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Apex Flashcards > miscellaneous topics overview part 2 (continued) > Flashcards

miscellaneous topics overview part 2 (continued) Flashcards

1
Q

Surgical Care Improvement Project has 7 measures designed to reduced postop surgical site infection

A
  1. prophylactic abx within 60m of surgical incision (vanc is 120m)
  2. choice of abx determined by site of surgery
  3. d/c’d 24h post surgery (48h for cardiac patents)
  4. cardiac surgical patients must achieve glycemic control (<200mg/dL)
  5. postop wound infection is diagnosed during initial hospitalization
  6. surgical patients receive appropriate hair removal
  7. colorectal patients are normothermic upon arrival to PACU (>36c)
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2
Q

precautions for covid

A

airborne

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3
Q

creutzfeldt jakob disease

A

prion disease, can lead to encephalopathy and dementia. etiologies: consumption of contaminated animal protein, contaminated implants (corneal or dural tissue), cadaveric pituitary hormone supplementation.

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4
Q

how to dx TB

A

skin test (+) >10mm induration and (+) CXR

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5
Q

tx for TB

A

isoniazid first line (se: peripheral neuropathy and hepatotoxicity). can include pyroxidine to reduce incidence of liver damage
rifampin (se: TCP, leukopenia, anemia, kidney failure. urine sweat and tears will take on an orange/red color
other first line: pyrazinamide, streptomycin, ethambutol

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6
Q

TB special anesthetic considerations

A

anesthesia provider should wear N95
HEPA between y piece and patients aw
bacterial filter on expiratory limb of circle circuit
ideal: dedicated anesthesia machine and ventilator
pre and post op care in negative pressure isolation room

elective procedures should be delayed until patient is on anti TB chemo, has 3 negative active fast bacillus tests, demonstrates sx improvement

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7
Q

WBC’s can be divided into _________ and __________

A

granulocytes (neutrophils, basophils, eosinophils)
agranulocytes (monocytes, lymphocytes)

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8
Q

basophils overview

A

essential component of allergic rxn
releases histamine, leukotriene, prostaglandins (mast cells do same thing)
epinephrine prevents degranulation (release of intracellular contents) by binding to B2 receptors on cell membrane

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9
Q

monocytes overview

A

fights bacterial, viral, or fungal infections (phagocytosis)
release cytokines
present pieces of pathogens to T lymphocytes

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10
Q

types of lymphocytes

A

B lymphocytes (humoral immunity- produce antibodies)
T lymphocytes (cell mediated, does not produce antibodies)
NK: limit spread of tumor and microbial cells

(fx is reduced by opioids)

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11
Q

hypersensitivity reactions cause and effect

A
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12
Q

type 1: immediate hypersensitivity reaction

A

antigen and antibody interaction in a patient who has been previously sensitized to the antigen
IgE mediated
tryptase is released from mast cells during allergic reaction. it is therefore best lab test to determine if allergic response has occurred
ex) anaphylaxis, extrinsic asthma

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13
Q

type 2: antibody mediated reaction

A

IgG and IgM bind to cell surfaces of extracellular regions
reaction activates complement cascade
ex) ABO incompatibility, HIT

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14
Q

type 3: immune complex mediated reaction

A

immune complex is formed and deposited into patients tissue (normally these complexes are cleared from body)
reaction activates complement cascade
ex) snake venom

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15
Q

type 4: delayed

A

delayed at least 12 hours following exposure
ex) contact dermatitis, graft v host reaction, tissue rejection

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16
Q

tx of intraop anaphylaxis

A

d/c offending agent
increase FiO2, provide aw support
epi 5-10mcg IV for HoTN and .1-1mg IV for CV collapse
liberal IV hydration (crystalloid 10-25mL/kg or colloid 10mL/kg. repeat PRN)
H1 receptor antagonist (diphenhydramine .5-1mg/kg IV)
H2 receptor antagonist (ranitidine 50mg IV or famotidine 20mg IV)
hydrocortisone 250mg IV (prevents delayed release of inflammatory compounds, does not produce immediate effect)
albuterol for bronchospasm
vasopressin for refractory HoTN (start at 0.01unit/min)

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17
Q

common culprits for periop allergic rxn’s

A
  1. NMB’s (most common, and succ is most common NMB)
  2. latex (high risk groups: spina bifida, myelomeningocele, atopy, healthcare workers, allergy to banana, kiwi, mango, papaya, pineapple, tomato
  3. abx (beta lactams are most common)
  4. others: chlorhexidine, protamine, contrast media, colloids, blood products, opioids, hypnotics, LA’s
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18
Q

review the chemotherapeutic agents this “chemo man” represents and the unique SE’s

A

Cisplatin (alkylating agent)–> acoustic nerve injury and nephrotoxicity
Vincristine and vinblastine (tubulin binding drug)–> peripheral neuropathy
Bleomycin (antitumor antibiotic)–> p.fibrosis (keep FiO2 <30%)
Doxorubicin (antitumor antibiotic)–> cardiotoxic
5-fluororacil (antimetabolite)–> bone marrow suppression
Methotrexate (antimetabolite)–> bone marrow suppression

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19
Q

most chemotherapeutic agents cause which two things? and which agent is the exception?

A

bone marrow suppression and thrombocytopenia. bleomycin is the exception

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20
Q

Tamoxifen uses and SE’s

A

selective estrogen receptor modulator. if the tumor does not express estrogen receptors, it does not respond to this drug.
SE’s hot flashes, increase risk of endometrial cancer

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21
Q

5 key hormones that regulate digestive activity include

A
  1. gastrin
  2. secretin
  3. cholecystokinin
  4. gastric inhibitory peptide
  5. somatostatin
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22
Q

gastrin
role
site of production
stimulus
function

A

when food enters the stomach, gastrin increases stomach acid and stimulates chief cells to secrete pepsinogen.
in the presence of stomach acid, pepsinogen is converted to pepsin (aids in protein digestion)
produced in G cells in stomach
stimulus: food in stomach
function: increase gastric acid and pepsinogen secretion

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23
Q

secretin
role
site of production
stimulus
function

A

tells pancreas to secrete bicarb and liver to secrete bile
site of production: S cells (small intestine)
stimulus: acid in duodenum
function: increased pancreatic bicarb secretion, decreased gastrin secretion

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24
Q

cholecystokinin
role
site of production
stimulus
function

A

tell pancreas to release digestive enzymes and gallbladder to contract
site of production: I cells, small intestine
stimulus: food in duodenum
function: increase in gallbladder contraction (bile release), increased pancreatic enzyme secretion, decreased gastric emptying

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25
gastric inhibitory peptide role site of production stimulus function
slows gastric emptying and stimulates pancreatic insulin release site of production: K cells- small intestine stimulus: food in duodenum function: increased insulin release, decreased gastric acid secretion, decreased gastric motility
26
somatostatin role site of production stimulus function
universal off switch for digestion site of production: D cells (pancreatic islet), stomach, small intestine stimulus: food in gut, gastrin, CCK function: decreases all GI function (enzyme and motility). universal "off" switch
27
what is increased in a patient with zollinger ellison syndrome
gastrin -->increased gastric acid--> increased ulceration
28
gallbladder pain after a fatty meal is caused by
CCK release
29
tx for carcinoid tumors
somatostatin
30
things that decrease gastric barrier pressure (aka lowering LES tone)
anticholinergics cricoid pressure pregnancy
31
things that increase gastric barrier pressure (aka increasing LES tone)
metoclopramide
32
things that don't affect gastric barrier pressure aka LES tone
succ-->increased LES tone but increased intragastric pressure = 0 net charge
33
barrier pressure =
LES pressure - intragastric pressure
34
review direct sensory input to vomiting center (NTS) in medulla (3 pathways) and the receptors involved in each pathway
35
5HT3 antagonist receptor target ligand examples and dosages
receptor target: 5HT3 ligand: serotonin examples: ondansetron 4-8mg, granisetron 1mg, dolasetron 12.5mg
36
NK1 antagonists receptor target ligand examples and dosages
receptor target: NK1 ligand: substance P examples and dosages: aprepitant (PO) 40mg
37
dopamine antagonists receptor target ligand examples and dosages
receptor target: D2 ligand: dopamine examples and dosages: droperidol .625-1.25mg haldol .5-2mg metoclopramide 10-20mg prochlorperazine 10mg
38
antihistamines receptor target ligand examples and dosages
receptor target: H1, M1 ligand: H1 (histamine), M1 (Ach) examples and dosages: diphenhydramine 25mg hydroxyzine 12.5-25mg promethazine 12.5-25mg
39
anticholinergics receptor target ligand examples and dosages
receptor target: M1 ligand: Ach examples and dosages: scopolamine (transdermal) 1.5mg
40
steroids receptor target ligand examples and dosages
receptor target: intracellular steroid receptors ligand: steroid examples and dosages: dexamethasone 4-10mg
41
PONV patient risk factors
female non smoker hx motion sickness previous PONV age loosely associated (youth>elderly)
42
PONV surgical risk factors
surgical duration >1h GYN procedures laparoscopy breast plastics peds procedures (strabismus, orchiopexy, T&A)
43
PONV anesthetic risk factors
halogenated anesthetics nitrous oxide (>50%) opioids etomidate neostigmine
44
is BBB well developed at CTZ
no, which explains why it is stimulated by noxious chemicals
45
motion induced nausea is the result of
H1 and M1 stimulation in the vestibular system of the inner ear
46
when should you apply transdermal scopalamine
>4h before induction
47
SE of methyl methacrylate (bone cement) includes (basically describe bone cement implantation syndrome)
increases intramedullary pressure of bone that causes micro emboli. can result in VQ mismatch, increased dead space and in severe cases right heart failure residual bone cement can enter systemic circulation where it causes bradycardia, dysrhythmias, HoTN, decreased SVR, pHTN (increased PVR), hypoxia, and cardiac arrest
48
highest risk of BCIS
hip arthroplasty
49
first signs of BCIS: awake versus asleep patient
awake: dyspnea, AMS asleep: decreased EtCO2
50
first line tx for BCIS
100% FiO2, IV hydration, neo for HoTN
51
fat embolism syndrome
complication of long bone trauma. greatest risk inside first 72h of injury. explains why prompt stabilization of injury is important
52
risk factors of fat embolism syndrome include
pelvic fx, femoral fx, instrumentation of femoral medullary canal
53
triad of FES includes
respiratory insufficiency (hypoxemia, bilateral infiltrates on CXR, ARDS) neurologic involvement (confusion to coma) petechial rash (skin and neck of axilla, oral mucosa, conjunctivae
54
maximum inflate time of a pneumatic tourniquet
2h
55
inflation pressure of pneumatic tourniquet for UE versus LE surgery
UE: 70-90mmHg above SBP LE: 2x over SBP
56
when pneumatic tourniquet is used for a bier block, what is the inflation pressure for UE versus LE
UE: 250mmHg or 100mmHg over SBP (whichever is higher) LE: 350-400mmHg
57
releasing the pneumatic tourniquet produces transient changes that include
increased EtCO2 decreased core body temp decreased BP decreased SvO2 (SaO2 usually normal) metabolic acidosis
58
tourniquet pain usually lasts how long after inflation
45-60m -via c fibers, unresponsive to analgesics
59
ix COX1 always present? COX2?
COX1 is always present and maintains physiologic function. COX2 is not always present and is expressed during inflammation
60
drugs that perform non selective cox inhibition include
ASA ibuprofen naproxen ketorolac diclofenac indomethacin
61
COX2 selective inhibition drugs
celecoxib and any drugs with the suffix -coxib
62
key complications of COX inhibitors
63
ketorolac 30mg IV ~ morphine _____ IV
10mg
64
aspirin toxicity can cause a
gap metabolic acidosis
65
Samters triad
ASA associated respiratory disease. asthma, allergic rhinitis, nasal polyps -patients can develop life threatening bronchospasm after admin of asa or other NSAIDS
66
ephedra (ma huang) use interactions and toxicity d/x before surgery
use: diet aid, athletic enhancer, nasal decongestant interactions and toxicity: interaction with MAOI's--> serotonin syndrome sympathomimetic effects catecholamine depletion with long term use --> hemodynamic instability d/x before surgery: 24h
67
garlic use interactions and toxicity d/x before surgery
use: anti platelet, HTN, HLD interactions and toxicity: increase bleeding risk, decrease serum glucose d/x before surgery: 7 days
68
ginger use interactions and toxicity d/x before surgery
use: nausea interactions and toxicity: increased bleeding risk d/x before surgery: no data
69
ginkgo balboa use interactions and toxicity d/x before surgery
use: anti aging, poor circulation interactions and toxicity: increased bleeding risk d/x before surgery: 36h
70
ginseng use interactions and toxicity d/x before surgery
use: antioxidant interactions and toxicity: increases bleeding risk, enhances SNS effects of sympathomimetics, may cause Hoglycemia (risk in fasting patient) d/x before surgery: 7 days
71
kava kava use interactions and toxicity d/x before surgery
use: anxiety interactions and toxicity: decreases MAC (increases GABA), may prolong DOA of anesthetic agents d/x before surgery: 24h
72
licorice use interactions and toxicity d/x before surgery
use: gastric and duodenal ulcers interactions and toxicity: mimic effects of aldosterone. Na/H2O retention and therefore decreased K, can be confused with conns syndrome d/x before surgery: no data
73
saw palmetto use interactions and toxicity d/x before surgery
use: BPH interactions and toxicity: increased bleeding risk d/x before surgery: no data
74
st johns wort use interactions and toxicity d/x before surgery
use: depression interactions and toxicity: induction of CYP3A4, decreases serum levels of warfarin, protease inhibitors, digoxin, may prolong DOA of anesthetic agents, interaction with MAOI's and meperidine--> serotonin syndrome d/x before surgery: 5 days
75
valerian use interactions and toxicity d/x before surgery
use: anxiety interactions and toxicity: decreases MAC (increases GABA), may prolong DOA of anesthetic agents, abrupt d/c may cause withdrawal (d/c over weeks) d/x before surgery: no data
76
4 G's that increase risk of bleeding
garlic, ginger, ginkgo, ginseng
77
tasks to complete before every patient include
1. verify adequate suction 2. verify presence and function of required monitors and alarms 3. check that vaporizers are filled and that ports are tightly closed 4. determine that CO2 absorbent is not exhausted 5. perform high pressure leak test 6. assess unidirectional valves 7. document that procedures listed above were completed 8. set ventilator appropriately and conduct anesthesia TO 9. O2 monitor must be calibrated once a day (not before every case)
78
american society for testing and materials
sets standards for required components of anesthesia machine (ASTM F1850)
79
US DOT is responsible for
setting standards for compressed gas cylinders
80
FDA sets standards for
food and drugs, also created 1993 FDA anesthesia machine pre check out procedures
81
OSHA sets standards for
acceptable occupational exposure to volatiles
82
4 zones for MRI, definition, and example
83
are ferromagnetic objects allowed in zone 4
no
84
safe metals for MRI include
stainless steel, titanium, aluminum, copper
85
color of MRI safe cylinders
silver with color code at top
86
overview of modified aldrete score (and what it includes- 5 areas)
used to assess readiness to discharge from PACU
87
minimum modified aldrete score that correlates with PACU discharge?
9 or greater
88
2 anti emetic drug groups that can be used in the parkinson population
anticholinergics NK1

Apex Flashcards (71 decks)

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