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Apex Review > Miscellaneous topics 6 > Flashcards

Miscellaneous topics 6 Flashcards

1
Q

What are the respiratory presentation of anaphylaxis?

A

bronchospasm- decreased EtCO2, decreased SaO2, increased peak inspiratory pressure
laryngeal edema
increased mucus production

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2
Q

What are the GI effects of anaphylaxis?

A

abdominal cramping
N/V
diarrhea

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3
Q

What are the skin effects of anaphylaxis?

A

flushing
urticaria (hives)
erythema
pruritus

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4
Q

Type 1 is a _____________ mediated reaction

A

IgE

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5
Q

The best lab test to determine if an allergic response has occurred is

A

tryptase

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6
Q

Type 2 is a ______________ mediated reaction

A

IgG and IgM

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7
Q

High risk groups for a latex allergy include

A

spina bifida/myelomeningocele, atopy, health care workers and allergy to banana, kiwi, mango, papaya, pineapple, and tomato

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8
Q

Other common allergens in the OR include

A

chlorhexidine, protamine, contrast media, colloids, blood products, opioids, hypnotics, and local anesthetics

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9
Q

Cisplatin, a chemotherapeutic agent, can cause

A

acoustic n. injury + nephrotoxicity

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10
Q

Vincristine & vinblastine, a chemo drug, can cause

A

peripheral neuropathy

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11
Q

Bleomycin, a chemo drug, can cause

A

pulmonary fibrosis (keep FiO2 <30%)

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12
Q

Doxorubicin, a chemo drug, can cause

A

cardiotoxicity

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13
Q

5-fluorouracil, a chemo drug, can cause

A

bone marrow suppression

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14
Q

Methotrexate, a chemo drug, can cause

A

bone marrow suppression

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15
Q

A history of severe N/V can impact

A

volume status and electrolyte balance

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16
Q

____________ may be a reason to avoid an oral airway, nasal airway, LMA, or esophageal temperature probe.

A

Mucositis (ulceration of mucous membranes)

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17
Q

What are the five key GI hormones?

A

Gastrin
secretin
cholecystokinin
gastric inhibitory peptide
somatostatin

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18
Q

The universal “off” switch for digestion is this hormone:

A

somatostatin

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19
Q

This hormone increases stomach acid and stimulates chief cells to secrete pepsinogen:

A

gastrin

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20
Q

This hormone instructs the pancreas to secrete bicarbonate and the liver to secrete bile:

A

secretin

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21
Q

This hormone slows gastric emptying and stimulates pancreatic insulin release:

A

gastric inhibitory peptide (K cells)

22
Q

Barrier pressure is reduced by things that

A

reduce LES tone (cricoid pressure, anticholinergics, pregnancy)
increase intragastric pressure (pregnancy)

23
Q

__________ is increased in the patient with Zollinger-Ellison syndrome

A

Gastrin (gastrin secreting tumor–> increased stomach acid–> gastric ulceration)

24
Q

Gallbladder pain after a fatty meal is caused by

A

increased CCK release

25
Q

The treatment for carcinoid tumors is

A

somatostatin

26
Q

___________ is a drug that increases barrier pressure

A

metoclopramide

27
Q

Which agent primarily targets the chemoreceptor trigger zone?
a. ondansetron
b. scopolamine
c. dexamethasone
d. hydroxyzine

A

a. ondansetron

28
Q

What are the 6 types of antiemetics?

A

5-HT3 antagonists
Neurokinin-1 antagonists
dopamine antagonists
antihistamines
anticholinergics
steroids

29
Q

What type of anesthetic reduces the risk of PONV?

A

TIVA & regional anesthesia

30
Q

_____________ should be administered during induction to be effective

A

Dexamethasone

31
Q

Ondansetron should be administered

A

30 minutes before emergence

32
Q

Dopamine antagonists include

A

butyrophenones, phenothiazines, metoclopramide

33
Q

Dopamine antagonists can cause

A

extrapyramidal symptoms

34
Q

These drugs are contraindicated in the patient with Parkinson’s disease:

A

dopamine antagonists

35
Q

Metoclopramide is contraindicated with

A

bowel obstruction

36
Q

Propofol at _____- produces an antiemetic effect

A

10-20 mg

37
Q

Ephedrine given ___________ may reduce PONV by

A

25 mg IM by maintaining BP and cerebral perfusion

38
Q

Transdermal scopolamine is best applied

A

> 4 hours before the induction of anesthesia; lasts for 72 hours

39
Q

The vomiting center resides in the

A

nucleus tractus solitarius (medulla)

40
Q

Sensory input to the vomiting center arises from

A

the chemoreceptor trigger zone, GI tract, and vestibular system

41
Q

The GI tract gives rise to these receptors involved in vomiting:

A

5-HT3
NK-1

42
Q

The CTZ gives rise to these receptors involved in vomiting:

A

5-HT3
NK-1
DA-2
noxious chemicals

43
Q

The vestibular apparatus gives rise to these receptors involved in vomiting:

A

H1
M1

44
Q

Patient risk factors for PONV include

A

female gender
nonsmoker
history of motion sickness
previous episodes of PONV
age is loosely associated (youth> elderly)

45
Q

Anesthetic risk factors for PONV include

A

halogenated anesthetics
nitrous oxide (>50%)
opioids
etomidate
neostigmine

46
Q

Surgical risk factors for PONV include

A

long surgical duration (> 1 hr)
GYN procedures
laparoscopy
breast
plastics
peds procedures: strabismus, orchiopexy, T&A

47
Q

The most common side effects of ondansetron are

A

headache and/or diarrhea

48
Q

5HT3 antagonists and butyrophenones can prolong

A

the QT interval (droperidol has a black box warning for QT prolongation)

49
Q

Motion induced nausea is the result of

A

M1 & H1 stimulation in the vestibular system of the inner ear

50
Q

Patients undergoing _______ should receive antiemetic agents that target the vestibular system

A

middle ear surgery

51
Q

Prochloroperazine produces significant

A

sedation

52
Q

A nonpharmacologic method of reducing PONV is

A

the P6 acupressure point- pressure point located 3 finger breadths below the wrist on the inner forearm

Apex Review (224 decks)

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