pastest Flashcards
how are NSAIDs categorised by risk of GI bleeding? give examples?
low risk - ibuprofen
intermediate - ketorolac, diclofenac, indomethacin
high - piroxicam , azopropazone
which is the most ototoxic drug?
cisplatin - everyone gets a degree of hearing loss
what is more ototoxic aminoglycosides or furosemide?
aminoglycoside abx - gentamicin
what is the mechanism of clonidine and dexamedetomidine? what effects does this have?
alpha 2 agonist
hypotension
analgesia
sedation
is tramadol safe in renal failure?
no,
active metabolite (O-desmethyltramadol) which is excreted renally
what is the mechanism of cabergoline?
what is another example of drug in this group?
when are these used?
dopamine D2 receptor agonist
bromocriptine
hyperprolactinaemia - inhibits prolactin at anterior pituitary
acromegaly - inhibits GH release
give an example of a somatostatin analogue ?
what is the indication?
octreotide
used for acromegaly as it inhibits GH release
what is the bio-oral availabiltiy of paracetamol and aspirin and diclofenac?
paracetamol - 90%
aspirin - 70%
diclofenac - 50%
what breaks down succinylcholine?
pseudo cholinesterase
aka as plasma esterases.
which class I antiarrhythmic can be used in ALS?
lidocaine (1b)
when amiodarone is not available/contraindicated.
which class of anti-arrhyhmic is lidocaine?
1b
outline main mechanism of class I to IV anti-arrhythmics and their main effect on ECG…
class 1 = Na channel blocker
2 = B blocker
3 = K channel blocker
4 = Ca channel blocker
class 1 - widens QRS
class 2 - slows rate and widens PR
class 3 - prolongs QT
class 4 - slows rate and widens PR
list the inducers of warfarin at CYP450
Abx - rifampicin
antiepileptic - phenytoin, carbemazepine, topiramate, barbiturates
other - Griseofulvin and st johns
PS CRAPT = phenytoin, st johns, carbemazepine, rifampicin, alcohol (indirect), phenobarbital (barbiturates) , topiramate
which antiemetic is particularly useful for chemo induced N&V?
dexamethasone
how do the class I anti-arrhythmics affect phase 0 of action potential, the refractory period and action potential duration?
phase 0
- class I a - moderate reduction
- class I b - small reduction
- class Ic - large reduction
action potential duration
- a - increased
b - reduced
c - no effect
refractory period
a - increased
b - reduced
c - no effect
how do amiodarone and digoxin differ in effects on vision?
amiodarone - optic neuropathy
digoxin - red green colour vision change
which anti-arrhythmic drug class does phenytoin belong to? what can it do to heart rhythm with IV administration?
clas Ib
complete heart block - increases PR
reduces refractory period
what is the oil gas partition for sevoflurane?
80
what is the molecular weight of sevo?
200Da
which volatile has highest molecular weight?
SEVO
what is the % of metabolism of the different volatiles?
0.02% desflurane
0.2% - isoflurane
2% - sevoflurane & enflurane
20% - halothane
what is the SVP of halothane
32
what is the SVP of isoflurane?
33
what is the SVP of desflurane?
89
what is the SVP of enflurane?
23.3
what is the SVP of sevoflurane
22.7
what is the MAC of halothane?
0.75
what is the MAC of sevoflurane?
2.2
what is the MAC of isoflurane? and enflurane?
isoflurane = 1.17
enflurane = 1.91
what is the MAC of desflurane?
6
what is the mac of nitrous oxide?
103
what muscarinic receptor is found in heart and what type of receptor is this
M2
Gi
where are M1 receptors located?
autonomic ganglia
salivary glands
gastric tissue
Gq receptor
where are M3 receptors located? what type of receptor is this?
smooth muscle - bronchoconstriction, GI movement
also eyes - miosis
Gq
where are M4 and M5 receptors found and what type of receptors are these?
both in CNS
M4 = Gi
M5 = Gq
what does phentolamine do to the nasal mucosa?
congestion
increases risk of bleeeding
Phentolamine = adrenoreceptor alpha antagonist
which model is used for TCI propofol in kids?
2 options
kataria
paedfusor
what is the Shuttler model?
TCI propofol model
what is the domino model?
TCI for ketamine
what class drug is pioglitazone?
TZD -
Thiazolidinedione
what class drug is sitagliptin?
gliptins
DDP4 inhibitors
diabetes
which pain med is well suited for chronic pain/ chronic regional pain syndrome?
IV ketamine
what are routes of administration for salbutamol?
IV
oral
inhaled
sub cut
what mixture does salbutamol consist of?
Racemix mixture of R and S enantiomers
which anaesthetic induction agent has the highest clearance?
propofol
30-60ml/kg/min
which anaesthetic induction agent has highest Vd?
propofol
which anaesthetic induction agents have active metabolites?
thio
ketamine
which anaesthetic induction agent is least protein bound?
ketamine - 25%
what anaesthetic drug is most likely to cause bronchospasm ?
atracurium
(more so than desflurane)
what is the delta ratio?
the ratio of change in the anion gap to the ratio of change in bicarbonate..
<0.4 = normal anion gap
0.4-0.8 = mixed normal and high gap
1-2 = high anion gap met acidosis
>2 = met acidosis and alkalosis
how can TRALI and TACO be differentiated by time frame?
TRALI
- within 6 hours
TACO
- within 12 hours, up to 24
what does a funnel plot in statistics do?
checks for risk of publication biased
which type of study does a forest plot look at?
meta analysis
what is the power of a study?
the sample size that is required to pick up a significant difference
how do sulphonamide antibiotics work?
false substrate for folic acid synthesis pathway - prevent folic acid production and DNA synthesis
how does chloramphenicol work?
binds 50s - inhibits protein synthesis
how does fusidic acid work?
bacteriocidal
inhibits protein synthesis
what are the symptoms of a stellate ganglion block?
warm dry hand
horners - constricted pupil, ptosis, enopthalmos, anhydrosis
what is the reason for urinary retention with cauda equina?
reduced bladder sensation
what are the different degrees of nerve injury?
neuropraxia - compression - local myelin damage only
axonotmesis - crush - neuron damaged but surrounding e.g. epineureum, perinerum remain in tact
neurotmesis - transection
what are the nerve roots of the common peroneal nerve?
L4-S2
how many values lie within 1, 2, 3 Standard deviations of the mean?
1= 67.7 %
2 = 95
3 = 99.7
what is the most accurate info that can be obtained from an arterial line?
directly measured is systolic and diastolic pressures therefore this is most accurate
indirectly calculated is stroke volume, contractility , SVR - less accurate
which statistical test is used for parametric data comparing 2 groups?
student unpaired t test
e.g. comparing group having a placebo and drug - unpaired because they are 2 separate groups
or student paired t test
e.g. comparing before and after results - paired because the each result needs to be paired for each patient.
when is chi squared test used?
for categorical data
which zone of the liver is for drug detox?
zone 3 - furtherest from portal triad, lowest perfusion
which zone of the liver does bile production? what else occurs here?
zone 1
cholesterol production
gluconeogenesis
what do sodium levels do to MAC?
hyponatremia - lower MAC
what is class I , II and III electrical equipment ?
class I - earthed case
class 2 - double insulation of all parts
class 3 - extra low voltage
how is SVT treated?
adenosine
if asthmatic - verapamil / diltiazam (CaCB)
how does venturi effect and bernouli principle relate?
venturi effect is an APPLICATION of the bernoulli principle
what is the formula for estimating weight of a child?
(age x 3) + 7
how do different LMA sizes relate to weight?
0-5kg - size 1
5-10kg - size 1.5
10-20kg - size 2
20-30kg - size 2.5
>30kg - size 3
how is amps of power of a circuit calculated?
watts/ volts
what is the normal value for vital capacity?
around 4500ml
ERV (1000) +IRV(3000)+ TV(500)
when is liver damage at its max post paracetamol OD?
3-4 days
when is IV acetylcysteine given before blood results are back?
if more than 150mg/kg
8-24 hours post ingestion
which enatiomer of bupivacaine is less cardiotoxic?
S (not R)
which metabolite of pancuronium is active and can cause prolonged muscle paralysis in renal failure?
3 - hydroxypancuronium (50% as potent)
which anticoag has shortest half life?
unfractionated heparin
what are the levels of evidence?
1a = systematic review
1b = well designed RCT
2a = well designed, controlled non randomised
2b - cohort
3 - case control
4 - expert opinions
what are the recommendation grades in in statistics?
A - level 1 evidence = 1a and 1b
B - level 2 evidence
C- level 3 evidence
D - level 4 evidence
size of LMA ?
0-5 kg = 1
5-10kg = 1.5
10-20 = 2
20-30 = 2.5
30 -50 = 3
50-70=4
70+ = 5
which statistical test looks at incidence?
chi squared
what are more powerful, parametric or non-parametric tests?
parametric
how does confidence interval vary with sample size?
larger sample size
smaller confidence interval - i.e. narrower range of which 95% chance of true value lying between
what type of data can median and SD be used?
Median and Standard Deviation are reserved for quantiative data that has a normal distribution.
give examples of ordinal data
qualaitive but given a value e.g. ASA, frailty score
can be compared by Chi squared
if the P value is <0.05 what can we say?
statistically significant
but cant say if clinically significant i.e. cant confirm one treatment is better than the other
