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Medicine > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

What is the MOA of non-depolarising NM blockers?

A

AChR competitive antagonists

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2
Q

What is the MOA of depolarising NM blockers?

A

AChR competitive agonists

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3
Q

Give 1 example of a depolarising NM blocker

A

Suxamethonium

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4
Q

Give 1 example of a non-depolarising NM blocker

A

Rocuronium

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5
Q

How would you reverse the effects of NM blockers? What is the MOA?

A

Neostigmine

This is a Cholinesterase inhibitor

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6
Q

Which patients are particularly sensitive to non-depolarising agents?

A

Patients with Myasthenia Gravis

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7
Q

When is it appropriate to use suxamethonium?

A

Rapid sequence induction for intubation

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8
Q

What are the adverse effects of suxamethonium?

A

Malignant hyperthermia
Hyperkalaemia

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9
Q

What is an alternative name for suxamethonium?

A

Succinylcholine

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10
Q

What is Amitriptyline and when is it used in anaesthetics?

A

TCA

Used for neuropathic pain

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11
Q

What is Duloxetine and when is it used in anaesthetics?

A

SNRI antidepressant

Used for neuropathic pain

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12
Q

What is Gabapentin and when is it used in anaesthetics?

A

Anticonvulsant

Used for neuropahtic pain

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13
Q

What is Pregabalin and when is it used in anaesthetics?

A

Anticonvulsant

Used for neuropathic pain

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14
Q

Name 3 GABA(A) potentiators, what are their uses?

A

Propofol
Thiopental
Etomidate

They’re used for hypnosis

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15
Q

Name 2 adverse effects of propofol

A

Pain on injection (due to actiation of the pain receptor TRPA1)

Hypotension

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16
Q

Name 1 side effect of thiopental

A

Laryngospasm

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17
Q

Name 2 side effects of etomidate

A

Primary adrenal suppression (secondary to reversibly inhibiting 11β-hydroxylase)

Myoclonus

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18
Q

Which hypotic agent would you use in cases with a high risk of vomiting?

A

Propofol

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19
Q

Which hypnotic agent is used in cases of haemodynamic instability? Why?

A

Etomidate

It causes less hypotention than Proprofol and Thiopental

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20
Q

What is the MOA of Ketamine and what is its’ use in anaesthetics?

A

It is an NMDA blocker

1) Used as a dissociative anaesthetic

2) Doesn’t cause a drop in blood pressure so useful in trauma

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21
Q

What are the 2 main side effects of ketamine?

A

Disorientation
Hallucination

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22
Q

What might cause malignant hyperthermia?

A

Volatile anaesthetics (isoflurane, sevoflurane, desflurane)

Suxamethonium

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23
Q

Name 4 inhaled GAs

A

Sevoflurane
Desflurane
Isoflurane
Nitrous oxide

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24
Q

Why isn’t desflurane a favoured inhaled GA?

A

It’s bad for the environment

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25
Q

When is nitrous oxide used as an inhaled anaesthetic?

A

it may be used in combination with other anaesthetic medications

Sometimes as a gas induction in paediatrics

26
Q

What is dantrolene used for?

A

Treating malignant hyperthermia

27
Q

What is the MOA of dantrolene?

A

ryanodine R antagonist

28
Q

How do you alter DM drugs pre-operatively?

A

If it’s a normal surgery then leave as is, but in OD insulins (Lantus, Lenevir), and reduce by 20% regardless of procedure time

Afternoon surgeries
Sulfonylureas -> max 1 dose daily
SGLT2 inhibitors (-flozins) -> omit on day
Insulins -> 0.5 morning dose

29
Q

What sized cannula is the default?

A

20G (pink)

30
Q

How is propofol administered peri-operatively?

A

1.5 - 2.5 mg/kg at 20-40mg every 10s

31
Q

What risks are associated with omeprazole?

A

Hyponatraemia
Osteoporosis
C. Diff -> yikes!

32
Q

What is the MOA of Flumazenil?

What needs to be considered with respect to its’ half life?

A

Competitive antagonist at GABA binding sites (competes with benzodiazepines)

Since benzodiazepines have longer 1/2T than flumazenil, patients still require close monitoring after receiving the drug

33
Q

When should halothane be avoided?

A

It’s hepatotoxic so any cases of liver dysfunction

34
Q

Describe the causes of post-operative pyrexia

A

Worry not <24 hours and no other Sx
Wind day 1-2 - pneumonia, apiration, atelectasis
Water day 3-5 - UTI
Wound day 5-7 - surgical site infection or abscess formation
Walking day 5+ - DVT, PE

35
Q

How do you wake someone from anaesthesia?

A

1) Change inspired gases to 100% only
2) Dicontinue any infusions and reverse muscle paralysis
3) Extubate once spontaneously breathing
4) Recovery position, O2 facemask

36
Q

How do you treat LA toxicity?

A

20% lipid emulsion

37
Q

Which anti-emetic is contraindicated in GI obstruction?

A

Metoclopramide

38
Q

How is Warfarin dosing managed peri-operatively?

A

Stop in the peri-operative period

In those at risk of VTE then bridge to LMWH 5 days prior to surgery

39
Q

What mutation is associated with malignant hyperthermia?

How is it inherited?

A

mutation in ryanodine receptor 1

AD

40
Q

What is a typical reaction to metoclopramide?

How would you manage it?

A

Acute dystonia

Anticholinergic agent - procyclidine, biperiden

41
Q

How would you manage TCA overdose?

A

sodium bicarbonate

42
Q

When should you avoid metoclopramide?

A

Parkinson’s patients (antidopaminergic)

GI surgery (prokinetic so may cause perf)

43
Q

What is the most common complication when using an epidural during vaginal delivery?

A

Maternal hypotension due to sympathetic effects

This can cause maternal and foetal distress

44
Q

What is T2RF?

How would you manage it?

A

Hypercapnia
Hypoxia

BiPAP

45
Q

What is T1RF?

How would you manage it?

A

Normal CO2
Hypoxia

CPAP

46
Q

How would you manage pts on long term steroids perioperatively?

A

Risk of adrenocortical insufficiency

IV hydrocortisone (increased dose to account for stress response)

If hypotensive then cosider adding fludrocortisone.

Start oral steroids again 48-72 hours post-op

47
Q

How do you calculate fluid administration volume for someone with a fluid deficit?

A

Fluid deficit + maintenance fluids (25-30ml/kg/day)

48
Q

What imaging would you use for basal skull fractures?

A

CT head

Much higher sensitivity than MRI

49
Q

How can you limit the risk of pneomothorax during central line insertion?

A

Trendenlenburg position

50
Q

How would you manage hypovolaemic shock?

A

Crystalloid fluid bolus

51
Q

How long before surgery should you stop clopidogrel?

A

7 days

52
Q

How long before surgery should you stop ACEIs?

A

Night before

53
Q

Name two fluids which are not suitable for resuscitation

Why?

A

Dextrose - does not stay in the intravascular compartment

Gelofusine - risks anaphylaxis

54
Q

When should you commence post-op LMWH thromboprophylaxis following elective THA?

A

6-12 hours after surgery

55
Q

What ASA grade would a patient with end stage renal disease with regular dialysis be?

A

ASA 3

56
Q

When is adding adrenaline to a LA contraindicated?

A

Patients on MAOIs or TCA

57
Q

Why would you add adrenaline to a LA?

A

Prolongs duration of action, permiting higher doses

58
Q

Can you think of an example where adrenaline wouldn’t be used as an adjunct to an LA?

A

Ingrown toenail ablation

Risks digital ischaemia

59
Q

In a patient with an MI, what would your next step be if you can’t cannulate them?

A

Intraosseous access

60
Q

Which anaesthetic agent should be used with caution in patients with a pneumothorax?

Why?

A

NO

diffuses into air-filled spaces, worsening cardiopulmonary impairment

Medicine (21 decks)

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