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General study MD3 > Acute care > Flashcards

Acute care Flashcards

1
Q

Adverse effects of opioids (GOBS SC)

A

GI slowing - constipation, urinary retention
Opioid induced respiratory depression (with increased CO2 and possibly raised ICP)
Bradycardia
Strong addictive potential
Seizure threshold reduced
CNS depression (intensifies w benzo’s, alcohol)

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2
Q

Effects of opioids (AG)

A

Analgesia
GI slowing

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3
Q

Opioid receptor full agonists (MMM FC)

A

Morphine
Methadone
Meperidine
Codeine
Fentanyl

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4
Q

Opioid receptor partial agonist (B)

A

Buprenorphine

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5
Q

Opioid receptor full antagonists (NNM)

A

Naloxone
Naltrexone
Methylnaltrexone

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6
Q

Difference between naloxone and naltrexone and clinical use

A

Naloxone - rapid action, short acting (half life 30-90mins, PO, IM, IV, SC, IO, intranasal)
Naltrexone - long acting (half life 4-10hrs, PO, IM)

Naltrexone used once detoxified to prevent opioid dependence relapse

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7
Q

What is malignant hypothermia?

A

A subclinical myopathy - general anaesthesia triggers and uncontrollable contraction of skeletal muscle that leads to a life-threatening hypercatabolic state and an increase in body temperature

It is primarily autosomal dominant - mutations in receptors predispose to volatile anaesthetic agents or succinylcholine causing an accumulation of intracellular calcium in skeletal muscle that leads to its overactivation and hypermetabolism.

In acute setting - clinical diagnosis, increase in end-tidal CO2

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8
Q

What is the treatment for malignant hypertension?

A

Dantrolene (ryanodine receptor antagonist - prevents release of calcium from the sarcoplasmic reticulum of striated muscle - reduced muscle rigidity and hyperthermia)

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9
Q

Clinical presentation of DKA (DANK DF)

A

Delirium/psychosis
Abdominal pain
Nausea/vomiting
Kussmaul breathing
Dehydration
Fruity (acetone) breath

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10
Q

Clinical presentation of HHS (DPP LFS)

A

Dehydration (profound)
Polydipsia
Polyuria
Lethargy
Focal neurological deficits
Seizures

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11
Q

Diagnosis of DKA

A

Hyperglycemia
Anion gap metabolic acidosis (inc hydrogen ions, decreased HCO3)
Normal or increased serum K+ (decreased intracellular K+)
Hyperketonuria
Leukocytosis
No insulin

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12
Q

Diagnosis of HHS

A

Elderly more susceptible
Insulin present
Hyperglycemia
Normal or increased serum K+ (decreased intracellular K+)
Normal serum pH and ketones

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13
Q

Complications of DKA (CCHM)

A

Cerebral odema
Cardiac arrhythmias
Heart failure
Mucormycosis

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14
Q

Complications of HHS (CD)

A

Coma
Death

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15
Q

Treatment of DKA

A

Fluid resuscitation
Short acting IV insulin
Replacement of potassium
Glucose supplementation if needed

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16
Q

Treatment of HHS

A
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17
Q

Treatment of hyperkalemia

A
  • Discontinue exogenous sources of potassium
  • Treat reversible causes
  • Calcium gluconate (stabilises cardiac membrane)
  • Calcium chloride (only given in central venous lines as irritating to peripheral vessels)
  • Insulin and glucose (usually 10 units of regular insulin given with 50ml of a 50% dextrose solution)
  • B2 adrenergic agents (such as albuterol) will also shift potassium intracellularly - usually given at much higher doses than commonly used for bronchodilation
  • Loop or thiazide diuretics may help enhance potassium excretion
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18
Q

Definition of hyperkalemia

A

Serum plasma potassium above upper limit of normal
- Usually 5.0mEq/L to 5.5mEq/L

19
Q

ECG signs of hyperkalemia based on K concentration

A
  • K= 5.5 to 6.5 will show tall, peaked T waves
  • K= 6.5 to 7.5 will show loss of p waves
  • K= 7 to 8 will show widening of QRS complex
  • K= 8 to 10 will produce cardiac arrhythmias, sine wave pattern and asystole
20
Q

Clinical features of hyperkalemia

A
  • Weakness
  • Fatigue
  • Palpitations
  • Syncope
  • Mild hyperkalemia is usually asymptomatic
  • Symptoms usually develop around 6.5 to 7mEq/L
  • May be asymptomatic with chronic hyperkalemia
  • Hypertension in renal failure
21
Q

Complications of hyperkalemia treatment

A
  • Hypokalemia
  • Hypocalcemia as a result of bicarbonate infusion
  • Hypoglycemia due to insulin
  • Metabolic alkalosis from bicarbonate therapy
  • Volume depletion from diuresis
22
Q

Common inhalational anaesthetics

A

Nitrous oxide
Desflurane
Sevoflurane

23
Q

Effects of inhalational anaesthetics

A
  • Sedation/narcosis
  • Decreased respiration and arterial BP, myocardial depression
  • Increased cerebral flow and ICP
24
Q

Risks of inhalational anaesthetics

A
  • Post op N+V
  • Malignant hyperthermia
25
Q

Common IV anaesthetics

A
  • Propofol
  • Ketamine
  • Etomidate
  • Opioids (fentanyl, morphine)
  • Benzodiazepines (midazolam)
  • Barbituates (thiopental and methohexital)
26
Q

Propofol indications

A
  • Total IV anaesthesia drug of choice
  • Rapid sequence induction
  • Sedation in ICU
  • Short procedures
27
Q

Propofol MOA and effects

A
  • Agonist on Na channels of the reticular formation agonist on GABAa receptors and an antagonist on NMDA receptors - leading to decreased ICP, global CNS depression and hypnotic, antiemetic and anticonvulsant effects
  • No analesic or muscle relaxant effects
28
Q

Ketamine MOA and effects

A

NMDA receptor antagonist
- Dissociative anaesthesia, sympathomimetic effects, increased cerebral blood flow

29
Q

Adverse effects of opioids

A
  • Muscle rigidity
  • CVS and respiratory depression
30
Q

Adverse effects of benzodiazepines

A
  • Anterograde amnesia
  • Decreased BP
  • Can cause severe respiratory depression
31
Q

Indications for benzodiazepines in anaesthesia

A
  • IV anasthesia induction
  • Short outpatient procedures
  • Preoperative sedation
  • Endoscopy
32
Q

Benzodiazepine MOA

A
  • Indirect GABAa receptor antagonism - leads to decreased neuronal excitability
33
Q

Atropine MOA and uses

A
  • Anticholinergic that competitively blocks muscarinic acetylcholine receptors
  • Used to treat acute symptomatic bradycardia or AV block, decrease salivation, reverse neuromuscular blockade and reverse organophosphate poisioning
34
Q

Paracetamol overdose definition for adults and children

A
  • > 7.5g for adults
  • > 150mg/kg for children
35
Q

Paracetamol overdose treatment

A
  • N-acetylcysteine (anti-oxidant that restores depleted hepatic glutathione in patients with paracetamol overdose)
36
Q

Cardiac causes of chest pain

A

STEMI
NSTEMI
Unstable angina
Aortic dissection
Cardiac tamponade
Pericarditis
HF exacerbation
Thoracic aortic aneurysm
Takotsubo cardiomyopathy

37
Q

Pulmonary causes of chest pain

A

Pulmonary embolism
Tension pneumothorax
Pneumonia
Spontaneous pneumothorax
Asthma exacerbation
COPD exacerbation
Pleural effusion

38
Q

GI causes of chest pain

A

GORD
Erosive oesophagitis
Gastritis
PUD
Pancreatitis
Mallory-weiss tear
Esophageal hypermotility disorders

39
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41
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General study MD3 (16 decks)

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