Clinical Flashcards
1
Q
Describe the different ASA categories
A
1- normal, healthy
2- mild systemic disease
3- severe systemic disease
4- severe systemic disease that is constant threat to life
5- moribund patient not expected to survive w/o surgery
6- brain-dead (organ harvest)
2
Q
What are some predictors of difficult airway?
A
history of difficult intubation, neck circumference >16 in (F) or >17 in (M), thyromental distance <7 cm, Mallampati 3 or 4
3
Q
What are some predictors of difficult mask ventilation?
A
age >55, BMI >26, lack of teeth, beard, snoring
4
Q
What is the MoA of propofol?
A
GABA agonist
5
Q
What is the induction dose of propofol?
A
1-3 mg/kg
6
Q
What is the maintenance dose of propofol?
A
75-300 mcg/kg/min
7
Q
What is a pro of propofol (Diprivan)?
A
antiemetic
8
Q
What are some cons of propofol?
A
accumulates in tissue with prolonged use, pain on injection, CV and respiratory depression, hypotension
9
Q
What is the MoA of etomidate (Amidate)?
A
GABA modulation
10
Q
What is the induction dose of etomidate?
A
0.2-0.6 mg/kg
11
Q
What are some pros of etomidate?
A
minimal CV and respiratory depression
12
Q
What are some cons of etomidate?
A
pain on injection, N/V, myoclonus, adrenal suppression
13
Q
Does etomidate provide analgesia?
A
no- must combine with opioid or esmolol for laryngoscopy
14
Q
What is the MoA of ketamine (Ketalar)?
A
NMDA antagonist
15
Q
What is the induction dose of ketamine?
A
1-4.5 mg/kg (usually no more than 2 needed)
16
Q
What is the maintenance dose of ketamine?
A
0.1-0.5 mg/min
17
Q
What are some pros of ketamine?
A
minimal CV and respiratory depression, provides analgesia, several routes of administration
18
Q
What are some cons of ketamine?
A
increases BP, HR, ICP, and SNS, post op dysphoria, hallucinations
19
Q
Who would you avoid ketamine in? Who might you use it on?
A
Avoid in CAD, use in trauma
20
Q
What is the MoA of dexmedetomidine (Precedex)?
A
alpha 2 agonist
21
Q
What is a pro of using precedex?
A
minimal respiratory depression
22
Q
What is the typical dosing of precedex?
A
1 mcg/kg followed by infusion of 0.2 mcg/kg/h
23
Q
What are some cons of precedex?
A
no amnesia properties, can cause bradycardia
24
Q
What is the MoA of barbiturates? (thiopental, methohexital)
A
GABA agonist
25
What is a pro of using barbiturates?
decreases ICP
26
What are some cons of barbiturates?
CV and respiratory depression, hypotension, porphyria, no reversal
27
What types of cases are barbiturates usually used for?
neurosurgery
28
What is the MoA of benzos?
GABA agonist
29
What is the typical dose of midazolam/Versed?
1-2.5 mg
30
What is the reversal agent for benzos?
flumazenil
31
What are some cons of benzos?
CV and respiratory depression, hypotension, post op delirium
32
In what type of patient may the half life of benzos be prolonged?
cirrhosis
33
What is the reversal agent for opioids?
naloxone
34
What is a typical dose of morphine?
2.5-5 mg IV every 3-4 hours
35
What is a pro of morphine?
long duration of action
36
What are some cons of opioids?
respiratory depression, hypotension, N/V, decreased GI motility, urinary retention, histamine release (morphine)
37
How is morphine excreted?
renally- renal failure may prolong action secondary to active metabolites
38
What is the most potent opioid?
sufentanil
39
What is the shortest duration opioid?
remifentanil
40
What is a typical dose of dilaudid?
0.2-1 mg
41
What is an advantage of using dilaudid over morphine?
no histamine release, 5x more potent
42
How do anesthetic gases work?
alters ACh, GABA, and glutamate receptor activity
43
What two gases cause bronchodilation?
iso and sevo
44
Which anesthetic gas can be used for induction?
sevo
45
How are anesthetic gases eliminated?
ventilation
46
Which anesthetic gas preserves renal, coronary, and cerebral blood flow?
isoflurane
47
Which anesthetic gas has the slowest onset and offset?
isoflurane
48
Which anesthetic gas has the quickest onset and offset?
desflurane
49
What are some pros of using nitrous?
decrease volatile anesthetic requirements, less myocardial depression, no odor
50
What are some cons of using nitrous?
diffuses into air filled spaces, increases pulmonary vascular resistance, decreases FiO2
51
What is the MoA of succinylcholine?
ACh receptor agonist causing persistent depolarization?
52
What is different about a depolarizing vs nondepolarizing block?
depolarizing has phase I (twitching and fasciculations) and phase II (flaccid paralysis) whereas nondepolarizers only have "phase II"
53
What is the induction dose of succs?
0.5-1.5 mg/kg
54
Who should you avoid succs in?
hyperkalemia, myopathies, burns, MH
55
What is the MoA of nondepolarizing NMBs?
ACh receptor antagonist
56
What is a standard induction dose of roc?
0.6-1.2 mg/kg (usually 0.5)
57
What is an induction dose of vec?
0.08-0.1 mg/kg
58
Ideally how many twitches do you want present during a case?
1-2
59
What is a typical dose of neostigmine?
0.03-0.07 mg/kg
60
What are some unwanted side effects of AChE inhibitors? How do we avoid them?
bradycardia, increased secretions, and bronchoconstriction- pretreat with anticholinergic
61
What is the typical dose of glyco when given with neostigmine?
0.2 mg per 1 mg of neostigmine
62
What do you give first during reversal, AChE inhibitor or anticholinergic?
anticholinergic
63
What is nicardipine and a typical dose?
CCB (lowers BP and peripheral vascular resistance)- 5 mg IV
64
What are some unwanted side effects of nicardipine?
N/V, tachycardia
65
Who would you avoid giving nicardipine in?
aortic stenosis
66
What does nitroprusside do?
decreases afterload and myocardial O2 demand
67
What is a typical maintenance dose of nitroprusside?
0.2 mcg/kg/min up to 10
68
What can an infusion rate of >2 mcg/kg/min of nitroprusside lead to?
cyanide toxicity, methemoglobinemia
69
What is esmolol and what does it do?
beta 1 antagonist- lowers chrono- and inotropic activity, fast acting
70
What is a typical dose of esmolol?
1 mg/kg over 30 seconds
71
What kind of conditions are esmolol contraindicated in?
2nd or 3rd degree heart block
72
What s/s may esmolol mask?
signs of hypoglycemia
73
Why would esmolol be preferred over other beta blockers in asthmatics?
minimal bronchoconstriction (beta selective)
74
What is labetalol and what does it do?
alpha and beta antagonist- decreases BP, HR, and CO
75
What is a typical dose of labetalol?
20-80 mg IV
76
Who would you avoid labetalol in?
obstructive airway disease, heart block
77
What is hydralazine?
short acting direct vasodilator
78
What is a typical dose of hydralazine?
1.7-3.5 mg/kg daily in 4-6 doses
79
What is an unwanted SE of hydralazine? Who would you avoid it in?
tachycardia; avoid in CAD and mitral valve disease
80
What is phenylephrine and what does it do?
alpha 1 agonist- increases SBP and MAP
81
What is a typical dose of phenylephrine?
50-100 mcg
82
What may be a reflex result of using phenylephrine?
bradycardia
83
What is norepinephrine and what does it do?
alpha and beta 1 agonist (a>b), increases MAP, constricts both arteries and veins and increases contractility
84
What is the typical infusion rate of norepinephrine?
0.01-3 mcg/kg/min
85
Vasoconstriction from using norepinephrine can decrease blood flow to?
renal, splanchnic and cutaneous
86
What is epinephrine and what does it do?
alpha and beta agonist- relaxes bronchial smooth muscle, increases HR and CO, dilates skeletal muscle vasculature
87
What is a typical infusion rate of epi for acute hypotension?
0.05-2 mcg/kg/min
88
What is a typical dose of epi for anaphylaxis?
0.2-0.5 mg IM
89
What does epi do to cardiac O2 demand?
increases (should not be used in cardiac shock)
90
What is dopamine and what does it do?
dopamine agonist at low doses, B-1 at medium, alpha at high- causes renal, mesenteric, coronary, and intracerebral vasodilation at low doses which increases RBF and GFR
91
What is a typical maintenance dose of dopamine for cardiogenic or septic shock?
5-10 mcg/kg/min
92
When is dopamine contraindicated?
pheochromocytomas
93
What is dobutamine and what does it do?
primary beta 1 agonist (some alpha and beta 2)- increases contractility and cardiac output
94
What is a typical maintenance dose of dobutamine for cardiac decompensation?
0.5-1 mcg/kg/min
95
Who should you not use dobutamine in?
hypertrophic cardiomyopathies
96
What is isoproterenol and what does it do?
beta 1 and 2 agonist- increase CO, relaxes smooth muscle, vasodilation of peripheral vasculature
97
What is a typical maintenance dose of isoproterenol?
0.5-5 mcg/min
98
What does isoproterenol do to myocardial O2 demand?
increases
99
What is the MoA of local anesthetics?
voltage-gated Na channel antagonist
100
What are the esters?
procaine, tetracaine (only 1 i in the name)
101
What are the amides?
lidocaine, bupivacaine, ropivacaine (>2 i's in the name)
102
How are esters metabolized?
plasma esterases
103
How are amides metabolized?
liver
104
What does alpha 1 stimulation do?
increase vascular smooth muscle contraction, mydriasis, increase intestinal and bladder sphincter muscle contraction
105
What does alpha 2 stimulation do?
decreases sympathetic tone, decreased insulin release, decreased lipolysis, increased platelet aggregation
106
What does beta 1 stimulation do?
increases HR, contractility, renin release, and lypolysis
107
What does beta 2 stimulation do?
vasodilation, bronchodilation, increased lipolysis, insulin release, decreased uterine tone, relaxes ciliary muscle
108
What does beta 3 stimulation do?
increased lipolysis and thermogenesis
109
What does dopamine (DA)-1 stimulation do?
vasodilation of renal, cerebral, coronary, and splanchnic arteries
110
What are typical sizes of ETT for men vs women?
8 mm for men, 7.5 for women
111
What is the minimum ETT size needed for bronchoscopy?
7.5
112
What are some criteria for extubation?
stable vital signs, spontaneous RR 6-30, TOF 4/4, spontaneous TV >5 ml/kg and VC >15 ml/kg, protective reflexes returned, awake and able to follow commands
113
What is minute ventilation?
TV x RR
114
Describe controlled mandatory ventilation (CMV) mode
MV is set, breaths are not synchronized to patient's effort
115
Describe assist control (AC)
minimum MV set, pt can initiate breaths and a set TV is delivered
116
Describe intermittent mandatory ventilation (IMV)
minimum MV set, pt can initiate extra breaths but no volume is delivered with them
117
Describe SIMV
variation of IMV where ventilator delivered breaths are synchronized with pt breaths
118
Describe pressure support ventilation (PSV)
pt determines TV and RR but a set pressure is delivered- it augments spontaneous breathing and is good for weaning
119
Describe how to dilute ephedrine in a syringe (at Grant)
initial concentration is 50 mg/1 ml- draw it up in a syringe with 9 mL of normal saline for a final concentration of 5 mg/ml
120
Describe how to dilute epinephrine in a bag (at Grant)
initial concentraiton is 1 mg/1 ml- draw up in a syringe and inject into a 100 ml bag of NS for a final concentration of 10 mcg/ml
121
Describe how to dilute nicardipine in a bag (at Grant)
Initial concentration is 25 mg/10 mL vial- remove 10 ml of NS from a 100 mL bag of NS, then draw up the 10 mL of nicardipine in an empty 10 mL syringe and inject into the remaining 90 ml of NS for a final concentration of 250 mcg/mL
122
Describe how to dilute norepinephrine in a syringe (at Grant)
initial concentraiton is 4 mg/250 ml premixed bag- draw up 5 mL of norepinephrine from bag in a 10 ml syringe and dilute with 5 ml of NS for a final concentration of 8 mcg/ml
123
Describe how to dilute phenylephrine in a bag (at Grant)- NOT the same as the prefilled syringes
initial concentration is 10 mg/1 ml vial- draw up 1 ml and inject into 100 ml bag for a final concentration of 100 mcg/ml
124
Describe how to dilute vasopressin in a syringe (at Grant)
initial concentration is 20 units/mL- draw 1 ml of vasopressin in 20 ml syringe and dilute with 19 ml of normal saline for a final concentration of 1 unit/ml
