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anesthesia rotation notes > pre quiz notes > Flashcards

pre quiz notes Flashcards

1
Q

does ace lower the seizure threshold?

A

no

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2
Q

How does ketamine act with ICP?

A

Ketamine will increase ICP at large doses with CSF outflow tract obstruction

ketamine can control seizures (it is anti-epileptic)

KETAMINE INCREASES SEIZURE THRESHOLD AND ICP

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3
Q

your p is getting 1L.min O2 from your machine, raising this flow rate to 2L/min will do what to FIO2?

A

no effect; fracture of inspired O2

O2 1L/min (98%)
ISO 2% = 100%

or O2 2L/min (98%)
ISO 2%
= 100%

but what if….

O2 2L/min (99%)
but ISO is 1%? –? 1%
then O2 is 99%

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4
Q

doppler vs. oscillating BP

A

Both provide systolic blood pressure and heart rate; Oscillometric also provides diastolic and mean arterial pressures

Doppler is indirect and oscillometric is Direct

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5
Q

using buprenorphine before surgery means the amount of any full mu agonist administered during anesthesia in surgery will need to be

A

Increased

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6
Q

T/F hypotension usually occurs due to premeds and induction agents

A

False, the inhalant drug

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7
Q

How do you tx VPC’s?

A

Lidocaine (only if a run/triad)

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8
Q

What is metabolic acidosis? Respiratory acidosis?

A

meta- decreased HCO3-
Resp. increased PaCO2

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9
Q

what is metabolic alkalosis? Resp. alkalosis?

A

meta- increased HCO3-
resp- decreased PaCO2

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10
Q

what is metabolic alkalosis? Resp. alkalosis?

A

meta- increased HCO3-
resp- decreased PaCO2

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11
Q

What premeds reduce insulin release and cause hyperglycemia as a result?

A

alpha 2 agonists

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12
Q

How long do alpha-2 drugs work?

A

30 mins to 1 hour

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13
Q

what receptor is responsible for surgical and ortho pain in mammals?

A

mu receptors

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14
Q

why do we not want to give lrg animals full mu opioids?

A

slows GI motility

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15
Q

how long does fent last?

A

15-30 mins

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16
Q

how long does methadone last?

A

2-4 hours

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17
Q

What drug is a kappa agonist and mu antagonist and is poor for pain control?

A

butorphanol

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18
Q

what drug is an antitussive?

A

butorphanol

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19
Q

what drug for pain is most likely to cause histamine release so we do not want it for MCT p?

A

morphine

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20
Q

benzos are DEA class ____ and cause muscle relaxation, anti seizures, decreases MAC, but no pain control

A

class 4

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21
Q

what is the reversal for benzos (mid and diazepam)

A

flumazenil

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22
Q

___ is water soluble but ____ is lipid soluble and cannot give IM

A

midazolam; diazepam

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23
Q

what drug is a D2 dopamine antagonist without analgesia but sedation?

A

Acepromazine (which is a phenothiazine)

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24
Q

what drug can be dangerous in boxers?

A

Acepromazine

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25
Q

What heart condition do boxers usually get?

A

Boxer arrhythmogenic right ventricular cardiomyopathy

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26
Q

what drug is GOOD in DCM but BAD in HCM?

A

dissociative which are NMDA antagonists (like ketamine)

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27
Q

what drug combats SLUDGE and increases HR and can cause 2nd degree AV blocks?

A

anticholinergics (atropine or glycopyrrolate)

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28
Q

what are the C/I of epidural/local anesth?

A

cannot ID landmarks (severely obese)
in shock/hypotensive
abscess/infection
neoplasia
blood disorder
sepsis

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29
Q

if P is too cold, what can we use to increase HR?

A

norepinephrine

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30
Q

Low CO2 =

A

high pH= resp. alkalosis

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31
Q

High CO2=

A

Low pH= resp. acidosis

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32
Q

high bicarb (HCO3-)=

A

high pH= metabolic alkalosis

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33
Q

low bicarb (HCO3-)=

A

Low pH= metabolic acidosis

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34
Q

PaCO2 less than ___ mmHg means resp. alkalosis

A

35mmHg

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35
Q

why is PaCO2 more than ETCO2?

A

bc there is alveolar dead space in the tube that dilutes the CO2 in the ET Tube

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36
Q

AG more than 12=

A

gap acidosis due to loss of bicarb (HCO3-) and increase of Chloride (Cl-) or due to increased acids or hypoalbuminemia

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37
Q

what are the 5 causes of hypoxemia?

A

LOW FIO2
HYPOVENTILATION
DIFFUSION IMPAIRMENT
SHUNTING- RIGHT TO LEFT
V/Q MISMATCH (Atelctasis, pulm. edema, pneumonias)
v= ventilation
p= perfusion

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38
Q

what neuromuscular drug blocks acetylcholine? how do you test when p is paralyzed?

A

Atracurium; you have to use a nerve stimulator
evidence is whether or not p can buck ventilator, heart rate jumping up, hypertension

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39
Q

What is the last thing in the body to become paralyzed with a neuromuscular blocker agent?

A

the diaphragm (fine motor goes first)

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40
Q

What is the reversal for neuromuscular blocking agents?

A

Neostigime which inhibits acetylcholine breakdown, an acetylcholinesterase inhibitor, ach build up and kicks out the nerve blocking agent and muscle will begin contracting again

make sure to give glyco or atropine before reversing

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41
Q

What are the causes of hypoxemia?

A
  1. V/Q (ventilation/flow) mismatch
  2. R to L shunt
  3. Hypoventilation
  4. Low inspired O2
  5. Diffusion impairment
  6. decreased CO
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42
Q

What are the Side effects of Dexmed?

A

Vasoconstriction, second degree AV block, brady

43
Q

what is the MOA of atropine?

A

acetylcholine antagonist at the muscarinic receptor

44
Q

low dose vs high dose dopamine:

A

low dose- increasing HR and CP and renal vasodilation
High dose- alpha 1 increasing SVR and BP (vasoconstriction)

45
Q

What is the MOA for anticholinergic agents?

A

Competitive antagonism of acetylcholine at the parasympathetic muscarinic cholinergic receptors

46
Q

what effects do anticholinergic agents have on the body??

A

increased HR, decreased secretions, bromchodilation, decreased GI motility

47
Q

which anticholinergic agent crosses the BBB and placenta?

A

atropine

48
Q

Which anticholinergic agent is more likely to cause tachycardia and maybe some arrhythmias?

A

Atropine

49
Q

what is the onset of glyco? How long does it last?

A

onset is about 10 mins and lasts for 30-45 mins IV

50
Q

What is the class of acepromazine?

A

Phenothiazine (used to smooth induction and recovery)

51
Q

what effects does acepromazine have on the body?

A

Tranq, vasodilation, leading to hypotension

52
Q

what are the C/I for using ace?

A

C/I in hypovolemic shock bc atangonizes peripheral alpha-1 and prevents the vasoconstrictive responses needed to respond to shock (and be carefulll in stallions and Boxers- can cause brady in Boxers)

53
Q

MOA of benzos

A

Gaba agonists

54
Q

in what p are benzos MOST LIKELY to cause dysphoria?

A

in healthy p

55
Q

What alpha-2 agonists were discussed in class?

A
  • xylazine
  • detomidine
  • dexmedetomidine
  • romifidine
56
Q

What animals should alpha-2 agonists be avoided in? Why? What is the exception to this?

A

animals with cardiovascular compromise (exception: can work for cats with HCM) - these agents commonly cause profound bradycardia and 2nd degree AV blocks

57
Q

Why is the use of anticholinergics with alpha-2 agonists not recommended?

A

The hypertension caused by alpha-2 agonists is compounded by the tachycardic effects of anticholinergics, leading to myocardial oxygenation compromise and increased incidence of ventricular arrhythmias

58
Q

Which opioid is most likely to cause histamine release? What can this lead to?

A

Morphine; histamine release causes hypotension secondary to vasodilation

this is why we give abx and morphine slowww

59
Q

what premed agents are DEA scheduled?

A

Benzos, opioids, some dissociative (ketamine and telazol)

60
Q

Give some examples of full (mu) agonist opioids

A

Morphine, hydromorphone, fentanyl, methadone

61
Q

Butorphanol is a kappa ___ and Mu ___

A

agonist; antagonist

62
Q

What are the critical mean arterial pressures that describe the upper and lower limits of autoregulation of tissue blood flow?

A

60-160 mmHg

63
Q

Why is mean arterial pressure not necessarily a good indicator of tissue perfusion?

A

A high MAP could potentially be due to vasoconstriction or even a high vascular volume, but not necessarily due to adequate blood volume

64
Q

Why do we need to administer 3-4 times more isotonic crystalloid than you would whole blood in the face of acute hemorrhage?

A

Isotonic crystalloids have a large volume of distribution in the body, so up to 75-80% will leave the vascular space and enter the interstitial space in 30-45 minutes

65
Q

Why is administration of IV crystalloid fluids necessary following administration of hypertonic saline?

A

Hypertonic saline pulls water from the interstitial space into the vascular space, so an isotonic crystalloid must be given to replace the fluids taken from the interstitial space

66
Q

Both inotropes and pressors have the potential to raise blood pressure in hypotensive anesthetized patients, but inotropes are generally preferred. Why?

A

Inotropes improve perfusion and blood pressure by increasing the contractility of the heart, whereas pressors increase blood pressure by increasing vascular resistance, which doesn’t necessarily improve perfusion

67
Q

What is the intravascular residence time for isotonic crystalloid solutions like plasmalyte or LRS???

A

30 minutes

68
Q

The intravascular residence time for isotonic colloids is…

A

24 hours

69
Q

what is the relationship b/t arterial, alveolar, and end tidal CO2???

A

ETCO2 < PAO2 < PaO2

70
Q

PaCO2 more than ___ is hypoventilation

A

45 mmHg

71
Q

Why are alpha-2 agonists not particularly good agents in neonatal and pediatric patients?

A

Due to weak myocardial contractility and inability to maintain cardiac output against an increase in afterload

72
Q

You are going to administer the alpha-2 adrenergic agonist, xylazine, to a colt as a premed. Which of the following statements regarding this drug is most accurate?

A

The drug will cause peripheral vasoconstriction and bradycardia

73
Q

sevoflurane is slightly less soluble in blood than is isoflurane; therefore, onset and recovery times are slightly_____ with sevoflurane than iso

A

faster!!!!

74
Q

Speed of onset and recovery of inhalational anesthetic drugs is inversely proportional to which of the following properties?

A

Solubility

75
Q

What does this capnograph trace indicate? What are the differentials?

it looks like a shark fine with exp. on the left being gradual to a point then inspiration drops straight down

A

Expiratory resistance:
- obstructed endotracheal tube
- bronchospasm
- expiratory valve malfunction

76
Q

Will atropine work on ruminants to decrease their saliva??

A

Nah

77
Q

Which fluid type is contraindicated in liver disease due to hepatic metabolism?

A

LRS fluid

78
Q

Which preanesthetic drugs should not be used in cases of hepatic encephalopathy? Why?

A

Benzodiazepines - the benzodiazepine reversal agent, Flumazenil, is the mainstay of treatment for hepatic encephalopathy

79
Q

Which pre-med/induction agents are best to use if the liver function is compromised?

A
  • opioids
  • etomidate
  • propofol
  • inhalants
80
Q

What is the reversal agent for alpha-2 agonists?

A

Atipamezole

81
Q

What is the reversal agent for benzos?

A

Flumazenil

82
Q

What is the Cushing reflex?

A

Increased ICP causes sympathetically mediated increases in blood pressure (hypertension) with reflex bradycardia - may indicate imminent brain herniation

83
Q

What anesthetic drugs could increase cerebral blood flow, therefore increasing intracranial pressure?

A

Atipamezole, inhalants, ketamine

84
Q

Although Ketamine can cause an increase in cerebral blood flow and therefore, intracranial pressure, it is not contraindicated in neuro patients. Why?

A

The increase in CBF/ICP can be eliminated by administering a GABA agonist, such as propofol or benzodiazepines, and Ketamine has a neuroprotective effect to prevent ischemic injury to a reduction of glutamate neurotoxicity

85
Q

What is the mechanism of action of atracurium?

A

It is a competitive nondepolarizing neuromuscular blocking agent that has a competitive affinity for acetylcholine receptors, but does not activate it, therefore it blocks it, leading to neuromuscular blockade and paralysis

86
Q

Which of the following are not DEA controlled substances?
- Fentanyl
- Morphine
- Dexmedetomidine
- Lidocaine
- Buprenorphine
- Bupivicaine
- Acepromazine
- Tramadol
- Butorphanol
- Glycopyrrolate
- Propofol
- Alfaxalone

A
  • Dexmedetomidine
  • Lidocaine
  • Bupivacaine
  • Acepromazine
  • Glycopyrrolate
  • Propofol
87
Q

does ace lower seizure threshold?

A

No

88
Q

Does ketamine increase ICP and lower seizure threshold?

A

No, it does not lower seizure threshold but it dose raise ICP

89
Q

An animal has been given buprenorphine prior to surgery. The amount of any full-mu agonist administered during surgery for analgesia will be:
a. increased
b. decreased
c. remain the same

A

a. increased

90
Q

Why do patients undergoing a laparoscopic abdominal surgery need to be on a ventilator?

A

the pressure on the abdomen and CO2 absorbing into the blood stream during procedure can make these patients not breathe well

91
Q

What are your primary concerns with pediatric patients?

A

Hypoglycemia and they rely on heart rate to maintain adequate blood pressure

92
Q

What fluid solution is atracurium incompatible with?

A

LRS solution

93
Q

How can you distinguish between VPCs and 2nd degree type 1 blocks without using an ECG (only your senses)?

A

2nd degree: no beat on auscultation and no pulse
VPC: apex beat on auscultation but missing pulse

94
Q

What occurs when you combine an alpha-2 and an opioid in horses?

A

Produces a standing chemical restraint - horse may plant itself before you have it where you want it to go (give opiate after getting the horse where it needs to be)

95
Q

Ideal MAP is __-___

A

60-160

96
Q

F circuit vs bain circuit

A

F circuit is circle circuit for animals more than 9kgs and bain is smaller non rebreathing circuit on a bain block for smaller p less than 9kg

97
Q

Hyperventilation is defined as….

A

low PaCO2

98
Q

Know all capnograph stuff

A

///

99
Q

All about anticholinergic drugs (atropine and glyco)

A

MOA: competitive antagonism of acetylcholine at the parasymp. muscarinic cholinergic receptors

S/E tachy, decreased resp. and salivary secretions, bronchodilation, decreased GI motility, can lead to secondary AV block

C/I in animals with pre-existing tachyarrhythmias

100
Q

All about alpha 2 agonists

A

MOA: central presynaptic inhibition of norepi release, peripheral activation of post synaptic alpha receptors (these receptors are like everywhereee)

effects- sedation, analgesia, muscle relax, bradycardia, peripheral vasoconstriction, insulin inhibition, resp. depression, mild hypertension followed by hypotension, decreased CO

indications- preanesthetic sedatives, analgesia, sedation

C/I- avoid in p with AV block or arrythmias, avoid in DCM dogs, avoid in highly stress p because can make them more excited, may increase risk of abortions in cattle, not rec. in p with anticholinergics on board already

101
Q

Opioids, all about it

A

MOA: binding to specific opiate receptors (mu, kappa, delta) in the brain, SC, and peripheral sites to prevent the transmission of nociceptive information

side effects- analgesia, resp. depression, hypoventilation ad bradycardia, cough suppression, dysphoria, sedation

indications- preanesth for sedation, analgesia, reduction of anesth. meds, minimal CV compromise, but may cause vagally mediated brady which can be tx with glyco or atropine

C/I- can cause histamine release if given fast IV, avoid using without traq in cats and horses bc causes dysphoria, avoid in p w head injuries when CSF pressure is questionable

102
Q

Why are opioids used cautiously or not at all in CSF pressure status being unknown?

A

Because opioids can cause hypoventilation which may cause an increase in CO2 which will then cause cerebral vasodilation and further increase the CFS pressure

103
Q

Dissociatives and all the information about them:

A

MOA: interference with transmission of nervous impulses of brain leading to dissociation between subconscious and conscious systems

Indications: best with combo of other drugs, premed IM or add to prop or alfax

S/E- increase symp and muscle tone, increased intracranial and intraocular pressures, DO NOT GIVE TO HORSES IM, may cause excessive salivation, can cause increased HR, contractility, BP, CO, and myocardial O2 demand

class 3 controlled substance
no reversal

C/I- IM in horses, HCM, DCM

these drugs are ketamine, tiletamine (Telazol)

104
Q

___ does not cross BBB but __ does and placenta but no affect on fetus :)

A

glycopyrrolate; atropine

anesthesia rotation notes (7 decks)

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