Random6

Question 1

what meds are unchanged in the pulmonary circulation?

Answer 1

epinephrine, dopamine, histamine, vasopressin, oxytocin, PGI2, AT2

carcinoid syndrome - vasoactive amines released by tumor, metabolized by lungs so impact R side mostly

Question 2

p50 for fetal hemoglobin

Answer 2

19mmHg

27 for adults

Question 3

how to treat extrapyramindal symptoms caused by antidopaminergic meds?

Answer 3

anticholinergic like benztropine or diphenhydramine (which inhibits serotonin reuptake, potentiates opiates, has anesthetic like properties, antiH1 and anticholinergic properties)

Question 4

recommended metoclopramide dosing for PONV

Answer 4

25-50 (weak antiemetic <20)

Question 5

how does bicarb cause depressed LV contractility?

Answer 5

transiently binds with serum ionized Ca -> decreasing Calcium

can also cause IVH (increased preload) and increased affnity for hgb (more alkalotic)

Question 6

bioavailability of midaz from greatest to least

Answer 6

IV (avoid first pass) > IM > intranasal > rectal > oral

Question 7

90% stenotic lesion along what artery can cause AV nodal block?

Answer 7

posterior descending artery (branch of RCA)

Right coronaries dominance in 75% of people

Question 8

why do newer volatiles cause less hepatic dysfunction post operatively?

Answer 8

undergo less biotransformation, less likely to covalently modify intrahepatic proteins

Question 9

factors that increase MAC

Answer 9

Drugs: amphetamines, cocaine, ephedrine, chronic etoh
Age: highest at 6 months
Electrolytes: hypernatremia
Hyperthermia
Red hair

Question 10

factors that decrease MAC

Answer 10

Drugs: most others
Elderly
Hyponatremia
Anemia (hgb <5)
hypercarbia
hypothermia
hypoxia
pregnancy

Question 11

fentanyl can reduce MAC by up to

Answer 11

80%

in analgesic doses (fentanyl 3mcg/kg) - about 50% reduction

other MAC reducers: opioids - mostly fentanyl TYPE opioids
lidocaine (10-30% in high doses)
benzos
alpha 2 agonists

Magnesium is weird - decreases TIVA but increases with volatile

Question 12

phenytoin MOA

Answer 12

binds to vg Na channels to terminate ventricular arrhythmias

side effects: gingival hyperplasia, ENHANCEMENT NDMBs with initiation, DIMINISH with chronic use

a class 1b antiarrhythmic just like lidocaine is (mexiletine, tocainide)

Question 13

how do barbiturates impact cerebral autoregulation?

Answer 13

they MAINTAIN it.

they cause a dose-dependent reduction in CBF and CMRO2 (30% with induction doses)

Question 14

what do inhalational anesthetics at >1 MAC do to CBF and CMRO2?

Answer 14

increase CBF, decrease CMRO2 (uncouple flow-metabolism relationship). IV anesthestics do NOT uncouple.

Question 15

what’s the change of MAC with age?

Answer 15

6% per decade

rises at 1 month
peaks at 6 months
regresses to normal at 1 year (SEVO has a 2.5-3% INCREASE in ages 1m-1y)

Question 16

bradycardia following spinal common in patients with:

Answer 16

high vagal tone, anesthetic levels > T5, decreased cardiac preload (reverse Bainbridge reflex - decreased stretch)

Question 17

factors impacting the HEIGHT of an intrathecal block

Answer 17

patient position, baricity, dose of LA

Question 18

what is the bainbridge reflex?

Answer 18

preload in the myocardium causes stretch -> increases intrinsic activity of heart

Question 19

What inotrope prevents degradation of cAMP?

Answer 19

milrenone

PDE 3 inhibitor

Question 20

All about dobutamine

Answer 20

MOA: synthetic catecholamine which acts on beta-adrenergic receptors -> increases cAMP .
Actions: Increase HR and contractility. Some vasodilation.
Use: cardiogenic shock. Problem: tachyarrythmias

Question 21

All about isoproterenol

Answer 21

MOA: beta agonist
Action: increase HR
Use: increase HR in denervated heart (wont respond to antimuscarinic meds, needs direct agonism)
Problems:

Question 22

All about levosimendan

Answer 22

MOA: calcium sensitizing med
Action:increase inotropy and CO
Use:
Problems: tachyarrythmias, hypotension

Question 23

All about milrenone

Answer 23

PDE-i on PDE3 -> increases cAMP -> increased phosphorylation of Ca and K channels
Action: Increased HR, contractility, conduction velocity, vasodilation
Use: pHTN (improved pulm blood flow and LV filling
Problems: increases mortality in CHF patients

Question 24

MC cause of litigation in MAC?

Answer 24

respiratory event (from over-sedation)

equipment failure/malfunction, then CV, inadequate anestheisa

Question 25

all about buprenorphine

Answer 25

MOA: U-partial agonist, k-antagonist
Action:
Use:
Problems: ceiling effect at higher doses