Miscellaneous topics 4 Flashcards
A transverse abdominal plane block would be useful for all of the following procedures EXCEPT:
a. inguinal hernia repair
b. appendectomy
c. cystoscopy
d. kidney transplant
c. cystoscopy
The TAP block targets the nerves of the
anterior and lateral abdominal wall
The TAP block is best suited for abdominal procedures that involve the
T9 to L1 distribution
The landmarks for the TAP block form the
triangle of Petit:
1. external oblique muscle
2. Latissimus dorsi muscle
3. iliac crest
Potential complications of the TAP block include
peritoneal puncture
liver hematoma
Abdominal wall structures organized from superficial to deep:
subcutaneous tissue–> external oblique muscle–> internal oblique muscle–> transverse abdominis muscle–> peritoneum
Where should you inject for a TAP block?
between the internal oblique and the transverse abdominus
_______________ is pain localized to a dermatome
neuralgia
____________ is impaired nerve function
Neuropathy
______________ is abnormal sensation described as pins and needles
Paresthesia
___________ is abnormal and unpleasant sense of touch
Dysethesia
__________ is no pain is sensed in response to a stimulus that produces pain
Analgesia
___________ is pain due to a stimulus that does not normally produce pain
Allodynia
______________ is a stimulus that is normally expected to produce pain
Algogenic
The ________block is used to relieve postdural puncture headache
sphenopalatine
The _________- is the only cranial nerve that is enveloped by the meningeal sheath and bathed in CSF
optic nerve
Inadvertent local anesthetic injection into the optic sheath is a risk of a
retrobulbar block
Regional blocks used for pain management include
thoracic paravertebral block
celiac plexus block
superior hypogastric plexus block
The thoracic paravertebral block is used for
breast surgery
thoracotomy
rib fractures
The celiac plexus block is used for the management of
cancer pain of the upper abdomen
The superior hypogastric plexus block is used for the management of
cancer pain of the pelvic organs
Complex regional pain syndrome is characterized by
neuropathic pain with autonomic involvement
The key distinction between type 1 and type 2 complex regional pain syndrome is
type 2 is always preceded by nerve injury
Pain modulation occurs in the
spinal cord
These drugs can be used to treat chronic pain because they increase concentrations of norepinephrine and serotonin
antidepressants- tricyclics, SSRIs, SNRIs
Risk factors for complex regional pain syndrome include
female gender
previous trauma
previous surgery
Treatment for complex regional pain syndrome is
ketamine infusion
memantine (an NMDA antagonist)
gabapentin
regional sympathetic blockade
physical therapy
steroids
amitriptyline
Complications of a celiac plexus block include
orthostatic hypotension
retroperitoneal hematoma
hematuria
diarrhea
AAA dissection
back pain
retrograde migration of the injectate
The most common side effect of prophylactic antibiotics is
pseudomembranous colitis
Allergic reactions are most commonly caused by
beta-lactam antibiotics
Is there cross-reactivity between penicillin and cephalosporins?
rare-1%
__________ and _____________ cephalosporins are associated with the lowest rate of cross-reactivity
3rd and 4th generation
These antibiotics are contraindicated during pregnancy:
chloramphenicol
erythromycin
tetracyclines
fluoroquinolones
Giving vancomycin quickly can cause
histamine release & hypotension
Vancomycin should be administered
at a rate of 10-15 mg/kg over 1 hour
If a patient reports an allergy to PCN, they can receive
cephalosporin if the reaction was not IgE mediated (anaphylaxis, bronchospasm, urticaria) and did not produce exfoliative dermatitis (Stevens-Johnson syndrome)
What are examples of aminoglycosides?
gentamycin
streptomycin
What are risks associated with aminoglycosides?
ototoxicity
nephrotoxicity
skeletal muscle weakness
What are examples of tetracyclines?
doxycycline
What are risks associated with doxycycline?
hepatotoxicity
nephrotoxicity
What are examples of macrolides?
erythromycin
What are risks associated with macrolides?
P450 inhibition
What are examples of fluoroquinolones?
ciprofloxacin
levofloxacin
moxifloxacin
What are risks associated with fluoroquinolones?
GI intolerance
tendonitis & tendon rupture
What are risks associated with clindamycin?
skeletal muscle weakness
allergic reaction
What are risks associated with metronidazole?
peripheral neuropathy
alcohol intolerance
What are risks associated with vancomycin?
hypotension following rapid infusion (histamine)
red man syndrome
Stevens-Johnson syndrome
Cephalosporins act by
disrupting bacterial cell wall synthesis (peptidoglycan)
Vancomycin acts by
disrupting bacterial cell wall synthesis
What is the antibiotic of choice for an active MRSA infection?
vancomycin
