naloxone
Naltrexone Nalmefene |
|
In which NMB will you see hypotension and reflex tachycardia w/ rapid admin of high doses?
|
Mivacurium
|
|
What does Cromolyn Sodium do and what is it used for?
|
Used prophylactically to prevent histamine release and bronchoconstriction
|
|
What are some physiologic properties of NMBs?
|
100% ionized at physiologic pH
Highly protein bound do not cross BBB or placenta Trapped in renal tubule bc of high degree of ionization |
|
NDNMB is decreased by?
|
Chronic anticonvulsants
thermal burn injury |
|
A alpha EFFERENT fibers do what?
|
adjust skeletal muscle force and length
|
|
SEs of Beta2 agonists include?
|
hypokalemia
hyperglycemia hypomag lactic acidosis tremor tachycardia transient decrease in arterial oxygenation |
|
Adenosine is what? Is used for? Dose?
|
endogenous neucleotide occurring in all cells.
admin to: 1. slow conduction through AV node 2. interrupt reentry pathways through AV node 3. restore NSR in PSVT with WPW Dose is: 6-12mg IV rapid injection. |
|
Dopamine is used to?
|
Simultaneously increases CO, RBF, GFR, UOP, and Na excretion.
|
|
Phenoxybenzamine is ____. Used to?
|
long acting nonselective alpha antagonist
used to control BP in pts w/ pheochromocytoma |
|
Cholinesterase inhibitor drugs include?
|
Neostigmine
Pyridostigmine Physostigmine Ecothiophate Edrophonium |
|
What is Bethanechol and what is it used for?
|
cholinergic agonist/parasympahtomimetic
used to tx adynamic ileius and urinary retention |
|
Alpha agonist drugs include?
|
Phenylephrine
Methoxamine Clonidine |
|
Antimuscarinic/anticholinergic drug names include?
|
Atropine
Scopolamine Glycopyrrolate |
|
What is Doxapram and what is it used for?
|
general CNS stimulant
used to increase alveolar ventilation; reverse respiratory depression |
|
Which drugs are indirect acting agents?
|
Ephedrine
Metarminol Mephentermine |
|
SVR=
|
80(MAP-CVP)/CO
900-1500 dynes/sec/cm-5 |
|
CCBs drug names include?
|
Verapamil
Diltiazem Nifedipine (reflex increase HR) all are arterial dilators |
|
Which NMBs produce significant hypotension?
|
Succ
dTubocurarine metocurine |
|
SV=
|
SV=CO/HR
60-90ml |
|
PVR=
|
80(PAP-PCWP)/CO
50-150 dynes/sec/cm-5 |
|
Ace Inhibitor drugs include?
|
Captopril
Enalapril Are arterial dilators |
|
What drugs are predominantly centrally acting sympathomimetics?
|
Alpha Methyldopa
Clonidine Dexmedetomidine (Precedex) |
|
Prazosin is ______
works by ______ |
Prazosin is an A1 antagonist
decreases BP without increasing release of norepi |
|
Which drugs are alpha antagonists (blkrs)?
|
Phentolamine (non selective)
Phenoxybenzamine (non selective) Yohimbine Prazosin |
|
Cholinergic agonists/parasympathomimetics include what drugs?
|
Chloramphenicol
Arecoline Methacholine Pilocarpine Bethanechol Muscarine |
|
Xanthine drugs are?
Used for? |
Aminophylline
Theophylline used to produce bronchodilation Aminophylline is used to tx neonatal apnea |
|
Direct acting vasodilators are?
|
Nitroprusside-arterial & venous
Nitroglycerin -venous Hydralazine-arterial Diazoxide-arterial |
|
Pilocarpine and Carbachol are used to tx?
|
Narrow angle glaucoma
parasympathomimetics mimic activation of PNS->miosis which facilitates drainage of aqueous humor-> decreased IOP |
|
Adrenergic Agonists used in respiratory pharmacology include?
|
Epi >
Isoproterenol >non selective Ephedrine > Metaproterenol - Isoethrine - selective Albuterol - B2 Terbutaline - agonists |
|
SI=
|
SI=SV/BSA
40-60ml/m2 |
|
murmur heard with AR?
|
diastolic
L sternal border |
|
murmur heard with MR?
|
holosystolic
apex->axilla |
|
murmur heard with AS?
|
systolic
2nd ICS ->neck |
|
murmur heard with MS?
|
diastolic
apex or in axilla |
|
Adhesion of PLTs to damaged vascular wall requires?
|
Von Willebrands Factor (VIII, VWF)
|
|
Activation of PLTs requries?
|
Thrombin (factor IIa)
|
|
Aggregation of PLTs requries?
|
Thromboxane A2 and ADP
(are mediators released by the activated PLT) when thrombine IIa combines w/ the thrombin receptor on PLT and activates the PLT. |
|
Cryoprecipitate containes?
|
factor VIII
factor XIII factor I fibrinogen |
|
Coagulation factors of the extrinsic pathway are?
|
3, 7
You can purchase the extrinsic pathway for 37 cents. |
|
Coagulation factors of the intrinsic pathway are?
|
11, 12, 9, 8
If you cannot purchase the intrinsic pathway for $12, you can get it for $11.98. |
|
Coagulation factors of the final common pathway are?
|
5, 10, 1, 2, 13
You can purchase the final common pathway at the five and dime for 1 or $2 on the 13th. |
|
Opiod agonist/antagonist drug names are?
|
Nalbuphine
Nalorphine Butorphanol Buprenorphine Dezocine Pentazocine |
|
Phosphodiasterase Inhibitors include?
What do they do? |
Inamrinone
Milrinone Phosphodiasterase inhibitors block the breakdown of cAMP, Increase contractility and decrease SVR (relaxes vascular smooth muscle). |
|
What drugs should be avoided with hypertrophic cardiomyopathy?
|
Nitrates
diuretics digoxin will worsen LV outflow obstruction want to keep full and forward (maintain NSR, increase preload and afterload, decrease contractility to reduce obstruction) |
|
What drugs cause abnormal PLT aggregation
|
ASA
NSAIDs (Ketorolac, ibuprofen) Plavix Ticlopidine Dipyridamole GP IIB/IIIa (tirofiban, eptifibatide, abciximab) |
|
What are GPIIB/IIIa drugs and what do they do?
|
Tirofiban
eptifibatide abciximab prevent PLT aggregation |
|
FFP contains?
|
All coag and anticoag factors produced by the liver including antithrombin
does not contain PLTs |
|
Normal PT value?
Assesses? |
8-14 seconds
assesses extrinsic and final common pathway (Coumadin) |
|
Normal PTT value?
Assesses? |
25-35 sec
Assesses the intrinsic and final common pathway (Heparin) |
|
Normal bleeding time?
|
3-10 min
|
|
Which coag factors are not made in the liver?
|
3, 4, 8
factors 3, 4, and 8, the liver does not make. |
|
The clotting factor responsible for cross linking fibrin is?
|
factor XIII
|
|
What substance converts fibrin to fibrin split products?
|
Plasmin
Plasmin breaks down fibrin |
|
Major motor nerve of the larynx?
|
Recurrent Laryngeal Nerve
Supplies all muscles of the larynx except the cricothyroid |
|
Cricothyroid muscle is innervated by?
|
External superior laryngeal nerve
|
|
Which nerve is the major sensory nerve of the larynx?
|
Internal superior laryngeal nerve
supplies sensation from the vocal cords up |
|
External branch of the superior laryngeal nerve innervates?
|
cricothyroid muscle
|
|
Internal branch of the superior laryngeal nerve innervates?
|
major sensory nerve of the larynx.
sensory from vocal cords up |
|
What muscle relaxes the vocal cords?
|
thyroarytenoid
|
|
Recurrent laryngeal nerve supplies motor innervation to?
sensory innervation to? |
all the muscles of the larynx except the cricothryoid.
sensory below the vocal cords |
|
How do you calculate the amount of O2 dissolved in blood?
|
.003 X PaO2
|
|
Whose law allows the amount of dissolved O2 in blood to be calculated?
|
Henrys law
|
|
How do you calculate the amount of CO2 dissolved in blood?
|
.067 x PCO2
|
|
Which nerve carries sensory impulses form the carotid bodies?
|
glossopharyngeal
|
|
Which muscles tense the vocal cords?
|
cricothyroid
|
|
Which nerve carries sensory impulses from aortic bodies and stretch receptors in lung parenchyma?
|
Vagus nerve
|
|
What nerve supplies sensory innervation to laryngeal mucosa inferior to the vocal cords?
|
Recurrenl Laryngeal Nerve
|
|
Antithrombin III inhibits what clotting factors?
|
2, 9, 10, 11, 12
strongly inhibits 2a and 10a of the final common pathway partially inhibits factors 9a, 11a, 12a of intrinsic pathway |
|
Formula for total amount of Hgb bound and dissolved O2 in blood is?
|
(1.34*Hgb*Sat)+(.003*PaO2)
|
|
Short cut to figure out PaO2 and PAO2.
PaO2= PAO2= |
PaO2=%*5
PAO2=%*6 |
|
Normal ACT value?
Assesses? |
80-150 sec
Assesses adequacy of heparinization |
|
Hirudin, Ximelagatran, and Argatroban are what kind of drugs?
|
direct thrombin inhibitors
|
|
What is mannitol and how does it work?
|
Mannitol is an osmotic diuretic
Is freely filtered into bowmans capsule and remains trapped in the renal tubule exerting an osmotic force that hinders the reabsorption of H2O->diuresis |
|
What is the urine volume and osmolality when ADH release is inhibited?
|
Decreased ADH=low osmolality and large volume of urine.
In absence of ADH, distal tubule and collecting duct are impermeable to H2O, a large volume of dilute urine is formed. (increased ADH=reabsorption of H2O) |
|
What hormone controls extracellular fluid volume?
|
volume=aldosterone
Aldosterone is the most important hormone for regulating extracellular fluid volume |
|
What hormone controls extracellular sodium concentration?
|
sodium conc=ADH
Increased ADH=Increased H2O reabsorption (dilutes extracellular Na) |
|
Potassium sparing diurtec drug names include?
|
Spironolactone (aldactone)
Trieamterine Amiloride |
|
Where is ADH synthesized and what stimulates its release?
|
ADH is synthesized in the hypothalamus
stored in the posterior pituitary released by: increased osmolality hypotension stress pain CPAP, PEEP, volatile agents |
|
Metoclopramide does what?
|
Increases LES tone
speeds gastric emptying decreases pyloric sphincter tone relaxes deodenum no effect on gastric pH |
|
What drugs should be avoided in Parkinson's disease?
|
Dopaminergic antagonists
metoclopramide (Reglan) prochlorperazine (compazine) droperidol (Inapsine) |
|
The formula for calculating volume of distribution is?
|
Vd-quantity/concentration
Vd=Q/Cpt=0 |
|
Tissues ranked from highest to lowest blood flows are?
|
IV
Tracheal Intercostal Caudal Paracervical Epidural Brachial plexus Subarachnoid, Sciatic, Femoral SubQ |
|
With age, PAO2-PaO2=
|
0.21 * (age +2.5)
|
|
Types of phase I reactions include?
|
Hydrolysis
Oxidation Methylation Reduction |
|
Where are nicotinic receptors located?
|
autonomic ganglia
adrenal medulla motor end plate of skeletal muscle |
|
Name of NMBs with intermediate DOA?
|
Vecuronium
Rocuronium Atracurium Cisatracurium |
|
Dopamine primarily stimualtes ______ receptors?
|
A1, A2, B1, D1
|
|
A alpha and A beta SENSORY fibers are responsible for?
|
proprioception (position sense)
|
|
dC fibers carry sensations of?
|
throbbing pain and temp
|
|
A delta fibers carry sensations of?
|
sharp, prickling pain and temp
|
|
What are leukotriene antagonist drug names?
What do these drugs do? |
Zafirlukast
Montelukast Zileuton Decrease bronchospasm, vasoconstriction and eosinophil recruitment promoted by leukotrienes |
|
Loop diuretics are?
|
pneumonic To BFE
Torsemide Bumetanide Furosemide Ethacrynic acid |
|
Thiazide diuretic drug names include?
|
Chlorothiazide
Chlorthalidone Hydrochlorothiazide Metolazone |
|
Carbonic anyhdrase inhibitor drug name?
Used for? |
Acetazolamide
Inhibits reabsorption of bicarb and Na-> diuresis (hyperchloremic metabolic acidosis) and decreased formation of aqueous humor (decreased IOP) |
|
H2 antagonists include?
|
Cimetidine
Ranitidine Famotidine (pepcid) |
|
What do H2 antagonists do?
|
Inhibit HCL acid production
raises gastric pH decreases gastric volume |
|
Antiemetic drugs include?
|
Droperidol > dopamine
Prochlorperazine> antagonists Metoclopramide > Scopolamine (antimuscarinic) Ondansetron (5HT3 antagonist) |
|
LAs with short DOA include?
|
Procaine
Prilocaine Chloroprocaine |
|
LAs with a moderate DOA?
|
Lidocaine
Mepivicaine |
|
LAs with a long DOA?
|
Bupivicaine
Etidocaine Ropivicaine Tetracaine |
|
Short acting Barbituates include?
|
Thiopental
Methohexital Thiamylal |
|
Thiopental should not be given to which pts?
|
Porphyria
Severe Asthma Hypoalbuminemia (drug is highly protein bound, hyopalbuminemia->increased free durg=increased drug effects. |
|
Which barbituate has prominent excitatory effects?
|
Methohexital (hiccups, myoclonus)
|
|
Short acting Benzos are?
|
Midazolam
Lorazepam Diazepam |
|
Effects of Benzodiazepines include?
|
antianxiety
amnesia sedation hypnotic anticonvulsant muscle rlxn poor analgesic decrease CBF and CMRO2 little effect on CV system unless volume depleted |
|
What IV anesthetic directly depresses cortisol output from the adrenal cortex and depresses the immune system?
|
Etomidate
|
|
Vapor pressure of the volatile agents at 20C?
|
Des 669
Sevo 170 Iso 240 Enflurane 172 Halothane 244 |
|
1mmHg= _____cmH2O
|
1mmHg=1.36cmH2O
|
|
1atm=___mmHg=____psi=____kpa= ____bar
|
1atm=760mmHg=14.7psi=101kpa=1 bar
|
|
1psi=____mmHg
|
1psi=54mmHg
|
|
*A blood vessel that is anuerysmal has greater wall tension
*With greater ventricular filling during diastole, there is greater tension in the wall at end diastole *In ARDs, smaller alveoli empty into larger alveoli (atelectasis) |
Law of Laplace
|
|
For IV admin, fluid flow is increased by:
increased diameter of needle decreased length of needle raising IV bag polycythemic pts has decreased flow anemic pt has increased flow |
Poiseulles' law
|
|
*Explains teh release into the atmosphere of a large amount of gas from a compressed cylinder
*Squeezing the ambu bag increases pressure and decreases volume |
Boyles Law
|
|
The inflatable cuff on an ETT or LMA expands during sterilization in an autoclave.
|
Charles Law
|
|
As a cylinder of compresed gas empties, the pressure in the cylinder falls
|
Ideal gas law
|
|
*Permits calculation of the % concentration of a gas
* Permits calculation of the partial pressure of a gas |
Daltons Law
|
|
Concentration effect
Second gas effect Diffusional hypoxia Expansion of gas spaces |
Ficks Law of Diffusion
|
|
Calculation of SVR
Calculation of resistance of flow through a tube |
Ohms Law
|
|
The solubility of a gas increases with decreased temp.
|
Le Chateliers Principle
|
|
Explains why smaller substances diffuse in greater quantities
|
Grahams Law
|
|
Which LAs have short onset and very short DOA?
|
Prilocaine
Chloroprocaine |
|
Which LAs have an intermediate onset and DOA?
|
Lidocaine
Mepivicaine |
|
Which LAs have a slow onset & long DOA?
|
Bupivicaine
Ropivicaine |
|
The order in which nerves are blocked following epidural administration of LA are?
|
B fibers
C and A delta (pain, temp, touch) A gamma A beta A alpha |
|
Dosage for caudal in children is?
|
0.5-1 mg/kg of 0.125% to 0.25% bupivicaine
|
|
Dosage for caudal in a premie?
|
Chloroprocaine 1ml/kg bolus then 0.3ml/kg to desired level
|
|
Dosage for caudal in an Adult?
|
S5-L2=15-25ml
S5-T10=35ml |
|
An ankle block consists of anesthetizing what 5 nerves?
|
Saphenous
Sural Superficial peroneal Deep peroneal Posterior tibial |
|
Which nerve of the ankle is the most difficult to block?
|
Posterior tibial
|
|
Which nerves of the ankle are superficial?
|
Sural
Saphenous Superficial peroneal |
|
Which nerve is frequently missed with and interscalene block?
|
Ulnar
|
|
Extension of the elbow
Supination of the forearm Extension of wrist and fingers is accomplished by what nerve? |
Radial nerve
|
|
Pronation of forearm
Flexion of wrist Opposition of middle, forefinger and thumb Flexion of lateral 3 fingers is due to what nerve? |
Median nerve
|
|
What nerve is responsible for flexion at the elbow?
|
Musculocutaneous nerve
|
|
Injury to the ulnar nerve leads to?
|
Inability to abduct or oppose the 5th finger
decreased sensation over ring and pinky fingers eventually claw hand |
|
Injury to what nerve causes an inability to abduct or oppose the 5th finger, decreased sensation over rink and pinky fingers, and eventually to claw hand?
|
Ulnar nerve
|
|
Injury to the radial nerve results in?
|
wrist drop
|
|
Injury to the median nerve results in?
|
Inability to oppose thumb (1st and 5th digits)
|
|
The sciatic nerve divides into?
|
Common peroneal (further divides into superficial and deep peroneal nerves)
Tibial (divides into sural nerve) |
|
Injury to the common peroneal nerve results in?
|
foot drop
loss of dorsal extension of the toes inability to evert the foot |
|
Foot drop, loss of dorsal extension of the toes, and inability to evert the foot are caused by injury to what nerve?
|
common peroneal nerve
|
|
The most common postop peripheral neuropathy is?
|
Ulnar nerve
|
|
Injury to this nerve eventually leads to claw hand.
|
Ulnar nerve
|
|
Injury to this nerve prevents abduction and opposition of the 5th finger.
|
Ulnar nerve
|
|
Which nerve is compressed when pressure is applied to the spiral groove of the humerus?
|
Radial nerve
|
|
Injury to this nerve results in decreased sensation over the dorsal surface of the lateral 3 1/2 fingers.
|
Radial
|
|
This nerve may be damaged during IV starts.
|
Median nerve
|
|
When this nerve is injured, opposition of the 1st and 5th digits is precluded.
|
Median nerve
|
|
Dosage of intrathecal (spinal) and epidural opiods are?
|
Drug spinal epidural
Morphine 0.5-1mg 7.5-10mg Meperidine 10-20mg 100mg Fentanyl 10-25mcg 50-100mcg Sufentanil 3-10mcg 10-30mcg |
|
Intrathecal and epidural dose of morphine is?
|
0.5-1mg intrathecal
7.5-10mg epidural |
|
Intrathecal and epidural dose of Meperidine is?
|
10-20mg intrathecal
100mg epidural |
|
Intrathecal and epidural dose of Fentanyl is?
|
10-25mcg intrathecal
50-100mcg epidural |
|
Intrathecal and epidural dose of Sufentanil is?
|
3-10 mcg intrathecal
10-30 mcg epidural |
|
Early FHR decelerations are caused by?
|
head compression or stretching of the neck during contractions (vagal stimulation)
|
|
Late decelerations of FHR are due to?
|
uteroplacental insufficiency
fetal compromise w/ a decrease HR classified as severe if FHR decreases by >45bpm |
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Variable decelerations of FHR are caused by?
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cord compression
severe if FHR decreases by 60bpm, FHR decreases to <60bpm or decelerations last 60 sec or longer |
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Normal mag level is?
|
Mag level = 1.5-2 mEq/L
|
|
At what mag levels will you see:
ECG changes Loss of DTR SA & AV block Respiratory paralysis Cardiac arrest |
Mag levels
ECG changes=5-10 loss of DTR=10 SA & AV node block=15 Resp paralysis=15 CV arrest=25 |
|
The blood gas partition coefficients for the inhalation agents are?
|
N2O .46.
Des .42 Sevo .65 Iso 1.4 Enflurane 1.91 Halothane 2.5 |
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Blood solubility of a volatile agent determines?
|
speed of onset and offset
|
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Mac of the volatile agents are?
|
N20 104
Des 6 Sevo 2 Iso 1.15 Enflurane 1.65 Halothane .74 |
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The oil:gas partition coefficients for the volatile agents are?
|
N20 1.4
Des 18 Sevo 53 Iso 90.8 Enflurane 98.5 Halothane 224 |
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How does aging affect spinal and epidural anesthesia?
|
With aging spinal has:
increased DOA increased sensory block with aging epidural has: increased cephalad spread Decreased DOA, motor blk, and dose |
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Formula for hourly fluid maintenance is?
|
4ml/kg for 1st 10 kg
2ml/kg for next 10kg 1ml/kg for ea kg >20 short cut: if > 20kg, add 40=maint |
|
Estimated blood volume (ml/kg)
premature infant (<6wks) toddler (6wks-2yrs) child (2-12) adult M adult F |
EBV
premature=90ml/kg infant (<6wks)=80 toddler (6wks-2yrs)=75 child (2-12yrs)=72 Adult M=70 Adult F=65 |
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Formula for ETT length at mouth?
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10+age/2
|
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Formula for ETT ID?
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4+ (age/4)
or 16+age/4 |
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LMA sizes and cuff volume?
|
< or equal to 5kg=1 4cc
5-10kg=1.5 7cc 10-20kg=2 10cc 20-30kg=2.5 14cc 30-50kg=3 20cc Adult=4 30cc Adult=5 40cc >100kg=6 50cc |
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Bilateral superior laryngeal nerve damage leads to?
|
Hoarseness
|
|
Unilateral recurrent laryngeal nerve damage leads to?
|
Hoarseness
|
|
Bilateral recurrent laryngeal nerve damage.
Acute= Chroic= |
Acute bilateral RLN damage=stridor
Chronic bilateral RLN damage=aphonia |
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Unilateral vagus nerve damage=
|
hoarseness
|
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Which nerve when stimulated will cause laryngospasm?
|
superior laryngeal nerve
|
|
BIS ranges are?
|
100=awake
90-70=light/mod sedation 70-60=deep sedation 60-40=general anesthesia 40-10=deep hypnotic state 10-0=flat line EEG |
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Red light is absorbed?
|
by deoxyhgb at 660nm
|
|
Infrared light is absorbed?
|
by oxyhgb at 940nm
|
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Normal CVP is?
|
0-8mmHg
|
|
The a wave on CVP is?
|
atrial contraction
|
|
the C wave on CVP is?
|
ventricular contraction
|
|
the x descent on CVP is?
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pulling down of atrium by ventricular contraction
|
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the v wave on CVP is?
|
pressure buildup from venous return before AV valve opens
|
|
the y descent on CVP is?
|
decline in atrial pressure as AV valve opens
|
|
Pulmonry artery Catheter measurements at
Subclavian RIJ LIJ RAC LAC Femoral |
RA (+10)RV(+15)PA
Subclavian 15 25 40 RIJ 20 30 45 LIJ 25 35 50 RAC 40 50 65 LAC 45 55 70 Femoral 50 60 75 |
|
Diastance of PA cath to RA at:
Subclavian RIJ LIJ RAC LAC Femoral |
Subclavian 15
RIJ 20 LIJ 25 RAC 40 LAC 45 Femoral 50 add 10 to find distance to RV and add another 15 to find distance to PA |
|
RA pressure is?
|
1-8mmHg
|
|
RV pressure is?
|
15-25/1-8mmHg
|
|
PA pressure is?
|
15-25/8-15mmHg
(diastolic step up) |
|
PCWP=
|
6-12mmHg
|
|
Addisons disease s/s include?
|
aldosterone deficiency=hyponatremia
hypovolemia hypotension Hyperkalemia metabolic acidosis Cortisol deficiency=weakenss fatigue hypoglycemia hypotension wt. loss |
|
Addisons disease is?
|
adrenal gland destruction
|
|
Cushings disease is?
|
Excess corticosteroids
|
|
Cushings s/s include?
|
muscle wasting
weakness osteoperosis central obesity abdominal striae glucose intolerance HTN mental status changes |
|
What is the dose and concentration of mannitol for decreasing intracranial volume?
where does mannitol work? |
20% 1g/kg
works in the proximal tubule |
|
A bilateral superior laryngeal nerve block is performed by?
|
injecting 3ml of 2% lido 1cm below the L and R greater cornu of the hyoid bone.
Provides anesthesia to the airway below the epiglottis |
|
glossopharyngeal block is performed by?
|
pt. open mouth
inject 2ml of LA bilaterally at base of the palatoglossal arch (anterior tonsillar pillar) |
|
Formula for ideal body weight is?
|
height in cm-100 for men
heigh in cm-105 for women 1 inch=2.54cm |
|
1 inch=____cm or ____meters
|
1 inch =2.54 cm
1 inch=.0254meters |
|
Which benzodiazepine has the longest elimination half life?
|
Diazepam (30hrs)
Lorazepam (15hrs) Midazolam (2hrs) |
|
What fluid is considered isotonic?
|
D5 1/4 saline
|
|
Benzocaine is what type of LA?
|
Amide
Is the only amide LA that does not have two i's in its name. |
|
A alpha, beta, gamma
B and C fibers do what? |
A alpha=heavily myelinated=somatic motor impulses & proprioception
A beta=moderately myelinated=touch & pressure A gamma=moderately myelinated=proprioception B fibers=lightly myelinated=autonomic impulses Cfibers=pain & temp impulses |
|
What fibers are responsible for pain and temp?
|
C fibers
|
|
What fibers are responsible for autonomic impulses?
|
B fibers
|
|
What fibers are responsible for touch and pressure?
|
A beta
|
|
What fibers are responsible for proprioception?
|
A alpha
A gamma |
|
Huntingtons Chorea is characterized by?
|
Choreiform movements that progress to weakness of pharyngeal muscles-> increased risk of aspiration pneumonia and increases sensitivity to both depolarizing and ND NMBs.
|
|
What is the response to NMBs seen in a pt with Huntingtons Chorea?
|
Increases sensitivity to both depolarizing and nondepolarizing NMBs.
|
|
Subarachnoid space extends from the foramen magnum to?
|
Adults=S2
children=S3 |
|
Spinal cord extends to?
|
Adults=L1
children=L3 |
|
Formula for SV=
|
SV=EDV-ESV
|
|
What LAs produce vasoconstriction?
|
Cocaine
Ropivicaine |
|
What is nominal data?
|
Used to identify the data
ex. blood type eye color |
|
Ordinal data is?
|
ordered or ranked
ex. pain scores ASA classification |
|
Chi2 analysis?
|
evaluates difference between observed and expected frequencies from nominal (categories) or ordinal (ordered or ranked) data
|
|
ANOVA analysis?
|
tests the difference among the means of >2 independent groups or more than 1 independent variable given normally distributed interval or ratio data
|
|
student t-test?
|
given normally distributed interval or ratio data, evaluates the difference between dependent, paired sample outcomes.
ex. pretx and post tx |
|
Which type of analysis evaluates the difference between pretx and post tx?
|
student t-test
|
|
Which type of analysis is used when more than 1 independent variable exists or there are more than 2 independent groups?
|
ANOVA
|
|
What type of analysis is used for nominal or ordinal data?
|
Chi2 analysis
|
|
Subendocardial injury on the ECG is manifested by?
|
ST segment depression
|
|
Subepicardial or transmural injury on the ECG is manifested by?
|
ST segment elevation
|
|
Inferior ECG leads are?
|
2, 3, AVF
|
|
Anterior ECG leads are?
|
V1-V4
|
|
Lateral ECG leads are?
|
I, AVL, V1, V2
|
|
Loop diuretics work in?
|
thick ascending loop of henle
|
|
K sparing diuretics work in?
|
collecting duct
|
|
Thiazide diuretics work in?
|
distal convuluted tubule
|
|
Carbonic anyhdrase inhibitors work/act on the?
|
proximal convuluted tubule
|
|
Formula for replacement of fluids in a burn pt?
|
%BSA*Kg*2-4ml
|
|
Formula for predicting the decline in PaO2 with age is?
|
PaO2=100-(0.4*age in years)
|
|
Von Willebrands disease will result in prolongation of what lab?
|
PTT
|
|
Cerebral blood flow is calculated as?
|
CBF=CPP/cerebral vascular resistance
|
|
Dose of flumazenil to antagonize a benzo in a pediatric pt?
|
.05-1mg/kg
1mg max IV |
|
Acid base disorder seen in pyloric stenosis is?
|
Hypochloremic
hypokalemic met alkalosis |
|
Addisons disease is due to autoimmune destruction of adrenal gland causing decreased glucocorticoid and mineralcorticoid production. S/S include?
|
hyperpigmentation
hyperkalemia increased urinary Na excretion decreased androgen production |
|
Which muscle relaxants will precipitate when placed in an IV line with thiopental?
|
Vec
Roc Atracurium |
|
A nondepolarizing block is augmented by?
|
Hypocalcemia
Hypothermia Hypokalemia Hyper Mag |
|
Myasthenia Gravis is?
|
Acquired autoimmune disorder in which antibodies attach Ach receptors
|
|
Which ND NMB does not underg any form of metabolism?
|
Rocuronium
|
|
Which ND NMB can prolong the effects of Succ?
|
Pancuronium
by inhibiting psuedocholinesterase & slowing metabolism of Succ. |
|
What increase and decreases in the trendelenburg position?
|
In the trendelenburg position:
Increased MAP, PCWP, SVR decreased CBF No change in CI, O2 delivery, O2 consumption |
