Principles Exam II Flashcards
1
Q
Humalog
A
diabetes
2
Q
Seroquel
A
schizophrenia
3
Q
Strattera
A
ADHD
4
Q
Zostavax
A
shingles vaccine
5
Q
Chantix
A
smoking cessation aid
nicotinic receptor partial agonist
6
Q
Evista
A
osteoporosis
also reduces risk of breast cancer
7
Q
Combivent Respimat
A
COPD and asthma
albuterol and ipatropium inhaler
8
Q
Avodart
A
Benign Prostatic Hypertrophy
9
Q
Pradaxa
A
anticoagulant
10
Q
Pristiq
A
depression
11
Q
LoLoestrin Fe
A
birth control
12
Q
Focalin XR
A
ADHD
13
Q
Travatan Z
A
glaucoma
14
Q
Lumigan
A
glaucoma
15
Q
Vytorin
A
cholesterol
16
Q
Toprol XL
A
beta blocker
17
Q
Lunesta
A
sleep aid
18
Q
Janumet
A
diabetes
19
Q
Exforge
A
hypertension
20
Q
Exelon
(rivastigmine)
A
Alzheimer’s
21
Q
Humira
A
rheumatoid arthritis
22
Q
Victoza
A
diabetes II
23
Q
Welchol
A
diabetes
24
Q
Combigan
A
glaucoma
25
Onglyza
diabetes II
26
Xoponex
asthma
27
Detrol LA
urinary incontinence
28
Enbrel
rheumatoid arthritis and psoriatic
29
Dulera
steroid and bronchodilator
30
Ranexa
chronic angina
31
Truvada
HIV
32
Avapro
anti-hypertensive
33
Ultram
| (tramadol)
narcotic
34
Synthroid
hypothyroidism
35
Spironolactone
diuretic for high blood pressure
36
Protonix
acid reflux
## Footnote
proton pump inhibitor
37
Thiamine
vitamin B1 deficiency
38
Prochlorperazine
nausea and vomiting
## Footnote
can treat anxietyand schizophrenia
39
Tegretol
seizures and nerve pain
40
Amaryl
type II diabetes
41
Mobic
| (meloxicam)
osteoarthritis and rheumatoid arthritis
NSAID
42
Allopurinol
kidney stones and gout
## Footnote
reduces uric acid
43
Prednisone
steroid for inflammation
44
Voltaren
NSAID
45
Ultracet
acetaminophen and tramadol
46
Deplin
B vitamin deficiency
## Footnote
depression
47
Dexilant
acid reflux
## Footnote
proton pump inhibitor
48
Imuran
immunosuppressant for arthritis
49
Bronchopleural Fistula
buildup of air in the pleural space
* concern with positive pressure ventilation
* need to use low pressures so you do not force air into that pleural space
50
Bullectomy
surgical removal of an air pocket in the lung
* more commonly seen in patients with emphysema
51
Considerations for Bullectomy and volume reduction pneumoplasty
* single-lung ventilation
* avoid PEEP
* minimize use of long-acting respiratory depressants
* restrict administration of intravenous fluids
52
Intraoperative Complications of Bullectomy with volume reduction pneumoplasty
* tension pneumothorax
* pneumothorax
* hypoxia
* hypercarbia
53
Decortication
removal of fibrous surface layer tissue over an organ
54
Hunsaker tube
allows jet ventilation during bronchoscopy
* can also measure CO2
55
Portex Adaptor
allows ventilation while someone is visualizing with a bronchoscope
56
Cessation of smoking for _____ weeks is associated with decreased incidence of postoperative respiratory complications
4 - 8 weeks
* decreases sputum production
* improves ciliary activity
57
Cancer Classification
T - cell type
N - lymph node involvement
M - metastatic spread
58
VAT
Video-assisted thoracoscopy
59
Pleurodesis
treatment for pneumothorax that stick the membranes of the lungs back together
* talc or tetracycline
60
Unique considerations for Esophagectomy
* single-lung ventilation
* anticholinergic drug to block carotid sinus reflex
* avoid N2O with abdominal surgery
* increased risk for aspiration
61
Intraoperative Complications of Esophagectomy
* aspiration
* bradycardia
* dysrhythmia
* hemorrhage
* hypotension
* Hypoxia and hypercapnia
* recurrent laryngeal nerve injury
* tacheal tears
62
Bleomycin
cancer treatment
* risk of pulmonary toxicity when given 100% oxygen
63
Doxorubicin
Cancer treatment
* potential cardiac damage
* check echocardiogram
64
LASER
Light Amplification by Stimulated Emission of Radiation
65
What is the most common laser?
CO2
66
Most common jet ventilator
Sanders
67
Mediastinoscopy
supine position and neck extended, incision through the suprasternal notch
68
Unique considerations for Mediastinoscopy
* place BP cuff on left
* avoids artifact induced by artery compression
* place pulse ox on right hand
* detects brachiocephalic artery compression
69
Intraoperative complications of Mediastinoscopy
* air embolism
* asthma
* dysrhythmia
* hemorrhage
* neurologic event
* perforation of esophagus
* pneumothorax
* respiratory compromise
* recurrent laryngeal nerve injury
70
Ventilation during Mediastinoscopy
single-lumen tube
71
Tracheal malacia
weakening of the trachea due to compression
72
Papilledema
optic disc swelling that is caused by increased intracranial pressure
* clinical finding associated with mediastonal masses
73
Cardiovascular symptoms of Mediastinal Masses
* jugular distension
* neck or facial edema
* orthostatic hypotension
* papilledema
* pulsus paradoxus
74
Anesthesia for Medistonal Mass
preferably awake
* spontaneous ventilation should be maintained
75
Ventilation of Medistonal Mass
spontaneous ventilation
* flexible bronchoscope
76
Unique considerations for Medistonal Mass
* avoid muscle relaxants
* cardiovascular collapse
* inability to ventilate
* superior vena cava syndrome
77
Intraoperative complications of Medistonal Mass
* bleeding
* hypotension
* hypoxia
* obstruction of airway
78
Superior Vena Cava Syndrome
obstruction of vena cava that impedes venous flow from the head and upper extremities
* occurs mainly in lung carcinoma patients
79
Pathophysiology of Superior Vena Cava Syndrome
* decreased venous return
* development of collateral venous circulation
* increased peripheral venous circulation and pressure
80
Cardiac features of Superior Vena Cava Syndrome
* cyanosis
* distended veins over chest wall
* edema
* tachycardia
* thoracic and cervical venous distension
81
thoracic outlet syndrome
compression of neurovascular bundle at the thoracic outlet between the 1st rib and clavicle
82
Therapy for Myasthenia Gravis
* anticholinesterase
* corticosteroids
* immunosuppressant
* thymectomy
83
Myasthenia Gravis
neuromuscular junction disorder causing weakness and rapid fatigue
* antibodies attach to post-synaptic acetylcholine receptors
84
2 anticholinesterases for Myasthenia Gravis
neostigmine or pyridostigmine
85
Preoperative considerations for a Thymectomy with Myasthenia Gravis
* assess respiratory function
* evaluate strength
* review anticholinesterase medications
86
Ventilation for a Thymectomy with Myasthenia Gravis
usually single lumen tube
* double lumen tube if by VAT surgery
87
Unique considerations for a Thymectomy with Myasthenia Gravis
increased sensitivity to muscle relaxants
risk of remaining intubated
88
Hemoptysis
coughing up blood
* massive indicates greater than 600mL
* mostly caused from pulmonary artery rupture from catheterization
89
Causes of Massive Hemoptyis
* tuberculosis
* lung abscess
* cystic fibrosis
* pulmonary embolus
* mitral stenosis
90
Ventilation for Foreign Body Retrieval
maintain spontaneous ventilation
91
Unique Considerations for Foreign Body Retrieval
* respiratory status
* sedation as tolerated
* antisialagogue
* precautions for "full stomach"
* Metoclopramide
* H2 - blocker
* cricoid pressure
92
Complications for Foreign Body Retrieval
* loss of airway
* hypoxia
* cardiac arrest
* aspiration
* hemoptysis
93
Zenker's Diverticulum
outpouching of the pharyngeal mucosa
* high risk of aspiration
* risk of perforating it with ETT
94
What hormone makes your feet bigger while pregnant?
Relaxin
95
Cardiovascular changes during Pregnancy
* increases cardiac output
* SVR decreases
* Blood volume increases 35%, mostly plasma
* Down regulation of alpha/beta receptors
* less responsive to vasopressors and chronotropic agents
* Caval compression
* decreased venous return to right atrium and therefore decreased CO
* treat with left uterine deplacement
96
Respiratory changes during Pregnancy
* vascular engorgement of airway
* Oxygen consumption increases
* increased minute ventilation by 3-4 L/min
* decrease in FRC
* can only tolerate 2-3 min of hypoxia
97
Hepatic changes during Pregnancy
* little to no change in blood flow
* decreased pseudocholinestersase
* decreased colloid oncotic pressure
98
Hematologic changes during Pregnancy
* plasma volume increases by 45%
* "anemia"
* HgB \< 11 g/dL is abnormal
* hypercoagulable state
99
What is the leading cause of maternal mortality?
thromboembolism
greatest risk for DVT and PE immediately after delivery
100
Endocrine changes during pregnancy
* insulin resistance
* thyroid gland enlarges 50-70%
101
Renal changes during Pregnancy
* renal plasma flow and GFR increase
* BUN and Cr decrease
102
CNS changes during pregnancy
* pituitary increases in size
* brain decreases
103
How does pregnancy affect MAC?
MAC for inhaled anesthetics is decreased up to 40% during pregnancy
104
Normal fetal heart rate
110-160 bpm
105
Term Labor
38-40 weeks
106
EDC
expected date of confinement
"due date"
107
EGA
estimated gestational age
108
Risk Factors of Preterm Labor
* history of preterm labor
* infection
* diabetes
* hypertension
* asthma
* smoking, alcohol, cocaine
109
Neonate
first 30 days out of uterus
110
Indomethacin
prostaglandin synthetase inhibitr
* reduces preterm labor
* may constrict ductus arteriosus
111
Tocolysis
drug therapy used to reduce preterm labor
uses Nifedepine and Indomethacin
112
Nifedipine for tocolysis
CCB that relaxs the myometrium
113
chorioamnionitis
infection that occurs within the uterus when the membranes around the amniotic fluid have broken
114
Pre-eclampsia
abnormally high blood pressure typically during the 20th week of gestation
* proteinuria
* edema
* decrease in intravascular volume
* elevated Cr and BUN
* elevated hemoglobin
115
Eclampsia
pre-eclampsia with CNS involvement leading to seizures
* severe eclampsia characterized by end-organ disease
116
What do you give to reduce seizures?
magnesium sulfate
also diazepam and phenytoin
117
Risk factors for Pre-eclampsia
* asthma
* diabetes
* first pregnancy
* hypertension before pregnancy
* lupus
* kidney disease
* maternal age (\<20 or \>40)
* multiple births
* obesity
* scleroderma
118
Most common death due to pre-eclampsia
intracerebral bleeding
119
(2) major causes of antepartum hemorrhage
placenta previa and placental abruption
120
Placenta previa
placenta completely covers the mother's cervix
* must have C-section if complete previa
* acreda, increda, and percreda
* percreda is worse; patient will continue to bleed if any placenta is left in the uterus
121
Placental abruption
placenta peels away from the inner wall of the uterus before delivery
122
risk factors for placenta abruption
* advanced maternal age
* cocaine
* diabetes
* high blood pressure
* history of
* multiple pregnancies
* pre-eclampsia
* smoking
123
organogenesis
primary organs are developing
* first 56 days
* most susceptible to teratogenic defects
124
Drugs for uterine atony
Oxytocin (patosin) or Methergine
125
Symptoms of local anesthetic toxicity
* tinnitus
* metalilic taste
* circumoral numbness
126
Signs of Local Anesthetic Toxicity
* altered mental status
* seizures
* hypotension
* bradycardia
* ventricular arrhythmias
* cardiovascular collapse
127
Treatment for Local Anesthetic Toxicity
1.5 mL/kg bolus of 20% intralipid IV
then infusion at 0.25 mL/kg/min
128
What do you avoid in local anesthetic toxicity
vasopression, CCB, BB, and local anesthetics
129
Where does the spinal cord terminate?
conus medullaris
L1-L2 in adult
130
CSF production
choroid plexus of the ventricles
131
Contents of epidural space
fat, venous plexus, and segmental arteries
132
Common spinal needle for cutting
Quincke
133
pencil-point spinal needles
Whittacre, Sprotte, and Gertie-Marx
134
gauge of typical epidural needle
16-20
135
Most common epidural needle
Tuohy
136
Which type of neuraxial anesthesia is used in a foot surgery?
spinal
sacral roots are only anesthetized with a spinal
137
Intercrestal Line
top of the hips
around L4-L5
138
Contraindications for neuraxial anesthesia
* patient refusal
* hypovolemia
* infection at site
* increased intercranial pressure
* coagulopathy (platelet \< 90,000)
Minor contraindications include peripheral neuropathy and sepsis
139
Spinal height for upper abdominal and C-section
T4-T5
140
Spinal height for appendectomy
T6-T8
141
Spinal height for vaginal delivery, prostate, and hips
T10
142
Spinal height for lower extremity surgeries
L2-L3
143
spinal height for perineal procedures
S1-S2
144
Where are epidurals usually placed?
under L2
can place one higher, but risk of spinal cord injury
145
Order of tissues in spinal block
skin
subcutaneous tissue
supraspinous ligament
interspinous ligament
ligamentum flavum
dura
arachnoid into subarachnoid space
146
Which epidural approach is better for elderly?
paramedian
older patients have calcification
147
Hyperbaric
dextrose added
solution will fall
148
Hypobaric
add sterile water
solution will rise
149
Isobaric
add CSF or saline
150
Why do pregnant women requires less local anesthetic?
* progesterone changes
* vascular engorgement
* less space
* shape of spinal cord
151
Fentanyl in Neuraxial anesthetics
100 mcg - epidural
20 mcg- spinal
152
Diamorphine in neuraxial anesthetics
2. 5 mg - epidural
0. 25 mg - spinal
153
Epinephrine in neuraxial anesthesia
0.5 mg - spinal
5mcg/mL - epidural
154
Test dose for epidural
Lidocaine (1.5%) and Epinephrine (1:200,000)
3cc
therefore, 45mg Lidocaine and 15mcg of Epi
155
alkalinization of local anesthetic solutions
raises the pH closer to the pKa of the local anesthetic, thereby increasing the proportion in the **non-ionized** form
* able to cross cell membranes
* speed onset
156
Which neuraxial procedure has a greater chance of hypotension?
epidural
more sympathetic response
157
PMPH or PDPH
postmeningeal puncture headache
158
Effects of spinal blocks
relaxes sphincters therefore higher chance of aspiration
urinary retention
159
Treatment for PDPH
hydration, caffeine, analgesics, blood patch
160
Risk factors for PDPH
* younger patients
* large needles
* several attempts
161
Transient Neurologic Symptoms (TNS)
pain in the butt and thighs after neuraxial anesthesia
* using lidocaine with smaller needles
* lasts 3-5 days
162
Onset and duration of **Lidocaine** for Epidural Anesthesia
onset: moderate
duration: intermediate
163
Onset and duration of **Bupivacaine** for Epidural Anesthesia
onset: slow
duration: long
164
Onset and duration of **Ropivacaine** for Epidural Anesthesia
onset: slow
duration: long
165
Onset and duration of **2-chloroprocaine** for Epidural Anesthesia
onset: fast
duration: short
166
Onset and duration of **Tetracaine** for Epidural Anesthesia
onset: slow
duration: long
167
epidural and spinal dose of Morphine
epidural: 2.5 - 5 mg
spinal: 0.1-0.2 mg
168
Cerclage
suture placed around the cervical os to prevent pregnancy loss because of an incompetent cervix
169
external cephalic version
turn baby in uterus so it is not in breach
* need to have C-section ready
* may want to place epidural beforehand
170
Stages of Labor
1. onset or regular contractions
1. level of anesthesia: T10-L1
2. complete dilation to delivery
1. lower lumbar and sacral fibers
3. delivery of placenta
171
most common local anesthetic for C-sections
Bupicavaine
172
VBAC
vaginal birth after cesarean
* increased risk of uterine rupture
173
Signs and Symptoms of Transient Neurologic Syndrome (TNS)
pain in the lower back and buttocks
174
Treatment for TNS
* NSAIDS
* opioids
* heat
* muscle relaxants
* leg elevation
175
Signs and Symptoms of Cauda Equina Syndrome
* pain in lower back with variable motor and sensory deficits
* radicular pain
* sensory loss
* bladder and bowel dysfunction
176
Treatment of Cauda Equina Syndrome
corticosteroids
177
Signs and Symptoms of Traverse Myelitis
pain in low back with motor weakness and sensory alterations
* allodynia
* bladder and bowel dysfunction
178
Treatment of Traverse myelitis
corticosteroids
* physiotherapy
* exercise
179
Signs and Symptoms of Anterior Spinal Artery Syndrome
painless loss of motor and sensory function
180
Treatment for Anterior Spinal Artery Syndrome
correcting of hypotension and vasospasm
* exercise
181
Signs and Symptoms of Arachnoiditis
pain in low back with variable motor and sensory deficits
* unilateral pain that increases with activity
182
Treatment of Arachnoiditis
* physiotherapy
* steroid injections
* electrical stimulation
183
Signs and Symptoms of Epidural Hematoma
pain or pressure in low back with progressive motor or sensory blockade
184
Treatment for epidural hematoma
surgical compression
185
Signs and Symptoms of Epidural Abscess
tender pain in low back that is accompanied by sensory and motor deficits and fever
186
Treatment of Epidural Abscess
* antibiotics
* percutaneous drainage
* laminotomy with washout
* laminectomy
187
What 3 medications can increase uterine tone?
oxytocin, methlyergonovine, prostaglandin
188
gravid hysterectomy
hysterectomy after birth
189
What is wrong with giving magnesium to pre-eclampsia patients?
causes uterine atony
| (muscle relaxant)
190
Antenatal hemorrhage
bleediuring during 24+ weeks of pregnancy
* commonly caused by placental abruption or placenta previa
191
Why do pregnant women appear anemic?
high increase in plasma, so dilutionally they have lower hemoglobin
(10 is normal, 8 is low)
192
Why do you not give 100% O2 with Bleomycin?
may cause pulmonary fibrosis
193
Adriamycin
treats endometrial carcinoma and ovarian cancer
* may cause myocardial fibrosis and CHF
194
cis-Platinum
treatment for cervical cancer
* may cause renal tubular dysfunction
195
