Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fiser Absite > Fiser Absite. Ch 08-09. Anesthesia. Fluid And Electrolytes > Flashcards

Fiser Absite. Ch 08-09. Anesthesia. Fluid And Electrolytes Flashcards

1
Q

What is MAC?

A

minimum alveolar concentration = smallest concentration of inhalation agent at which 50% of patients will not move with incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does a small MAC mean?

A

more lipid soluble = more potent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Speed of induction is inversely proportional to ____

A

solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which inhalation agent is fastest but has high MAC (low potency), also minimal myocardial depression?

A

Nitrous oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which inhalation agent is slow, higest degree of cardiac depression and arrhythmias; least pungent; which is good for children?

A

Halothane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the sx of Halothane hepatitis?

A

fever, eosinophilia, jaundice, increased LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which inhalation agent can cause seizures?

A

Enflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which inhalation agent is good for neurosurgery but has higher cost?

A

Isoflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which inhalation agent has less myocardial depression, fast onset/offset, less laryngospasm; higher cost?

A

sevoflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which induction agent is a fast acting barbituate with side effects of decreased cerebral blood flow and metabolic rate, decreased blood pressure.

A

sodium thiopental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which induction agent has very rapid distribution and on/off; amnesia; sedative. Not an analgesic. Metabolized in liver by plasma cholinesterases. Do not use in patients with egg allergy.

A

Propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the side effects of propofol.

A

hypotension and respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which induction agent has dissociation of thalamic/limbic systems; places pt in a cataleptic state (amnesia, analgesia). No respiratory depression.

A

Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the side effects of Ketamine?

A

hallucinations, catecholamine release (increased carbon monoxide, tachycardia), increased airway secretions, and increased cerebral blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is ketamine contraindicated?

A

pts with a head injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which induction agent has fewer hemodynamic changes; fast acting. Continuous infusions can lead to adrenocortical suppression.

A

Etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the last muscle to go down and 1st muscle to recover from paralytics?

A

diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first muscle to go down and the last to recover from paralytics?

A

neck muscles and face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the only depolarizing agent?

A

succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the 1st sign of malignant hyperthermia?

A

increased end-tidal CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx for malignant hyperthermia?

A

Dantrolene inhibits Ca release. cooling blankets, bicarb, glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Do not use succinylchoine in pts with what?

A

burn pts, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What can happen if pt with open-angle glaucoma gets succinylcholine?

A

it can become close angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Atypical pseudocholinesterases

A

cause prolonged paralysis with succinylcholine (Asians)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do nondepolarizing paralytic agents work?

A

inhibit neuromuscular junction by competing with acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which paralytic undergoes Hoffman degredation. Can be used in liver and renal failure. Histamine release.

A

Cis-atracurium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which paralytic is fast, short acting; degradation by plasma cholinesterases. Histamine release.

A

Mivacurium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which paralytic is fast, intermediate duration; hepatic metabolism.

A

Rocuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which paralytic is slow acting, long-lasting; renal metabolism. Most common side effect is tachycardia.

A

Pancuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What two drugs can be given for reversing nondepolarizing agents and what is their MOA?

A

Neostigmine and Edrophonium, they block acetylcholinesterase, increasing acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

___ or ___ should be given with neostigmine or edrophonium to counteract the effects of generalized acetylcholine overdose

A

atropine or glycopyrrolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Local Anesthetics work by increasing action potential, preventing ____

A

Na influx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How much lidocaine can you use?

A

0.5 cc/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Relative length of action of bupivacaine, lidocaine, procaine

A

bupivacaine > lidocaine > procaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Name conditions where you cannot use epinephrine with local anesthetics.

A

arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals (fingers, toes, penis, nose, and ear), uteroplacental insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How to tell the difference between the amides and the esters?

A

Amides all i in the first part of the name: lidocaine, bupivacaine, mepivacaine; Esters: tetracaine, procaine, cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the biggest difference between the amides and the esters?

A

Amides rarely have allergic reactions. Esters have increased allergic reactions secondary to PABA analogue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Name 4 opioids?

A

Morphine, fentanyl, Demerol, codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Where are the opioids metabolized and excreted?

A

metabolized in liver and excreted by kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Avoid use of narcotics in patients on MAOIs can cause ____

A

hyperpyrexic coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Morphine, Demerol and Fentanyl which one causes histamine release?

A

morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Fentanyl is ___x the strength of morphine

A

80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

sufentanil, alfentanil, remifentanil

A

very fast-acting narcotics with short half-lives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Versed, Ativan, Valium what are their generic names and short or long acting

A

Versed (midazolam) short acting; Ativan (lorazepam) long acting; Valium (diazepam) long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Morphine in epidural can cause ___

A

respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Lidocaine in epidural can cause ___

A

decreased HR and BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Tx for acute hypotension and bradycardia with epidural?

A

turn epidural down; fluids; phenylephrine; atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

T-___ epidural can affect cardiac accelerator nerves

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Epidural contraindicated with ___, ____ -> can get inadvertent spinal anesthesia.

A

hypertrophic cardiomyopath, cyanotic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Good for pediatric hernias, and perianal surgery.

A

Caudal block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Epidural and spinal complications

A

hypotension, headache, urinary retention, abscess/hematoma formation, neurologic impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

High spinal can cause ____

A

respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Spinal headache tx and what makes worse?

A

rest, increased fluids, caffeine, analgesics; blood patch to site persists >24 hrs. Headache worse sitting up.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What two conditions are associated with them most postoperative hospital mortality?

A

CHF and renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

May have no pain or EKG changes; can have hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia

A

Postop MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Patients who need cardiology workup.

A

Angina, previous MI, shortness of breath, CHF, walks 5/min, age > 70, patients undergoing major vascular surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

List the ASA classes with description

A

I - healthy; II - mild disease without limitation (controlled HTN, obesity, DM, older age); III - severe disease (angina, previous MI, poorly controlled HTN, DM with complictions, moderate COPD); IV - severe constant threat to life ( unstable angina, CHF, renal failure, liver failure, severe COPD); V - moribound (ruptured AAA, saddle pulmonary embolus, ascending aortic dissection with HF); VI - donor; E - emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Biggest risk factors for postop MI

A

age > 70, DM, previous MI, CHF and unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Best determinant of esophageal vs. trachael intubation?

A

end-tidal CO2

60
Q

Intubated patient undergoing surgery with sudden transient rise in ETCO2. Most likely Dx? Tx?

A

alveolar hypoventilation; increase tidal volume (most likely due to atelectasis) or increase respiratory rate

61
Q

Intubated patient with sudden drop in ETCO2. List 3 likely reasons

A

disconnected from vent, PE or significant hypotension

62
Q

ET tube should be placed ___ cm above carina

A

2

63
Q

Most common PACU complication

A

N/V

64
Q

Roughly ___ of the total body weight is water (men); ___ have a little more body water, ____ have a little less

A

2/3, infants, women

65
Q

2/3 of water weight is located where? and the other 1/3?

A

intracellular (mostly muscle), extracellular

66
Q

2/3 of extracellular water is located where? and the other 1/3?

A

interstitial, plasma

67
Q

What determines plasma/interstitial compartment osmotic pressures? what about intracellular/extracellular?

A

proteins, Na

68
Q

Most common cause of volume overload? what is the first sign?

A

iatrogenic, weight gain

69
Q

What is the meqs in 0.9% NS?

A

Na 154 and Cl 154

70
Q

Lactated Ringer’s has the ionic composition of plasma, what is it?

A

Na 130, K 4, Ca 2.7, Cl 109, bicarb 28

71
Q

How to calculate plasma osmolarity and what is the range of normal?

A

(2 x Na) + (glucose/18) + (BUN/2.8); 280-295

72
Q

How to estimate volume replacement in cc/kg/hr

A

4 cc/kg/hr for first 10 kg, 2 cc/kg/hr for second 10 kg, 1 cc/kg/hr each kg after that; (110 cc/hr for 70 kg man)

73
Q

What is the best indicator for adequate volume replacement?

A

urine output

74
Q

During open abdominal operations, fluid loss is ___ L/hr unless there are measurable blood losses

A

0.5-1.0 L/hr

75
Q

Usually do not have to replace blood lost unless it is >____ cc

A

500

76
Q

Insensible fluid losses is ___ cc/kg/day, 75% skin, 25% respiratory (pure water)

A

10

77
Q

IV replacement after major adult GI surgery: During operation and 1st 24 hours use ____.

A

LR

78
Q

After 24 hrs switch to ___

A

D5 1/2 NS with 20 mEq K

79
Q

5% dextrose will stimulate ___, resulting in amino acid uptake and protein synthesis (also prevents protein catabolism)

A

insulin

80
Q

D5 1/2 NS @ 125 /hr provides 150 g glucose per day (____ kcal/day)

A

525

81
Q

Stomach secretes ___ L/day

A

1 to 2

82
Q

Biliary system secretes ___ mL/day

A

500-1000

83
Q

Pancreas secretes ___ mL/day

A

500-1000

84
Q

Duodenum secretes ____ mL/day

A

500-1000

85
Q

Normal K+ requirement is ___ mEq/kg/day

A

0.5-1.0

86
Q

Normal Na+ requirement is ___ mEq/kg/day

A

1 to 2

87
Q

Which bodily fluid has the highest concentration of K+

A

saliva

88
Q

Primary electrolyte(s) lost in the: Stomach?

A

H+, Cl-

89
Q

Primary electrolyte(s) lost in the: Pancreas?

A

HCO3-

90
Q

Primary electrolyte(s) lost in the: Bile?

A

HCO3-

91
Q

Primary electrolyte(s) lost in the: Small Intestine?

A

HCO3-, K+

92
Q

Primary electrolyte(s) lost in the: Large Intestine?

A

K+

93
Q

Gastric losses should be replaced with which fluid?

A

D5 1/2 NS with 20 mEq K+

94
Q

Pancreatic/biliary/small intestine losses should be replaced with which fluid?

A

LR with HCO3-

95
Q

Large intestine (diarrhea) losses should be replaced with which fluid?

A

LR with K+

96
Q

GI losses should generally be replaced ___ ?

A

cc/cc

97
Q

UO should be kept at least ___ cc/kg/hr; should not be replaced usually a sign of normal postoperative diuresis?

A

0.5

98
Q

Normal range of K+

A

3.5-5.0

99
Q

Initial finding of hyperkalemia on EKG?

A

peaked T waves

100
Q

Tx for hyperkalemia: ____ membrane stabilizer for heart

A

Calcium gluconate

101
Q

Tx for hyperkalemia: ____ causes alkalosis, K enters cell in exchange for H

A

Bicarb

102
Q

Tx for hyperkalemia: ____ K driven into cells along with glucose

A

10 U insulin and 1 ampule of 50% dextrose

103
Q

Tx for hyperkalemia: ___ binder

A

Kayexalete

104
Q

Tx for hyperkalemia: ___ if refractory

A

Dialysis

105
Q

EKG with hypokalemia?

A

t waves disappear

106
Q

Hypokalemia tx: may need to replace ___ before you can correct K+

A

Mg+

107
Q

Normal range of sodium?

A

135-145

108
Q

What are the sx of hypernatremia?

A

restlessness, irritibility, ataxia, seizures

109
Q

Correct hypernatremia with ___ slowly to avoid ___

A

D5W, brain swelling

110
Q

Formula for total body water?

A

0.6 x patient’s weight

111
Q

Formula for total free water deficit

A

TBW x (([Na+]/140) -1)

112
Q

Formula for water requirement in hypernatremia

A

Water requirement = (desired change in Na over 24 hrs x TBW) / desired Na after giving the water requirement; For a 70 kg man with Na 165 = (16 x 42)/149 = 4.5 L

113
Q

In hypernatremia change Na at ____ mEq/h

A

0.7

114
Q

Sx of hyponatremia

A

headaches, delirium, seizures, nausea, vomiting

115
Q

Formula for Na deficit in hyponatremia

A

Na deficit = 0.6 x weight in kg x (140 - Na)

116
Q

What is the first tx for hyponatremia? second? third?

A

water restriction, diuresis, NaCl replacement

117
Q

Why is Na corrected slowly In hyponatremia and what is the rate?

A

avoid central pontine myelinosis, 1 mEq/h

118
Q

What is the formula for correcting Na in pseudohyponatremia caused by hyperglycemia?

A

for each 100 increment of glucose over normal add 2 points to the Na value

119
Q

What is the normal Ca range?

A

8.5-10.0

120
Q

Most common malignant cause of hypercalcemia?

A

breast CA

121
Q

What drug causes retention of Ca2+ and should not be given to patient with hypercalcemia?

A

thiazides (also LR contains Ca2+)

122
Q

What is the tx for hypercalcemia?

A

NS at 200-300 cc/hr, Lasix

123
Q

Tx for malignant hypercalcemia?

A

mithramycin, calcitonin, alendronic acid, dialysis

124
Q

Main sx of hypercalcemia?

A

lethargic state

125
Q

Sx of hypocalcemia?

A

hyperreflexia, Chvotstek’s sign (tapping on face produces twitching), perioral tingling and numbness, Trousseau’s sign (carpopedal spasm), prolonged QT

126
Q

In hypocalcemia, may need to correct ___ before being able to correct Ca

A

Mg

127
Q

Protein adjustment for Ca

A

(4.0 - serum albumin) * 0.8

128
Q

Normal range of Mg

A

2.0-2.7

129
Q

Sx of hypermagnesemia? What type of pts?

A

lethargic state; burn, trauma and dialysis pts

130
Q

Tx for hypermagnesmia

A

Ca

131
Q

Signs and sx of hypomagnesmia are similar to what?

A

hypocalcemia

132
Q

Formula for anion gap and normal range

A

Na - (HCO3 + Cl)

133
Q

Mnemonic for anion gap acidosis

A

MUDPILES; methanol, uremia, diabetic ketoacidosis, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates

134
Q

Normal gap acidosis usually due to loss of ____/____

A

Na/HCO3

135
Q

Normal gap acidosis seen with?

A

ileostomies, small bowel fistulas

136
Q

Tx for metabolic acidosis is underlying cause; keep pH > ___ with bacarbonate; severely decreased pH can affect ____

A

7.20, myocardial contractility

137
Q

Metabolic alkalosis is usually the result of ____

A

contraction alkalosis

138
Q

Nasogastric suction results in what electrolyte abnormality and what is the urine?

A

hypocholoremic, hypokalemic, metabolic alkalosis, paradoxical aciduria

139
Q

Why is there hypokalemia in nasogastric suction?

A

because loss of water causes kidney to resorb Na iand dump K (Na/K ATPase)

140
Q

What causes paradoxical aciduria?

A

Na+/H- exchange activated in an effort to absorb water along with K+/H- exchanger in an effort to resorb K+

141
Q

Henderson-Hesselbach equation

A

pH = pK + log [HCO3−]/[CO2]

142
Q

What is the best test for azotemia?

A

FeNa: (urine Na/Cr)/(plasma Na/Cr)

143
Q

In Pre renal failure. What is the FeNa? urine Na? BUN/Cr ratio? urine osmolality?

A

FeNa 20; urine osmolality >500 mOsm

144
Q

In contrast dye induced ARF: What best prevents renal damage? What are 2 others?

A

volume expansion, HCO3-, N-acetylcysteine gtt

145
Q

Myoglobin is converted to ____ in acidic environment which is toxic to renal cells. Tx?

A

ferrihemate, alkalinize urine

146
Q

In tumor lysis syndrome there is increased ___ and ___ and decreased Ca. This can result in increased BUN and Cr, EKG changes. Tx?

A

phosphate and uric acid; hydration, allopurinol (decreased uric acid production), diuretics, alkalinization of urine

Fiser Absite (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions