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Advanced Principles I > Clinical > Flashcards

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)

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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

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3
Q

What are some predictors of difficult mask ventilation?

A

age >55, BMI >26, lack of teeth, beard, snoring

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4
Q

What is the MoA of propofol?

A

GABA agonist

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5
Q

What is the induction dose of propofol?

A

1-3 mg/kg

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6
Q

What is the maintenance dose of propofol?

A

75-300 mcg/kg/min

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7
Q

What is a pro of propofol (Diprivan)?

A

antiemetic

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8
Q

What are some cons of propofol?

A

accumulates in tissue with prolonged use, pain on injection, CV and respiratory depression, hypotension

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9
Q

What is the MoA of etomidate (Amidate)?

A

GABA modulation

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10
Q

What is the induction dose of etomidate?

A

0.2-0.6 mg/kg

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11
Q

What are some pros of etomidate?

A

minimal CV and respiratory depression

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12
Q

What are some cons of etomidate?

A

pain on injection, N/V, myoclonus, adrenal suppression

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13
Q

Does etomidate provide analgesia?

A

no- must combine with opioid or esmolol for laryngoscopy

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14
Q

What is the MoA of ketamine (Ketalar)?

A

NMDA antagonist

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15
Q

What is the induction dose of ketamine?

A

1-4.5 mg/kg (usually no more than 2 needed)

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16
Q

What is the maintenance dose of ketamine?

A

0.1-0.5 mg/min

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17
Q

What are some pros of ketamine?

A

minimal CV and respiratory depression, provides analgesia, several routes of administration

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18
Q

What are some cons of ketamine?

A

increases BP, HR, ICP, and SNS, post op dysphoria, hallucinations

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19
Q

Who would you avoid ketamine in? Who might you use it on?

A

Avoid in CAD, use in trauma

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20
Q

What is the MoA of dexmedetomidine (Precedex)?

A

alpha 2 agonist

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21
Q

What is a pro of using precedex?

A

minimal respiratory depression

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22
Q

What is the typical dosing of precedex?

A

1 mcg/kg followed by infusion of 0.2 mcg/kg/h

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23
Q

What are some cons of precedex?

A

no amnesia properties, can cause bradycardia

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24
Q

What is the MoA of barbiturates? (thiopental, methohexital)

A

GABA agonist

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25
Q

What is a pro of using barbiturates?

A

decreases ICP

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26
Q

What are some cons of barbiturates?

A

CV and respiratory depression, hypotension, porphyria, no reversal

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27
Q

What types of cases are barbiturates usually used for?

A

neurosurgery

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28
Q

What is the MoA of benzos?

A

GABA agonist

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29
Q

What is the typical dose of midazolam/Versed?

A

1-2.5 mg

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30
Q

What is the reversal agent for benzos?

A

flumazenil

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31
Q

What are some cons of benzos?

A

CV and respiratory depression, hypotension, post op delirium

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32
Q

In what type of patient may the half life of benzos be prolonged?

A

cirrhosis

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33
Q

What is the reversal agent for opioids?

A

naloxone

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34
Q

What is a typical dose of morphine?

A

2.5-5 mg IV every 3-4 hours

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35
Q

What is a pro of morphine?

A

long duration of action

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36
Q

What are some cons of opioids?

A

respiratory depression, hypotension, N/V, decreased GI motility, urinary retention, histamine release (morphine)

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37
Q

How is morphine excreted?

A

renally- renal failure may prolong action secondary to active metabolites

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38
Q

What is the most potent opioid?

A

sufentanil

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39
Q

What is the shortest duration opioid?

A

remifentanil

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40
Q

What is a typical dose of dilaudid?

A

0.2-1 mg

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41
Q

What is an advantage of using dilaudid over morphine?

A

no histamine release, 5x more potent

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42
Q

How do anesthetic gases work?

A

alters ACh, GABA, and glutamate receptor activity

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43
Q

What two gases cause bronchodilation?

A

iso and sevo

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44
Q

Which anesthetic gas can be used for induction?

A

sevo

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45
Q

How are anesthetic gases eliminated?

A

ventilation

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46
Q

Which anesthetic gas preserves renal, coronary, and cerebral blood flow?

A

isoflurane

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47
Q

Which anesthetic gas has the slowest onset and offset?

A

isoflurane

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48
Q

Which anesthetic gas has the quickest onset and offset?

A

desflurane

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49
Q

What are some pros of using nitrous?

A

decrease volatile anesthetic requirements, less myocardial depression, no odor

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50
Q

What are some cons of using nitrous?

A

diffuses into air filled spaces, increases pulmonary vascular resistance, decreases FiO2

51
Q

What is the MoA of succinylcholine?

A

ACh receptor agonist causing persistent depolarization?

52
Q

What is different about a depolarizing vs nondepolarizing block?

A

depolarizing has phase I (twitching and fasciculations) and phase II (flaccid paralysis) whereas nondepolarizers only have “phase II”

53
Q

What is the induction dose of succs?

A

0.5-1.5 mg/kg

54
Q

Who should you avoid succs in?

A

hyperkalemia, myopathies, burns, MH

55
Q

What is the MoA of nondepolarizing NMBs?

A

ACh receptor antagonist

56
Q

What is a standard induction dose of roc?

A

0.6-1.2 mg/kg (usually 0.5)

57
Q

What is an induction dose of vec?

A

0.08-0.1 mg/kg

58
Q

Ideally how many twitches do you want present during a case?

A

1-2

59
Q

What is a typical dose of neostigmine?

A

0.03-0.07 mg/kg

60
Q

What are some unwanted side effects of AChE inhibitors? How do we avoid them?

A

bradycardia, increased secretions, and bronchoconstriction- pretreat with anticholinergic

61
Q

What is the typical dose of glyco when given with neostigmine?

A

0.2 mg per 1 mg of neostigmine

62
Q

What do you give first during reversal, AChE inhibitor or anticholinergic?

A

anticholinergic

63
Q

What is nicardipine and a typical dose?

A

CCB (lowers BP and peripheral vascular resistance)- 5 mg IV

64
Q

What are some unwanted side effects of nicardipine?

A

N/V, tachycardia

65
Q

Who would you avoid giving nicardipine in?

A

aortic stenosis

66
Q

What does nitroprusside do?

A

decreases afterload and myocardial O2 demand

67
Q

What is a typical maintenance dose of nitroprusside?

A

0.2 mcg/kg/min up to 10

68
Q

What can an infusion rate of >2 mcg/kg/min of nitroprusside lead to?

A

cyanide toxicity, methemoglobinemia

69
Q

What is esmolol and what does it do?

A

beta 1 antagonist- lowers chrono- and inotropic activity, fast acting

70
Q

What is a typical dose of esmolol?

A

1 mg/kg over 30 seconds

71
Q

What kind of conditions are esmolol contraindicated in?

A

2nd or 3rd degree heart block

72
Q

What s/s may esmolol mask?

A

signs of hypoglycemia

73
Q

Why would esmolol be preferred over other beta blockers in asthmatics?

A

minimal bronchoconstriction (beta selective)

74
Q

What is labetalol and what does it do?

A

alpha and beta antagonist- decreases BP, HR, and CO

75
Q

What is a typical dose of labetalol?

A

20-80 mg IV

76
Q

Who would you avoid labetalol in?

A

obstructive airway disease, heart block

77
Q

What is hydralazine?

A

short acting direct vasodilator

78
Q

What is a typical dose of hydralazine?

A

1.7-3.5 mg/kg daily in 4-6 doses

79
Q

What is an unwanted SE of hydralazine? Who would you avoid it in?

A

tachycardia; avoid in CAD and mitral valve disease

80
Q

What is phenylephrine and what does it do?

A

alpha 1 agonist- increases SBP and MAP

81
Q

What is a typical dose of phenylephrine?

A

50-100 mcg

82
Q

What may be a reflex result of using phenylephrine?

A

bradycardia

83
Q

What is norepinephrine and what does it do?

A

alpha and beta 1 agonist (a>b), increases MAP, constricts both arteries and veins and increases contractility

84
Q

What is the typical infusion rate of norepinephrine?

A

0.01-3 mcg/kg/min

85
Q

Vasoconstriction from using norepinephrine can decrease blood flow to?

A

renal, splanchnic and cutaneous

86
Q

What is epinephrine and what does it do?

A

alpha and beta agonist- relaxes bronchial smooth muscle, increases HR and CO, dilates skeletal muscle vasculature

87
Q

What is a typical infusion rate of epi for acute hypotension?

A

0.05-2 mcg/kg/min

88
Q

What is a typical dose of epi for anaphylaxis?

A

0.2-0.5 mg IM

89
Q

What does epi do to cardiac O2 demand?

A

increases (should not be used in cardiac shock)

90
Q

What is dopamine and what does it do?

A

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
Q

What is a typical maintenance dose of dopamine for cardiogenic or septic shock?

A

5-10 mcg/kg/min

92
Q

When is dopamine contraindicated?

A

pheochromocytomas

93
Q

What is dobutamine and what does it do?

A

primary beta 1 agonist (some alpha and beta 2)- increases contractility and cardiac output

94
Q

What is a typical maintenance dose of dobutamine for cardiac decompensation?

A

0.5-1 mcg/kg/min

95
Q

Who should you not use dobutamine in?

A

hypertrophic cardiomyopathies

96
Q

What is isoproterenol and what does it do?

A

beta 1 and 2 agonist- increase CO, relaxes smooth muscle, vasodilation of peripheral vasculature

97
Q

What is a typical maintenance dose of isoproterenol?

A

0.5-5 mcg/min

98
Q

What does isoproterenol do to myocardial O2 demand?

A

increases

99
Q

What is the MoA of local anesthetics?

A

voltage-gated Na channel antagonist

100
Q

What are the esters?

A

procaine, tetracaine (only 1 i in the name)

101
Q

What are the amides?

A

lidocaine, bupivacaine, ropivacaine (>2 i’s in the name)

102
Q

How are esters metabolized?

A

plasma esterases

103
Q

How are amides metabolized?

A

liver

104
Q

What does alpha 1 stimulation do?

A

increase vascular smooth muscle contraction, mydriasis, increase intestinal and bladder sphincter muscle contraction

105
Q

What does alpha 2 stimulation do?

A

decreases sympathetic tone, decreased insulin release, decreased lipolysis, increased platelet aggregation

106
Q

What does beta 1 stimulation do?

A

increases HR, contractility, renin release, and lypolysis

107
Q

What does beta 2 stimulation do?

A

vasodilation, bronchodilation, increased lipolysis, insulin release, decreased uterine tone, relaxes ciliary muscle

108
Q

What does beta 3 stimulation do?

A

increased lipolysis and thermogenesis

109
Q

What does dopamine (DA)-1 stimulation do?

A

vasodilation of renal, cerebral, coronary, and splanchnic arteries

110
Q

What are typical sizes of ETT for men vs women?

A

8 mm for men, 7.5 for women

111
Q

What is the minimum ETT size needed for bronchoscopy?

A

7.5

112
Q

What are some criteria for extubation?

A

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
Q

What is minute ventilation?

A

TV x RR

114
Q

Describe controlled mandatory ventilation (CMV) mode

A

MV is set, breaths are not synchronized to patient’s effort

115
Q

Describe assist control (AC)

A

minimum MV set, pt can initiate breaths and a set TV is delivered

116
Q

Describe intermittent mandatory ventilation (IMV)

A

minimum MV set, pt can initiate extra breaths but no volume is delivered with them

117
Q

Describe SIMV

A

variation of IMV where ventilator delivered breaths are synchronized with pt breaths

118
Q

Describe pressure support ventilation (PSV)

A

pt determines TV and RR but a set pressure is delivered- it augments spontaneous breathing and is good for weaning

119
Q

Describe how to dilute ephedrine in a syringe (at Grant)

A

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
Q

Describe how to dilute epinephrine in a bag (at Grant)

A

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
Q

Describe how to dilute nicardipine in a bag (at Grant)

A

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
Q

Describe how to dilute norepinephrine in a syringe (at Grant)

A

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
Q

Describe how to dilute phenylephrine in a bag (at Grant)- NOT the same as the prefilled syringes

A

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
Q

Describe how to dilute vasopressin in a syringe (at Grant)

A

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

Advanced Principles I (6 decks)

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