Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesiologist Assistant > Pharmacology (Orientation) > Flashcards

Pharmacology (Orientation) Flashcards

1
Q

Pharmacokinetics

A

a quantitative study of the absorption, distribution, metabolism, and excretion of injected and inhaled drugs and their metabolites “What the body does to the drug”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pharmacodynamics

A

study of the intrinsic sensitivity or responsiveness of receptors to a drug and the mechanics by which these occur “What does the drug do to the body”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tolerance

A

hyporeactive owing to chronic exposure to a drug
Cross-tolerance is common b/w drugs that produce similar pharmacologic effects (alcohol & inhaled anesthetics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tachyphylaxis

A

tolerance that develops acutely; reflects cellular tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Additive

A

two drugs (inhaled anesthetics) interact to produce an effect (MAC) equal to algebraic summation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Synergetic

A

two drugs interact to produce an effect greater than algebraic summation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Agonist

A

a drug that activates a receptor by binding the receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Partial agonist

A

a drug that binds weakly to the receptor and produces minimal pharmacological effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Antagonist

A

a drug that bind to a receptor w/out activating the receptor, and at the same time, prevents an agonist from stimulating the receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Competitive

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-Competitive

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2-Compartment Model

A

A drug is injected intravenously into the central compartment and subsequently distributes to the peripheral compartment, only to return eventually to the central compartment where clearance from the body occurs
Any residual drug present in the peripheral compartment at the time of repeat intravenous injection will result in a cumulative effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Elimination Half-Time-

A

the time necessary for the plasma concentration to decrease by 50% during the elimination phase (Only reflects elimination in the central compartment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Context-Sensitive Half-Time-

A

time necessary for the plasma concentration to decrease 50% after terminating an infusion of a particular duration (Describes multicompartment pharmacokinetics )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Oral Drug Administration

A

Undergoes liver first-pass , which decreases the amount of the drug being systemically circulated. Small intestine is the principal sight of injection
Oral Transmucosal Administration (Sublingual, Buccal, nasal mucosal )- No Hepatic first-pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Transdermal administration

A

(Sub-Q, IM, IV)- Rapid and precise drug delivery best achieved w/ IV administration, Hepatic first-pass does not occur (Vs. Enteral- Thru alimentary tract)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vd (Volume of Distribution)-

A

a mathematical expression (dose of IV drug administered/resulting plasma concentration) that depicts the distribution characteristics of a drug in the body
* Binding to plasma proteins and poor lipid solubility limit passage of a drug to tissues, thus maintaining a nigh concentration in the plasma and a small calculate Vd
* A lipid-soluble drug that is highly concentrated in tissues w/ a resulting low plasma concentration will have a high calculated Vd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clearance

A

the volume of plasma cleared of drug by renal excretion and/or metabolism in the liver or other organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Systemic Clearance

A

Permanent removal of a drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Intercompartmental Clearance

A

movement of drug from one compartment to another (Main cause of termination of effect for drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cytochrome p450

A

Responsible for the biotransformation of endogenous compounds, pharmacological agents, and environmental xenobiotics
* Propofol, Fentanyl, midazolam, morphine, lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Drug Concentration

A

Given as a weight (Mass)/ volume. Defines how much you have (Propofol conc.= 10mg/mL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Drug Dose

A

Given as a mass of drug per unit mass of the patient (Defines how much you give (Adult induction of propofol is 2 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Red Man Syndrome

A

an infusion-related reaction peculiar to vancomycin. It typically consists of pruritus, an erythematous rash that involves the face, neck, and upper torso. Less frequently, hypotension and angioedema can occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hyperalgesia

A

More sensitive to a pain stimulus
* Work in a longer-acting opioid when stopping a remifentanil infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Suboxone

A

mix of Buprenorphine and Naloxone used to treat heroin and methadone addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Scopolamine Patch

A

Motion sickness patch, helps with PONV and works up to 3 days
Works Quickly
Will dilate eyes if you touch the patch and then touch your eyes
Can cause dry mouth and dry eyes
Anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Type and Screen

A

Screen patient’s blood to make sure we have that product available. (Screening takes a long time) (About an hour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Type and Cross

A

Crossmatched with the units available and ready (About 20 mins after we have a type and screen)
Anticipate blood loss, just start with a type and screen, it can be over 2 hours during busy times.
Sometimes pre-op nurse doesn’t have time to send type and screen, use 2 pink vials.
One will print, the other put a patient label on there.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Dilute Phenylephrine

A

2.5cc+7.5 NS Phenylephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dilute Ephedrine

A

1+9 ephedrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Dilute Dilaudid

A

(1+9)=10 =200 mcg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Norepinephrine Dilution

A

2cc concentrate +8cc NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SYstemic Drug Redistribution

A

As the plasma concentration of a drug decreases below than in highly perfused tissues (liver, heart, brain, lungs), the drug leaves these tissues to be redistributed to less well-perfused sites, such as skeletal muscles and fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Biotransformation

A

substance changing from one chemical to another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Tissue Metabolism

A

Cleared in tissues or plasma via ester hydrolysis (Sux, Esmolol, Remifentanil) (Succinylcholine, Esmolol, Remifentanil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Renal Clearance

A

Kidneys eliminate drugs through filtration by the glomerulus
Steroidal musle relaxants (Vecuronium/Rocuronium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Distribution Clearance

A

Removal of drug from one compartment to another (blood to tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Protein Binding

A

Protein-bound drugs are not “bioavailable” to exert their effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

The Half-Life of a drug is increased with

A

a large Vd and decreased with a small Vd. Can’t be metabolized or cleared if it’s not in plasma or reaching the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Plasma concentration of a drug with a long half-life can still fall rapidly as

A

It redistributes from a vessel-rich compartment (Muscle/fat/synovial fluid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Half Life is not a predictor of

A

Drug effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Narcotic Bag at UC Anschutz includes

A
  • 2 Propofol 20 vials
    • Ephedrine 10 cc (5mcg/mL)
    • 2mL vials of Fentanyl (x2)
      1 vial of Dilaudid (2mg/mL)*Diluted)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Quick reversal of Benzodiazepines can result in

A

Propofol can help with this!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

1% Lidocaine concentration

A

10mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

2% Lidocaine Concentration

A

2mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

.5% Lidocaine Concentration

A

5mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

.25% Lidocaine COncentration

A

2.5mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

1:1000 Epi concentration

A

1g Epi in 1000mL of solution
or 1mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Morphine Opioid index

A

Morpine =1
Dilaudid =10
Fentanyl =100
Remi= 100-300
Sufentanil 500-1000
Alfentanil= 10-20x
Meperidine= 1/10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the active Metabolites of Morphine

A

M6G, M3G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What drug is dosed on total body weight instead of ideal body weight

A

Succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Properties of drugs with a high volume of distribution (Vd)

A

-Higher tissue concentration than in plasma
-Relatively lipid soluble
-Distributed intracellularly
-Not efficiently removed by hemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Role of metabolism

A

convert a pharmacologically active, lipid-soluble drug into water soluble, pharmacologically inactive metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Types of IV Access

A

Peripheral
Central Line
Picc Line
Tunneled Central Line (Hickman/ Broviac cath (No Reservoir)
Mediport/Portacath (reservoir)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Gauge of an IV

A

DIameter of the lumen
inversely proportional (Bigger number, smaller the diameter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Supplies needed to start an IV

A

IV Bag
Tourniquet
Gloves
Alcohol wipes/Chloraprep
IV Catheter
Tegaderm
Tape
4x4 Gauze
Local**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Peripheral IV complications

A

Infection
- Phlebitis
-Sepsis
-Infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Phlebitis

A

Inflammation of a vein that the body tries to naturally repair by clotting (Thrombosis)
This is bad if it travels to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Sepsis

A

Systemic bloodstream infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Infiltration

A

Blown Vein
Cannula situated outside the vein (extravasation), leaking fluids/meds in the tissue , causing necrosis, cellulitis, and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Central Line

A

Subclavian
Femoral
Internal Jugular
infuses large volumes quickly , remains for longer periods than an PIV
better for long-term pressor infusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Central Line Complications

A

Pneumothorax (Punctured Lung)
Hematoma, arrhythmia (tip of cath touches the heart wall , causing electrical conduction to change)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Tunneled Central Line (Hickman or Broviac)

A

Plastic cath with cuff (balloon) near exit site. Does not have reservoir
Large diameter (13fr)
Multiple lumens for simultaneous drug administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Mediport

A

Has a small reservoir subcutaneous (Under Skin)
Increased pt. comfort, accessed when needed, no tubing exiting skin
Decreased infection rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Total Body Water

A

Avg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Two major fluid compartments

A

ICF-Intracellular Fluid
ECF- Extracellular Fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

ECF (Extracellular Fluid)

A

Intravascular- in the bloodstream (mostly plasma)
PLUS
Interstitial- all fluid outside cells and outside vascular system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Rule of Approximate Thirds

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Normal Sodium (Na+ ) values

A

140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Normal Potassium(K+) Values

A

4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Normal Magnesium(Mg) Value

A

1.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Normal Calcium(Ca2+) Value

A

2.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Normal Chloride (Cl-) Value

A

100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Normal Bicarb (HCO3) Values

A

25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Normal Phosphorus (P) Values

A

1.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Capillary Hydrostatic Pressure

A

Pressure drives fluid out of capillary (filtration) and occurs highest at arteriolar end of capillary and lowest at venular end (think feeding tissues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Edema

A

Occurs when fluid moves into insterstitial space faster than it can be drained by the lymphatic system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Why is edema harmful

A

it increases the distance between capillary and tissue cells and that reduces the effectiveness of meeting metabolic needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Causes of edema

A

hypervolemia
Decreased renal fxn
cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

INterstitial fluid pressure

A

Pressure determined by interstitial fluid volume and by the compliance of the tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Plasma colloid osmotic Pressure

A

Because the capillary barrier is permeable to ions, the osmotic pressure within the capillary is principally determined by plasma proteins (oncotic) that are relatively impermeable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Fxn of plasma colloid osmotic pressure

A

Draws from interstitial space back to capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Molarity

A

Moles per liter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Molality

A

Moles per Kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Normal Osmolarity

A

285-290 mOsm/L around 273 mOsm/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

NS (Normal Saline)

A

Slightly hyperosmolar
at 308 mOsm/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

LR (Lactated Ringers)

A

Slightly hypoosmolar at 283 mOsm/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Plasmalyte

A

Isoosmolar (Seen mostly in cardiac trauma, and large blood loss cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Crystalloids

A

Used to replace maintenance of fluid requirement, deficits, evaporate losses, and third space losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Fluid that is cheap, readily leave intravascular system and go to the interstitial space

A

Crystalloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Normal Saline

A

Has same NaCL balance as the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Large volumes of NaCl can cause

A

Dilutional hyperchloremic acidosis b/c of its high Cl- concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Normal saline uses

A

Renal disease patients (No K+)
Giving PRBCs (No Calcium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Lactated Ringers (LR)

A

Most physiological solution when large volumes are needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

LR Osmolarity

A

SLightly hypotonic, 100mL free water/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

The liver metabolizes lactate into

A

Bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

5% Dextrose in Water (D5W)

A

Dextrose in metabolized leaving a large volume of free water
Used for pts on Sodium (Na+) Restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Percentages in IV Fluids and medications represent

A

Number of grams per mL of dilutent %g/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

IV half-life of crystalloids

A

20-30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

IV Half-Life of COlloids

A

3-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Colloids replace blood loss at what ratio

A

1:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Colloids

A

Used to replace blood loss or restore intravascular volume
It’s a solution of proteins & sugars with high molecular weight….large enough to exert oncotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Types of Colloids

A

Albumin
Hetastarch & Pentastarch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Hetastarch and Pentastarch

A

derived from plasma proteins or synthetic glucose polymers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Albumin

A

derived from human blood (5% or 25%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Which type of fluid replacement type is a plasma volume expander?

A

Colloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Which is more expensive? Colloids or crystalloids?

A

Colloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Hetastarch

A

Derived from the starch amylopectin, given as 6% solution in 0.9%NS or LR
Effect: is plasma volume expansion
Elimination: by kidney, degraded by circulating enzyme amylase
Half life IV: Hetastarch 25 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Hetastarch/ Pentastarch contraindications

A

pts with known sensitivity to hydroxyethyl starch, with a coagulopathy, with Congestive heart failure (CHF) where vol overload is a problem or with pts with oliguria or anuria (little urine or no urine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Use for Albumin

A

Used to increase intravascular volume for decreased blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Complications of fluid therapy

A

Peripheral Edema
Pulmonary Edema
Increased Intracranial Pressure (ICP)
Coagulopathies
Colloid allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Fluid losses are greater when

A
  • vomiting, diarrhea, bowel prep
    • fever
    • hyperventilation
    • loss of skin integrity (burns)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Insensible fluid loss

A

No electrolytes involved like in sweat.
Evaporative water loss from the respiratory tract.
-Insensible daily loss is 400 mL in adult
Evaporation of H2O that crosses skin via diffusion.
-Insensible loss from respiration is 400 mL/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Redistribution (3rd Spacing)

A

Shifting of fluid from vasculature to interstitial space
Traumatized tissue becomes edematous
3rd space loss is isotonic- replaces with LR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

3rd Spacing is caused by

A

caused by tissue edema (ie: surgical trauma pulls fluid from interstitial space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Blood Loss calculation

A

Volume in suction minus irrigation used
Volume on drapes
Volume on the floor
Volume in surgical sponges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

If there is substantial bloood loss intraoperatively, what should occur?

A

Serial monitoring of the patient’s hematocrit is warranted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

4x4 sponge holds how much blood?

A

10mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Raytec sponge will hold how much blood?

A

10-20mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Laps

A

will hold 100mL of blood fully soaked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Normal urine output in the OR

A

1-2mL/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Oligouria

A

Reduced urine production
<.5mL/kg/hr
May be a sign of dehydration, urinary obstruction, renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Anuria

A

No urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

H&H consists of

A

Hemoglobin and Hematocrit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Normal Hemoglobin levels

A

10-13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Normal Hematocrit Values

A

Men: 42-52
Women: 37-47

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

How do Hemoglobin and Hematocrit relate?

A

Hematocrit = 3 x Hgb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

EBV Equation

A

kg x BV (mL/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Blood volume for neonates

A

Premature 95 mL/kg
Full-term 85mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Blood Volume for Infants

A

80mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Blood volume for adults

A

Male 75mL/kg
Female 65mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

ABL

A

Allowable Blood Loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

ABL Equation

A

ABL = EBV x (Hct i – Hct f)/
Hct i
Wt = Weight in kg
EBV = Estimated blood volume (mL)
Hct i = Hematocrit initial (use in decimal value) Ie: Hct = 45%, use 0.45
Hct f = Hematocrit final

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Loss of skin causes

A

hypothermia, increased water loss, increases risk for infection and sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Minimal tissue trauma additional fluid replacement

A

2-4mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Moderate tissue trauma additional fluid replacement

A

4-6 mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Severe tissue trauma addional fluid replacement

A

6-8mL/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Midazolam/Versed Drug class

A

Benzodiazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Midazolam uses

A

Anxiolysis (anterograde) amnesia, sedation, andiconvulsant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Midazolam concentration

A

1mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Midazolam MOA

A

GABA Agonist- activates inhibitory neurotransmitter in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Midazolam usual adult bolus

A

1-2mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Caution for Midazolam

A

Synergy w/ Opioids
Liver Biotransformation into end products that are renally secreted (renal failure leads to prolonged effect)
Elderly require less or none at all because of risk of delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Benzodiazepine Reversal Drug

A

Flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Flumazenil use

A

reversing the sedative and respiratory depression of a benzodiazepine overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Cautions on Flumazenil

A

Can cause siezures in patients with rapid benziodiazepine reversal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Adult dose for flumazenil (reversal)

A

.2mg over 5 seconds
Repeat .1mg q 1min to a total of 1mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Fentanyl Concentration

A

50mcg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Fentanyl Dose

A

1-2mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Fentanyl Infusion Dose

A

1-2 mcg/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Routes of administration for Fentanyl

A

PO, IV, Transdermal patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Duration of Action for Fentanyl

A

30-60 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

How is fentanyl metabolized?

A

75% is metabolized by pulmonary uptake, which helps it last longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

How strong is fentanyl compared to morphine?

A

100x stronger than morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Which opioid is preferred over Morphine because it causes less histamine release?

A

Dilaudid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Dilaudid Concentration

A

1-2mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Dilaudid dose

A

01-.05mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Bolus dose for Dilaudid

A

0.2mg/dose titrated to respiratory rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Routes of administration for Dilaudid

A

IV, PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Peak effect of Dilaudid

A

10-20min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Duration of Dilaudid

A

3-4 Hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

How strong is Dilaudid in comparison to Morphine?

A

10x stronger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Dilaudid Metabolism and Clearance

A

H3G Liver biotransformation, can be neurotoxic (active metabolite)
Renal Clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Meperidine Trade Name

A

Demerol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Use for Meperidine/Demerol

A

Post-Op Shivering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Dose for Meperidine

A

12.5mg
May be repeated once
Post-Op Shivering 25mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Time to peak effect of Meperidine

A

15min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Duration of Action for Meperidine

A

2-3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Meperidine strength compared to Morphine?

A

1/10x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Meperidine Metabolism/ Clearance

A

Liver biotransformation into norMeperidine, an active metabolite
Renal Excretion of metabolite can lead to CNS Excitability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Remifentanil Trade Name

A

Ultiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

Remifentanil MOA

A

Potent Mu agonist mainly used as an infusion due to its rapid onset and metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Remifentanil Dose

A

Titrated infusion .5-1mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Bolus Dose for Remifentanil

A

1-2mcg/Kg (not as common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Duration of Action for Remifentanil

A

3-4 Minutes (stays consistent regardless of duration of infusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Remifentanil metabolism

A

Broken down by non-specific tissue esterases into remifentanil acid
Renal Excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What drug is used to reverse Opioids

A

Naloxone/ Narcan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Narcan/ Naloxone use

A

Reversing sedative and respiratory depression of a relative opiod overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Considerations when administering Narcan/ Naloxone

A

It may wear off before the opioid effects do and may require re-dosing
May cause flash pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Onset of Naloxone/Narcan

A

2 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Duration of Action of Narcan

A

30 Min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Typical adult dose of Narcan

A

0.04mg IV (40 mcg)
Needs to be dilutedS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Stock concentration of Naloxone/Narcan

A

.4mg/mL *Needs to be diluted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Mechanism of Action for Local Anesthetics

A

Block nerve transmission by blocking Na+ Channels inside the cell, inhibiting Na+ influx and propagation of an action potential (Nerve impulse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Ionic movement in Local anesthetic Mechanism of action

A

LAs must be uncharged to pass thru the cell membrane, but then need to be charged to bind to Na+ channel inside the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Onset of Local Anesthetics can be affected by

A

Decreasing pKa Speeds onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

How does chloroprocaine work so fast?

A

Results from high concentration used despite its high pKa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

What is the fastest acting Local Anesthetic

A

Chloroprocaine, used in emergency C-sections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

How does Lipid solubility relate to potency in Local Anesthetics?

A

Lipid Solubility increases potency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Local Anesthetics in order of potency

A

Tetracaine-> Bupivicaine-> Lidocaine-> MepivicaineA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

Amide Local Anesthetics

A

Have an I in them
LIdocaine
MepIvicaine
BupIvicaine
RopIvicaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Ester Local Anesthetics

A

Procaine
Chloroprocaine
Tetracaine
Cocaine
Benzocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

How are amide local anesthetics metabolized

A

Liver biotransformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

How are Ester local anesthetics metabolized?

A

Pseudocholinesterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Lidocaine infiltration dose

A

5mg/kg without Epi
7mg/kg with epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Lidocaine use in intubation

A

Used to blunt airway reflexes during induction at 1mg/kg given IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

What local anesthetic can be given IV?

A

Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Can Bupivicaine be delivered Intravenously

A

NO,
can lead to Local Anesthetic Toxxicity (LAST) and cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

Routes of administration for Bupivicaine

A

Skin infiltration, neuraxial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

Neuraxial anesthesia

A

Spinal
Epidurals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

Max dose of Bupivicaine

A

2.5mg/Kg
3 mg/Kg w epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

Propofol MOA

A

GABA Mediated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

Propofol Dose

A

1.5-2.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Propofol Concentration

A

10mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Propofol Infusion Dose

A

25-200 mg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

Considerations for Propofol

A

Can cause bacterial growth due to lipid emulsion. Change tubing after 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Propofol effects

A

Decrease BP, Cardiac Contractility
Respiratory depressant causing apnea
Cerebral Protectant (Lower oxygen demand in the brain)
Causes burning on IV Push (Give Lidocaine first)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Propofol metabolism and clearance

A

Liver metabolism
Renal Clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Etomidate Cardiac Effects

A

Cardiostable
Can be used for induction for patients with cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Etomidate MOA

A

Reticular activating system depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

Concentration of Etomidate

A

2mg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

Dose of Etomidate

A

.1-.4mg/kg (Adult)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

Effects of Etomidate

A

Burns when injected
PONV
Myoclonus
Causes Adrenal Suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Etomidate Metabolism/Clearance

A

Liver Enzymes and plasma Esterases (Not as rapid as propofol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

Ketamine Drug Class

A

Phencyclidine (PCP)

216
Q

Ketamine MOA

A

NMDA Antagonist (Dissociation of Thalmic and Limbic systems)

217
Q

Ketamine Concentration

A

10, 50, 100mg/mL

218
Q

Induction dose for Ketamine (IV)

A

1-2.5mg/kg

219
Q

IM induction dose for Ketamine

220
Q

Uses for ketamine

A

Induction, Analgesia, Amnesia

221
Q

Ketamine effect on the heart

A

Doesn’t depress HR and BP, good for Cardiomyopathy

222
Q

Benefit of using Ketamine as an analgesic vs. Opioids

A

Doens’t depress respiratory rate
Great for analgesia and avoiding opioid induced side effects/Respiratory depression

223
Q

What medication can be given IM for induction?

A

Ketamine (4-8mg/kg)

224
Q

Side effects of Ketamine

A

Increase RR, HR, BP
Increase in Salivation
Causes Delirium/hallucinations

225
Q

What adjunct drugs can we use for Ketamine’s side effects (Delirium/hallucinations + excess salivation)?

A

Midazolam for delirium
Glycopyrrolate for excess secretions

226
Q

Absorption time for Ketamine when given IM

227
Q

Ketamine Metabolism/ Clearance

A

Biotransformed into active metabolite Norketamine
Renal Excretion- with large doses can be prolonged in ESRD

228
Q

Volatile Anesthetics currently used

A

Nitrous Oxide
Sevoflurane
Desflurane
Isoflurane

229
Q

Which volatile anesthetic can be used for induction

A

Sevoflurane

230
Q

Why can’t desflurane be used for gas induction?

A

It is an airway irritant

231
Q

Why can’t Isoflurane be used for gas induction?

A

It takes too long to take effectWh

232
Q

Why can’t Nitrous oxide be used for gas induction?

A

It is impossible to achieve 1 MAC with nitrous oxide

233
Q

How do volatile anesthetics work?

A

Causes general anesthesia (Amnesia, Anesthesia, Akinesia) at varying concentrations in the blood/lungs

234
Q

How is volatile anesthetic effectiveness measured

A

MAC- Minimum alveolar concentration

235
Q

Define MAC-1

A

The concentration of gas that suppresses movement in 50% of surgical patients

236
Q

How does MAC change with age?

A

Decreases by 6% every decade after 40 years

237
Q

What factors can increase MAC

A

Acute Amphetamine use
Cocaine Use
Ephedrine
Ethanol (Chronic use)
hypernatremia
Hyperthermia

238
Q

MAC is highest at what age?

239
Q

Factors that decrease MAC

A

barbituates
Benzodiazepines
Ketamine
Ethanol (Acute use)
Local Anesthetics
Opioids
Lithium
Verapimil
Elderly age
Anemia
Pregnancy

240
Q

How are volatile anesthetics metabolized?

A

Absorbed via the lungs and eliminated via the lungs

241
Q

Anesthetic effect of volatile anesthetics is determined by

A

The partial pressure of the brain (Pbr)
Hard to measure clinically, so we use the lungs as a surrogate

242
Q

With volatile anesthetics, when does induction occur?

A

When FA=Fi

243
Q

Blood Gas Partition Coefficient

A

The ratio of gas dissolved in the blood versus what does not dissolve is a unique property of each gas and determines onset/uptake of the gas
Agents with low solubility in the blood saturate the blood quicker. Any additional molecules of gas after saturation are then transferred to the brain

244
Q

Blood Gas Partition Coefficient for Nitrous Oxide

245
Q

MAC % for Nitrous Oxide

246
Q

Blood Gas Partition Coefficient for Desflurane

247
Q

Desflurane MAC%

248
Q

Sevoflurane Blood Gas Partition Coefficient

249
Q

Sevoflurane MAC%

250
Q

Isoflurane MAC%

251
Q

Isoflurane Blood Gas Patition Coefficient

252
Q

Volatile anesthetic effects on BP

A

Decreases with increasing concentration of volatiles

253
Q

Volatile Anesthetic effects on HR

A

HR incrases with increasing concentrations of volatiles (Desflurane above 1 MAC is most clinically relevant)

254
Q

Volatile Anesthetic effects on Respiratory rate

A

Increase RR and lower tidal volumes in varying concentrations

255
Q

What type of drug is a bronchodilator?

A

Volatile Anesthetics

256
Q

What drugs can be used during bronchospasms or asthma attacks

A

Volatile Anesthetics, specifically Sevoflurane

257
Q

Volatile Anesthetic effects on Cerebral Bloodflow (CBF)

A

Increased Cerebral Bloodflow and can decrease Cerebral metabolic rate

258
Q

Volatile Anesthetic effects on Neuromonitoring

A

Can cause Decreased SSEP and MEP firings

259
Q

Sevoflurane Induction

A

Slower than Desflurane, faster than Isoflurane
Intermediate emergence time

260
Q

Sevoflurane concerns

A

Can be metabolized and broken down into a neprotoxic byproduct called compound A at low fresh gas flows

261
Q

Desflurane onset time

A

Fastest of the volatile anesthetics
Also has fast emergence

262
Q

Desflurane Concerns

A

Cost
Airway Irritant
Pungent smell
Caution in patients with Asthma/ COPD
Can lead to Carbon Monoxide poisoning in older CO2 Absorbers

263
Q

Isoflurane characteristics

A

Slow onset time, cannot be used for inhalation induction
Pungent and can be an airway irritant
Cheap

264
Q

Nitrous Oxide Onset speed

265
Q

Nitrous Oxide Concerns

A

PONV
Can fill enclosed airspaces
Avoid in COPD/ Lap procedures/inner ear/ LMA/ Intracranial procedures/ Pneumothorax

266
Q

How does Nitrous Oxide affect Vitamin Metabolism?

A

Can affect Vitamin B12 Metabolism

267
Q

Four Stages of Anesthesia

A

Analgesia
Excitation
Surgical Anesthesia
Coma

268
Q

Stage 1 of Anesthesia

A

Analgesia
The patient becomes sedated

269
Q

Stage 2 of Anesthesia

A

Excitation
There is an increase in heart rate and blood pressure

270
Q

Stage 3 of Anesthesia

A

HR and BP begin to return to normal
Patient is deep enough for surgery to begin

271
Q

Stage 4 of Anesthesia

A

Coma
The patient’s vital signs collapse

272
Q

Uses for Neuromuscular blockers

A

Chemically paralyze skeletal muscle at the NMJ

273
Q

NdMB MOA

A

Blocking nicotinic acetylcholine receptors

274
Q

D-NMBA MOA

A

Causing a prolonged depolarization

275
Q

WHich neuromuscular blocking agent is short acting

A

Succinylcholine

276
Q

What is a long-acting non-depolarizing Neuromuscular Blocking agent

A

Pancuronium

277
Q

Succinylcholine MOA

A

prolonged depolarization of NMJ (inactivating Na+ channels)

278
Q

Succinylcholine dose

A

1-2mg/kg, can also be given IM

279
Q

DOA for Succinylcholine

A

Rapid onset 30-60 seconds, hydrolyzed in 5-10 minutes

280
Q

Metabolism of Succinylcholine

A

Hydrolyzed by pseudocholinesterases in plasma prior to reaching the NMJ

281
Q

Situations where SUccinylcholine is preferred

A

RSI
Full stomach
Difficult Airway

282
Q

Side effects of Succinylcholine

A

Cardiac Dysrhythmias
Bradycardia, junctional rhythm, Sinus arrest
Hyperkalemia
Myalgia
Sore Muscles
Myoblobinemia
Increased intragastric/intracranial/
intraocular pressure

283
Q

Contraindications of Succinylcholine

A

Muscular Dystrophy
Burn Patients
Muscle Atrophy patients

284
Q

Pseudocholinesterase defficiency

285
Q

Pseudocholinesterase

A

a glycoprotein enzyme produced by the livr

286
Q

Dibucaine

A

An Amide Local Anesthetic used to test for Pseudocholinesterase deficiency
When administered IV, capable of inhibting the plasma cholinesterase enzyme

287
Q

In normal patients, dibucaine will inhibit

A

80% of enzyme activity which corresponds to dibucaine number of 80

288
Q

Homozygous typical pseudocholinesterase

A

Normal Dibucaine 70-80

289
Q

Heterozygous atypical Pseudocholinesterase

A

1/480 incidence
Lengthended response 50-100%
Dibucaine number 50-60

290
Q

Homozygous atypical pseudocholinesterase

A

1/3200
Dibucaine Number 20-30
Prolonged 4-8 hours

291
Q

Which genotype for pseudocholinesterase will have a prolonged effect for 4-8 hours and require a transfer to the ICU?

A

Homozygous Atypical
Dibucaine number 20-30

292
Q

Rocuronium COncentration

293
Q

Intubation dose of ROcuronium

A

.6-1.2 mg/kg

294
Q

Onset of Rocuronium

A

1-3 minutes

295
Q

DOA of ROcuronium

A

30-80 mins

296
Q

Clearance of Rocuronium

A

Hepatic Metabolism and Renal excretion

297
Q

Cautions when using ROcuronium

A

ESRD patients
Reduce in chronic kidney disease liver

298
Q

Doses of 1.2mg/kg of Rocuronium can achieve what

A

Muscle paralysis in <1min, making it useful for RSI when Sux is contraindicated

299
Q

Vecuronium concentration

A

1mg/mL
from a 10mg Powder

300
Q

intubation dose of Vecuronium

A

.08-.12 mg/kg

301
Q

Vecuronium onset

302
Q

Vecuronium DOA

303
Q

Vecuronium Clearance

A

Hepatic Metabolism and renal excretion

304
Q

Cisatracurium COncentration

305
Q

Cisatracurium intubation dose

A

.1-.2 mg/kg

306
Q

ONset of Cisatracurium

307
Q

DOA of Cisatracurium

308
Q

Clearance of Cisatracurium

A

Organ dependent form of elimination by being broken down by Hoffman Elimination in plasma

309
Q

What patient population is especially good for Cisatracurium use? WHy?

A

Due to its unique clearance, cisatracurium is generally used in severe renal or liver failure patients

310
Q

What neuromuscular blockers cannot be reversed with Sugammadex?

A

Succinylcholine
Cisatracurium

311
Q

Train of 4 Monitoring

A

Peripheral stimulation of 4 successive electrical impulses from a nerve stimulator
Each twitch causes a release of ACh at the NMJ

312
Q

If there is no paralysis, how will the TOF monitor reflect?

A

4/4 (4 twitches) with no fade

313
Q

If the patient is fully paralyzed, how will the TOF Monitor reflect?

A

0/4 (No Twitches)

314
Q

The degree of twitches indicates the degree of

A

Paralysis
this will guide the dose of the reversal agent

315
Q

How do neuromuscular blocking reversals work?

A

Unbinding the NMB from the Ach Receptor (Sugammadex) or indirectly by outcompeting the NMB from the Ach receptor by flooding the NMJ w/ Ach (Neostigmine)

316
Q

Common TO4 MOnitoring Sites

A

Ulnar Nerve
Facial Nerve
Posterior Tibial nerve

317
Q

TOF Ratio

A

> =0.9 as measured by the Adductor POlicis Muscle

318
Q

Neostigmine MOA

A

Anticholinesterase
Inhibits breakdown of Ach in the NmJ, allowing a higher amount of Ach to compete with NMBA at the NMJ

319
Q

Dose of Neostigmine

A

.04-.08mg/kg with a max dose of 5mg (Lower doses preferred w/ lower TOF ratios)

320
Q

DOA of Neostigmine

A

10-30 min for full effect since it is an inhibiting enzyme and indirectly increasing Ach levels

321
Q

Side effects of Neostigmine

A

SLUDGE
It increases ACh unspecifically by inhibiting AChE, it causes parasympathetic activation as well

322
Q

Since Neostigmine produces a parasympathetic activation as a side effect, what must we do?

A

Give an antimuscarinic (Glycopyrrolate) as an adjunct

323
Q

SLUDGE

A

Salivation
Lacrimation
Urination
Defecation
GI Upset
Emesis
Bradycardia/Bronchospasm

324
Q

Sugammadex

A

Directly antagonizes steroid NMB (Roc/Vec) by encapsulating the drug

325
Q

How fast does sugammadex work?

A

2-3 minutes with very few side effects

327
Q

Concerns with Sugammadex

A

THe bound drug is renally cleared and may not be removed with dialysis, so use with caution in ESRD Patients

328
Q

Sugammadex dose in 4/4 TOF

329
Q

Sugammadex dose in 3/4

330
Q

Sugammadex dose in 2/4

331
Q

Sugammadex dose in 1/4

332
Q

Sugammadex dose in 0 TO4 w/ 4/4 PTC

333
Q

Sugammadex dose in 0 TO4 with NO PTC

334
Q

PONV

A

`POst-Operative Nausea and Vomiting

335
Q

Risks for PONv

A

Female
Nonsmoker
History of PONV
History of MOtion sickness
<50yo

336
Q

What do we use/do that can cause PONV

A

VOlatile Anesthetics
Use of N2O
Duration of Anesthesia
Type of Surgery
Use of Opioids intraoperatively
post-op opioids

337
Q

Dexamethasone typical adult dose

338
Q

Dexamethasone contraindications

A

Diabetic Patients

339
Q

Side effects of dexamethasone

A

Can have an intense burning in apocrine glands after IV Push (armpits and genitals burn like crazy)

340
Q

Ondansetron MOA

A

5-HT3 receptor

341
Q

What is Zofran best for

A

Preventing vomiting better than preventing nausea

342
Q

ZOfran Dose

A

4mg IV or 8mg PO as ODT

343
Q

Zofran concerns

A

Can Cause QT Prologations

344
Q

Nausea is beleived to be regulated by

A

The CTZ (Chemoreceptor Trigger zone) in the brainstem through several different receptors

345
Q

Benadryl Drug class

A

H1, H2, M1 Antagonist

346
Q

DOse of Benadryl

A

1mg/kg (Generally 12.5 mg for anti-emetic)

347
Q

Cautions with Benadryl

A

Can cause sedation

348
Q

ONset of Benadryl

349
Q

Uses for benadryl

A

Anti-emetic
Anaphylaxis
Puritis

350
Q

Reglan MOA/Drug class

A

D1 Antagonist, cholinergic Agonist

351
Q

Dose for Reglan

352
Q

Properites of Reglan

A

Anti-Emetic
Promotes GI MOtility via cholinergic agonism

353
Q

Onset of Reglan

354
Q

Contraindications of Reglan

A

Avoid in Parkinson’s
GI Obstruction

355
Q

Droperidol MOA

A

Dopamine Antagonist

356
Q

Dose of Droperidol

A

.625 mcg for anti-emetic

357
Q

Concerns with Droperidol

A

avoid in people with Prolonged QT syndrome , Parkinson’s

358
Q

Onset time of Droperidol

A

3-10mins (Given Prior to wakeup)

359
Q

Phenergan(Promethazine) MOA/

A

H1, M1, D1 Antagonist

360
Q

Dose for Phenergan

A

6.25mg for anti-emetic

361
Q

Phenergan COncerns

A

May cause sedation
Avoid in Parkinsons

362
Q

ONset of Phenergan

363
Q

Use of Phenergan

A

Used as a rescue anti-Emetic in PACU due to fast onset

364
Q

Main goal of anesthesia

A

TO augment and control the autonomic nervous system during surgery

365
Q

Sympathetic Nervous system

A

Fight or Flight

366
Q

Parasympathetic Nervous system

A

Rest and digest

367
Q

Sympathetic nervous system characteristics

A

SHort pre-ganglionic fibers and long post-ganglionic fibers

368
Q

Parasympathetic Nervous system characteristics

A

Long Preganglionic fibers with short post-ganglionic fibers

369
Q

Alpha 1 Agonists (Adrenergic)

A

Vasoconstrictors
INcreases BP
Increased SVR

370
Q

B1 Agonists (Adrenergic)

A

Increases HR
Contractility
(Chronotropy/inotropy)

371
Q

B2 Agonist (Adrenergic)

A

Bronchodilators

372
Q

The CHolinergic (PNS) Response

A

Decrease HR
Decrease BP
Bronchoconstriction

373
Q

4 Factors that affect BP

A

HR
PReload
Contractility
Afterload

374
Q

COx SVR

375
Q

(HRx SV) x SVR

376
Q

(HR x (LVEDV-LESV)))x SVR

377
Q

LVEDV

378
Q

LVESV

A

Contractility of the heart

379
Q

HRx (Preload-Contractility)) x Afterload

380
Q

Vasoactive Medications typically

A

Increase or Decrease HR, BP, and SVR

381
Q

What is the goal for Anesthesia when maintaining BP/HR

A

Maintaining values and output within 20% of pre-operative values

382
Q

Epinephrine Drug class

A

Catechloamine/ Sympathiomimetic

383
Q

Epinephrine Use

A

Increase HR/ BP
Treat Anaphylaxis
Treat Bronchospasm
Used in Cardiac Arrest
Can be aerosolized to treat airway edema and croup

384
Q

Croup

A

disease that causes swelling in the airways and problems breathing. Children with croup often have a high-pitched “creaking” or whistling sound when breathing in. This is called stridor

385
Q

EPinephrine MOA

A

Alpha 1
Alpha 2
Beta 1
Beta 2
AGONIST

386
Q

Concentration of Epinephrine

387
Q

Dose of Epinephrine

A

.01-.05 mcg/kg/min (Titrate to effect)

388
Q

Small Dose of Epi Receptor Effects

A

1-2mcg/min
Beta 2 Agonist

389
Q

Medium Dose of Epi

A

4mcg/min
Beta 1 Agonist

390
Q

Large Dose of Epi

A

10-20 mcg/min
Alpha and Beta Agonist

391
Q

Epinephrine as an Alpha 1 Receptor Agonist

A

Increased Vasoconstriction
Increased Peripheral Vascular Resistance
Decreased Mucosal Edema

392
Q

Epinephrine as an Alpha 2 Receptor Agonist

A

Decrease Insulin Release
Decreased Norepinephrine Release

393
Q

Epinephrine as a Beta 1 Agonist

A

Increased Inotropy
Increased Chronotropy

394
Q

Epinephrine as a Beta 2 Agonist

A

Increased Bronchodilation
Increased Vasodilation
Increased Glycogenesis
Decreased Mediator Release

395
Q

Norepinephrine Drug Class

A

Catechloamine/ Sympathiomimetics

396
Q

MOA of Levophed/ Norepinephrine

A

Potent Alpha 1 Agonist with enough Beta 1 to prevent reflex bradycardia/ Maintain HR and Cardiac Output

397
Q

MOA of Levophed/ Norepinephrine

A

Considered an Alpha 1 agonist with some B1 effects

398
Q

Concentration of Levophed/ Norepinephrine

399
Q

Dose of Norepinephrine

A

.01-.5mcg/kg/min (Titrate to effect)

400
Q

What is the general use of Levophed/ Norepinephrine?

A

Generally given centrally in septic/ Vasoplegic shock patients

401
Q

Concerns with Levophed

A

High doses peripherally can cause distal tissue necrosis/ ischemia from the vasoconstriction

402
Q

Ephedrine Drug glass

A

Synthetic Non-Catechloamine/ Sympathiomimetics

403
Q

Uses for Ephedrine

A

Increases HR
Increases Contractility
Increases BP

404
Q

Concentration of Ephedrine

405
Q

Dose of Ephedrine

406
Q

MOA of Ephedrine

A

Stimulates release of catechloamines in pre-junctional nerve terminals and binds to alpha and beta receptors on the post-junctional membrane

407
Q

Onset of Ephedrine

A

Onset is relatively short
but longer compared to catechloamines due to its indirect mechanism of action

408
Q

Tachyphylaxis

A

Tolerance where subsequent doses are not effective, as catechloamine stores are depleted pre-junctionally

409
Q

Ephedrine indirectly releases what catechloamine

A

Norepinephrine

410
Q

Concerns with Ephedrine

A

Tachyphylaxis
Persistent blockade of adrenergic receptors
Depletion of Norepi storage

411
Q

Phenylephrine class

A

Synthetic non-catechloamine/Sympathiomimetics

412
Q

Phenylephrine MOA

A

Stimulates the Alpha 1 receptor (Increase BP/Afterload)

413
Q

Use for Phenylephrine

A

Vasoconstrictor
(increase BP, can be used as a nasal decongestant )

414
Q

Bolus DOse of Phenylephrine

A

500-100mcg or more depending on BP response

415
Q

Infusion Dose of Phenylephrine

A

.1-1 mcg/kg/min

416
Q

Cautions with Phenylephrine

A

Increases afterload, making it undesirable with certain cardiomyopathies/ Valvular Problems

Also causes Reflex Bradycardia

417
Q

What is our first choice agent when BP is low and Cardiac output is thought to be adequate

A

Phenylephrine

418
Q

Albuterol Drug Class

A

Beta 2 Agonist

419
Q

Albuterol Drug type

A

Bronchodilator
Causes smooth muscle relaxation in the bronchioles - adminstered via an inhaler or nebulizer

420
Q

Albuterol Uses

A

Treat restrictive airway disease (COPD), asthma, emphysema, bronchitis (Bronchospasm)

421
Q

What is an alternate use for Albuterol

A

Can also be used to slow premature labor

422
Q

Vasopressin

A

An endogenous form of ADH released from the posterior pituitary gland and works on V1 and V2 Receptors

423
Q

Vasopressin works on which receptors?

424
Q

Vasopressin V1 MOA

A

Increases BP via increased SVR without theoretically reducing cardiac output

425
Q

Vasopressin V2 MOA

A

Increased blood Volume by increasing water reabsorption from the kidney (ADH Action)

426
Q

Vasopressin Metabolism

A

Hepatic/Renal

427
Q

Vasopressin Half-Life

A

10-20 Mins

428
Q

Bolus Dose of Vasopressin

A

.5-1.0 unit bolus for refractory Hypotension

429
Q

Septic Shock Dose for Vasopressin

A

.02-.1 Units/min for septic shock infusion

430
Q

Cautions for Vasopressin

A

Gastric hypoperfusion from potent vasoconstriction: Bowel Ischemia/ Raised Liver enzymes/ reduced platelet count

431
Q

Higher doses of Vasopressin may cause

A

Myocardial Ischemia
Hyponatremia
Cutaneous Necrosis from extravasation

432
Q

Hyponatremia

A

Low Sodium Values

433
Q

Effect of Hyponatremia

A

Seizures, delirium

434
Q

Indications for Vasopressin

A

Vasoplegic/ Septic Shock
Refractory Hypotension
+ Lisinopril administration

435
Q

What patient population would benefit from Vasopressin over other pressors?

A

Pulmonary Hypertension patients could benefit from Vasopressin since there is alpha receptors in the pulmonary artery , but not V1 receptors

436
Q

How can vasopressin be substituted for epineprine in a code/ Cardiac Arrest?

A

Single dose of 40 units IV may replace a round of 1mg of epi in a code

437
Q

Anti-Hypertensives

A

Metoprolol
Labetalol
Esmolol
Hydralazine (Vasodilator)
Calcium Channel Blocker ( Nicardipine)

438
Q

Beta Blockers MOA

A

Work by blocking B1 receptors (Decrease HR, Inotropy, and BP)

439
Q

Overdosing a beta blocker can result in

A

Bradycardia
CHF in cardiomyopathy

440
Q

Which Beta Blocker has a higher affect on BP than HR?

441
Q

Labetalol affects what receptors?

A

Alpha 1
Beta 1
Beta 2

442
Q

Labetalol Use

A

Lowe HR and BP (Better at lowering BP)

443
Q

Concetration of Labetalol

444
Q

Bolus dose of Labetalol

A

5mg boluses titrated to effect

445
Q

Esmolol Drug class

A

Cardioselective B1 Blocker

446
Q

Esmolol Use

A

Short-Term Decrease in HR

447
Q

Esmolol Concentration

A

10mg/mL in 10mL

448
Q

Dose of Esmolol

A

Titrated boluses usually

449
Q

Esmolol Duration of Action

A

Short DOA
1-3 minutes due to elimination by plasma esterases

450
Q

Metoprolol Drug Class

A

Cardioselective B1 Blocker

451
Q

Uses for Metoprolol

A

Decrease HR/BP

452
Q

Concentration of Metoprolol

453
Q

Dose of Metoprolol

454
Q

Metoprolol DOA

A

Longer DOA and often used for chronic HTN

455
Q

Hydralazine Class

A

Vasodilator

456
Q

Hydralazine use

A

HTN-Great for hypertensive patient who may have some underlying cardiomyopathy where decreasing inotropy/ HR may be contraindicated

457
Q

Concentration of Hydralazine

A

20mg in 1 mL

458
Q

Dose of Hydralazine

A

5mg 10mg titrated to effect

459
Q

Onset of Hydralazine

460
Q

Duration of Hydralazine

461
Q

Cautions of Hydralazine

A

Prinicpal arterial dilator and long onset time, so easy to overdose and cause hypotension

462
Q

Two types of calcium channel blockers

A

Dihdydropyridines
Non-dihydropiridines

463
Q

Dihydropyridines

A

Ca2+ channel blockers
Primary vasodilators (Don’t decrease HR)

464
Q

Non-Dihydropyridines

A

Ca2+ Channel blockers
More cardioselective and decrease HR and causes vasodilation

465
Q

Nicardipine Uses

A

Lowers BP without causing an increase in ICP

466
Q

Non-dihydropyridine drugs

A

Diltiazem, verapamil

467
Q

What cases would probaby benefit from Nicardipine?

A

Neuro cases or those that require tight BP control

468
Q

Dihydropyridine drugs

A

Nicardipine, Clevidopine, nifedipine, amlodipine

469
Q

Nicardipine infusion dose

470
Q

Nicardipine blous dose

A

100-200mcg

471
Q

Nicardipine Onset

472
Q

Nicardipine Concentration

473
Q

Anticholinergic Drugs

A

Glycopyrrolate, Atropine, Scopolamine

474
Q

MOA of Anticholinergics

A

Antagonizes the sympathetic NS via blockade of muscarinic Ach receptors

475
Q

Uses for Anticholinergics

A

Bradycardia Treatment
Used in conjunction with acylcholinesterase inhibitors to block parasympathetic activation (Neostigmine)
Bronchodilation
PONV prevention

476
Q

Atropine Uses

A

Bradycardia response
Vagal Response
NMB Reversal

477
Q

Concentration of Atropine

478
Q

Atropine bradycardia dose

A

.4-.6 mg (up to 3mg)

479
Q

Which drug works faster? Glycopyrrolate or Atropine

480
Q

Which Anticholinergic drug crosses the bloodbrain barrier?

481
Q

Glycopyrrolate uses

A

Antisialagogue
NMB Reversal
Bradycardia

482
Q

Concentration of Glycopyrrolate

483
Q

Premed antisialagogue dose of Glycopyrrolate

484
Q

Glycopyrrolate reversal dose

A

.2mg per 1mg Neostigmine

485
Q

Glycopyrrolate Bradycardia dose

A

.2mg or more

486
Q

Scopolamine Uses

A

Antiemetic
delivered via transdermal patch behind the ear

487
Q

Precedex trade name

A

Dexmedetomidine

488
Q

Side effects from Scopolamine crossing the BBB

A

Blurred vision
Dry mouth and throat
Slight sedative/ delirium in elderly patients

489
Q

Precedex MOA

A

Alpha 2 agonist (Binds presynaptic ganglion inhibiting Norepi release)

490
Q

Use for Precedex

A

Sedation/ anxiolysis without respiratory depression and able to respond to commands, analgesia, sedation for fiberoptic intubations, smooth emergence

491
Q

Concentration of Precedex

A

Diluted typically to 4mcg/kg over 5-15 minutes followed by infusion dose of .2-1mcg/kg/hr

492
Q

Precedex Metabolism

493
Q

Side effects of Precedex

A

Large boluses can cause HTN, but more frequently we see sympthiolysis (Bradycardia/ hypotension) with infusion

494
Q

Precedex is great for

A

Sedation with minimal respiratory depression and the patient will respond to commands . Also a great analgesic and is used frequently for multimodal pain modalities

495
Q

Describe the negative Feedback Loop of Precedex

A

Precedex blocks presynaptic Alpha 2 receptors in a negative feedback loop, resulting in the suppression of Norepinephrine release

496
Q

5 A’s of Anesthesia

A

Amnesia
Anesthesia
Analgesia
Anxiolysis
Akinesa

497
Q

Amnesic

A

Causes Memory loss for an event/time period

498
Q

ASA 1

A

Normal Healthy Patient

499
Q

ASA 2

A

Patient with mild systemic disease

500
Q

ASA 3

A

Patient with severe systemic disease that is not a constant threat to life

501
Q

ASA 4

A

Patient with severe systemic disease that is a constant threat to life

502
Q

ASA 5

A

Moribund patient not expected to survive with or without surgery

503
Q

ASA 6

A

Organ donor, Brain Death, DCD

504
Q

STOP BANG Questions

A

Snoring
Tirdedness
Observed Apnea
Pressure
BMI >35kgm^-2
Age over 50
Neck Circumference >40
Gender (Male)

505
Q

High risk for OSAS (STOP-BANG)

A

> =3 positive responses

506
Q

Low risk for OSAS (Stop-Bang)

A

<3 positive Responses

507
Q

Contraindications for Nasopharyngeal Airway

A

Skull Fractures
Anticoagulants
Actively bleeding nose (Epitaxis)

508
Q

Contraindications for Oropharyngeal Airway

A

Gag Reflex intact
Foreign body obstructing the airway
Mouth Surgery

509
Q

What is the concern when a patient is under sedation without a protected airway?

A

Aspiration

510
Q

LMA/SGA Absolute Contraindications

A

Trauma
Non-Fasted Patients (RSI-GETA)
Bowel Obstruction
Emergency Surgery
Delayed Gastric Emptying

511
Q

LMA/SGA Relative Contraindications

A

Major Abdominal surgery
Pregnancy >14 weeks
Prone Positioning
Airway Surgery
Laparoscopic Surgery
Obesity (BMI>30)
Decreased Lung Compliance (W PIP>20cm H2O)
Altered Mental Status

512
Q

Why shouldn’t we let the vent pressure (w/ LMA) or bag mask pressure exceed 20cm H2O

A

Because the esophageal sphincter is opened at pressures higher than 20 cmH20

513
Q

How long do we wait after pushing Rocuronium for ET tube placement

A

3 Minutes
Start the NIBP, bag mask if not RSI

514
Q

What do we set the vent to after we have placed the ETT?

515
Q

Most common blade sizes for direct laryngoscopy

A

Miller 2
MAC 3

516
Q

Where does the MAC Blade sit inside the patient’s mouth/airway?

A

Inside the Vallecula

517
Q

Where does the miller blade sit in the patient’s airway/mouth?

A

Elevates the epiglottis

518
Q

What can we do to improve our view during direct laryngoscopy?

A

Cricoid pressure
Video Scope
try a different blade
Try getting in a better sniff position
elevate the head of the bed for better visualization

519
Q

What classification system is used for views obtained by direct laryngoscopy?

A

Cormack-Lehane

520
Q

Predictors of difficult bag mask Ventilation

A

BOOTS
Moans
Beard, Old , Obese, toothless, snores

Mask seal
obstruction
Age
No teeth
Stiff lungs

521
Q

In theory, how long can we bag mask a patient?

522
Q

DAMMITS

A

Drugs
Airway
Machine
Monitors
IVs
Tube
Suction

523
Q

Drugs used for a typical GETA case

A

Versed
Fentanyl
Lidocaine
Propofol

Sux
Roc
Ephedrine/Phenylephrine

524
Q

What airway supplies will we need for each ETT Placement?

A

Stylet
Eye Tape
TUbe Tape
Laryngoscopes+ blades
Bite Block
Oral/Nasal Airway

525
Q

What’s included in Standard ASA Monitors

A

Temp
EKG (3 or more leads)
Pulse Oximeter
NIBP
EtCO2

526
Q

Malampatti I

A

Complete visualization of the soft palate

527
Q

Malampatti II

A

Complete visualization of the uvula

528
Q

Malampatti Class III

A

Visualization of only the base of the vulva

529
Q

Malampatti Class IV

A

Soft palate is not visible at all

530
Q

Planned procedure during which the patient undergoes local + sedation and analgesia. Patient is typically able to breathe on their own and respond to commands

A

MAC- Monitored Anesthesia Care

531
Q

Unlike IV drugs ___ are absorbed via the lungs and eliminated via the lungs

A

Volatile Anesthetics

532
Q

When is anesthesia achieved with volatile anesthetics

A

When inaled= ExhaledT

533
Q

TIVA-

A

Total IV Anesthesia

534
Q

Increased Risk of PONV

A

Female
Type of Surgery
Dehydration
Smoking Decreases PONV Risk
Pre-Op Anxiety

535
Q

In Volatile Anesthetics, how does Cardiac Output affect induction

A

Slow cardiac output increases speed of induction

536
Q

Induction is achieved when

A

Fa=Fi (Inspired)

Anesthesiologist Assistant (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions