Pharmacology + fluids Flashcards
What is the IM adrenalin dose for adults?
0.5mg [0.5ml of 1:1000]
Repeat every 5 minutes as needed
What is the IM adrenalin dose for children?
10mcg [0.01ml/kg] of 1:1000
[min dose 0.1ml]
[max dose 0.5ml]
Repeat every 5 minutes as needed
What drugs are given during bronchospasm?
Salbutamol inhaled 8-12 puffs
Salbutamol IV bolus 250mcg [100mcg/ml]
Magnesium
Adrenalin
ketamine
What drug do you give for an adult cardiac arrest?
Adrenalin 1mg IV and repeat every 2nd cycle [3-5 minutes]
How do you treat hyperkalaemia?
Sodium bicarbonate
Insulin actrapid
Calcium chloride
What is the paediatric dose of adrenaline for a cardiac arrest Asystole/PEA
Adrenaline 0.01mg/kg of the 0.1mg/ml concentration
Max dose 1mg
Repeat every 3-5 minutes
What is the intubation dose of propofol for adults?
1-2mg/kg
What is the intubation dose for suxamethonium IV?
2mg/kg
What is the intubation dose for suxamethonium IM?
4mg/kg
How much propofol do you give to break a laryngospasm event?
20% of an induction dose 0.25-0.5mg/kg
What is the immediate bolus dose of 20% intralipid during a local anaesthetic emergency event?
1.5mg/kg over 1 minute [100ml for 70kg]
If remains unstable Repeat 2 more doses at 5-minute intervals max
What is the infusion dose of 20% intralipid?
15ml/kg/hr [1000ml/hr for 70kg]
If remains unstable double infusion rate
Is propofol a substitute for intralipid?
No
How do you prepare the dantrolene?
20mg vial mixed with 60mls sterile water
What is the dose of dantrolene
2.5mg/kg [60kg = 8 vials]
How long after immediate treatment of dantrolene should you consider giving another repeat bolus?
10 minutes if still symptomatic
How does dantrolene work?
Dantrolene directly interferes with muscle contraction by decreasing calcium in muscle cells
preventing electrical impulses traveling to muscles and preventing muscle contractions
What complications can MH cause?
Acidosis – treat with hyperventilation, sodium bicarbonate
Arrhythmias
Disseminated intravascular coagulation [DIC] -abnormal blood clotting
Hyperkalaemia – high potassium levels in blood
Hyperthermia – cold fluids, ice
Hypotension – fluid bolus, vasopressor
Cardiovascular collapse and cardiac arrest
Plasmalyte is ______ compared to body water
Isotonic
Sodium chloride 0.9% is ______ compared to body water?
Isotonic
0.45% sodium chloride is ______ compared to body water?
Hypotonic
What is the adult blood volume per kg in mls?
70
What is the paediatric blood volume per kg in mls?
80
True or false – hypotonic fluids might be used to treat diabetic ketoacidosis
True
True or false – Hypertonic fluids are not used in treatment of oedema
False
True or false – Albumin must be given through a blood pump set?
False
Fresh frozen plasma is used to treat coagulopathies and what other purpose?
increase circulating volume
Untreated haemorrhage or dehydration could lead to which of the 4H’s and 4T’s
Hypovolaemia
True or false – platelets are stored in the fridge
False
What is the micron size range for a blood filter?
170-200
Who is the universal blood donor?
O Negative
Who is the universal blood recipient?
AB positive
Who is the universal plasma donor?
AB
Who is the universal plasma recipient?
O
In normal use, how many units of blood should be given through a blood filter?
4
true or false – in a massive transfusion, it is acceptable to give more units than 4 through a filter
True
Can rhesus positive blood be given to rhesus negative patients?
No
What blood products should not be given in the same line as RBC’s
Platelets
A haemolytic transfusion reaction causes destruction of what?
Haemoglobin
What is the adult cardiac arrest adrenaline dose? Include units
1mg
What is the adult anapahylaxis IM adrenaline dose? Include units
0.5mg
What is the paediatric cardiac arrest adrenaline dose? mcg/kg
10 mcg/kg
What is the paediatric amiodarone cardiac arrest dose? mg/kg
5 mg/kg
What is the intralipid bolus dose in ml/kg?
1.5ml/kg
Which medication can be given to reduce metabolic acidosis in malignant hyperthermia?
Sodium Bicarbonate
Insulin - acrapid
Calcium Choride
Which blood test is used to confirm anaphylaxis after the incident?
Tryptase
When should tryptase be taken after an anaphylaxis event?
A - Immediately and after 24 hours
B- 1 hour, 4 hours and 24 hours
C - Immediately, 2 hours and 6 hours
D - When I can be bothered doing a blood gas
B
MTP box 1 contains what?
A) 4 RBC, 4 FFP
B) 2 RBC, 2 FFP
C) 4 RBC, 4 FFP, 3 Cryo
D) 4 RBC, 4 FFP, 1 Platelets
B
MTP box 2 contains what?
A - 4 RBC, 4 FFP, 3 Cryo
B - 2 RBC, 2 FFP
C - 4 RBC, 4 FFP, 1 Platelets
D - 4 RBC, 4 FFP
A
MTP box 3 contains what?
A 2 RBC, 2 FFP
B 4 RBC, 4 FFP, 1 Platelets
C 4 RBC, 4 FFP, 3 Cryo
D 4 RBC, 4 FFP, 1 Cryo
B 4 RBC, 4 FFP, 1 Platelets
Which boxes are repeated in an MTP?
A - 1 & 2
B - 3 & 4
C - 1 & 4
D - 2 & 4
B
What are the 4 H’s related to an emergency?
Hypovolemia,
Hypoglycaemia/Hyperkalaemia,
Hypo/Hyperthermia,
Hypoxia
What are the 4 T’s related to an emergency?
Tension pneumothorax,
Tamponade,
Thrombosis,
Toxins
What does MAC stand for?
Minimum alveolar concentration
Five common causes of anaphylaxis?
Latex
Colloid
Antibiotics
Muscle relaxant
Chlorhexidine
Patient blue
sugamadex -[likelihood appears to be dose-related]
What are 5 symptoms of anaphylaxis?
Difficult/noisy breathing
Wheeze/Persistent cough
Swelling of the face and tongue
Swelling/tightness in the throat
Difficulty talking
Persistent dizziness/ loss of consciousness
Abdominal pain and vomiting
Hives, welt and body redness/rash
Hypotension
Tachycardia
What are the signs and symptoms of Local Anaesthetic Toxicity?
Tingling on the lips and fingers, metallic taste, ringing in the ears, confusion, and dizziness
Convulsions and loss of consciousness
Hypotension, bradycardia, and respiratory arrest
What are the early signs and symaptoms of Malignant hyperthermia?
Prolonged muscle spasm after Suxamethonium
Tachycardia
Tachypnoea in a spontaneous breathing patient
Increased CO2
Cardiac arrhythmias
What are the Developing Signs and Symptoms of Malignant hyperthermia?
Rapid increase in temperature (0.5 degrees every 15 minutes)
Respiratory and metabolic acidosis
Hyperkalaemia
Profuse sweating
Decrease SpO2
Mottled skin
Cardiac instability
Muscular rigidity
What does TACO stand for and what is it?
Transfusion Associated Circulatory Overload
Pulmonary oedema primarily caused by volume excess
Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.
What does TRALI stand for and what is it?
Transfusion Related Acute Lung Injury
Repaid onset of excess fluid in the lungs.
Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest
What is Acute Haemolytic Transfusion Reaction
AHTR
A life-threatening reaction to receiving a blood transfusion that results from the rapid destruction of donor red blood cells by host antibodies (Can be delayed)
ESBL
Extended Spectrum Beta-Lactamase
HELLP
Haemolysis Elevated Liver Enzyme and Low Platelets
MRSA
Methicillin Resistant Staphylococcus Aureus
What is the triad of anaesthesia
Amnesia
Analgesia
Muscle relaxation
What are some examples of colloid substances?
RBC
Albumin
FFP
Name some crystalloid fluids
Heartmans
Sodium Chloride
Plasmalyte
Dextrose saline
manitol
Do crystalloids have high or low cell permeability?
High
Do colloids have high or low cell permeability
Low
What temperature is FFP stored at?
-30’C
What temperature is RBC stored at?
2- 6’C
What are the signs and symptoms of a blood transfusion reaction?
Increased temperature
Hypotension
Tachycardia
Anaphylaxis
Elevated ventilation pressure
List fractionated blood products available;
Plasma
Cryoprecipitate
Platelets
Immunoglobins
Albumin
Irradiated and leuko depleted red blood cells
What are leukocytes and what is their main purpose?
White blood cells
Main immune system cell
Name a depolarising muscle relaxant;
Suxamethonium
Name non-depolarising muscle relaxants;
Rocuronium
Vecuronium
Atricurium
What are the 5 R’s of drug administration?
Right drug
Right patient
Right dose
Right route
Right time
What are some induction agents?
Propofol
Thiopentone
Etomidate
What medications can provide analgesia?
Fentanyl
Alfentanil
Remifentanil
Morphine
Paracetamol
Parecoxib
What are some antiemetics?
Ondansetron
Dexamethasone
Define a half-life regarding medications;
It is the time taken for half of the drug to be broken down by biological processing
Define agonist;
Is a chemical that binds to a receptor on a cell to cause activation thus causing a response
Define antagonist;
A chemical substance that binds to and blocks the activation of receptors on cells preventing a biological response
Define toxicity;
Chemicals or drug concentrations are at such high levels in the body that they can damage organs and tissues
Define bioavailability;
The rate and extent to which the rate a drug is absorbed and reaches circulation
IV administration has a bioavilability of 100%
What items can contain chlorhexidine in operating theatres?
Skin antiseptic wipes
Hand gels and hand wash solutions
Surgical skin disinfectants
Pre-surgery wash sponges and wipes
Lubricant preparations
Central venous lines
Surgical dressings and mesh
Mouth wash
Outline the guidelines for fluid maintenance relating to body weight in paediatric anaesthesia;
0-10kg = 4ml/kg/hr
10-20kg = 2ml/kg/hr
> 20kg = 1ml/kg/hr
4-2-1 rule
Do children require higher weight-adjusted doses of most medications compared to adults?
Yes
Children have higher rates of metabolism and elimination than adults which means they require a higher weight-adjusted dose of medication
Define pharmacodynamics;
The study of the molecular, biochemical and physiologic effects and actions on the body
Define pharmacokinetics;
The study of how the body interacts with administered substances for the entire duration of exposure
Discuss 3rd spacing in relation to fluid shifts during a major laparotomy;
3rd spacing describes the movement of bodily fluid from the blood into the spaces between the cells
This can lead to problems such as oedema, reduced cardiac output and hypotension
3rd space fluid shifts are calculated as 4-6ml/kg/hr which can be compensated with fluids
What muscle relaxant produces a rise in ICP and is commonly avoided for neurosurgical patients?
Suxamethonium
What are 3 contraindications for suxamethonium
Neurosurgery due to increase in intracranial pressure is not ideal
Muscular disorders
MH history
What are the side effects of suxamethonium?
Bradycardia
Hypotension
Increased intracranial / Intraocular pressure
MH
Post operative muscle pain
why should GTN spray be available in an obstetric theatre?
GTN is a smooth muscle relaxant and vasodilator
What medication is commonly given for preeclampsia?
Magnesium sulfate
why is oxytocin given in an obstetric case and what is the infusion dose?
Oxytocin prevents excessive postpartum bleeding by helping the uterus contract.
The medication works immediately when given IV
40IU Oxytocin in a 500 ml saline bag running at 125 ml/hr for 4 hours
List two drugs used for gastric emptying;
Ranitdine
Metoclopromide
sodium Citrate
What type of rhythm, and what dose and when during the CPR is amiodarone given?
VF / VT - 300mg IV after 3rd cycle
