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SEE NCE Boards CoreConcepts > Anesthesia EFFECTS, COMMONs, Triads, DISSOCIATION CURVES, REFLEXES > Flashcards

Anesthesia EFFECTS, COMMONs, Triads, DISSOCIATION CURVES, REFLEXES Flashcards

1
Q

Carbon dioxide dissociation curve: When blood contains mainly oxygenated hemoglobin , the CO2 dissociation curve shifts to the _______

A

Right

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2
Q

When does the CO2 dissociation curve shifts to the Right?

A

When blood contains mainly oxygenated hemoglobin

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3
Q

When blood contains mainly oxygenated hemoglobin and the CO2 dissociation curve shifts to the RIGHT what does that do?

A

REDUCE the BLOOD CAPACITY to HOLD CO2

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4
Q

When blood contains mostly DEOXYhemoglobin , the CO2 dissociation curve shifts to the _______

A

LEFT

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5
Q

When does the CO2 dissociation curve shifts to the LEFT?

A

When blood contains mostly DEOXYhemoglobin

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6
Q

When blood contains mainly DEOXYhemoglobin and the CO2 dissociation curve shifts to the LEFT what does that do?

A

Increasing the capacity to carry CO2

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7
Q

CO2 dissociation curve mnemonic to remember

A

Right O2

Left

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8
Q

Explain the HALDANE EFFECT?

A

Allows the blood to LOAD more CO2 at the tissue level where more deoxyhemoglobin is present
And to UNLOAD CO2 at the lung, where more HgbO2 is present .

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9
Q

This effect permits more CO2 to be carried in the form of bicarbonate ions

A

Haldane effect

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10
Q

With this effect: The associated of H+ with the amino acids of hemoglobin lowers the affinity of hgb of O2, shifting the HgbO2 dissociation curve to the right at low pH or HIGH CO2

A

Bohr effect

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11
Q

The Haldane Effect (along with the Bohr Effect) facilitates the

A

release of O2 at the tissues and the uptake of O2 at the lungs.

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12
Q

The Haldane Effect results from the fact that deoxygenated hemoglobin has a

A

higher affinity (~3.5 x) for CO2 than does oxyhemoglobin.

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13
Q

HALDANE EFFECT MAINLY states that

A

Deoxygenated blood can carry increasing amounts of carbon dioxide, WHEREAS oxygenated blood has a reduced carbon dioxide capacity.

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14
Q

The Haldane Effect describes the effect of

A

oxygen on CO2 transport.

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15
Q

Bohr effect describes the effect of

A

carbon dioxide on oxygen transport

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16
Q

Central chemoreceptors respond to

A

H+ in the CSF

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17
Q

Peripheral chemoreceptors respond to

A

↑ H+, ↑ CO2, and ↓ PaO2

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18
Q

What is the primary stimulus for ventilatory response?

A

PaCO2

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19
Q

Hamburger shift”

A

Cl- exchange for HCO3- in RBC’s:

HCO3- out, Cl- in; non-pulmonary

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20
Q

Occulocardiac Reflex: Afferent and Efferent Pathway

A

Afferent pathway = Trigeminal nerve Efferent pathway = Vagus nerve

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21
Q

Cushing’s triad : What is it and what does it tell you?

A

HTN
Bradycardia
Irregular respirations

Increased ICP

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22
Q

Triple H Therapy: is used for

A

For treatment of cerebral vasospasm

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23
Q

What is the triple H therapy ?

A 
Hypervolemia = CVP > 10 mm Hg PCWP = 12-20 
Hypertension = SBP 160-200 mmHg 
Hemodilution = Hct 33%
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24
Q

Obesity Hypoventilation syndrome triad

A

Obesity
Daytime hypoventilation
Sleep disordered breathing

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25
Q

What does Virchow’s triad tells you?

A

Risk factors for venous thrombosis

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26
Q

Virchow’s triad (HIS)

A

Venous stasis
Venous injury (endothelial)
Hypercoagulable State

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27
Q

Hepatopulmonary syndrome Triad (LAW)

A

PORTAL HTN
Hypoxemia (Arterial deoxygenation)
Widespread pulmonary vasodilation

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28
Q

Cholecystitis triad:

A

Sudden RUQ tenderness
Fever
Leukocytosis

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29
Q

Clinical significant Hypoglycemia WHIPPLE TRIAD

A

Hypoglycemia (catecholamine)
Low blood glucose
Relief of symptoms after IV glucose

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30
Q

DKA Triad

A

Hyperglycemia
Ketonemia
ACIDEMIA

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31
Q

Pheochomocytoma Triad

A

Paroxysmal diaphoresis
Tachycardia
Hypertension

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32
Q

Hypothermia TRIAD

A

ACIDOSIS
Hypothermia
COAGULOPATHY

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33
Q

SPINAL shock TRIAD

A

Hypotension
Bradycardia
Hypothermia

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34
Q

SAMTER syndrome Triad

A

Nasal polyps
Asthma
Aspirin allergy

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35
Q

FIRE TRIAD

A

Fuel
Oxidizer
Ignition source

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36
Q

Beck’s triad indicates

A

Cardiac Tamponate

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37
Q

What is beck’s triad?

A

JVD
Hypotension
Muffled heart sounds

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38
Q

Aortic stenosis Triad

A

Angina
Syncope
CHF (dyspnea)

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39
Q

Ruptured Abdominal Aortic Aneurysm triad

A

Severe abdominal pain radiates to back
Pulsatile abdominal mass
Hypotension

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40
Q

Chronic pancreatitis triad

A

Steatorrhea
Pancreatic calcification
Diabetes mellitus

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41
Q

Myotonic dystrophy triad in males

A

Frontal baldin
premature ocular cataracts
testicular atrophy

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42
Q

Bezold-Jarish reflex is associated with this triad?

A

hypotension, bradycardia, and coronary vasodilation

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43
Q

The Bezold-Jarisch reflex results in

A

unmyelinated vagal afferent stimulation in response to noxious ventricular stimuli (chemical or mechanical),

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44
Q

2 things that are increased with Bezold-Jarisch reflex

A

increased parasympathetic tone

Increased ANP and BNP

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45
Q

Up to 25% of patients undergoing surgery in the beach chair position under general or regional anesthesia can experience hemodynamically significant hypotensive bradycardic events thought to be caused by

A

ventricular underfilling and the Bezold–Jarisch reflex.

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46
Q

Bainbridge reflex causes an

A

increase in heart rate when the right atrium or great veins are stretched by increased vascular volume.

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47
Q

Associated with the Bainbridge reflex are the

A

Venous baroreceptors–> are located in the right atrium and great veins

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48
Q

When blood pressure increases which receptors are stimulated?

A

the baroreceptors are stimulated

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49
Q

When baroreceptor are stimulated, what happens to myocardial contractility, venous tone, heart rate, systemic vascular resistance (SVR), and blood pressure?

A

When stretched, the baroreceptors fire –> inhibit the *sympathetic nervous system outflow resulting in a decrease in myocardial contractility, a decrease in heart rate, a decrease in venous tone, a decrease in SVR, and a decrease in blood pressure. *Parasympathetic outflow is simultaneously increased, which also decreases heart rate.

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50
Q

What nerves carry the afferent and efferent signals o f the Bainbridge reflex?

A

When the great veins and right atrium are STRETCHED BY INCREASED vascular volume, stretch receptors send AFFERENT signals to the medulla VIA the VAGUS nerve. The medulla then transmits EFFERENT signals via the sympathetic nerves to increase heart rate (by as much as 75%) and myocardial contractility.

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51
Q

What does the Bainbridge reflex help prevent?

A

prevent damming up of blood in veins, the atria, and the pulmonary circulation.

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52
Q

The Bainbridge reflex, in which stimulation of

A

right atrial stretch receptors leads to vagal afferent stimulation of the medulla and subsequent inhibition of parasympathetic activity (increasing the heart rate, or, in the case of decrease atrial pressure, lowering heart rate)

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53
Q

What three maneuvers can trigger the

oculocardiac reflex?

A

1) traction on the extraocular mus-
cles, especially the medial rectus
(2) ocular manipulation
(3) manual pressure on the globe of the eye.

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54
Q

What nerves carry the afferent and effer- ent action potentials in the oculocardiac reflex arc?

A

The trigeminal nerve (cranial nerve V) carries afferent (sensory) action potentials and the vagus nerve (cranial nerve X) carries efferent (motor) action potentials. This is the five (V) and dime (X) or nickel (V) and dime (X) reflex.

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55
Q

What reflex best explains bradycardia during spinal anesthesia?

A

The Bainbridge reflex relates to the characteristic but paradoxical slowing of the heart rate seen with spinal anesthesia..

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56
Q

The usual mechanism given for bradycardia with spinal anesthesia is

A

blockade of the sympathetic efferents from Tl-T4 (cardioaccelerator fibers) with subsequent unopposed parasympathetic stimulation (bradycardia)

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57
Q

However, bradycardia during spinal anesthesia is more clearly related to the development of arterial hypotension than to the height of the block. The primary deficiency in the development of spinal hypotension is a

A

Decrease in venous return.

The reduced venous pressure is sensed by low pressure venous baroreceptors, resulting in a reflex bradycardia.

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58
Q

A decrease in cardiac filling pressures may also stimulate vagally mediated bradycardia via the.

A

Bezold– Jarisch reflex.

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59
Q

A decrease in cardiac filling pressure may stimulate what?

A

A decrease in cardiac filling pressures may also stimulate vagally mediated bradycardia via the Bezold– Jarisch reflex (SLOWS THE HR SO THAT HEART CAN FILL)

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60
Q

An INCREASE in cardiac filling pressure

A

increase HR to get rid of extra fluid
BAINBRIDGE
RA & great veins → Bainbridge reflex, stretch of Right Atrium
Increases HR with inspiration via vagus nerve.

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61
Q

Hering-Breuer reflex:

A

Vagus nerve, prevents over-stretching

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62
Q

The primary components of this DESCENDING pain inhibition system, but certainly not all-inclusive, is the “triad” of the

A
  • Periaqueductal gray (PAG)
  • Rostral ventral medulla (RVM)
  • Dorsolateral pontine tegmentum (DLPT).
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63
Q

One of the principal goals during early management of the hemorrhaging trauma victim is to avoid the development of the so-called vicious cycle or lethal triad, consisting of –>

A

Hypothermia
Acidosis
Dilutional coagulopathy

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64
Q

Signs of cyanide toxicity include the triad of

A

Elevated mixed venous O2 (SVO2)
Increasing requirements for SNP (tachyphylaxis)
metabolic acidosis.

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65
Q

Preeclampsia is diagnosed by the triad of

A

HEP

hypertension, edema, and proteinuria.

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66
Q

Occurs in 15-30% of patients and can be treated by volume, atropine, and ephedrine. what reflex?

A

Bezold -Jarish REFLEX

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67
Q

Treatment for Bainbridge reflex

A

None (per APEX)

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68
Q

How do you treat Symptoms of Bezold Jarish refelx

A 
Restore preload (IVF, raise legs above heads, EPI)
Increase HR, atropine, ephedrine
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69
Q

Full heart –> Increase HR

A

BainBridge

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70
Q

Empty heart –> Decrease HR

A

Bezold-jarisch

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71
Q

Autransfusion during childbirth is an example of what reflex

A

Bainbridge

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72
Q

Sensors of Bezold Jarisch located in

A

RV
Mechanoreceptors (VR)
Chemoreceptors (Ischemia)

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73
Q

1st -3rd treatment step of oculocardiac receptor

A

Surgeon removes stimulus
100 oxygen , proper ventilation, deepen anesthetic
Anticholinergics

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74
Q

Inhalation on intrathoracic pressure/ venous return / HR

A

Decrease intrathoracic pressure
Increase venous return
Increase heart rate

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75
Q

Exhalation on intrathoracic presssure/venous return/ HR

A

Increase intrathoracic pressure
decrease venous return
decrease heart rate.

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76
Q

In a patient with a history of a spinal cord lesion higher than T7, ___________ and ________is concerning for autonomic hyperreflexia.

A

marked hypertension and bradycardia

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77
Q

AUTONOMIC DYSREFLEXIA explain

A

Normally, descending inhibitory impulses travel down the spinal cord to block reflex arcs to cutaneous, visceral, or proprioceptive stimuli. This arc is disrupted in spinal cord injury and can lead to autonomic instability, most notably severe hypertension followed by a sustained vagal response including bradycardia, vasodilation, and cutaneous flushing.

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78
Q

AUTONOMIC DYSREFLEXIA Treatment

A

Treatment is supportive, including stopping the inciting stimulus (ask surgeons to pause) and lowering the blood pressure to normal levels via vasodilators and assuring adequate levels of anesthesia.

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79
Q

Proposed mechanism of bradycardia when doing ISB block?

A

Bezold-Jarisch reflex.

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80
Q

What is the most common cause of AKI ?

A

Prolonged renal hypoperfusion

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81
Q

What is the leading cause of transfusion-related fatalities and the most common cause of major morbidity and death after transfusion?

A

TRALI (transfusion-related acute lung injury)

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82
Q

The most common cause of cholestasis is

A

Obstruction of the biliary tract outside of the liver

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83
Q

Most common cause of Peptic Ulcer disease is

A

Ingestion of NSAIDS

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84
Q

Major and most common cause of pancreatic insufficiency

A

Chronic pancreatitis

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85
Q

Most common cause of Methemoglobin in clinical practice is

A

Medications ( Benzocaine and procaine LAs; dapsone ABT; Nitroglycerin and nitric oxide)

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86
Q

Most common cause of drug hypersensitivity reactions during anesthesia

A

Antibiotics

87
Q

Still the most common cause of adult valvular disease

A

RHD (rheumatic heart disease)

88
Q

Most common cause of Hypercalcemia and 2nd most common cause

A

Primary hyperparathyroidism

Malignancy

89
Q

FDA has identified the most common cause of Transfusion related deaths as

A

TRALI followed by hemolytic transfusion reactions.

90
Q

What is the most common cause of Central Retinal Artery OcclusioN (CRAO)?

A

Head positioning that result in external pressure on the eye.

91
Q

What is the most common cause of Post operative vision loss associated with prone spine surgery in adult patients?

A

ISCHEMIC OPTIC NEUROPATHY

92
Q

Most common cause of UNANTICIPATED difficulty with the airway>

A

Lingual tonsil hyperplasia

93
Q

Most common cause of acute pericarditis is

A

Viral infection

94
Q

Chronic constrictive pericarditis CURRENTLY (not in the past)

A

Idiopathic, post cardiac surgery, neoplasia, uremia

95
Q

What is the most common cause of Aortic stenosis

A

CONGENITAL DEFECT resulting in a BICUSPID AORTIC VALVE and as a SEQUELAE of Rheumatic valvular heart disease

96
Q

Most common dysrhythmias associated with MVP

A

PVCs.

97
Q

Most common cause of sudden death in pediatric young adult populations>

A

Hypertrophic Cardiomyopathy.

98
Q

What is the most common cause of peripheral vascular occlusive disease?

A

Atherosclerosis

99
Q

What is the most common cause of aneurysmal vascular occlusive disease?

A

Atherosclerosis

100
Q

Most common causes of COPD

A

Chronic Bronchitis

EMPHYSEMA

101
Q

Most common cause of Pulmonary edema due to upper airway obstruction?

A

Laryngospasm after extubation OR GA.

102
Q

What is the most common cause of POSTOP. respiratory dysfunction after or under General anesthesia?

A

Atelectasis

103
Q

In nonsurgical setting, most common cause of death with chronic renal failure is

A

Ischemic heart disease.

104
Q

What is the most common cause of death associated with Acromegaly?

A

Cardiac and respiratory complications

105
Q

The most common cause of Cushing syndrome today is the

A

Administration of glucocorticoids

106
Q

Outside of Glucorticoids, the most common cause of Cushing syndrome is

A

Cushing’s disease.

107
Q

Primary Adrenocortical insufficiency aka

A

Addision’s disease

108
Q

What is the most common cause of acute Stent thrombosis?

A

Premature discontinuation of dual anti platelet therapy.

109
Q

AKI is the most common after 5 days of burn injury and the most common cause is

A

Sepsis.

110
Q

The most common cause of Thyrotoxicosis

A

Hyperthyroidism

111
Q

The most common cause of HYPERTHYROIDISM

A

Grave’s disease (Multinodular diffuse goiter)

112
Q

The most common cause of postoperative mortality after bariatric surgery is

A

Thromboembolism

113
Q

The most common signs and symptoms of a leak and %

A

Tacychardia 72%
Fever 63%
Abdominal pain 54%

114
Q

The most common causes of Anesthesia related maternal mortality in obstetrics include

A

High cephalic spread of neuraxial block.

115
Q

The most common cause of arrest in non cardiac procedures is

A

Hyperkalemia

116
Q

The most common cause of AIRWAY obstruction in the immediate postoperative phase is the

A

loss of pharyngal muscle tone in a sedated/obtunded patient.

117
Q

The most common causes of hypoxemia in the PACU include (6)

A 
Atelectasis (can lead to increase in R-to-L shunt)
Pulmonary edema
Pulmonary embolism
Aspiration
Bronchospasm
Hypoventilation
118
Q

The most common causes of delayed awakening

A

Prolonged action of anesthetic drugs

119
Q

Common causes of delayed awakening other than anesthetic drugs.

A

Metabolic causes

Neurologic injury.

120
Q

Most common causes of pediatric anesthesia adverse events for both therapeutic or diagnostic procedures TOP 3 only

A

Drugs errors
Nitrous oxide in combination with other sedative
Inability to rescue the patient from an adverse anesthetic event.

121
Q

Most common cause of Postoperative arterial hypoxemia

A

Atelectasis.

122
Q

The most common cause of significant anesthetic related morbidity and mortality in Laboring women is

A

Unrecognized intrathecal injection of local anesthetics.

123
Q

The most common cause of upper GI obstruction in the newborn?

A

Pyloric Stenosis.

124
Q

Most common cause of death or CNS injury during MAC cases

A

Excessive sedation leading to respiratory compromise

125
Q

Most common cause of hyperphosphatemia is

A

Renal failure.

126
Q

The most common causes fo the anaphylaxis, IgE mediated events

A

NMBAs (58%), latex, ABT

127
Q

The leading injuries in anesthesia-related malpractice claims

A

Death
Nerve damage,
Permanent brain damage
Airway injury

128
Q

Most common cause of serious bronchiolitis and lower respiratory tract disease in infants and young children>

A

Human RSV

129
Q

Most common cause of ARDS

A

SEPSIS

130
Q

Most common cause of acute increase in dead space in the acute setting?

A

Decreased CO

131
Q

Most common cause of Intraoperative death?

A

Uncontrollable bleeding (80%) f/b brain herniation and air embolism.

132
Q

Most common cause of early trauma mortality

A

CNS injury and hemorrhage.

133
Q

The most common causes of acute transplanted lung failure

A

Acute graft rejection

134
Q

Most common cause of 30-day mortality following liver transplantation ?

A

Cardiovascular disease.

135
Q

The most common cause of AKI

A

Acute Tubular necrosis (ATN)

136
Q

Most common cause of metabolic alkalosis is

A

GI loss due to vomiting or NG suctioning.

137
Q

The most common causes of stridor in infants

A

Laryngomalacia

138
Q

Most common cause of elevated liver enzyme in adults

A

Nonalcoholic fatty liver disease (NAFLD)

139
Q

Most common cause of acute liver disease

A

Drug toxicity AND Infection

140
Q

What is the hallmark of MI and ventricular aneurysm?

A

Dyskinesia (paradoxical movement)

141
Q

What is the hallmark of Asthma? (clinically)

A

Inflammation of the airways

142
Q

In acute parenchymal injury offers the most rapid and reliable hallmark of liver dysfunction ?

A

Prothrombin time

143
Q

Hallmark signs of upper airway obstruction in the unanesthesized patient include

A

Hoarse or muffled voice
Difficult swallowing secretions
stridor and dyspnea.

144
Q

Hallmark of OSA is

A

habitual snoring

Fragmented sleep –> Day time somnolence

145
Q

Hallmark of COPD (symptoms)

A

Chronic productive cough

progressive exercise limitation

146
Q

Hallmark of COPD (signs)

A

Reduction of FEV1

147
Q

What is the hallmark of Asthma? (symptoms)

A

Recurrent wheezing
Dyspnea
cough

148
Q

Traditional hallmark of early pulmonary edema

A

Detection of basilar crackles on auscultation

149
Q

The hallmark sign of aspiration pneumonitis (and is frequently the first sign of aspiration) is

A

Arterial hypoxemia

150
Q

Hallmark finding of ARDS

A

NONCARDIOGENIC pulmonary edema

151
Q

Hallmark of Flail chest is

A

Paradoxical movement of the chest wall.

152
Q

Hallmark sign of tension pneumothroax

A 
Hypotension
hypoxemia
Absent breath sounds on AFFECTED SIDE
Tachycardia
Increased CVP
Increased airway pressure
153
Q

Hallmark clinical signs related to TURP (3)

A

Water intoxicatoion
fluid overload
Hyponatremia

154
Q

Clinical hallmark of Myasthenia Gravis?

A

Generalized muscle weakness that IMPROVES WITH REST

Inability to sustain or repeat muscular contractions.

155
Q

Hallmkar of DI is the

A

Excretion of abnormally large volume of dilute urine (polyuria)

156
Q

Hallmark of initial therapy for burn?

A

Fluid resuscitation

Airway management

157
Q

Minimum UO for burn patients

A

0.5 - 1 ml/kg/hr

158
Q

American Burn consensus formula for fluid resuscitation?

A

2-4 ml x kg body weight x % of TBSA burned

159
Q

Hallmark of burn shock is

A

Reduction in CO

160
Q

May develop within 5 years of post lung transplantation

A

Bronchiolitis obliterans syndrome (BOS)

161
Q

Bronchiolitis obliterans syndrome (BOS) hallmark is

A

Development of airway obstruction with a reduction of FEV1 that does not respond to bronchodilation

162
Q

Hallmark of both primary and secondary immunodeficiency

A

Increased susceptibility to infection

163
Q

Hallmark of quality anesthetic care

A

Evidence-based practice (EBP)

164
Q

During cryoablation, _____% of the CO is lost when the pulmonary artery is occluded

A

25%

165
Q

Coanda Effect explains the

A

tendency of fluid flow to follow a curved surface upon emerging from a constriction

166
Q

With the coanda effect If a constriction occurs at a bifurcation due to

A

due to increase in velocity and reduction of pressure, hence the fluid/air tends to stick to the side of the branch causing maldistribution.

167
Q

Application of Coanda Effect in anesthesia

A
  1. Mucus plug at the branching of tracheo-bronchial tree may cause maldistribution of respiratory gases.
  2. Unequal flow may result because of atherosclerotic plaques in the vascular tree
168
Q

Bernoulli’s principle describes what?

A

Described the effect of fluid flow through a tube containing a constriction

169
Q

Bernoulli’s principle states that as flow pass through a ________, the velocity of flow ________and there is a corresponding _______in pressure

A

narrowing in a tube; decreases; decrease

170
Q

Jet ventilation is based on which effect

A

Venturi effect

171
Q

2 key players in the mechanism of anesthesia

A

neurotransmitter-gated ion channels

K+ Channels

172
Q

What is the approximate blood loss per minute during the resection phase of a transurethral prostate resection?

A

2-4 mL

173
Q

The average amount of fluid absorbed during a TURP is about

A

20 mL/min of resection time.

174
Q

The most commonly used endogenous marker of renal reserve or GFR is

A

Creatinine clearance

175
Q

For trigeminal neuralgia (tic douloureux). What is the MOST appropriate first-line pharmacologic treatment?

A

Carbamazepine

176
Q

What is the most common cause of death in the period following resection of a pheochromocytoma??

A

Hypotension

177
Q

How much of the cardiac output does the kidney receive?

A

15-25%

178
Q

The liver gets its blood supply from the portal vein and the hepatic artery which together receives what % of cardiac output?

A

20-25%

179
Q

% of CO to the brain is

A

20%

180
Q

The most common cause (organism) of epiglottis infection

A

haemophilus influenza

181
Q

The 4Ds of epiglottis are

A

Drooling
Dysphonia
Dysphagia
Dyspnea

182
Q

What is the most common serious complication associated with opioid intrathecal and epidural administration?

A

Respiratory depression

183
Q

All local anesthetics cause vasodilation except for (ROLICO)

A

cocaine, lidocaine, and ropivacaine.

184
Q

LA with low potency and short duration is

A

Procaine

185
Q

Elevated carbon dioxide levels can increase the potential for toxicity for

A

all local anesthetics, including tetracaine.

186
Q

Duration of which local anesthetic is prolonged the most by the addition of the epinephrine?

A

Lidocaine

187
Q

Prevent the euphoric effect of opioids?

A

Naltrexone

188
Q

Butorphanol vs nalbuphine in that it is a kappa receptor agonist and a weak mu receptor antagonist, but it has

A

greater analgesic qualities

greater sedative effects

189
Q

Opioids and the CO2 responsiveness curve

A

They shift the curve to the right, which represents a decrease in responsiveness to CO2

190
Q

What is the main determinant of the rate at which an amide local anesthetic is metabolized?

A

Hepatic clearance

191
Q

The Cockcroft and Gault equation can be used to estimate based upon__________ (select three) SAW

A

creatinine clearance

Serum Creatinine
Age
Weight (SAW)

192
Q

Creatinine Clearance formula

A

(140-age) x weight / Serum Cr x 72

193
Q

Most drug metabolism is performed by microsomal enzymes in the smooth endoplasmic reticulum of the

A

liver cells

194
Q

Most potent endogenous glucocorticoid produced by the adrenal cortex is

A

cortisol.

195
Q

Hepatic clearance is the product of the 2 things :

A

Hepatic blood flow

Hepatic extraction ratio of the drug.

196
Q

The percent of a drug that the liver can clear as it passes through it is referred to as the

A

hepatic extraction ratio

197
Q

The primary etiologic factor in the development of retinopathy of prematurity (ROP) is the

A

gestational age.

198
Q

Factors such as (3) are also associated with an increased risk of developing ROP.

A

hyperoxia, hypocarbia, and acidemia

199
Q

What layer of skin is the rate-limiting layer for the absorption of eutectic mixture of local anesthetic (EMLA) cream?

A

stratum corneum

200
Q

The only process that does not involve the cytochrome P450 pathway is

A

hydrolysis

201
Q

The most frequent cause of hospitalization in patients older than 65 is

A

heart failure.

202
Q

Glucagon increases the blood glucose concentration by

A

Stimulating glycogenolysis in the liver

203
Q

The primary inhibitory neurotransmitter in the “brain

A

GABA

204
Q

The primary inhibitory neurotransmitter in the :”spinal cord

A

Glycine

205
Q

Which anesthetic agent is most associated with a transient increase in liver enzyme levels?

A

Desflurane

206
Q

Changes in alveolar ventilation affect which agent more? a soluble agent or a non-soluble agent?

A

a soluble agent more than a poorly-soluble agent.

207
Q

Spontaneous ventilation will ______ the uptake of inhalation anesthetics by ________ alveolar ventilation.

A

decrease, decreasing

208
Q

Which volatile agent increases cerebrospinal fluid absorption?

A

Isoflurane

209
Q

Chemotherapy drugs that can produce renal and hepatic dysfunction.

A

Methotrexate

210
Q

Peripheral neuropathies are most common in patients treated with

A

Methotrexate

211
Q

Doxarubicin (Adriamycin) can result in

A

cardiomyopathy and congestive heart failure.

212
Q

Alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis.

A

Cyclophosphamide is an

213
Q

Alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis.

A

Cyclophosphamide

214
Q

The alveolar-arterial difference for oxygen increases from approximately ______-at age 20 and to ___mmHg at age 70

A

8 mm Hg at age 20 to approximately 20 mm Hg at age 70.

SEE NCE Boards CoreConcepts (44 decks)

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