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Fa: Sim 3 > 7. ERAS/Transplant > Flashcards

7. ERAS/Transplant Flashcards

1
Q

ERAS

A

enhanced recovery after surgery

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2
Q

ERAS was first designed for

A

colorectal surgery

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3
Q

FIVVE therapy is used for

A

anemia correction

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4
Q

FIVVE therapy

A

Folate
Iron
Vit B12
Vit C
Erythropoetin

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5
Q

alcohol usages incr incidence of

A

cardiomyopathy
infection
arrythmias

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6
Q

alcoholism incr risk of post-op complications

A

50-200%

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7
Q

alcoholism consumption

A

> 36 gm/day
or
3 drinks/day

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8
Q

COMA BAC

A

0.4-0.5 g/dL

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9
Q

sleep/stupor BAC

A

0.25-0.4 g/dL

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10
Q

confusion/impaired balance BAC

A

0.15-0.3 g/dL

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11
Q

euphoria/decr judgement BAC

A

0.05-0.1 g/dL

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12
Q

mild euphoria/decr inhibitions BAC

A

0.01-0.05 g/dL

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13
Q

1 drink =

A

1.5 oz 40% liquor
5 oz 12% wine
12 oz 5% beer

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14
Q

alcoholism labs

A

hypokalemia
hypomagnesemia
hypocalcemia
hypophosphatemia

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15
Q

alcoholism treatment

A

thiamine
benzos

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16
Q

cough med alcohol

A

16-25%

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17
Q

vanilla alcohol

A

35%

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18
Q

glass cleaner alcohol

A

10%

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19
Q

hand sanitizer alcohol

A

62%

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20
Q

mouthways alcohol

A

25%

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21
Q

perfume alcohol

A

80%

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22
Q

nictoine is used for

A

smoking cessation

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23
Q

20 mins smoking cessation

A

decr effects of nicotine on BP
vasoconstriction

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24
Q

8 hrs smoking cessation

A

CO levels halved

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25
Q

12 hrs smoking cessation

A

CO levels normalized***

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26
Q

24 hrs smoking cessation

A

chances of MI decreased

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27
Q

48 hrs smoking cessation

A

mucus expulsion increased
incr risk of surgery

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28
Q

2 weeks smoking cessation

A

lung inflammation starts to decr

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29
Q

e-cigs can cause

A

EVALI

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30
Q

NPO

A

nil per os

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31
Q

NPO standard

A

8 hrs
clear liquids up to 2 hrs prior

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32
Q

pre-op goals

A

normoglycemia
normothermia
multi-modal analgesia

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33
Q

opioids

A

meds that mimic papaver somniferum (opium poppy)

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34
Q

opioid mechanism

A

pure mu agonist
mixed mu agonist/antagoionist

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35
Q

opioid SE

A

pruritus
resp depre
histamine release
urinary retention
N/V
ileus

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36
Q

which opioids causes histamine release

A

morphine
meperidine

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37
Q

Multi-modal anesthesia

A

use more than one class of analgesic med

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38
Q

MMA goal

A

improve analgesia
decr SE

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39
Q

MMA dosing

A

smaller doses of more meds

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40
Q

what is gabapentin best for

A

neuropathic pain

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41
Q

what is mg best for

A

nerve stabilization

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42
Q

what is esmolol good for

A

prevents HR/BP windupw

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43
Q

which meds inhibit pain perception

A

opioids
alpha 2 agonist
TCAs
SSRIs
SNRIs

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44
Q

which meds inhibit ascending pain transmission

A

LAs
opioids
alpha 2 agonists

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45
Q

which meds facilitate descending pain modulation

A

TCAs
SSRIs
SNRIs
gabapentinoids

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46
Q

which meds inhibit pain transduction

A

LAs
alpha 2 agonists
gabapentinoids
acetaminophen
NSAIDs
glucoroticoids

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47
Q

physiological pain

A

acute
nociceptive
protective

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48
Q

pathological pain

A

neuropathic
fibromyalgia
disesase is pain

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49
Q

psychogenic pain

A

phantom limb

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50
Q

neuropathic pain types

A

allodynia
hyperalgesia
OIH
opioid tolerance

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51
Q

allodynia

A

pain due to stimulus that does not usually provoke pain

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52
Q

hyperalgesia

A

incr pain from simulus that usually provokes pain

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53
Q

OIH

A

exposure to narcotic that induces hyperalgesia

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54
Q

opioid tolerance

A

incr narcotic need to illicit similar analgesia
due to incr metabolism

55
Q

OIH pain stimulus

A

incr

56
Q

in OIH, opioids _____ pain

A

incr pain

57
Q

opioid tolerance pain stimulus

A

no change

58
Q

what helps with OIH

A

NMDA antagonisms

59
Q

which opioid has higher risk of OIH

A

remi
(shorter acting = higher risk of OIH)

60
Q

which drug can help reset pain perception

A

ketamine

61
Q

ketamines effect on opioids

A

ketamine makes smaller doses of opioids more effective

62
Q

CTZ activation results in

A

vomiting center response

63
Q

CTZ

A

mu
kappa
dopa-2
neurokinin-1
serotonin type 3
enkephalin
histamine 1/2

64
Q

factors that incr PONV risk

A

female
non smoker
history of PONV/motion sickness/migrane
young
anxiety

65
Q

does the dose or the agent of opioids correlated with incr PONV risk?

A

dose

66
Q

which opioid may benefit pONV

A

alfentanil

67
Q

which opioids is a poor choice for pONV

A

morphine

68
Q

which VA is best for PONV

A

all are equal

69
Q

surgical factors incr PONV

A

vestibular stimulation
swallowing blood/secretions
emotional distress
peritoneal irritation
serotonin releae
vagal stimulation
strabismus surgery

70
Q

primary PONV treatments

A

4 mg zofran
4-8 mg decadron

71
Q

secondary PONV treatment

A

haloperidol
phenergan
aprepitant
scopolamine
TIVA
P6 acupuncture

72
Q

Apfel risk factors

A

female
non-smoker
post-op opioids
hx PONV

73
Q

haloperidol dose

A

0.5-2 mg IM/IV
(end of surgery)

74
Q

phenergan dose

A

6.25-12.5 mg IV
(induction)

75
Q

aprepitant

A

40 mg PO
(1-3 hrs pre-op)

76
Q

scopolamine

A

1.5 mg Topical patch
(> 1 hr pre-op)

77
Q

dopa antagonisms

A

metoclopramide
droperidol

78
Q

metoclopramide dose

A

10 mg

79
Q

droperidol dose

A

0.625-1.225 mg

80
Q

which pts should not receive dopa antagonists

A

parkinsons pts

81
Q

which dopa antagonist prolongs QT

A

droperidol

82
Q

histamine antagonists

A

diphenhydramine
phenergan

83
Q

diphenhydramine dose

A

25-50 mg

84
Q

diphenhydramine SE

A

sedation
urinary retention
extrapyramidal

85
Q

diphenhydramine CI

A

dementia

86
Q

phenergen (promethazine) dose

A

12.5-25 mg

87
Q

when is atropine an antiemetic

A

if use with neostigmine

88
Q

scope patch lasts

A

72 hours

89
Q

scope patch coverage

A

vestibular PONV

90
Q

zofran SE

A

QT prolongation

91
Q

5-HT3 antagonists

A

ondansetron
granistron
palonosetron
remosteron

92
Q

neurokinin-1 antagonist

A

aprepiatant

93
Q

aprepitant location of action

A

nucleus tractus solitarius

94
Q

which is more effective aprepitant or zofran

A

aprepitant

95
Q

decadron location of action

A

nucleus tractus solitarius

96
Q

1 gm ancef

A

< 60 kg
or
reduced renal function

97
Q

2 gm ancef

A

60-120 kg

98
Q

3 gm ancef

A

> 120 kg

99
Q

when do you repeat ancef

A

3-4 hrs
or
EBL > 1 L

100
Q

hypothermia SE

A

arrythmias
ischemia
Left shift curve
coagulopathy
plt dysfunction
protein catabolism
decr renal function
decr drug metabolism
poor wound healing
incr infection
incr cortisol

101
Q

lung protection vent settings

A

lower TV (4-6 ml/kg)
PEEP 5-10 cmH2O

102
Q

blood loss volume replacement crystalloids

A

3:1

103
Q

blood loss colloid replacement

A

1:1

104
Q

bowel prep fluid deficit

A

1L

105
Q

PPV fluid responsive

A

> 12
(some sources say 15)

106
Q

intraop glucose

A

80-180 mg/dL

107
Q

brain dead tests

A

comatose
lack of brainstem replexes
apnea test

108
Q

what is crucial for prevention of donor organ damage

A

perioperative HD stabilization

109
Q

organ donation SBP

A

> 100 mmHg

110
Q

organ donation MAP

A

70-110 mmHg

111
Q

organ donation PO2

A

> 100 mmHg

112
Q

organ donation UOP

A

> 100 mL/hr
(1-1.5 mL/kg/hr)

113
Q

organ donation Hgb

A

> 10 g/dL

114
Q

organ donation CVP

A

5-10 mmHg

115
Q

organ donation FiO2

A

< 40%
(if tolerated)

116
Q

organ donation glu

A

< 200 mg/dL

117
Q

should you use pressors in organ donation

A

no

118
Q

why avoid phenylephrine in organ donation

A

acidosis risk

119
Q

which drug is given prior to organ retriveal

A

heparin

120
Q

which drugs help stabilize HD

A

VA
naroctics

121
Q

can you give versed to elective organ donors

A

no

122
Q

which transplant case is one of the most involved

A

hepatic

123
Q

hepatic transplant lines

A

central
arterial
large bore IV

124
Q

preanhepatic SE

A

blood loss
hyponatremia
hyperkalemia
citrate tox

125
Q

anhepatic effects

A

no drug metabolism

126
Q

neohepatic effects

A

reperfusion syndrome
hepatic ischemia

127
Q

reperfusion syndrome

A

cold
acidotic
hyperkalemic
emboli

128
Q

hepatic donation

A

Right lobe

129
Q

what immunosuppresant is given in renal transplant

A

antithymocyte globulin rabbit

130
Q

SE of immunosuppressant

A

hypotension
immune reaction

131
Q

treat immune response prophylactically

A

diphenhydramine 50 mg
solu-medrol 250 mg

132
Q

how do you give thymocyte

A

centrally
(with filter)

133
Q

renal transplant goal CVP

A

15 mmHg

134
Q

fluids for renal transplant

A

NS (SLH)
mannitol
lasix

Fa: Sim 3 (15 decks)

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