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anesthesia rotation notes > Med Notes > Flashcards

Med Notes Flashcards

1
Q

DO NOT use _____ or _______ in dogs with heart issues?

A

anticholinergics; alpha 2 adrenergic agonists (but are good for cats with HCM)

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2
Q

what do we use in p coding/asystole?

A

Epi and atropine together

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3
Q

What drugs are good for p with heart issues?

A

Benzodiazepines and opioids (and local blocks)

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4
Q

What drug is not usually rec. in p with cardiac dysfunction but good with cats with HCM?

A

Alpha-2 adrenergic agonists

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5
Q

How is alpha-2 adrenergic agonists good for cats with HCM?

A

reduced HR with increased afterload improves CO

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6
Q

DO NOT USE ____ or ________ in p with HCM?

A

Dissociative; inotropes

but can use Alpha-2 adrenergic agonists

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7
Q

P with what cardiac condition need inotropes usually?

A

DCM

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8
Q

What drugs to premed with for severeeeee valvular insuff or stenosis p?

A

Opioid + benzo
induce with ketamine/diazepam and fentanyl

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9
Q

What if a cat has HCM, what to premed with?

A

Alpha-2 agonist and +/- opioid

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10
Q

DCM- premed and induce with….

A

premedicate with opioid and benzo, induce with fentanyl or ketamine/diazepam
or fent plus prop

be prepared to use inotropes to support blood pressure

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11
Q

what do we do anesthetic plan for puppy with PDA?

A

Opioid + ace or benzo
Give and anticholinergic to maintain heart rate
induce with porp, or alphaxalone, or ketamine/diazepam

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12
Q

ketamine is a ____ _____ causing dissociative anesthetic agent

A

NMDA antagonist

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13
Q

what are the side effects of ketamine?

A

increased HR, contractility, BP, and intracranial pressure can occur, increased muscle tone, delirium

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14
Q

___ is an antiseizure med used in managing neuropathic pain

A

gabapentin

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15
Q

diazepam or mid is more irritating to tissues?

A

Diazepam is more irritant to the tissue so better to avoid giving it IM

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16
Q

do not give ____ or ____ fast bc anaphylaxis rxn

A

morphine and antibiotics

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17
Q

What drugs are good for brachycephalics reducing the risk of respiratory depression?

A

Benzos and butorphanol + opioids

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18
Q

____ may cause increased HR, CO, salivation, and increased muscle rigidity

A

ketamine

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19
Q

advantages of ventilators:

A

prevents atelectasis, keeps asleep even w long procedures, helps w ventilation, can still take a breath on their own

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20
Q

Glycopyrrolate at too low of a dose can cause….

A

second degree AV block

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21
Q

escape beats and VPC’s can look similar but what is a clear ID of which is which?

A

low HR= escape beats
higher HR= VPC’s

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22
Q

ETCO2 low on the expired side (to the left) means….

A

leak (looks like shark fin)

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23
Q

bucking against vent means what in the p…

A

waking up or painful

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24
Q

BP n of medium dog is-

A

60-120 bpm

Systolic should be more than 80 and diastolic should be more than 40

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25
Q

what is the MAP automatically if you feel strong peripheral pulses?

A

MAP is AT LEAST 60

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26
Q

our vent is positive pressure ventilation T/F

A

TRUEE

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27
Q

escape beats tx with ____ VPC’s tx with ____

A

atropine; lidocaine

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28
Q

kitty magic consists of what drugs

A

Butorphanol, dexmedetomidine, and ketamine

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29
Q

ketamine and midazolam without propofol or other induction agents are good for injection in healthy p T/F

A

Trueeee

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30
Q

so you thought your procedure was nonpainful like a dental without extractions so you chose butorphanol but now they are doing extractions so now what do you/can you do?

A

you can only give more butorphanol or highhhh full mu like fent which sucks ass for pain

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31
Q

brachial plexus blocks from where to where

A

elbow to paw.

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32
Q

LRS bolus in dog is =
Colloid bolus in dogs is =

A

LRS bolus in dogs= 3mL x kg
Colloid bolus in dogs= 4mL x kg (mL/kg is mL TIMES kg)

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33
Q

how do local blocks work?

A

the neuron is positive outside of it and neg inside, so the action potential is generated when Na (which is positive charged) enters the inside which is negatively charged. The local block works to prevent Na from getting inside and no actional potential is generated

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34
Q

Why can we not use morphine in GDV’s?

A

more GI motility

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35
Q

what do we do for c section dogs?

A

no premeds, just prop, iso and O2 and can give dexmed after pups are out

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36
Q

horse with bilateral arthro anesthetic meds:

A

xylazine, butorphanol IV
ketamine and midazolam IV
dexmed q 1 hour IV

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37
Q

Bilateral elbow arthroscopy dog anesthetic meds:

A

Dexmedetomidine and methodone IM
propofol IV
fent CRI 5mcg/kg/hour

38
Q

bronchoscopy procedure dog anesthetic meds:

A

no premeds, already on shit ton of meds and NSAIDs
fentanyl 5mcg/kg + prop + midazolam
no fent CRI

39
Q

Upper GI scope dog anesthetic meds:

A

Dexmed + butorphanol IV
cerenia IV
Propofol IV

40
Q

debulking digit FB on healthy, young dog anesthetic meds:

A

Acepromazine + hydromorphone IM
propofol IV

41
Q

Conjunctivial graft dog anesthetic meds:

A

dexmed + methadone
propofol
atracarium
fent CRI 5mcg/kg/hour

42
Q

TPLO anesthetic meds:

A

Dexmed and methadone im
propofol IV
epidural with bup and morphine
fentanyl 5mcg/kg/hr

43
Q

fx paw dog anesthetic meds:

A

Dexmed and methadone IM
Prop and midazolam IV
LS epidural with bup and morphine
fent CRI if needed

already on Trazadone and Tylenol 4
mean doggo

44
Q

nadir is the…

A

lowest glucose in the day

45
Q

goals with MMVD dog?

A

reduce preload and afterload, maintain contractility but avoid increases in myocardial O2 demands, avoid tachycardia

46
Q

why would ALT and BUN be increased in MMVD dog?

A

usually increased in dogs w mitral valve insuff bc renal and hepatic perfusion are altered so elevated enzymes are a result of congestion of these organs

47
Q

what drugs are absolutely C/I in MMVD p?

A

alpha-2 agonists bc they vasocontrict and can cause pulm. edema in these heart patients due to increased preload

best to use midazolam and ketamine combo

48
Q

IVDD small dog anesthetic meds:

A

Dexmedetomidine + fentanyl IV
propofol
CRI of fent 5mcg/kg/hr and ketamine 3mcg/kg or Lidocaine

49
Q

spay anesthetic meds

A

dexmed + methadone IM
Prop IV

could also do ace+ hydro IM
propofol IV

50
Q

what is good about positive ionotropes?

A

used to increase CO but not increase HR

51
Q

What drug should we avoid with MDR1 mutant dog? What could we use instead?

A

Acepromazine, we could use dexmedetomidine instead

52
Q

why are we concerned about using propofol in p with low albumin/total proteins?

A

Propofol is protein bound but this does not change a lot if total protein in p is wonky (low TP for example a regular dose of proofol may cause overdose) GIVE TO effect SLOWLY to avoid overdosing this p because she has low total protein
Alfaxalone will be about the same he said

53
Q

Tell me about a cyanotic dog, what would its hgb be?

A

Patient will only be cyanotic if hgb is less than 5, dog may die pink because has bad hypoxemia but high than 5 Hgb count

54
Q

V/Q mismatch- how does it happen?

A

it happens when part of your lung receives O2 without bf or bf without O2

55
Q

V/Q mismatch causes….

A

hypoxia (which is low O2 in your blood) and can lead to resp. failure

56
Q

V/Q
V means
Q means

A

V means ventilation, air breathed in
Q means perfusion, which is blood perfusion

57
Q

MOA for dorzolamide eye meds:

A

Meds to lower intraocular pressures- dorzolamide DROPS, the drops do not impact anesth. But the oral does.
Affects acid/base effects, causes metabolic acidosis, can impact bloodwork
Decreases production of water to drop the pressures of the eye (aqueous humor of the eye, it inhibits carbolic anhydrase which splits carbonic acid into CO2 and H2O so decreases H2O and bicarb is lost which is why it cause metabolic acidosis due to low HCOX3- in the blood, beware can be a lot worse when they are also diabetic)

58
Q

Ocular cardiac reflex–

A

ocular trigeminal reflex where it can push on the optic nerve and send efferent impulse to the phrenic nerve and decrease the HR and can be very dangerous, tx with atropine or glycopyrrolate (anticholinergic drugs)
Because eye is so close to CNS it can impact all of anesthesia

59
Q

___ has acetate to balance alkalosis

A

plasmalyte

60
Q

What fluids do we use for craniotomies?

A

mannitol/hypertonic saline

61
Q

What is the rule when giving hypertonic fluids???

A

If you give hypertonic saline, you are shrinking all of the cells and need to give another fluid to balance and replace deficits

62
Q

Do not give more than ___mL/kg/day of colloids

A

15

63
Q

Why do colloids not help with hydration status improvement?

A

Colloids do not help with hydration bc so efficient at staying in vasculature that it ignores all of the other compartments, volume expansion is very effective

64
Q

When should you avoid using colloids??

A

avoid in head trauma p, renal p, and metabolic acidosis p
also avoid LRS in renal p too
in head p- use hypertonic saline or mannitol only with increased intracranial pressure

65
Q

Key number for blood volume loss is acute loss of __-__% blood loss means you need to do what?

A

15-20% blood loss means you need a blood transfusion

66
Q

HR _____ and BP ____ with increased blood loss

A

HR increases and BP decreases

67
Q

What fluids have crystalloid + lactate?

A

LRS fluids

68
Q

How are fluids distributed?

A

5% intravascular
15% interstitial
40% intracellular

69
Q

LRS has ____ while plasmalyte and normalsol do not

A

calcium

70
Q

what fluids do we want to use if p is in metabolic alkalosis?

A

0.9% NaCl

71
Q

____ is used for absolute hypovolemia

A

colloids

72
Q

____ for dehydration and use _____ for hypovolemia

A

crystalloids; colloids

73
Q

What is the difference between SPO2 and PaO2 (PO2)?

A

PaO2 (PO2) is the measurement of actual O2 in the arterial blood and SPO2 is oxygen saturation which is the % of Hgb binding sites in the blood that are carrying O2

74
Q

can you give glyco with dexmed?

A

only in ER sit, not ideal at all

75
Q

Horses with high potassium, what do you give and why?

A

Give calcium bc it does not solve the issue but it will delay neg effects

76
Q

Give______ and _____ and ____ to correct high potassium

A

Dextrose with insulin and sodium bicarb

77
Q

increased PaCO2 means hyper or hypoventilation?

A

Hypoventilation

78
Q

if ETCO2 is too high what do we want to do with our vent?

A

increase rate and volume

79
Q

ped p depend on HR for BP so what drugs do we like to use with them and why??

A

We use dexmed and ketamine bc ketamine helps offset bradycardia from dexmed by sympathetic stimulation

80
Q

what is the cushing reflex?

A

vasopressor response, physiological nervous system response to acute elevations on intracranial pressure (ICP) resulting in cushing’s triad of
-increased BP
-bradycardia
-resp. effort

81
Q

how can you tx the cushings reflex?

A

Mannitol but most die quickly

82
Q

How much of CO come from the atria?

A

20-30% (less than half is the key to know)

83
Q

What kind of heart diseases lead to A fib?

A

DCM because heart is so dilated and stretchy, ectopic foci are stretched out and unhappy and cause major conduction abn

DCM dogs have faster HR than other dogs because decreased CO because cannot contract as well so compensating with rate
Medications usually fix the rate but not the A fib entirely (beta blockers)

84
Q

How can we tx VPC’s?

A

Tx with: Lidocaine blocks sodium channels leading to reversible block of action potentials

85
Q

Every other beat being a VPC is called ____

A

bigeminy

86
Q

In order for it to be VPC or V tach there is specific things

A

Wide and weird and early= premature
Normal looking and premature= atrial premature
Abn and looking premature= ventricular premature
AKA triplets

87
Q

Not V tach unless rate is above ___-__

A

180-200

88
Q

What rhythms do we get with no pulse?

A

Pulse-less electrical activity (PEA) (you see stuff on ECG but patient does not have a pulse)
○ Barely a rhythm but ventricles are trying= escape beats, atrioventricular rhythm
○ If you treat this with lidocaine it will die supperrr fast
Give atropine

89
Q

Ventricular arrhythmias where no pulse and fast= tx with lidocaine and epinephrine

what if you have slow rhythm or nothing?

A

If you have slow rhythm or nothing= CPR and use atropine and epinephrine

90
Q

can you use ace in heart dogs?

A

yup apparently but not in HCM cat/patients

anesthesia rotation notes (7 decks)

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