complications and treatment

Question 1

treatments for sphincter of Oddi spasm

Answer 1

Glucagon
Naloxone
Atropine
Nalbuphine
NTG

Question 2

Glucagon dose for Oddi spasm

Answer 2

2 mg IV

Question 3

Naloxone dose for Oddi spasm

Answer 3

40 mcg IV

Question 4

Glucagon MOA

Answer 4

inhibits gastrointestinal and duodenal motility by relaxing smooth muscles, decreasing the frequency and amplitude of phasic activity of the sphincter of Oddi.

Question 5

Atropine dose for Oddi spasm

Answer 5

0.2 mg IV

Question 6

Atropine MOA on the heart

Answer 6

no machR activation -> K+ channels are not activated to hyperpolarize the cell since they are blocked = they are excitable = increase HR

Question 7

Why do diabetics have decreased gastric mobility?

Answer 7

The vagus nerve, which controls how quickly the stomach empties. When it’s damaged by hyperglycemia the digestion slows down.

Question 8

Atropine MOA on sphincter of oddi

Answer 8

Distention of the stomach causes Sphincter of Oddi contraction, producing a resistance to reflux of duodenal contents through the Sphincter of Oddi= pylori-sphincter reflex.

The reflex is abolished by atropine suggesting mediation by cholinergic nerves.

Question 9

Nalbuphine dose for oddi spasm

Answer 9

10 mg IV

Question 10

Nalbuphine MOA

Answer 10

opioid agonist- antagonist

µ receptors agonist: equally potent to Morphine
+ competitive Antagonist

Question 11

NTG dose for Oddi spasm

Answer 11

50 mcg IV

Question 12

NTG MOA

Answer 12

vasodilator by
Releasing NO that activates soluble guanylyl cyclase and increases CGMP that stimulates PKG to phophorilate ca channels = decrease constriction and then increase myosin light chain phosphatase activity by phosphorilation to increase the speed of removal of phosphate from the myosin head resulting in relaxation.

Question 13

Laryngospasm treatment

Answer 13

positive pressure ventilation (close apl to 40cmh20)
- wait for them to breathe

Larsons maneuver (Apply for 3-5 seconds, then release for 5-10 seconds)

succ 10-20 mg IV

Question 14

Drug most likely to cause sphincter of oddi spasm

Answer 14

fentanyl

Question 15

MH triggers

Answer 15

Halothane, enflurane, isoflurane, sevoflurane, desflurane, and succinylcholine

Question 16

Signs of onset of MH

Answer 16

Tachycardia, tachypnea, rapidly increasing CO2, skin mottling, arrhythmias, hyperthermia, unstable BP, Dark urine, musle rigidity, and masseter muscle rigidity

Question 17

treatment for MH

Answer 17

Stop triggering agent
hyperventilate w/ 100% and high flow
administer dantrolene or ryanodex
correct metabolic acidosis
correct hyperkalemia
acitvely cool pt
check labs q 15 min until stable
maintain urine output > 2ml/kg/hr with hydration, mannitol or lasix

Question 18

Dantrolene dose for MH

Answer 18

dilute each 20 mg of dantrolene vial in 60 ml of sterile water
2.5 mg/kg IV repeats q5-10 min until symptoms controlled

max 10mg/kg

in ICU continue 1 mg/kg every 4-6 hrs or 0.25 mg/kg/hr for 24 hrs

Question 19

Dantrolene MOA

Answer 19

Blocks ca++ release channels/ the ryr compelx

Question 20

Physiology of MH

Answer 20

Disordered opening of the Ryanodine calcium release channels on the sarcoplasmic reticulum in skm that are triggered to open by the dihydropyradine receptors in the T tubules = massive calcium in the cell and massive amount of myosin/ actin cross bridge cycling.

Question 21

Ryanodex dose

Answer 21

2.5 mg/kg
dilute 250 mg vial in 5 ml of sterile water.