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Anes& Coex > Immunity > Flashcards

Immunity Flashcards

1
Q

Respiratory complications HIV

A

PCP, bacterial pna, TB, aspergillosis, CMV, oral/pharyngeal candidiasis, kaposi’s sarcoma, herpes, direct HIV pulm destruction (leads to RF and chronic disease like emphysema). Tracheobronchial/great vessel compression w/adenoma they, endobronchial kaposi’s (massive hemoptysis)

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2
Q

Cardiac complications HIV

A

Chronic trophic viral infection, co infection, drug related. Pericarditis, pericardial effusion, myocarditis (late stages), dilated CM, endocarditis (IVDA), pulm htn, thromboembolism, CAD/MI, abd aortic aneurysm/dissection

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3
Q

Gi complications of HIV

A

Diarrhea, proctitis, GI bleed, cholecystitis, anorexia, NV, dysphagia, candida, esophagitis, hep B/C.

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4
Q

Renal and endocrine complic of HIV

A

Nephropathy, ATN, nephrotic syndrome, adrenal insufficiency, glucose intolerance (HAART)

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5
Q

Hematologist complic HIV

A

Leukopenia, lymphopenia, thrombocytopenia, anemia

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6
Q

Neuro complic HIV

A

Sensory neuropathy (parasthesias, painful), encephalopathy/AIDS dementia complex, opportunistic infections, behavioral changes, HAART related CVD

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7
Q

NRTI effects

A

Nausea, diarrhea, myalgia, inc LFTs, pancreatitis, peripheral neuropathy, renal toxic, marrow supp, anemia, lactic acidosis, inhib P450 (zidovudine + steroids can lead to severe myopathy inc respiratory muscle dysfunction)

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8
Q

Protease inhibitor effects (ritonavir)

A

Hyperlipidemia, glucose intolerance, abnormal fat
distribution, altered LFTs, inhibition of cytochrome
P-450 3A4 (decreased fentanyl clearance ~ 67%)

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9
Q

NNRTI effects

A

Delavirdine inhibits cytochrome P450 may inc
conc of sedatives, antiarrhythmics, warfarin,
Ca-channel blockers. Nevirapine induces cytochrome P450 by 98%!

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10
Q

Integrates strand transfer inhibitor fx

A

Appear well tolerated, may have unknown SE

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11
Q

CCR5 antagonists and entry inhibitors SE

A

Appear well tolerated, may have unknown SE. Interacts w midazolam, alters clearance/effect

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12
Q

Ritonavir interactions w anesthetic drugs, avoid what drugs

A

Midazolam and versed (increased fx- sedation, confusion, resp dep). Avoid: demerol, amio, diazepam (life threatening)

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13
Q

HIV pre op prep

A

Universal precautions. Na hypochlorate kills virus. Look at disease progression/organ fx. Drug reg/SE. Lab results: CD4 (<200 bad, 500-700 good), T lymph (200 low), viral load, CBC, BMP, coags, cxr, ekg, echo, puts

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14
Q

HIV GA considerations

A

Avoid intubation if extensive pulm disease. Titrate according to anemia, autonomic neuropathy, adrenal insuff, upper a/w obstruc/difficult a/w w kaposis sarcoma. Careful w sux if periph neurop/SC involvement.

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15
Q

HIV regional consid. Why it is good

A

Still good for pregnant pts. Decreases opioid req- good bc decreased opioid clearance w/protease inhib

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16
Q

HIV regional consid: contraindications, careful w what

A

Coagulopathy, infection at site, focal neuro lesions, inc ICP. Try other methods before epidural blood patho (risky)

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17
Q

TB s/s

A

Non productive cough, wt loss, fever, night sweats, malaise, hemoptysis, chest pain

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18
Q

SE isoniazid

A

Hepatotoxic, periph neurotoxic, renal toxic possible, drug interactions

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19
Q

Rifampin SE

A

Hepato and renal toxic, anemia, thrombocytopenia, GI upset, drug interactions

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20
Q

Pyrazinamide and ethambutol SE

A

P- hepatotoxic, GI upset, arthralgia. E- ocular neuritis

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21
Q

TB drugs

A

Isoniazid, rifampin, pyrazinamide, ethambutol

22
Q

No elective sx on tb pt until what

A

No longer contagious: 3 neg sputu, smears, improving symptoms, chest x ray

23
Q

How to minimize TB: OR room

A

N 95 mask (pt wears when outside of rm). Keep pt in neg p rm whenever possible. Use separated OR when most ppl not there, keep doors shut

24
Q

TB protection for vent

A

Dedicated machine, filter b/w pt circuit and y piece, bacterial filter on exhalation limb to decrease room exposure, staff wears n 95

25
Q

Prophylactic abx consid in normal pt

A

Goal to prevent SSI, within 1 hr before incision. Larger dose if obese. Repeat if sx >4 hrs. Avoid hypothermia/hypocarbia/hyperglycemia/blood transfusions/hypoxia

26
Q

Endocarditis: pts who should get prophylaxis

A

Artificial heart valve, hx endocarditis, some congenital malformations (repaired <6 mo ago or issues still in valve), damaged heart valves, hypertrophic CM, transplant w problem in valve

27
Q

Sx where pts get abx if high risk

A

Dental/oral w mucosa perf, invasive Resp tract infec where mucosa perf (tonsillectomy, adenoids, abscess), infec GI/GU/skin/MS tissue procedure, cardiac sx, hepatobilliary w high risk bacteremia

28
Q

Abx proph

A

Still give up to 2 hrs after. Amp 2g (50mg/kg peds), cefazolin 1g (50 mg/kg peds), ceftriaxone 1 g (50 mg/kg), clindamycin 600 mg (20 mg/kg peds)

29
Q

Type 1 allergic rxn

A

Antigen-Antibody (IgE, mast cells,
basophils - anaphylaxis, immune-mediated
hypersensitivity)

30
Q

Type 2 allergic rxn

A

cytotoxic - Complement Activation (IgG
or IgM binding of the antigen-drug; alternate
pathway, kinin or plasmin activation)

31
Q

Type 3 allergic rxn

A

damage secondry to immune complex

formation or deposition

32
Q

Type 4 allergic rxn

A

T lymphocyte mediated delayed

hypersensitivity

33
Q

Anaphylactoid reaction

A

Chemical Mediator w/no antigen-antibody
reaction (mast cells and basophils activate in a
non-immune reaction)

34
Q

Anaphylactioid: magnitude of histamine related to what. Hypotension fx. Drugs more apt to do it

A

total
dose of drug admin and rate of infusion. Basophils release large amounts of histamine in
response to such drugs as muscle relaxants, opioids,
and protamine. Hypotension unlikely unless histamine concentration
doubles

35
Q

Anaphylactoid prophylaxis in pts w hx

A

Steroid, h1 and h2 receptor antagonist

36
Q

Common anaphylaxis offenders

A

Abx (pcn mostly), anesthetics (except for ketamine and benzos), radiocontrast dyes, foods, insect venom

37
Q

What anesthetic causes most anaphylaxis. Other things we give than can cause

A

50% of total from Muscle relaxants. Induction agents (thiopental), abx, protamine (seafood allergy), VA, opioids, LAs, blood (even w match), dextran, hetastarch, vascular grafts, latex

38
Q

PCN allergy predisposes pt to what

A

3-4x > risk of rxn to any drug

39
Q

Differential dx for anaphylaxis

A

PE, PTX, AMI, CVA, hemorrhage, aspiration, pulm edema, venous air embolism, vasovagal rxn, med OD, asthma, arrythmia, tamponade, postextubation stridor, sepsis

40
Q

Make sure what equipment is latex free

A

Mask, ambu bag, suction cath, anesthesia circuit, tourniquet, gloves, stethoscope, IV bags/ports/syringe, pen rose drain, tape, bandage, electrode pads, bp cuff, bair hugger

41
Q

Early s/s anaphylaxis

A

Flushing, itching, hypotension, difficult intub (edema), inc PIP/cant ventilate, cv collapse (ischemia and arrhythmias), bradycardia if MR

42
Q

Biggest abx offenders

A

B lactam, quinolones, sulfonamides, vanc

43
Q

What to do when notice anaphylaxis

A

Communicate to surgeon and team, stop admin of agent, oxygenate, elevate legs, volume: at least 10-25 ml/kg (colloids preferred 10 ml/kg)

44
Q

Anaphylaxis pharm: 1st line

A

Epi. Inhib inflammatory mediator release. Relaxes bronchial muscle. Inc bp and notropy.

45
Q

Adult and child epi doses

A

Adult 10 mcg/1 mg q 1-2 min. Child 1-10 mcg/kg q 1-2 min

46
Q

What to give if resistant to epi for anaphylaxis and doses

A

Glucagon (1-5 mg bolus, gtt 1-2.5 mg/hr). Levo (.05-.1 mcg/kg/min). Vaso (2-10u bolus, gtt .01-.1 unit/min)

47
Q

Secondary meds for anaphylaxis

A

B2 ag (albuterol). Diphenhydramine 0.5-1 mg/kg, ranitidine 50 mg. Steroids. Hydrocortisone is favored 250mg IV (Methylprednisolone also OK 80 mg IV)

48
Q

Anesthesia for septic pt. Pre op focus, arrange for what

A

ABG/VS/UOP/mental status/pressors/sedation. Large bore/2 IVs. Ensure red cells in fridge. Monitors: a line, CVP/PA, TEE maybe

49
Q

Optimization goals for septic pt

A

Normal temp/bg/UOP/ph. MAP >65, CVP 8-12, MV02 >70%, TV 6-8 ml/kg, PIP <30, hgb 7-9, prevent additional infection

50
Q

Induction for septic pt

A

Maintain SVR. Etomidate. Consider length of immobility before giving sux

51
Q

Maintenance consid for septic pt. And emergence

A

Inotropic/pressors support if needed (dopa, doubt, epi, levo, vaso), consider steroid if unresponsive. May remain intubated on pos pressure to icu

52
Q

Regional in septic pt

A

Absolute contraindication to epidurals. Esp w hemodynamic instability- wont tolerate SVR lability. Epidural abscess if bacteremic blood introduced into epidural space

Anes& Coex (15 decks)

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