ACE 2012-9b Flashcards
Pt is on daily oral naltrexone, what should he do about this drug in preparation for surgery?
Naltrexone should be stopped immediately
Opioid requirements for a patient undergoing surgery that has been taking an oral combo drug of extended release morphine and naltrexone (Embeda)
Unchanged if pill is used correctly.
T-test is what type of analytical test?
Parametric test that can be used to determine if there is a significant difference between the means of 2 groups
2 types of analysis most commonly used for survival analysis
Kaplan-Meier analysis and Cox proportional hazards regression model
Jaw necrosis is a well documented complication of what drug?
Bisphosphonates
Chronic pain drugs associated with development of osteoporosis
First generation anticonvulsants like phenytoin
Common drawbacks of gabapentin
Sedation, weight gain, peripheral edema, cognitive effects
Cardiac abnormality associated with hyperthyroidism
Atrial fibrillation
Cardiac abnormality associated with hypothyroidism
Pericardial effusion
Management of pt with mediastinal mass causing tracheal compression
- Secure airway while awake if possible
- maintain spontaneous ventilation
- monitor airway compromise postop
RIFLE criteria for AKI
1 of the following criteria within 48 hrs
- absolute increase in Cr of 0.3
- 50% or more increase in Cr
- UOP < 0.5 mL/kg/hr for > 6 hrs
Standard stimulation site for SEP
Median nerve
Standard response site for MEP
Abductor pollicis brevis
Drug dosing based on Ideal body weight or lean body weight in a morbid obese pt would result in too small of a dose
Ideal body weight
Dose of propofol for induction and fentanyl and remifentanil should be based on what type of weight for obese pts?
Lean body weight (LBW)
Dose of succinylcholine for induction should be based on what type of weight for obese pts?
TBW (total body weight)
Dose of vecuronium and rocuronium for induction should be based on what type of weight for obese pts?
IBW (ideal body weight)
Larynx of neonate is located at what vertebral level?
C3-4
Larynx of adult is located at what vertebral level?
C4-5
Anterior attachment of neonate vocal cords in relation to posterior attachment
More caudad. “Anterior = away”
Larynx of preterm neonate is located at what vertebral level?
C3
Mechanism of action of dabigatran (pradaxa)
Direct thrombin inhibitor
Half life of dabigatran (pradaxa)
12 hrs
Peak effect of dabigatran (pradaxa)
2-3 hrs
Mechanism of action of clopidogrel and ticlopidine
Platelet inhibitors, ADP receptor inhibitor
Mechanism of action of tirofiban
Platelet inhibitor, 2b-3a receptor inhibitor
Wrist drop and diminished brachioradialis reflex is injury of what nerve?
Radial nerve
Loss of thumb abduction is injury of what nerve?
Median nerve
Baroreceptors are part of carotid body or sinus?
Carotid sinus
Chemoreceptors are part of carotid sinus or body?
Carotid body
Propofol’s effect on QT interval
Little effect
Combo of glycopyrrolate and reversal agent’s effect on QT interval
Prolongs QT interval
Carboxyhemoglobin level less than what percent does not require supplemental O2 therapy
Less than 10%
Carboxyhemoglobin level greater than what percent is an indication for hyperbaric oxygen therapy
Greater than 25%
Carbon monoxide’s affinity to hemoglobin is how many times greater than oxygen
250 times
American academy of pediatrics recommends lateral X-rays for all Down’s syndrome kids between what ages?
3-5 years of age
How does cervical instability compare between adults and children with Down’s syndrome
Same
Endotracheal tubes opened and checked can be stored and used within how many hours?
48 hrs
Osler-Weber-Rendu syndrome or hereditary hemorrhagic telangiectasia is characterized by formation of multiple…
Arteriovenous malformations, with life threatening locations such as pulmonary, hepatic, and cerebral circulations
Most common symptom associated with post dural puncture headache
Nausea, followed by neck stiffness, vomiting, visual, auditory
Drugs that increase serum level of lithium
ACE inhibitors, NSAIDS, loop diuretics, metronidazole
Drugs that decrease serum levels of lithium
Acetazolamide, theophylline
First manifestation of oxygen toxicity
Retrosternal tightness
Decrease in vital capacity caused by oxygen toxicity can be detected after how many hours?
24 hrs
When does supplemental oxygen cause seizures?
The partial pressure of oxygen is in excess of 2 atmospheres
Odds of renal failure and mortality with use of hetastarch compared to crystalloids
Increase
How does cessation of smoking 24 hrs prior to surgery affect risk of postop pulmonary complications
Increase in pulmonary complications when smoking cessation began less than 8 weeks prior to surgery
Primary sign of autonomic dysfunction
Orthostatic hypotension
Drug used to keep autonomic dysfunction patient euvolemic in preparation of surgery
Fludrocortisone, mineralocorticoid that causes sodium retention and increases intravascular volume
Why should aspiration prophylaxis be given to Parkinson’s patient with severe autonomic dysfunction?
Possible vocal cord dysfunction
Main advantage of retrobulbar block compared with peribulbar block
Reduced block onset time
Train of four response in a paraplegic patient’s normal limb compared to paretic limb
Response is exaggerated in paretic limb compared to normal limb
Does a negative molecular genetic test for a patient with family history of MH exclude susceptibility to MH?
NO!!!! Gold standard is muscle biopsy for caffeine halothane contracture test, only 4 testing centers in the US
How is rocuronium excreted?
Bile
Aminosteroid neuromuscular blockers
Rocuronium, vecuronium, pancuronium
Mechanism of action of tapentadol (Nucynta)
Mu opioid receptor agonist, also like tramadol, it prevents neuronal reuptake of norepinephrine and serotonin
Why are thiazides contraindicated for treatment of hypercalcemia
Thiazides increase tubular reabsorption of calcium
Cardiac output for a parturient is highest when?
Immediately postpartum, up to 75% above prelabor values
When does cardiac output postpartum return to prelabor values?
48 hrs postpartum
Time to peak analgesia for fentanyl
6.8 min
Time to peak analgesia for sufentanil
6.2 min
Time to peak analgesia for alfentanil
1.4 min
Time to peak analgesia for remifentanil
1.1 min
pKa of fentanyl
8.4
pKa of sufentanil
8.0
pKa of alfentanil
6.5
pKa of remifentanil
7.2
How does 3 degree decrease in body temp affect plasma propofol concentration
Increase by 30%
How does each degree drop in body temp affect MAC of isoflurane?
Decrease by 5%
Risk of aortic dissection in a patient with asymptomatic bicuspid aortic valve
Increased
Occurrence of neurologic consequences with identifiable embolic events in patients undergoing carotid endarterectomy
Most do not develop a stroke
Stage of labor that can be prolonged by neuraxial analgesia
2nd stage when cervical dilation is complete
