Melanie's Guide Flashcards
1
Q
daily aspirin therapy – why?
A
inhibits platelets, antiinflammatory
2
Q
flumazenil: metabolism
A
hepatic (99%, according to the eenernets) Residation
3
Q
local anesthetics – target channels
A
Na+ (activated state)
4
Q
mechanism of action for barbituates
A
chloride conduction
5
Q
propofol: CV effects
A
decreased BP and increased HR
6
Q
induction drugs: hiccups
A
brevital(methohexital) and Etomidate
7
Q
alpha 1 glycoprotein (protein binding)
A
basic compounds
8
Q
local anesthetics: epinephrine concentration
A
1:200,000 (5mcg/mL)
9
Q
propofol: additives
A
1% propofol, 10% soybean oil, 2.25 glycerol (burns), 1.2 egg phosphatide, 0.005 disodium edetate (bacteriostatic)
10
Q
midazolam – clinical effects
A
anxiolysis, sedation, anterograde amnesia, anticonvulsant
11
Q
midazolam – oral preperation
A
For peds: 0.5mg/kg up to 15mg total. No grapefruit juice (P450)
12
Q
benzodiazepine contraindication
A
pregnancy
13
Q
aspirin – effect on platelets
A
decreased production of thromboxane A2
14
Q
pH for ionization of basic drugs
A
pH < pKa
15
Q
penicillin: cephalosporin cross reactivity
A
low risk: 20% immunological studies, 1% clinical study
16
Q
midazolam: drug interactions
A
increased ventilatory depression w/ opioids
17
Q
opoid receptors: dynorphins
A
kappa
18
Q
ketamine: treatment for emergence delirium
A
benzos
19
Q
myastenia gravis: succynlcholine
A
increase dose – 2.6 x ED95
20
Q
division of cardiac ouput
A
VRG = 75%; Muscle = 19%; Fat = 6%; VPG = 0%
21
Q
steroids: stress dose
A
100 mg
22
Q
inhaled anesthetic agents: metabolism
A
Breath it off - respiratory
23
Q
uptake: increase inspired partial pressure
A
increase FGF, decrease circuit volume, decrease absorption
24
Q
uptake and distribution: alveolar partial pressure
A
uptake = solubility x CO x (Pa - Pv)
25
percodan: combination
oxycodone and aspirin
26
volatile anesthetics: cerebral blood flow
increased vasodilation, decreased vascular resistance, increased CBF and ICP, halothane worst and iso minimal
27
isoflurane: cardiovascular effects
decreased SVR, increased HR, coronary steal
28
desflurane: physical properties
liquid at room temperature
29
inhaled anesthetics: circulatory effects
increased HR with iso and des
30
inhaled anesthetics: cerebral metabolic rate of oxygen
decreased CRMO2
31
definiton of pKa
50% ionized and 50% of unionized
32
side effects of opioid administration
respiratory depression, constipation, biliary colic
33
opioid potency
compared to morphine (1.0) -- Meperidine = 0.1, Fentanyl = 75-125, Sufentanil = 1000 (5-10x more than fentanyl), Alfentanil = 10-20 (1/5-1/10x more than fentanyl), Remifentanil = 100, Hydropmorphone = 8
34
midazolam: 1st pass metabolism
PO = 50%
35
opioids: metabolism
remi: plasma/tissue esterases
morphine: liver and kidneys
meperidine: liver metabolism and renal elimination
fentanyl: pulmonary uptake
36
premedication: children
Versed 0.5 mg/kg PO 30 minutes before, often mixed with juice and acetaminophen
37
cortisol secretion -- induction drugs
Etomidate
38
thiopental stability
anhydrous, refrigerated lasts 2 weeks after reconstitution
39
racemeic mixture definiton
50% L andd 50% D
40
benzos: clinical effects
GABA, no analgesia, anxiolytic, anterograde amnesia
41
induction drugs: effect on ICP
propofol and ketamine increase, thipental and etomidate decrease
42
volatile anesthetics: analgesia
N20 & Methoxyflurane
43
synergism definition
1+1=3
44
thiopental pH
10.5
45
barbituates: Side effects
decreased ventilatory action, still have laryngeal response
46
drugs that do and do not interact with GABA
Ketamine doesn't
47
propofol: physical properties
white emulsion
48
antihypertensive therapy
Dexmetomidate/Clonidine (alpha 2 agonists)
49
volatile anesthetics: preservatives
halothane: thymol
50
induction drugs: mechanism of action
GABA, except ketamine
51
MAC: factors affecting
increased with: hyperthermia, hypernatremia, and catecholamines
52
volatile anesthetics: blood:gas coefficient
des: 0.42, nitrous: 0.47, sevo: 0.5, iso: 1.4, halo: 2.4
53
induction drugs: analgesia
ketamine
54
induction drugs: dose of etomidate
0.3 mg/kg
55
thiopental concentration
2.50%
56
treatment of myastenia gravis
anticholinesterase -- pyridostigmine
57
induction drugs -- myoclonus
Etomidate
58
volatile anesthetics: coronary blood flow
Iso
59
inhaled anesthetics potency
nitrous
60
thiopental: pharmacokinetics
GABA, 80% protein bound
61
anesthetic uptake: CO
/\CO delays onset
62
propofol dose and concentration
1-2.5 mg/kg
| 10 mg/ml
63
anticholinergic drugs and sedation
scopolamine is most potent sedative
64
EMLA definition
Eutectic Mixture Locain Anesthestic
65
local anesthetic -- methemoglobinemia
prilocaine and benzocaine
66
anticholinergic: lipid solubility
atropine and scopolamine cross BBB but glycopyrrolate does not
67
EMLA components
5% lidocaine, 5% prilocaine
68
calculation: bupivicaine in epidural infusion
10-20 minutes
69
propofol: ICU
3 days then hyperlipidemia
70
routes of drug administration: parenteral
IM, IV, SubQ, pulmonary, nasal, topical
71
opioids in renal failure
Alfentanyl
72
cell membrane diffusion: factors affecting
blood flow, surface area, solubility of drug
73
inhaled anesthetics - time constants
volume/flow
74
vancomycin side effects
redman syndrome
75
desflurane and CO2 absorber
carbon monoxide production over time
76
bupivicaine dose
2.5 mg/kg
77
duration of antiplatelet effects of aspirin
~10 days
78
effect of volatile anesthetics on pattern of spontaneous ventilation
Small, rapid breathing. net decrease in MV.
79
opioid for neurological assessment post op
Remifentanyl
80
local anesthetics -- metabolism
amides = liver, esters = cholinesterase enzymes
81
desflurane CV effects
tachycardia due to SNS stimulation
82
local anesthetics and nodes of ranvier
2
83
compound A formulation
sevo interaction with CO2 absorbers
84
benzodiazepine ion channel effect
Cl- hyperpolarization
85
inhaled agents: bone marrow suppression
N2O
86
opioids: histamine release
morphine and meperidine
87
glycopyrrolate: premedication
secretions, best antisaligogue, doesn't cross BBB so no sedation, less HR increase than atropine
88
opioid receptors
mu: endorphins, morphines, and synthetic opioids
kappa: dynorphins and agonist-antagonists
delta: enkephalins
89
opioids: seizures
meperidine
90
local anesthetics: signs of cardiotoxicity
circumoral numbness, tinitis
91
dibucaine number
80
92
succinylcholine: reason for short duration
plasma cholinesterases break it down
93
anitcholinesterases: lipid solubility
Physostigmine is lipid soluble, crosses the BBB
94
opioid side effects: glucagon
treatment of biliary colic (2 mg IV)
95
anticholinesterases: pharmacologic effectts
BBLUDS
96
thiopental: redistribution
effects of thiopental last 5-10 minutes because of redistribution
97
anticholinesterases: onset
(fastest to slowest) Edrophonium, neo, pyridostigmine
98
edrophonium: onset
fastest
99
local anesthetics -- signs of toxicity
circumoral numbness, tinitis
100
opioid receptors: dynorphins
kappa
101
rocuronium: rapid sequence
1 mg/kg
102
neuromuscular blocking drugs: CV effects
Pancuronium causes tachycardia
103
nondepolarizing NMB: onset
fast as sux with highest dose roc
104
neuromuscular blockade: phase I block
twitches and tetani with no fade
105
succinylcholine: electrolyte levels
hyperkalemia
106
local anesthetic: function of epinepherine
increased duration due to vasoconstriction
107
inhaled anesthetics and MH
discontinue
108
local anesthetics: cauda equine syndrome
5% lidocaine causes highest risk
109
mivacurium and laryngeal muscle spasm
IM mivacurium to treat laryngospasm in peds
110
antibiotics -- penicillin allergy
use clindamycin
111
chloroprocaine -- contraindicated in spinal
neurotoxic
112
properties of meperidine
antimuscarinic
113
volatiles: reactive airway
des contraindicated
114
maximum dose of Bupivicaine
2.5 mg/kg
115
dysrhythmias with sympathomimetics
epi
116
clinical use of dopamine
Increase CO and GFR
117
NMBD: choice for trauma patient with head injury
Roc
118
beta blockers -- airway resistance
Systemic absorption of timolol (normally eyedrops) causes increased airway resistance
119
beta blockers -- treatment of glaucoma
Timolol
120
beta blockers -- metabolism of
esmolol -- plasma esterases
121
benzodiazepine -- ion channel effect
hyperpolarization
122
side effects of neuraxial opioids
pruritis, N/V, urinary retention, ventilatory depression
123
antimicrobial prophylaxis: clean orthopedic procedure
ancef or vanc
124
antimicrobial, aminoglycoside class
gentamycin?
125
anticholinergic overdose
anticholinesterase
126
indirect agonist: definition
stimulates the release of an agonist (like ephedrine)
127
antacids -- side effects
metabolic alkalosis?
128
sympathomimetics associated with tachyphylaxis
ephedrine because it depletes N
129
oett drug administration
NAVEL: naloxone, atropine, valium, epi, lido
130
antimicrobial prophylaxis: knee replacement, PCN allergy
Vanco 1 g
131
routes of administration of epi
subQ, IM, IV, IO
132
milrinone dose
0.05 mg/kg loading dose, 0.5 mcg/kg/min infusion
133
surgical site infection: blood glucose
hyperglycemia, increased m/m at 200 mg/dL
134
side effect of milrinone
torsades, bronchospasm, severe infusion site reaction, ventricular arrhythmias
135
NMBD and histamine release
atracurium
136
IM ketamine dosing
4-8 mg/kg
137
cocaine for ENT
topical, vasoconstricts? pterygopalatine ganglion block?
138
norepi release regulated by what receptor
alpha 2
139
epinephrine -- arrythmias
PVCs and V-tac
140
local anesthetics and ion trapping
if baby is acidotic, local can be trapped in the baby and cause toxicity
141
milrinone method of action
cAMP
142
effects of norepi
Alpha (1&2) and Beta1
143
clinical uses for sympathomimetics
increase BP/CO
144
contraindications for acute intermittent prophyria
barbiturates
145
phosphodiesterase inhibitor -- myocardial contractility
cAMP
