Basics Flashcards
1) Reconium is a?
2) How is Reconium reversed?
1) Muscle relaxant
2) it is reversed using Neostigmine PLUS glycopyrolate to prevent bradycardia.
1) Name 3 Inhalational Anaesthesias?
2) Name two IV Anaesthetic agents?
3) what are the two categories of muscle relaxants?
4) Name each agent in each category?
1) Desflurane, Sevoflurane, Isoflurane.
2) Propofol and Thiopentone
3) Depolarising me Non-depolarising
4) Dep = Suxamethonium
Non-dep = Atracurium and Rocurnium
1) Name naturally occurring Opioids?
2) Name the opioids that were modified in 1900s?
3) 4 Synthetic Opioids were made in 1950s, what were they??
4) Name a Synthetic Partial Agonist?
5) . Opioid toxicity is revered using what Antagonist?
1) Morphine and Codeine
2) Diamorphine, Oxycodone and Dihydrocodeine.
3) • Pethidine. • Fentanyl. •Alfentanil. • Ramifenanil.
4) . Buprenorphine.
5) Naloxone
1) Explain the role of liver in morphine metabolism?
2) How long does single dose of morphine roughly last?
1) 50% of oral morphine is metabolised by FIRST PASS in liver. Therefore, you should give half the dose if it is NOT given orally. (I.e. 10mg orally = 5mg parenterally)
2) single dose roughly lasts 3-4hours.
1) what is morphine metabolised into and how is it excreted?
2) State any Precautions to be taken?
1) Morphine is metabolised to MORPHINE 6 GLUCURONIDE (more potent). Then M6G is excreted Renally. If Normal renal function, quick clearance.
2) Precaution in renal failure. If R. Failure, morphine can build up and cause Resp depression.
* If renal function is <30% ( creatinine clearance <30), it is dangerous to use morphine. Use OXYCODONE. If Not sure ASK.
1) State step by step management in the case of opioid induced Respiratory Depression?
Step 1. call for HELP
Step 2. ABC
Step 3. Give IV Naloxone.
Drug prep= 1ml of Naloxone in 10ml Saline.
Notes: DO NOT GIVE IV NALOXONE all at once. Titrate it.
• Naloxone has short Half-life.
• Beware of drug addict overdose in A&E
1) How should Propofol be administered?
2) Why is it important that drug is mixed evenly?
1) E.g = 70kg patient,
Cardiac output ~ 5L/min
Blood volume ~5L
So give IV Propofol over 1Min to make sure it’s evenly spread.
NOTE: if C. Output is low (elderly) inject even more slowly:
2) Even spread reduces side effects such as Hypotension.
1) Name the local Anaesthetics that are available?
2) what factors determine the choice of local Anaesthetics?
3) Which L.Anaesthetics is the has fastest onset of speed?
4) Which L.A has longest duration of action?
1) Lidocaine, Prilocaine, Bupivacaine. EMLA Cream.
2) • Speed of onset • Duration of action
3) Prilocaine > Lidocaine > Bupivacaine.
4) Bupivacaine > Lidocaine > Prilocaine.
1) Which LA is used during epidural and why?
2) what LA could you use for smaller pain fibres block post-operatively?
3) 1% Lidocaine is used for what?
1) For epidural, we use 0.5% Bupivacaine to provide a DENSE BLOCK.
2) 0.1% Bupivacaine PLUS fentanyl can be used for Post-Operative infusion to block smaller pain fibres.
3) 1% Lidocaine can be used for:
a) Large IV cannula
b) AB Gas
c) Minor surgery
d) Suturing in A&E
1) What Local Anaesthetic would you choose for post-operative analgesia in theatre?
2) what combination of L.Anaesthetics would you use for faster onset and longer duration in post-operative analgesia?
1) For post-operative analgesia, Bupivacaine is used.
•last up to 12hours in regional block.
• But takes 20-30mins to work.
2) For faster onset and longer duration: Mix Prilocaine and Bupivacaine for regional block.
1) What L. Anaesthetic is least toxic?
2) What L. Anaesthetic is most toxic?
3) what are the effects of toxicity?
4) resistant Ventricular fib is associated with which LA?
1) Prilocaine is least Toxic
2) Bupivacaine is most Toxic
3) Two main effects:
a) CNS fitting
b) Cardiovascular = Circulatory collapse and arrhythmias.
4) Bupivacaine
1) State safe limits of administration for Prilocaine, Lidocaine and Bupivacaine with and without Adrenaline?
1)
Without Arden With adren
P= 6mg/kg. 6mg/kg
L=. 3mg/kg. 6mg/kg
B=. 2mg/kg. 2.5mg/kg
1) what are the signs & Symptoms of LA toxicity?
2) How do you manage LA toxicity?
1) Symptoms:
* Tinnitus
* Tingling around lips
* Agitation, then altered consciousness
* Fitting
* Cardiovascular collapse and arrthymias
2) Management:
a) stop injecting LA
b) call for help and start ABCD
c) Control seizures with benzo
d) Treat Hypotension and arrhythmias
e) if CPR needed, give IV bolus of intralipid 1.5mg/kg. Mops up LA.
1) What is the post-operative analgesia ladder?
2) What other medication should be prescribed post-operation?
1) Reg Paracetamol > NSAIDs > weak Opioids (codeine) > strong opioids (morphine)
NOTE: be EXTRA careful about NSAIDs in asthmatics, renal impairments, platelet dysfunction, GI ulcers.
2) Anti-emetics. 3 main types.
a) 5HT3 antagonists e.g = Ondansetron
b) Antihistamine agents. e.g = Cyclizine
c) Antidopaminergic agents e.g = Metoclopramide
1) what should be monitored during sedation?
2) what Benzodiazpene could be used for sedation and name a benzo-antagonist?
1) Patient monitoring: BP, pulse oximetry, ECG,
2) Midazolam can be used for sedation as well as controlling seizures in toxicity.
Antagonist= Flumazenil
