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Crozer-Keystone > Medicine > Flashcards

Medicine Flashcards

1
Q

What are the reasons for post op fever?

A
  1. Wind (12-24 h): atelectasis, post-op hyperthermia
  2. Water (~24 h): UTI
  3. Walk (~48 h): DVT, PE
  4. Wound (72 h): post-op infection
  5. Wonder drug (anytime): drug fever
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2
Q

What are the treatments for post op fever?

A
  1. Wind: incentive spirometer
  2. Water: straight cath; UA with gram stain/culture/sensitivity; abs if necessary
  3. Walk: heparin or lovenox protocol; get patient up and walking; Ted hose
  4. Wound: X-ray; gram stain; culture and sensitivity; blood cultures; begin ab
  5. Wonder drug: d/c drug; give reversal if necessary
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3
Q

When do fever peaks occur?

A

Between 4-8 pm

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4
Q

What part of the brain regulates body temp?

A

Hypothalamus

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5
Q

What is malignant hyperthermia?

A

A side effect of general anesthesia - tachycardia, HTN, acid-base and electrolyte abnormalities, muscular rigidity, hyperthermia

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6
Q

What is the treatment for malignant hyperthermia?

A

Dantrolene

2.5 mg/kg IV x 1, then 1 mg/kg IV rapid push q6h until symptoms subside or until max dose of 10 mg/kg

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7
Q

If a risk of malignant hyperthermia is suspected, what pre-op test may be performed?

A

CPK - elevated in 79% of patients with malignant hyperthermia

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8
Q

What is the mechanism of action for local anesthetics?

A

Block Na+ channels and conduction of AP’s along sensory nerves

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9
Q

What is the toxic dose of lidocaine?

A

300 mg plain (4.5 mg/kg)

500 mg w/ epi (7.0 mg/kg)

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10
Q

What is the toxic dose of bupivacaine?

A

175 mg plain (2.5 mg/kg)

225 mg w/ epi (3.2 mg/kg)

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11
Q

How to convert percentage of solution to mg/ml?

A

Move decimal point of percentage one place to the right (ex: 1% solution has 10 mg/ml)

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12
Q

What are the side effects of lidocaine and bupivacaine associated with systemic exposure?

A
  1. CNS effects: initial excitation (dizziness, blurred vision, tremor, seizures) followed by depression (respiratory depression, depression, LOC)
  2. cardiovascular effects: hypotension, bradycardia, arrhythmias, cardiac arrest
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13
Q

What can be given to help reverse local anesthetic-induced cardiovascular collapse?

A

Intravenous fat emulsion (Intralipid)

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14
Q

Is there a risk with intra-articular injections of bupivacaine?

A

Studies have shown chondrocyte death following prolonged exposure to bupivacaine

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15
Q

In what age group should bupivacaine be avoided?

A

Children < 12 yo

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16
Q

Name two amides anesthetics and how they are metabolized.

A

Lidocaine
Bulivicaine

(Amides have two i’s!!)

Liver

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17
Q

Name an ester anesthetic. How are they metabolized?

A

Novocain

Plasma pseudocholinesterase

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18
Q

What is the only local anesthetic with vasoconstriction?

A

Cocaine

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19
Q

How is cocaine metabolized?

A

Plasma pseudocholinesterase (like other esters)

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20
Q

Can locals cross the placental barrier?

A

Yes

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21
Q

What does MAC (as in MAC with local) stand for?

A

Monitored anesthesia care

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22
Q

For anesthesia, what cannot be given to a patient with an egg shell injury?

A

Propofol (Diprivan)

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23
Q

Mnemonic for pain management with a codeine allergy?

A

STUD-N

S:Stadol
T:Toradol
T:Talwin
U:Ultram
D:Darvon
D:Darvocet
D:Demerol
N:Nubain
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24
Q

First choice for non-narcotic oral med?

A

Tramadol (ultram)

50 mg 1-2 tabs PO q4-6h prn pain

Max daily dose of 400 mg daily

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25
Q

First choice for non-narcotic IV?

A

Toradol 30-60 mg IV

Resident at Methodist told me that because this drug is an NSAID make sure you check kidney function first so you don’t cause AKI as this is a very common error

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26
Q

Name two non-narcotic analgesics

A

Ketoralac (Toradol)

Tramadol (Ultram)

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27
Q

What schedule drugs are Percocet, Vicodin, Tylenol #3, and darvocet?

A

Percocet: II
Vicodin: III
Tylenol #3: III
Darvocet: IV

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28
Q

What is Percocet 5/325?

A

Oxyocodone/acetaminophen 5mg/325mg

1-2 tabs PO q4-6h prn pain

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29
Q

What is roxicet?

A

Oxycodone/acetaminophen (5mg/325mg/5 mL)

Essentially a liquid form of Percocet that is good for pediatric patients

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30
Q

What is Vicodin 5/500

A

Hydrocodone/acetaminophen 5mg/500mg

1-2 tabs PO q4-6h prn pain

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31
Q

What is Tylenol #3?

A

Codeine/acetaminophen (30 mg/300mg)

1-2 tabs PO q4-6h

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32
Q

What is Darvocet-N 100?

A

Propoxyphene/acetaminophen 100mg/650mg

1 tab PO q4h prn pain

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33
Q

What is Toradol and dosing?

A

Ketorolac

10 mg PO q4-6

Or 30 mg IV q6h

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34
Q

What is OxyContin?

A

Oxycodone extended release

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35
Q

What is MS Contin?

A

Morphine sulfate extended release

15-30 mg 1 tab PO q8-12h prn pain

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36
Q

What is Dilaudid?

A

Hydromorphone

2-8 mg PO q3-4 hr
1-4 mg IV q4-6 hr

For severe pain!

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37
Q

What is Demerol?

A

Meperidine

Usually not used due to its side effects

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38
Q

What therapeutic effects are seen with acetaminophen?

A

Analgesic
Anti-pyretic

NO ANTI-INFLAM

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39
Q

What is the max daily dose of acetaminophen?

A

4 g

40
Q

What are the therapeutic effects seen with most NSAIDS?

A

Analgesic
anti-pyretic
anti-inflam

41
Q

What pathway do NSAIDs work on?

A

nonselectively inhibit Cox-1 and cox-2

42
Q

What is the most common side effect of NSAIDS?

A

GI disturbance (except with cox-2 inhibitors because cox-1 protects the stomach lining)

43
Q

What is the only FDA-approved Cox-2 inhibitor?

A

Celecoxib (Celebrex)

44
Q

What two nsaids only have anti-inflam effects?

A

Indomethacin

Tolmetin

45
Q

Do nsaids decrease joint destruction?

A

No, they only decease inflammation

46
Q

Do nsaids affect bone healing?

A

May inhibit Bone healing via their anti-inflammatory effects

47
Q

What nsaids cause irreversible inhibition of platelet aggregation?

A

Aspirin

48
Q

What NSAID does not inhibit platelet aggregation?

A

Celebrex

49
Q

What is the only IV NSAID?

A

Ketorolac (Toradol)

50
Q

Which NSAID is often given during surgery or immediately post-op to decrease pain and inflammation?

A

Toradol 30 mg IV

51
Q

What is the effect of NSAIDS on asthma?

A

Can increase symptoms of asthma

52
Q

What two nsaids are not renally clearly?

A

Indomethacin

Sulindac

53
Q

What are two cardiovascular effects of NSAIDS?

A

Can cause vasoconstriction and increase BP

54
Q

What two nsaids have the least cardiovascular effects?

A

Diclofenac

Ketoprofen

55
Q

What three nsaids are the most hepatotoxic?

A

Ibuprofen
Naproxen
Diclofenac

56
Q

What should be given for an indomethacin overdose?

A

Benadryl: decreases 5-HT and histamine release

57
Q

What is arthrotec?

A

Diclofenac/misoprostol

An NSAID with protection for the stomach

58
Q

What is the anti-inflamm dose of ibuprofen?

A

1200-3200 mg/day

59
Q

What is the difference between cataflam and voltaren?

A

Cataflam: diclofenac potassium (immediate release)

Voltaren: diclofenac sodium (delayed release)

60
Q

What is the only non-acidic NSAID?

A

Nabumetone

61
Q

What are 4 once a day NSAIds?

A

Celecoxib (Celebrex)
Piroxicam (Feldene)
Oxaprozin (Daypro)
Nabumetone (Relafen)

62
Q

What are three causes of acute arterial occlusion?

A

Embolism: detached thrombus, air, fat, or tumor

Thrombus: occlusion of vessel by plaque or thickened wall

Extrinsic occlusion: traumatic, blunt, penetrating

63
Q

What is the triad of a pulmonary embolism?

A

Dyspnea
Chest pain
Hemoptysis (although tachy is more common)

64
Q

What tests can be ordered to diagnose a PE? (3)

A

Chest x-ray
Ventilation perfusion scan
Pulmonary angiography

65
Q

What is virchows Triad?

A
  1. Venous stasis: tourniquet, immobilization
  2. Endothelial wall damage/abnormality: surgical manipulation, trauma, smoking
  3. Hypercoagulability: birth control, coagulopathy, history of DVT
66
Q

What does virchows triad predict?

A

Risk of DVT

Previous DVT is #1 risk factor for having another DVT

67
Q

What are risk factors for DVT (mnemonic)

A

I AM CLOTTTED

I: immobilization
A: arrhythmia (like afib)
M: MI (past hx)
C: coagulable states 
L: longevity (old age)
O: obesity
T: tumor
T: trauma
T: tobacco
E: estrogen
D: DVT (past hx)
68
Q

How is DVT diagnosed clinically?

A
  1. Pain, heat, swelling, erythema of unilateral limb
  2. Positive Pratt sign: squeezing calf causes pain
  3. Positive homan sign: abrupt DF of foot causes calf pain
  4. PE
69
Q

What 3 tests can be ordered to diagnose DVT?

A
  1. Doppler ultrasound
  2. Venogram
  3. D-dimer
70
Q

For long term prophylaxis of DVT what two drugs can be ordered?

A

Heparin

Coumadin

71
Q

What is the treatment for DVT?

A

Heparin 5000 units IV bolus, then 1000 units IV q1h and monitor PTT

72
Q

How to dose heparin for perioperative DVT prophylaxis?

A

5000 units SC 2h prior to surgery

5000 units SC q12h until patient ambulates

73
Q

What is the half life of heparin?

A

1.5 HR

74
Q

How does heparin work?

A

Intrinsic pathway

Potentials Antithrombin III, which inhibits serine protease in the clotting cascade

75
Q

How to reverse heparin?

A

Protamine sulfate 1 mg per 100 units of heparin

76
Q

What is enoxaparin (lovenox)

A

Low molecular weight heparin

77
Q

How to dose lovenox for perioperative DVT prophylaxis?

A

30 mg SC q12h for 7-10 days

78
Q

What is the Half-life of lovenox?

A

4.5 hrs

79
Q

What are the advantages of using lovenox vs regular heparin? Disadvantages?

A

Advantages: lovenox has longer plasma half-life w/ significant antjcoagulation in trough

Disadvantages: increased post-op complications when used with spinal/epidural anesthesia

80
Q

How is lovenox reversed?

A

Recombinant factor VII

81
Q

How to dose Coumadin?

A

5-10 mg PO daily for 3-4 days then adjust for INR

82
Q

What is the half life of Coumadin?

A

20-60 hrs

83
Q

How long before Coumadin is therapeutic?

A

3-5 days

84
Q

How does Coumadin work?

A

Extrinsic pathway

Interferes with clotting factors 2, 7, 9, 10

85
Q

How is Coumadin reversed?

A

Vit K

Fresh frozen plasma

86
Q

What are normal INR for someone not on anticoagulation and someone who is?

A

1

Intense anticoagulation: 2-3

87
Q

What are the levels of heparin and Coumadin for DVT/anticoagulation prophylaxis?

A

Heparin: maintain 2-3 times normal PTT

Coumadin: maintain 2 times normal INR

88
Q

What 3 nonpharmacologic measures are used for perioperative DVT prophylaxis?

A
  1. Early ambulation
  2. teds: thromboembolic deterrent stockings
  3. Sds: sequential compression devices
89
Q

What is a surgical treatment for a patient with prior DVTs or recurrent PEs?

A

Greenfield filter

90
Q

What level of the body is a greenfield filter inserted?

A

IVC below the renal veins

91
Q

What is Pletal?

A

Cilostazol

92
Q

What is trental?

A

Pentoxifylline

93
Q

What is an indication for pletal or trental?

A

Intermittent claudication

94
Q

What is CRPS?

A

Complex regional pain syndrome (previously known as RSD or reflex sympathetic dystrophy)

A progressive disease of the ANS causing constant, extreme pain that is out of proportion to the original injury

95
Q

What are the different types of CRPS?

A

CRPS type 1 (reflex sympathetic dystrophy)

CRPS type 2 (causalgia)

96
Q

What is CRPS type 1?

A
  • Nerve injury cannot be immediately identified
  • spontaneous pain not limited to single nerve distribution
  • abnormal response in sympathetic nervous system
  • abnormal reflex leading to vasomotor instability and pain

Crozer-Keystone (3 decks)

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