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Anaesthesia > Day 4: Fluids and Vasoactive drugs > Flashcards

Day 4: Fluids and Vasoactive drugs Flashcards

1
Q

why is it important to check blood products

A

Medicolegally
Risk of transfusion reactions
Risk of infection
Must be checked at several levels

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2
Q

What is the protocol for accepting blood products upon arrival?

A

Do not accept blood products without the accompanying form detailing specific information.

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3
Q

What crucial information does the form accompanying blood products contain?

A

The form includes the following details:
-Patient’s NAME
-Patient’s HOSPITAL NUMBER
-TYPE OF BLOOD -PRODUCT and BLOOD GROUP (if relevant)
-UNIQUE SERIAL NUMBER OF BLOOD PRODUCT
-EXPIRY DATE AND TIME

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4
Q

How does the information on the form compare with that displayed on the blood product?

A

The same information displayed on the form should also be present on the blood product itself.

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5
Q

Why is it important to verify the information on both the form and the blood product?

A

Verification ensures accuracy and helps prevent errors in patient identification and blood product administration.

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6
Q

What is the first step in the verification process for blood products?

A

Check both the products and the accompanying form separately against the patient’s name and folder number from the patient’s own folder.

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7
Q

Why is it important to verify against the patient’s own folder number?

A

Why is it important to verify against the patient’s own folder number?

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8
Q

After verifying against the patient’s folder number, what is the next step in the verification process?

A

Check the form against the blood products to see if the details match.

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9
Q

What is the ideal method for conducting this verification process?

A

Ideally, one person reads the form while another person goes through the blood products.

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10
Q

What action should be taken in the event of any discrepancy between the form and the blood products?

A

If any discrepancy is found, do not use the product; instead, return it to the blood bank.

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11
Q

How does the verification process differ for emergency issued blood?

A

Emergency issued blood is not crossmatched and may have limited details. However, the blood type, expiry date, and serial number must still be checked against the form.

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12
Q

what products must be checked?

A

ANY blood product from blood bank
-Packed red cells
-Fresh frozen plasma
-Whole blood
-Cryoprecipitate
-Platelets
-Whether issued as emergency or not

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13
Q

division of the CNS

A

brain
spinal cord

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14
Q

division of the PNS

A

Somatic
Autonomic

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15
Q

Division of the somatic

A

motor
sensory

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16
Q

division of the autonomic

A

sympathetic
parasympathetic

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17
Q

function of the autonomic NS

A

Responsible for the involuntary control of automatic body functions

Each organ system has autonomic control working all the time
We are not in conscious control of this

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18
Q

sympathetic autonomic NS

A

Thoracolumbar outflow
Postganglionic neurotransmitter is Noradrenaline
Αlpha and Beta receptors

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19
Q

parasympathetic autonomic NS

A

Craniosacral outflow
Postganglionic neurotransmitter is Acetylcholine
Nicotinic and muscarinic receptors

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20
Q

function of the sympathetic

A

Sympathetic: “FIGHT or FLIGHT”

Temperature, glucose, vascular responsiveness, ventilation, cardiac output and GIT

Stress response

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21
Q

function of the parasympathetic

A

Parasympathetic: HOMEOSTATIC

Maintains normal physiological functioning and energy levels

Digestions and Metabolism

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22
Q

the stress response pyramid

A

-humoral: HORMONAL
-Nueral: HAEMODYNAMIC
-stress response

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23
Q

stress response

A

Series of Neurohumoral responses to optimise the bodily defence mechanisms for short-term survival ….. “fight or flight

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24
Q

neural: HAEMODYNAMIC

A

-Increased sympathetic outflow
-Blood flow
*Increased: heart, lungs, brain and muscle (β)
*Decreased: GIT, kidney, liver (splanchnic circulation) and skin (α)

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25
Q

Humoral: HORMONAL

A

-Defence of blood volume
*Increased: aldosterone and ADH - salt and water retention
-Mobilisation of glucose stores to supply vital organs with energy
*Insulin inhibited

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26
Q

the adrenaline medulla

A

-specialized sympathetic ganglion with no postganglionic fibres
- postganglionic fiberes are secretory cells

27
Q

which hormonal that the medulla secrete when stimulated

A
  • noradrenaline- 70%
    -adrenaline
  • dopamine in small amounts
28
Q

neurotransmitters in the ANS

A

acetylcholine
noradrenaline

29
Q

2 types of receptors in the ANS

A

cholinergic- bind acetylcholine
noradrenergic- bind noradrenaline

30
Q

cholinergic receptors: distribution

A
  • all autonomic ganglia (including the adrenal medulla)
  • all parasympathetic postganglionic nerve terminals
    -sympathetic postganglionic nerve terminals in sweat glands (exception)
    -somatic NS- neuromuscular junction
31
Q

cholinergic receptors: subtypes

A

nicotinic
muscarinic

32
Q

nicotinic

A

-At skeletal NMJ and ALL autonomic ganglia (incl adrenal medulla)
-Stimulated by nicotine and Ach
-Inhibited by Neuromuscular blocking agents

33
Q

muscarinic

A

-At parasympathetic postganglionic fibres
-Stimulated by muscarine and Ach
-Inhibited by atropine, glycopyrrolate

34
Q

parasympathetic excess: the rule of B’s

A

Blindness (ptosis)
Bronchial secretions
Bronchospasm
Bradycardias
“B”- eristalsis (peristalsis)- vomiting, diarrhoea
Bile secretion
Bladder contraction

35
Q

adrenergic receptors distribution

A

only found at the sympathetic postganglionic nerve terminals

36
Q

adrenergic receptors subtypes

A

alpha
beta

37
Q

alpha 1

A

post-synaptic – smooth muscle vasoconstriction (e.g. blood vessels)
Increases the BP ± reflex bradycardia

38
Q

alpha 2

A

pre-synaptic – inhibits further NA release (central) –sedation, analgesia, hypotension

39
Q

beta 1

A

increased contractility, HR, AV node conduction, refractory period, renin secretion and lipolysis

40
Q

beta 2

A

increased skeletal muscle vessel dilatation, bronchial relaxation, uterine relaxation, bladder relaxation, glycogenolysis

41
Q

autonomic pharmacology

A

To create an effect, we can block one side of the autonomic system or stimulate the other

For example, to increase heart rate we can stimulate sympathetic (adrenaline) OR block parasympathetic (atropine)

42
Q

neostigmine: stimulation of PNS

A

-Blocks acetylcholinesterase, therefore natural concentration of Ach increases
-This will displace neuromuscular blocking agents (NMBs) and facilitates reversal of these drugs
-BUT… this also results in parasympathetic stimulation of muscarinic receptors (which are not blocked by NMBs)
-This causes side-effects!

43
Q

Anticholinergic drugs: muscarinic blockade of the PNS

A

-Postganglionic PNS receptors are muscarinic (Ach)
-Blockade inhibits muscarinic effects (e.g. atropine)
-Unmasks background effects of sympathetic nervous system
-Glycopyrroloate is an anticholinergic that does not cross the blood brain barrier

44
Q

stimulants

A

direct or indirect stimulation of adrenoreceptor

45
Q

antagonists

A

block receptors (both alpha and beta)

46
Q

What is the pharmacological effect of drugs that have β1 effects?

A

Drugs with β1 effects are termed inotropes as they increase the force of cardiac contraction.

47
Q

Name a drug that exhibits inotropic effects.

A

Dobutamine is an example of an inotrope.

48
Q

What is the pharmacological effect of drugs that have α1 effects?

A

Drugs with α1 effects are termed vasopressors as they cause vasoconstriction, leading to an increase in blood pressure.

49
Q

Give examples of drugs that act as both inotropes and vasopressors.

A

Adrenaline (epinephrine) and Noradrenaline (norepinephrine) are both inotropes and vasopressors.

50
Q

What drug is primarily a vasopressor and not an inotrope?

A

Phenylephrine is a vasopressor but does not have significant inotropic effects.

51
Q

Sympathomimetics

A

also known as adrenergic drugs, are a class of drugs that mimic the effects of the sympathetic nervous system. This system is responsible for the “fight or flight” response, which includes increased heart rate, dilation of pupils, and increased blood flow to muscles. Sympathomimetics act on adrenergic receptors, which are receptors that respond to adrenaline (epinephrine) and noradrenaline (norepinephrine).

52
Q

classification of sympathomimetics

A

direct acting
indirect acting

53
Q

direct acting sympathomimetics

A

Adrenaline (αll α & β))
Noradrenaline (α1, α2, β1)
Phenylephrine (α1 only)

Isoprenaline
Dobutamine
(Dopamine)

54
Q

indirect acting sympathomimetics

A

Ephedrine
-releases NA from sympathetic terminals, as well as direct (α β) effects

55
Q

Direct-acting sympathomimetics mechanism

A

These drugs directly stimulate adrenergic receptors

56
Q

Indirect-acting sympathomimetics: mechanism

A

These drugs work by increasing the levels of noradrenaline (norepinephrine) at the synaptic cleft, either by inhibiting its reuptake or by promoting its release

57
Q

a agonists

A

Phenylephrine
α1 only vasoconstrictor

Clonidine
Dexmedetomidine
α2
Sedative, analgesic

58
Q

b agonists

A

Isoprenaline
β1 and 2 effects

Salbutamol
β2
Bronchodilatation
Uterine relaxation

59
Q

alpha receptor antagonists (blockers)

A

Occasionally used as antihypertensives but are agents of choice in phaeocromocytoma

-Phentolamine – α1 and 2
-Phenoxybenzamine - α1 (noncompetitive)
-Prazosin and Doxazosin - α1

60
Q

beta blockers

A
  • all competitive with varying B1 and B2 effects
  • bradycardia, antiarrythmics, sedative, lower BP
  • decrease cardiac mortality
  • bronchospasm in asthmatics
  • inhibit gluconeogenesis in liver and lipolysis
61
Q

Combined α and β antagonists

A

Labetalol – racemic mixture but predominantly a β blocker

62
Q

ephedrine

A

Drug of choice for management of hypotension in most cases – given as 5-10 mg boluses IV

Raises blood pressure but tends to cause tachycardia (Beta effects predominate)

63
Q

phenylephrine

A

-Preferred vasopressor in obstetric spinal anaesthesia
-Extremely potent a1 agonist  reflex bradycardia
-MUST BE DILUTED (comes in 10mg ampoules  dose is only50-100 µg!!
10 mg is diluted into 200 mL N saline to give 50 µg / mL
-UNDILUTED PHENYLEPHRINE IS FATAL

64
Q

use of inotropes

A

-Generally given via INFUSION via a central line
-Adrenaline, noradrenaline
-For critically ill patients who need inotropic support (e.g. sepsis, cardiac failure)
-Adrenaline boluses are only given as part of resuscitation or as management of anaphylaxis

Anaesthesia (14 decks)

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