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Semester 4 TxWes > Principles of Anesthesia II Unit III > Flashcards

Principles of Anesthesia II Unit III Flashcards

1
Q

What type of immunity does not have “memory”, but the response to the pathogen is always identical?

A

Innate immunity

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2
Q

What are the non-cellular elements of innate immunity?

A

Epithelial and mucous membranes
Complement system
Acute phase proteins

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3
Q

What are the cellular elements of innate immunity?

A

Neutrophils, macrophages, monocytes and natural killer cells

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4
Q

What cellular element has the fastest response?

A

Neutrophils

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5
Q

What cellular element has a slower but more sustained response?

A

Macrophages

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6
Q

What is the complement system?

A

A large number of distinct plasma proteins that react with one another to opsonize pathogens and induce a series of inflammatory responses that help to fight infection

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7
Q

What augments phagocytes and antibodies?

A

The complement system

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8
Q

Where are the proteins for the complement system produced?

A

Most in the liver

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9
Q

What activates the complement system?

A

C1 or C3

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10
Q

What is the most numerous type of WBC?

A

Neutrophils

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11
Q

What cell releases cytokines and phagocytizes pathogens?

A

Neutrophils

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12
Q

Why do neutrophils break down quickly in the presence of infection?

A

An infection likely creates an acidic environment which neutrophils are sensitive to so they break down quickly

this breakdown of neutrophils is also what creates pus

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13
Q

What is the largest blood cell?

A

Monocytes

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14
Q

What type of monocytes are found in the: epidermis, liver, lung and CNS?

A

Epidermis = Langerhans
Liver = Kupffer
Lung = Alveolar cells
CNS = Microglia

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15
Q

Where would you expect to find Langerhans cells?

A

The skin (epidermis specifically)

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16
Q

Where would you expect to find Kupffer cells?

A

Liver

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17
Q

Monocytes/macrophages produce what 2 substances in response to infection?

A

Cytokines and NO

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18
Q

What is the least common blood granulocyte?

A

Basophils

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19
Q

Where would you expect to find mast cells?

A

In connective tissue close to blood vessels

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20
Q

Basophils and mast cells have high affinity receptors for what substance?

A

IgE

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21
Q

Basophils and mast cells release what in a hypersensitivity reaction?

A

Histamine, leukotrienes, cytokines, prostaglandins

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22
Q

Where would you expect to find the highest concentration of eosinophils?

A

In the GI tract (they protect against parasites and degrade mast cell inflammation)

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23
Q

What type of immunity has a “memory” to specific antigen response?

A

Adaptive immunity

only present in vertebrates

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24
Q

Adaptive immunity is derived from what cell?

A

Hematopoietic stem cells

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25
Q

Adaptive immunity primarily uses what cells to respond to pathogens?

A

T-cells, B-cells and NK cells

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26
Q

What role do T and B cells perform in adaptive immunity?

A

B cell = make antibodies
T cell = make interferon/interleukin and has a role in chronic inflammation and responding to infection as well as activating IgE

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27
Q

What cell activates IgE?

A

T-cells

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28
Q

A vaccine is what category of immunity?

A

Active

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29
Q

What is an example of passive immunity?

A

Getting antibodies from another - such as from maternal breast milk (this only lasts for a few weeks/months)

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30
Q

IvIG and IV immunoglobin are examples of what kind of immunity when used in a hospital setting?

A

Passive immunity

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31
Q

Neutropenia is what category of immune response?

A

Inadequate

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32
Q

Asthma is an example of what category of immune response?

A

Excessive/exaggerated

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33
Q

Autoimmune disorders are an example of what category of immune response?

A

Misdirection

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34
Q

What drugs commonly cause a hypersensitivity reaction?

A

NSAIDs, ABX and PPIs

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35
Q

What is a type I allergic response?

A

Immediate hypersensitivity, think asthma or response to a bee sting

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36
Q

Anaphylaxis, asthma, angioedema, conjunctivitis, dermatitis are all examples of what type of allergic response?

A

Type I

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37
Q

What interventions can be performed to reduce the effects of histamine in a type I allergic response?

A

First step is stop/remove trigger, then:
Prevent histamine effects:
Antihistamines
Cromolyn sodium
Bronchodilators
COX pathway inhibitors
Diagnostic tests
Small doses of allergen to desensitize (slightly controversial, must be done with an immunologist present)

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38
Q

Hemolytic anemia, myasthenia gravis, transfusion reactions are examples of what type of allergic response?

A

Type II

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39
Q

Treatment of a type II allergic response?

A

Anti-inflammatories and immunosuppressives

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40
Q

Systemic lupus erythematosus (SLE), and rheumatoid arthritis are examples of what type of allergic response?

A

Type III

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41
Q

Failure of the immune system to eliminate antibody-antigen complex causes is the classic presentation of what type of allergic response?

A

Type III

This also causes complexes to be deposited in the joints, kidneys, skin and eyes

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42
Q

What type of allergic response is mediated by IgG and IgM?

A

Type III

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43
Q

What type of allergic response does not involve antibodies?

A

Type IV

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44
Q

Contact dermatitis, tuberculosis, Stevens-Johnson syndrome (allergy response to NSAIDs) are examples of what type of allergic response?

A

Type IV

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45
Q

What types of allergic reactions are treated with Anti-inflammatories and immunosuppressives?

A

Type II and IV

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46
Q

What is biphasic anaphylaxis?

A

When a secondary anaphylactic episode occurs after the primary episode

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47
Q

Risk factors for a secondary anaphylactic episode?

A

Severe initial response and the initial response required multiple doses of epinephrine

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48
Q

Risk factors for perioperative anaphylaxis?

A

Asthma
Longer duration of anesthesia
Females (Not in teen years)
Multiple past surgeries
Presence of other allergic conditions

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49
Q

What are 3 tests that can be used to diagnose whether or not you have an anaphylaxis response to a certain irritant?

A

Plasma tryptase concentration, plasma histamine concentration and skin testing (wheal/flare response)

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50
Q

What lab test verifies mast cell activation/release?

A

Plasma tryptase concentration

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51
Q

If an anaphylactic response is resistant to epi, what are the other drugs you can give?

A

Give vasopressin, methylene blue

to inhibit NO production

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52
Q

What does epinephrine do in an anaphylactic response that makes it the DOC?

A

Decreases degranulation of mast cells and basophils which ↓ effect of degranulation causing less vasodilation

Alpha1: supports BP

Beta 1: inotropic and chronotropic effects

Beta 2: bronchodilation

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53
Q

What are 3 common examples of specific immune reactions?

A

Transfusion reactions, transplant rejection and Graves disease (d/t antibodies activating the TSH receptors too much)

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54
Q

Hereditary angioedema has a deficiency/dysfunction of what part of the immune system response?

A

C1 (complement 1) esterase inhibitor deficiency/dysfunction = excessive production of bradykinin (which is usually limited by C1)

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55
Q

Why is angioedema a medical emergency?

A

They are not responsive to anti-histamines, so they lose their airway FAST

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56
Q

What drug class can cause acquired angioedema?

A

ACE inhibitors

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57
Q

Acquired angioedema r/t ACE inhibitors mimics the s/sx of hereditary angioedema except for what symptoms?

A

Urticaria (hives) and itching

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58
Q

Angioedema treatment?

A

Airway maintenance

FFP

C1 inhibitor concentrate

Epinephrine

Antihistamines, glucocorticoids

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59
Q

What tests can be used to diagnose HIV/AIDS?

A

ELISA: 4-8 weeks after infection
Viral load
CD4/helper T lymphocytes <200,000
HAART agent sensitivity

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60
Q

What CV issues are common with immune system disease?

A

Abnormal EKG
LV dilation
Pulmonary hypertension
MI
Pericardial effusions (25%)

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61
Q

What neurological issues are common with immune system disease?

A

Dementia
Increased ICP
Autonomic nervous dysfunction
Peripheral neuropathy (35%)

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62
Q

Why is the rule of thumb to “start your dose low and work up” commonly used with immune system dysfunction?

A

It is very common for cytochrome P-450 to be inhibited in immune system disease, so drugs stick around longer

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63
Q

What population does scleroderma most commonly affect?

A

Women in their 20s - 40s

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64
Q

Why is scleroderma a red flag for anesthesia?

A

Aspiration risk: they have hypo-motility of the GI tract and their LES tone is decreased

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65
Q

What are the general anesthesia implications/concerns for scleroderma?

A

Organ system dysfunction

Arterial catheter concerns (Continue preop calcium channel blockers)

Contracted intravascular volume

Aspiration risk

Limited neck mobility/Pulmonary compliance

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66
Q

What anesthetic agent suppresses NK cells, induce apoptosis of T-cells, impairs phagocytes and has an unclear impact on tumor cells?

A

Inhalation agents

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67
Q

What anesthetic agent decreases migration of neutrophils?

A

Versed

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68
Q

What anesthetic agents depress NK cell activity?

A

Ketamine and opioids

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69
Q

What anesthetic agent decreases cytokines and promotes NK cells?

A

Propofol

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70
Q

What opioids in particular are notorious for suppressing NK cells?

A

Morphine and fentanyl

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71
Q

Why are NSAIDs helpful with anesthesia and the immunesystem?

A

They inhibit prostaglandin synthesis

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72
Q

What are the drawbacks of the BMI measurement?

A

It can’t differentiate between overweight and overfat, and doesn’t take into account waist circumference, waist-hip ratio or age

Per Cornholio, waist circumference is a more reliable measure of the severity of obesity in terms of weight gain

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73
Q

What obese body type is more associated with increased O2 consumption and CV disease?

A

Android (central obesity or upper body truncal)

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74
Q

What obese body type is more peripheral obesity, less metabolically active and not associated with CV disease?

A

Gynecoid (more accumulation in the hips, butt and thighs)

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75
Q

What are 3 CV system changes that occur as a result of obesity?

A

Total blood volume increased (On a volume-to-weight ratio is lower 50ml/kg and most is distributed to adipose tissue)

Cardiac output ↑ by20-30ml/kg of excess body fat d/t LV dilation and ↑ stroke volume

Cardiac dysrhythmias d/t fatty infiltrates of conduction system, CAD,

Low QRS voltage, LVH, left axis

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76
Q

What change on an 12-lead is very common in obesity?

A

Left axis deviation

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77
Q

How is the clotting cascade affected by obesity?

A

Increased levels of fibrinogen, factor VII, VII and von Willebrand = hypercoagulability. There is also endothelial dysfunction d/t levels of factor VIII and von Willebrand.

combine this with immobility r/t obesity = perfect storm to create clots

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78
Q

What gastric changes make obese patients an aspiration risk with anesthesia?

A

Gastric volume and acidity both increase along with delayed gastric emptying. Intra-gastric pressure increases which causes relaxation of the LES and hiatal hernia formation

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79
Q

What volume and pH of the stomach are risk factors for aspiration pneumonitis?

A

Volume greater than 25 ml and pH less than 2.5

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80
Q

What renal changes are common to obesity?

A

Increased GFR and RBF, increased renal tubular reabsorption which impairs natriuresis and activates the RAAS

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81
Q

Which is more common in obese patients: hyper or hypo thyroidism?

A

Hypothyroidism d/t thyroid hormone resistance

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82
Q

T/F: the SNS activity level is increased in obesity

A

True: so you’ll have insulin resistance, enhanced pressor activity and sodium retention

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83
Q

What are the abnormalities r/t DM that are progressive in nature that constitute metabolic syndrome (you must have at least 3 of the starred ones to have metabolic syndrome)?

A

*Abdominal obesity
*Decreases levels of HDL
*Hypertriglyceridemia
Hyperinsulinemia
*Glucose intolerance
*Hypertension
Proinflammatory state
Prothrombotic state

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84
Q

What are some risk factors for metabolic syndrome?

A

Increased age, male and hispanic or south asian ethnicity

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85
Q

What drug classes may cause metabolic syndrome?

A

Chronic corticosteroids, antidepressants, antipsychotics, protease inhibitors

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86
Q

What can resolve metabolic syndrome 98% of the time?

A

Weight loss (either via diet/exercise or bariatric surgery, it doesn’t matter if it’s one or the other, the important part is losing the weight)

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87
Q

What is the basic difference between OSA and hypopnea?

A

OSA = actual apnea
Hypopnea = decreased airflow

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88
Q

How many apnea/hypopnea events constitute mild/moderate/severe disease states?

A

Mild: 5-15/hr
Moderate: 15-30/hr
Severe: > 30/hr

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89
Q

Treatment for both OSA/hypopnea is CPAP and weight loss to reduce the risk of what conditions?

A

Systemic/Pulmonary hypertension
LVH
Cardiac dysrhythmias
Cognitive impairment

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90
Q

Obesity hypoventilation syndrome can result in what over time?

A

Pulm HTN and Cor pulmonale

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91
Q

How is obesity hypoventilation diagnosed?

A

BMI greater than 30 along with awake hypercapnia

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92
Q

What medical therapy worked as an appetite suppressant, but only approved for 3 months at a time d/t CV system concerns?

A

Phentermine (CV issues were because this drug was a sympathomimetic)

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93
Q

What medical therapy worked by blocking the absorption of fat (but also had a LOT of GI s/e)?

A

Orlistat

94
Q

What medical therapy causes issues with clotting disorders from fat soluble vitamin deficiency and vitamin K deficiency?

A

Orlistat

95
Q

What is the one common effect of all GLP-1 drugs?

A

Delays gastric emptying

96
Q

If a GLP-1 is being used for DM management, what should be done if you are holding it longer than it’s dosing schedule?

A

Consult an endocrinologist for bridge therapy to avoid hyperglycemia

97
Q

A CPAP usage of what pressure is predictive of difficult mask ventilation?

A

Greater than 10 cm H2O

98
Q

What health conditions should you focus on finding evidence of in a pre-op evaluation of an obese patient?

A

HTN, DM, heart failure and hypoventilation syndrome

99
Q

What surgical history information from an obese patient would you want to explore/know?

A

Compare past/current weight
Ease/difficult intubations
Intravenous access (they don’t have bad veins, just have a lot of tissue covering them)
Need for ICU admission
Surgical outcomes

100
Q

What home meds do you generally discontinue for obese patients prior to surgery?

A

Anti-hypertensives, insulin, oral hypoglycemics

101
Q

What lung capacities/volumes are changed in obesity?

A

VC, IC, ERV and FRC all decrease

compliance is also low

102
Q

The closing capacity is close to or the same as what volume/capacity in obesity?

A

Vt (especially when supine/recumbent) = rapid desaturation

103
Q

Why is propofol generally not the first choice anesthetic agent for obese patients?

A

Because it redistributes to fat, it can greatly delay awakening in obese patients

104
Q

What are the risks of supine position in obese patients?

A

Ventilatory impairment

Compression of IVC and Aorta, diaphragm is also compressed

Reports of rhabdomyolysis on gluteal muscles (can occur in as little as 3 – 4 hours) - reposition if possible

105
Q

How does supine position in obese patients cause CV instability/changes?

A

From compression of the IVC and aorta

106
Q

How does the oropharynx change in obesity?

A

It becomes more of an ellipse shape

107
Q

Is BMI an independent predictor of difficult intubation?

A

No: for example, you could have a BMI of say 35, but if you are a powerlifter than its more muscle than fat

108
Q

What are the independent predictors of difficult intubation?

A

Small mouth opening
Large/protuberant teeth
Limited neck mobility
Retrognathia (lower mandible protrudes forward)

109
Q

What steps can you take to prevent atelectasis and desaturation throughout the perioperative period in obese patients?

A

CPAP during preoxygenation… 10cm

Positioning 25-30 degrees head up for obese patients (30 degrees reverse Trendelenburg even better)

Recruitment maneuvers then PEEP 10cm

Mechanical ventilation after induction rather than hand ventilate

110
Q

Why does neuraxial anesthesia have a higher incidence of hypotension in obese patient’s relative to normal BMI patients?

A

The IVC and aorta are compressed in obesity

111
Q

Why are epidural doses generally smaller in obesity?

A

They have a smaller epidural space d/t compression, this also increases the risk of cephalad spread

112
Q

What are some anesthetic monitoring techniques that may be warranted from common disease pathologies in obesity?

A

Pulmonary hypertension…pulmonary artery catheter or TEE

Difficult IV access…central line placement

High risk of DVT and PE…IVC filter

Difficult non-invasive BP…arterial line

Need to monitor ventilation/ABG’s…arterial line

113
Q

What anesthetic drugs have an exaggerated effect on obese patients?

A

Opioids, propofol and BZDs

short acting opioids like fentanyl and remi are favored as is precedex

114
Q

Why is nitrous use generally not favored with obese patients?

A

Because it will dilute oxygen, and obese patients have a much higher oxygen demand

115
Q

What are some anesthetic drugs that are dosed on IBW (focus on the ones listed in this units powerpoint)?

A

Propofol
Vecuronium
Rocuronium
Remifentanil

116
Q

What are some anesthetic drugs that are dosed on TBW?

A

Midazolam
Succinylcholine
Cisatracurium
Fentanyl
Sufentail

117
Q

Based on tissue solubility, which volatile is generally a better choice for obese patients?

A

Desflurane (suprane)

118
Q

What are the IV fluid requirements of obese patients relative to normal BMI patients?

A

Increased IV fluid needs to prevent ATN

NICOM is a good choice in these patients

119
Q

T/F: you should fully reverse the majority of your obese patients with Sugammadex?

A

True

120
Q

When does N/V peak and persist?

A

Peak = 6 hours
Persist = 24 - 48 hours

121
Q

What are the adult specific risk factors for PONV?

A

*Female
*Non-smokers
*History of PONV
*History of motion sickness
Delayed gastric emptying
Preoperative anxiety

122
Q

What reversal agent carries an increased risk of PONV?

A

Neostigmine

this is part of the reason why Sugammadex is becoming so popular

123
Q

What are the 2 primary adult surgical factors that increase PONV?

A

Longer duration of surgery and high risk surgery

high risk surgery examples: Laparotomy, ENT surgery, neurosurgery and breast/strabismus/plastics

124
Q

What pediatric procedures carry an increased risk of PONV?

A

Adenotonsillectomy
Strabismus repair
Hernia repair
Orchiopexy
Penile surgery

125
Q

How much higher is the PONV risk in pediatrics relative to adults?

A

2 times higher than adults

126
Q

What anesthetic gas should be avoided if PONV is of great concern?

A

Nitrous

127
Q

T/F: early ambulation reduces PONV risk

A

False

128
Q

Where is the emetic center located?

A

Located in lateral reticular formation of brainstem

129
Q

How does the emetic center cause N/V?

A

No substances directly act on it, but it does receive afferent input from other areas of the body (Pharynx, GI tract, mediastinum)

130
Q

Afferent nerves from higher brain centers that can modulate N/V emerge from what 2 areas?

A

The CTZ from the area postrema and the vestibular portion of the 8th cranial nerve

131
Q

T/F: the CTZ has no BBB

A

True

132
Q

What receptors make up the CTZ?

A

Dopamine
Serotonin
5-HT3
Opioid
Histamine
Muscarinic
Neurokinin-1?
Cannabinoid?

133
Q

T/F: there is a gold standard PONV drug

A

False

there are so many different receptors contributing to N/V, it is almost impossible for one drug to become THE standard

134
Q

What drugs in pre-op can reduce PONV risk?

A

BZDs

135
Q

During induction, what drugs increase PONV risk?

A

Volatiles, ketamine and etomidate

136
Q

What percentage of nitrous greatly increases PONV risk?

A

50% or greater

137
Q

What anti-muscarinic agent can directly reduce the risk of PONV?

A

Atropine

138
Q

List the prophylaxis for PONV for: low, moderate and high risk PONV

A

Low = 5HT3 antagonist
Mod = 5HT3 antagonist and a steroid
High = 5HT3 antagonist, steroid, propofol TIVA and scop patch

139
Q

Via the PONV algorithm, what are the rescue drugs for low risk or higher?

A

Phenothiazines, anti-histamines and reglan

140
Q

What is the theory behind acupuncture/pressure reducing PONV?

A

P6 region stimulation causes hypophyseal secretion of beta-endorphins which inhibits the CTZ and reduces acid secretion

141
Q

What are the anti-dopaminergic subtypes?

A

Butyrophenones (Haldol, Droperidol) and phenothiazines (Prochlorperazine, chlorpromazine and promethazine)

142
Q

What anti-dopaminergic carries a hypotension risk?

A

Droperidol

143
Q

What are the black box warnings of promethazine?

A

Vesicant and respiratory arrest in those younger than 2

144
Q

What do 5HT3 receptors antagonize?

A

Serotonin in the vagal nerve and CTZ

145
Q

Ideal timing for PONV prophylaxis with Zofran?

A

15 - 20 minutes of surgery end

146
Q

Ideal timing to administer a steroid for PONV prophylaxis?

A

During or just after induction

147
Q

What is the NK-1 antagonist drug?

A

Aprepitant

148
Q

What PONV drug depresses neural activity of the nucleus tractus solitarius and may interfere with afferent messages from enterochromaffin cells?

A

Aprepitant

149
Q

When is the ideal time to administer aprepitant?

A

2 - 3 hours prior to induction

150
Q

How does propofol exert its anti-emetic effects?

A

At the 5HT3 receptors by blocking serotonin release, it may also inhibit the CTR (chemo trigger zone)

151
Q

What aromatherapy is effective in reducing nausea?

A

Isopropyl alcohol

152
Q

What are the “other” causes of PONV that should be considered, particularly if the PONV is refractory to pharmacologic intervention?

A

Hypotension

Hypoxemia

Elevated ICP

Gastric bleeding

Hypoglycemia

153
Q

What type of cancer does not form solid tumors?

A

Leukemias

154
Q

What genes are the “drivers” of cancer?

A

Proto-oncogenes, tumor suppressor genes and DNA repair genes

155
Q

What type of cancer originates in the base of the epidermis?

A

Basal cell

156
Q

What type of cancer originates in the epithelial cells?

A

Squamous cell

157
Q

Where can squamous cell cancer originate?

A

The epithelial layer of the skin, stomach, intestines, lung and bladder

158
Q

What type of cancer originates in glandular tissue such as the breast or prostate?

A

Adenocarcinoma

159
Q

What type of cancer originates in the bone and soft tissue?

A

Sarcoma

160
Q

What type of cancer originates in blood forming tissue?

A

Leukemia

161
Q

What type of cancer originates in the T and B cells?

A

Lymphoma

T and B cells are lymphocytes

162
Q

What cancer screenings are standards of care and readily covered by insurance?

A

Colonoscopy, mammograms and Pap smears/tests

163
Q

What does each letter of the TNM for tumor staging evaluate?

A

T: size/extent of primary tumor
N: # of nearby lymph nodes which are +
M: is there metastasis

164
Q

Define this tumor staging: TX N3 M1

A

Tumor cannot be measured, it has spread to 3 lymph nodes and has metastasized to one other part of the body

165
Q

Define this tumor staging: T1 NX M0

A

A small tumor, we can’t measure it’s spread to lymph nodes with no metastasis

166
Q

Define this tumor staging: T3, N0, MX

A

A larger tumor, no cancer in the lymph nodes and we cannot measure metastasis

167
Q

Describe in SITU cancer staging

A

Abnormal cells are present but have not spread to nearby tissue

168
Q

Describe localized cancer staging

A

Limited to place where it started; no sign of spread

169
Q

Describe regional cancer staging

A

Has spread to nearby lymph nodes, tissues, or organs

170
Q

Describe distant cancer staging

A

It has spread to distant parts of the body

171
Q

What block may be used to help with Unresectable pancreatic cancer, hepatic or gastric cancer?

A

A celiac plexus block

172
Q

What block uses alcohol to provide pain relief for 3 - 6 months?

A

A celiac plexus block

173
Q

Why does a celiac plexus block have s/e of diarrhea and hypotension?

A

Because it causes neurolysis of the sympathetic fibers of T5-T12 and parasympathetic celiac plexus fibers

174
Q

What block would be helpful for metastasis to the ribs?

A

An intercostal block

175
Q

What block would be helpful for pain related to pelvic tumors?

A

A block targeting the lumbar sympathetic ganglion

176
Q

What non-cancer related conditions can chemotherapy help treat?

A

Control of overactive immune diseases such as lupus or RA

177
Q

What class of chemotherapeutics can cause dose-dependent leukemia?

A

Alkylating agents (the -platins)

178
Q

What class of chemotherapeutics works in all phases of the cell cycle?

A

Alkylating agents. This also means it can treat many different types of cancers

179
Q

What class of alkylating agents can treat brain cancer?

A

Nitrosoureas because they can cross the BBB

180
Q

What alkylating agent can cause renal failure and neuropathy?

A

Cisplatin

181
Q

What class of chemotherapeutics works by interfering with DNA and RNA?

A

Anti-metabolites

182
Q

What class of chemotherapeutics is indicated for treating breast, ovary, intestinal and leukemia?

A

Anti-metabolites

183
Q

Methotrexate and 5-FU are what class of chemotherapeutics?

A

Anti-metabolites

184
Q

What class of chemotherapeutics interferes with enzymes copying DNA?

A

Anti-tumor antibiotics

185
Q

What class of chemotherapeutics can cause damage to the heart with large doses?

A

Anti-tumor antibiotics

186
Q

Doxorubicin, bleomycin and mitomycin-C are part of what class of chemotherapeutics?

A

Anti-tumor antibiotics

187
Q

What classes of chemotherapeutics can work on a wide variety of cancer types?

A

Alkylating agents, mitotic inhibitors and anti-tumor antibiotics

188
Q

What class of chemotherapeutics are plant alkaloids that prevent strands of DNA from being separated to copy?

A

Topoisomerase inhibitors

189
Q

What class of chemotherapeutics increases your risk of a second cancer?

A

Topoisomerase inhibitors

190
Q

What class of chemotherapeutics treat leukemias, lung, ovarian, GI, colorectal and pancreatic cancers?

A

Topoisomerase inhibitors

191
Q

What class of chemotherapeutics are plant alkaloids that damage cells in all phases by preventing protein synthesis?

A

Mitotic inhibitors

192
Q

Hormone therapy works well for what kinds of cancer?

A

Breast, prostate and uterine

193
Q

What cells are most likely to be damaged during chemotherapy?

A

Blood forming in bone marrow

Hair follicles

Cells in mouth, digestive tract, and reproductive systems

194
Q

What is the concern with use of aprepitant to control N/V?

A

May inhibit hormonal contraceptives x 28 days

195
Q

What are the anesthesia related changes that we need to be aware of related to radiation treatment for cancer of the head/neck?

A

D/t peripheral vascular damage you are x6 more likely to have embolic events, increased risk of hypothyroidism, carotid artery disease likely and neck ROM is likely impaired

196
Q

What chemotherapeutic can cause cardiomyopathy?

A

Adriamycin

197
Q

What chemotherapeutic can cause pulmonary toxicity?

A

Bleomycin

198
Q

What chemotherapeutics can case peripheral neuoropathy?

A

Cisplatin and vincristine

199
Q

What lab abnormalities are common s/e of chemo?

A

Preoperative anemia, neutropenia, and/or thrombocytopenia

Preoperative hypercalcemia (Many drugs toxic to bone marrow, liver, and kidneys)

Adrenal insufficiency (r/t steroid treatment
Assess ACTH stimulation test)

200
Q

How does inflammation from tissue trauma and physiological stress promote cancer growth?

A

Activate overexpression of COX2 genes

Catalyzes prostaglandins and thromboxane from arachidonic acid

Elevated levels promote cell survival and growth of cancer cells

May suppress NK cells

201
Q

How does beta adrenergic stimulation promote cancer growth?

A

The tumors have beta receptors, stimulation allows for upregulation of the biological activity

202
Q

What anesthetic agent has the ability to reduce cancer growth/spread?

A

Propofol

203
Q

What effect does long term NSAID use have on cancer?

A

Decreased proliferation

204
Q

What is the most common type of lung cancer?

A

Non-small cell

205
Q

What is the origin of small cell cancer?

A

Generally neuroendocrine

206
Q

What type of cancer always recurs and is resistant to further treatment?

A

Small cell cancers

207
Q

What are the secondary conditions related to small cell lung cancer?

A

Hyponatremia (d/t SIADH), hypercortisolism and lambert-eaton syndrome

208
Q

How does Lambert-Eaton syndrome differ from myasthenia gravis?

A

Improves with exercise, ACh inhibitors don’t work and they are very sensitive to non-depolarizers

209
Q

What condition would you expect if the patient exhibits extreme lower limb fatigue that does not improve with exercise?

A

Myasthenia gravis

210
Q

What neuroendocrine tumor is usually benign with a high survival rate?

A

Carcinoid tumors

211
Q

What is carcinoid syndrome?

A

A carcinoid tumor likely of GI origin releasing serotonin, histamine, tachykinins, kallikrein, prostaglandins causing hemodynamic collapse and coronary artery spasm

212
Q

Treatment of carcinoid syndrome?

A

Octreotide

213
Q

What type of cancer is pathologically heterogenous?

A

Non-small cell lung cancer

40% chance of survival with surgery, without surgery its 10%

214
Q

What type of cancer grows to a large size but metastasizes late?

A

Squamous cell

215
Q

What s/sx are common to squamous cell cancer?

A

Hemoptysis
Obstructive pneumonia
Superior vena cava syndrome
Endobronchial tumor

This is d/t the mass effect of the tumors

216
Q

What type of cancer tends to metastasize early?

A

Adenocarcinomas

217
Q

What cancer tends to secrete growth hormone and secrete ACTH?

A

Adenocarinomas

218
Q

What type of cancer would you expect to find insulin resistance, a buffalo hump and avascular necrosis of the femoral head?

A

An adenocarcinoma

219
Q

What type of non-small cell cancer tends to metastasize rapidly and cause large cavitating tumors?

A

Large cell

220
Q

What are the “M’s” of assessing a patient with lung cancer?

A

Mass effect
Metabolic abnormalities - Hypercalcemia, hyponatremia, hyperglycemia (Cushings)

Metastases

Medications - Bleomycin: oxygen-induced pulmonary toxicity, Cisplatin: ARF with NSAIDS

221
Q

What factors predict desaturation during 1 lung ventilation?

A
  1. High % of ventilation or perfusion to the operative lung on preop V/Q scan
  2. Poor PaO2 during 2-lung ventilation
    Especially in the lateral position
  3. Right-sided thoracotomy
222
Q

How many dermatomes can a paravertebral block cover?

A

4 - 6

223
Q

Contraindications to a paravertebral block?

A

Infection at site
Empyema
Tumor in the paravertebral space
Chest deformities (kyphoscoliosis)

224
Q

What level of paravertebral block is indicated for a sternotomy?

A

T4

225
Q

What level of paravertebral block is indicated for a thoracotomy?

A

T6

226
Q

What level of paravertebral block is indicated for an abdominal procedure?

A

T10

227
Q

Indications for an intercostal block?

A

Thorax and upper abdomen surgery and mastectomy

228
Q

How many dermatomes require blockade if an intercostal block is performed?

A

2 dermatomes above/below incision

229
Q

Risks of a paravertebral block?

A

Pneumothorax and LA toxicity

230
Q

What cells are the initiators of hypersensitivity?

A

Basophils and mast cells

231
Q

What medication should you continue through pre-op for a scleroderma patient?

A

CCBs

Semester 4 TxWes (3 decks)

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