basic 2 Flashcards
when calculating minute ventilation in vent that has non compensating pnuematic bellows what do u have to take into consideration
add the FGF so its TV x RR + FGR
name 3 conditions associated with atlantoaxial instaiblity
- dwarfs
- rhematiod arthritis
- downs syndrome
what immunosuppresent can prolong Neuromuscular blocking agents
cyclosporin
mechanism of IV regional anesthesia
local anesthetic block of nerve endings via vascular beds
most common blood product that will lead to tranfusion assocaited sepsis
platelets bc stored at room temp
what opioid needs to be metabolized to have any effect
codeine to morphine via CYP2D6
spinal cord inhibiton is mediated by what transmitters/moleculres
opioids
GABA
glycine
list volatiles from most to least soluble
halothane > iso > sevo> N > des
nalbuphine MOA
mu antagonist
kappa agonist
haldane effect
hgb binding to O2 decreases hgb affinity for CO2
why are desflurane vapors heating
to prevent drastic changes in vapor pressure, since it vaoprizes at room temp
how is the binding ratio anti Xa: IIa ratio different betwen heparin and low molecular weight heparin
LMWH has smaller fragments and doesnt inhbiti thrombin IIa, as much as standard heparin so the anti Xa:IIa ratio is increased in LMWH
parameters in which PPV is most accurately predicted
-no peep
- tidal voluems > than 7-8cc/kg
-norma sinus rhythm
-positive pressure ventilation
why is edrophonium paired w atropine for reversal
bc similar onset and duration of action
think if u wanna reverse ur mistakes get AT (atropine) your PHONE (edrophonium)
mechanism of phenytoin
blockade of voltage gated sodium channels
whihv id why it can be anti epilectic and anti arythemic
when is pulmonary vasculate resistance the lowest
at FRC
volume less than FRC has decreased vessel radius, and kinked vessels
volume greater than FRC expands the alveoli and compresses the vessels
why is hypothermia in neonates lethal
hypothermia leads to nonshivering thermogenesis aka brown fat metabolism in neonates, this causes metabolic acidosis which is deleterious for neonates
whats the greatest risk factor for bradycardia when using succ
repeat doses of succ wtihin 5 minutes of each other can restumulate muscarinic receptor in cardiac
which opioid does not cause biliary spasm
butorphanol which is a synthetic my agonist-antagoinst and partial kappa agonsit
pathologies in what part of the heart may result in large R waves in v1 on EKG
right heart/artia/ ventricle strain etc. muscular dystrophy
name what artieries the anterior cardiac vein, middle cardiac vein and great cardiac vein are associated with
great –> left anterior descending
middle –> PDA(think ur in the middle of everyone when doing PDA)
anterior–> RCA think the ANTERIOR car is a RACE car (RCA)
what is poiselles law for flow
change in pressre *^4 * constant / length * viscosity * 8)
what happens to HR with 1.0 MAC of iso
HR icreases like ~15 BMP
symptoms of propopfol infusion syndrom
lactic acidosis
pancreatitis
high triglycerides
high K
renal failure/rhabo
cardiac failure
hepatomegaly
what determines the function of nitric oxide
the location that its produced
what paralytic has the least increase in dose for burn patients
mivacurium bc esterase metabolism
atrcurium is only partially metabolized by esterases
what number do u multiple by to convert to dynes
multiply by 80
transfusion realted immunomodulation causes benefit in what scenario (TRIM) R for renal survival
renal allograft survival rate
recovery of muscles after paralytics from first to last
diaphargm
laryngeal msucles
corrugator supercili
abdominal msucles
obicularies occuli
glenohyoid
adductor policus
odds ratio
AD/BC
how does liver disease affect nicardipine
liver onsuffiiency prolongs halflife of nicardiipine since its metabolized by ;iver and exccreted through GI
what clotting factors are decreased in prenancy
factors 11 and 13
what is the shape of a bobbin rotameter
wider at the top than the bottom so as flow increases cross secitonal area increases
what physiologic changes happen w bicarb
increased preload bc increased intravascular volume
decreased LV contractility
increased hgb afinity for O2 (left shift)
increased LA produciton
intracranial hemorrhage
what part of the leg is least likely to get parasthesias in lithotomy position
posterior thigh (think its hiding behind)
when used alone whats the most effective lead for detecting myocardial ischemia
v5
think 5 fingers on one hand ~~ 5 is an essential number and all u need ~~
how is anaphylaxsis vs anaphyloid reaction different
they are clinically the same
anyphylaxsis invles igE whereas anaphyloid is not igE but still has histamine release
the most effieicny mapleson circuits for spont and controlled ventilation
spont vent: all Dogs Can Bite
cntrolled vent: Dead Bodies Cant Argue
what are the least stable facotrs in fpp
factor 5 and 8
what gases have highest risk fo floride nephrotoxicity
sevo and enflursnce
what corresponds to closing of the mitral valve on ekg
the R wzve
what does the R wave on EKG correspond to
mitral valve closing
remember electricity is temporally a little ahead than the pressure in cardiac cycle
what is the mechanism of nitroprusside toxicity
cyandide ions binding to cytochome c oxidase
cyanomethemglobinemia
thiocynate production which causes the CNS side effects
how does glyco affect LES tone
causes decreased LES tone think its anti parasympathetic so anti digestion and lower tone may keep food from moving forward
how does end state liver disease affect metabolism of vec
vec is metabolized by the liver so clearance will be decreased
how does hypervolemia affect drug doses like for roc (cirrohsis etc).
increase volume of distribution so increase dose of roc required at induction
what LA has the lowest cardiac to cns dose toxicity
bupi
does IO or central access have faster insertion time/technically easier
IO is easier and quicker to place
what eye drug can cause convulsions if systemic absorption
cyclopentolate
what electrolyte abnormality potentiates the affects of digoxin toxicity
hypokalemia
eat bananas to avoid digoxin toxicity
why is nitrous oxide d/c’d when theres concern for co2 embolus
because u want to turn to 100% oxygen, turning of N20 itself doesnt help
do u get more allergic rxn from esteres or amides
usually from esters because they have PABA derivatives
think easter Eggs are ALLERGic
methyparaben is a perservative in esters and amides
if u ahve a ppower outage on ur machine what will not work
monitoring requires eletricity,
capanography wont work
what qualifies a patient to be at high risk of adrenal insufficiency
I they are getting 20mg or more of prednisone daily for 3 weeks
what has a stronger affect on BP venous or arterial dilation
venous dilation because majority of blood is in the veins
what is bayes theorem used for
to help develop preop testing alogirthms based on conditional probability
how is cerebral autoregulation affected by barbituates
unaffaceted
uncoupling of cerebral autoregulation happens with mac > 1
first sign of CNS toxicity w local adminsitration
numbness around the lips
how does chronic opioid use affect cortisol
will decrease cortisol
increase prolactin
increase testosterone and estrogen
what will contribute the most to CO production in co2 absorbent
presence of strong bases
barium/sodium/potassium hydroxide
what does adding bicarb to LA do
increases speed of onset because increases the unionized form
this can cause percipitant to form in certain LAs
how does PA-Pv gradient affect Fa/Fi rate of rise
higher gradient will slow down the rate of rise
how does ACEI affect bradykinin
increases bradykinin which increases AA metabolites increasing vasodilation and kidney natruesis affects
what is the dose amount of roc to give a patient to prevent fasciculations before succ
10% of ED95
which for paralytics dose that will cause 95% of twitched suppression
what is the afferent of the carotid body and what can inhibit it
glossopharyngeal nerve (hering nerve)
impaired y opiods, benzos, volatile anesthetics, b/l carotid surgery
why are peds more likely to have bradycardia on intubvation and DL
because peds have a over prominence of paraysympathetic NS
to pass through BBB molecules need to be 3 things
small < 500 daltons
unionized
liphophilic
only thing that causes decreased 2,3 BPG
stored RBCs
how should u adjust the dose if epi for LAST
decreased epi dose less than 1mcg/kg of epi
what who benzos undergo phase 2 glucuronidation without phase 1 metabolism
lorazepam
oxazepam
the LOR AX loves SUGAR
if someone w hemophilia a has antibiodies how do u treat
factor VII or factor II
intiail step is demopressin and cryo for minor bleeding bc this has fibrinogen and factor 8
how do CCB affect paralytics
mild augmentation of both depolarizing and non depolarizing
think it keeps the ca in the muscles so none of it can be used for contraction
how does hypoalbumin affect opioid and benzo dose
decrease benzo dose bc u have hella free benzo
increase opioid dose bc the hella free opoids will lead to tolerance development faster.
what is the function of renin
turn angiotensinigen to angiotensin 1
what are the indications for ffp transfusion
- warfarin reversal
- TTP
- heparin resistance bc no anti thrombin 3
- correct of certain coagulation deficiencies
why does morphine help w tet spells
decreases HR, anixety, RR but mostly decreases pullmonary vascular resistance
is stage 2 seen with inhalational induction
no
what happens if u use succ to reinduce a patient after reversing w neostigmine
prolonged succ during
what phase of diastole contributes the most blood
early RAPID filling ~~ flowing in like the rapids
how does going from upright to supine affect FRC and CC
FRC is decreased (think heart is compressing lungs )
closing capacity is unchanged
whats the most reliable sign for uterine rupture
non reassuring fetal heart tones
how long does it take for fent patch to onset and how long till peak affect
6-8 hours for onset
30 hours for peak affect
when cross typing blood what blood types do u mix w
anti A and anti B and anti d (rh) u dont test with anti O antibodies
what does vasopressin do to platlets
mild decrease
increases aggregation
standard error equation
SD/ sqare root of N
what pressor can u not give IM
norepi
think no no for norepi shot
how many mg of fibinrogen are in 1 unit of cry
200 mg
think 2 eyes and they are 2 circles
how is respiration affected w benzos
decreased tidal volume
think opooids affect RR more and benzos affect Tv more
sites for IO access
sternum
proximal humerus
proximal tibia
distal tibia
fasted onset opioid and why
alfentanil think A if first because its fast
its fast bc it has low pka
why does chlorprocaine have rapid onset of action
concentration
think c and c
what herbal meds are associated w increased bleeding
garlic
ginger
ginklo
vitamin E
nesiritide mechanism
recombinant form of BNP
when is p50 of oxygen highest and lowest
its highest in infants/kids till 10. year of age
lowest in new borns
what is the adult O2 consumption
whats the equation for FRC
3-4 cc/kg/min
FRC is 30 cc/ kg in healkthy adult
antiplatelet drug w longest duration of action
ticlopidine
second messenger for NMDA receptor
intracellular calcium
does oxymorphone work at the NMDA receptor
no
what does cryo contain
vWF
factor VIII
factor XIII
fibrinogen
fibronectin
urine osmolarity: plasma osmolarity ratio > 1.5 suggests what
prerenal injury
