TL block 3 Flashcards
1
Q
Guidelines for reducing the incidence or severity of TURP
A
-suspending irrigating fluid < 30cm above pt
=draining bladder regularly to avoid inc in bladder pressure
-limit resection time to < 1 hr
-avoid hypotonic IV fluids
-use vasopressors to tx hypoTN from regional -> regional dec venous pressures and inc absorption of irrigation
2
Q
why coagulopathy from TURP?
A
rare unless lenthy resection -> prostatic tissue plasminogen activator
-expediates conversion of plasminogen to plasmin promoting fibrinolysis
-tx: supportive blood product transfusion, incl cryo
3
Q
complications of glycine irrigation in TURP
A
glycine resembles GABA -> transient blindness
-metabolized to ammonia -> encephalopathy, N/V
4
Q
Complications of TURP
A
hypothermia (room temp irrigation)
transient blindness and hyperammonia (glycine)
intraperiteoneal bladder perf
extraperitoneal prostatic capsular perf
cardiopulm compromise
coagulopathy (fibrinolysis)
5
Q
landmarks for the infragluteal sciatic nerve block
A
greater trochanter of the femur
ischial tuberosity
sciatic groove
6
Q
infragluteal sciatic n block
A
7
Q
When to use a Mann-Whitney test for data analysis
A
nonparametric interval data
-compare data that is skewed towards a high or low value in an unpaired group
8
Q
Where are cardiac myxomas usually found?
A
Left atrium most commonly
interatrial septum
9
Q
more common: primary cardiac malignancy or mets of lung cancer to heart?
A
Mets
10
Q
Most common benign cardiac tumor in adults
A
myxoma
11
Q
Complications w/ cardiac tumors
A
arrhythmias
ventricular obstruction
heart failure
pulm edema
pulm HTN
arterial hypoxemia
dyspnea
positional hemodynamic compromise
embolism
12
Q
RF for placenta accreta
A
prior uterine surgery
placenta previa
adv maternal age
smoking
multiparity
13
Q
How is CO2 partial pressure measured w/ built-in gas analyzer?
A
Intensity of light detected by infrared spectrophotometer is inversely proportional to CO2 partial pressure
-b/c higher CO2 absorbs more of the infrared -> less reachs the analyzer
14
Q
which gases use infrared spectrophotometry to be analyzed?
A
CO2
volatile anesthetics
N2O
15
Q
How is O2 measured in gas analyzer?
A
paramagnetic analysis
16
Q
Why can an infrared spectrophotometry be used to measure CO2?
A
b/c CO2 is polar, asymmetric, and polyatomic
17
Q
Winter’s formula
A
PCO2 = (1.5 * bicarb) + 8 +/- 2
-if not within expected range -> more than 1 acid/base disturbance
18
Q
what causes a hyperchloremic hypokalemic non-anion gap metabolic acidosis
A
diarrhea
19
Q
pH changes w/ vomiting and diarrhea
A
vomiting goes up so does pH (met alk)
diarrhea goes down, so does pH (met acidosis)
20
Q
Why do we get histamine release from rapidly giving vancomycin?
A
Histamine release
21
Q
Why does cefepime cause worsening hypoTN in pt w/ E Coli
A
abx tx of gram negative bacteria -> release of lipopolysaccharide -> significant immune response -> release of multiple cytokines incl nitric oxide -> worsens sepsis response
22
Q
several hrs after uneventful spinal, weakness on plantar flexion of L ankle, red sensation on L posterior thigh, perineal paresthesias, no back pain, able to void, dx?
A
conus medullaris injury
-assoc w/ multiple peripheral n unilateral or b/l
23
Q
post spinal paraplegia, saddle anesthesia, and urinary/fecal retention
A
cauda equina syndrome
24
Q
contraindications for spinal cord stimulator
A
untreated psychological dx
substance abuse
lack of social support
sepsis
coagulopathy
prev surgery/trauma obliterating spinal canal
localized infection
spina bifida
25
Indications for SC stimulator
-thoracic and lumbar post-laminectomy syndrome
-post-herpetic neuralgia
-phantom limb pain
-cauda equina syndrome
-CRPS I and II
-cardiovascular angina
-lower extremity ischemic pain
-chronic cervical radiculopathy
-n root injury
26
Which coronary vessels are most likely to vasospasm?
right coronary artery and its branches
27
Physiologic effects of hypothermia
confusion and sedation
inc sz threshold
dec RR, inc pulm vascular resistance
dec cardiac output, QT prolongation, arrhythmias, vasoconstriction
cold diuresis
coagulopathy, thrombocytopenia
dec granulocyte count, dec monocyte activity
hyperglycemia, dec drug metabolism and clearance
28
at what temp do bradycardia and hypoTN occur 2/2 hypothermia
< 28C
29
why concern for shivering in PACU?
inc O2 consumption by 400% -> puts pts w/ coronary artery dx at risk of MI
30
Recommendations for TBI ICU pts
ICP < 20
SaO2 > 95%
Glucose < 180
CPP 50-70
PaCO2 35-40
Temp < 37
31
ppx needed for TBI ICU pts
sz, stress ulcer, DVT
32
Two most common causes of postop jaundice
hemolysis
breakdown of extravasated blood or hematoma
33
How to eval postop jaundice
pre-hepatic, intra-hepatic, post-hepatic
pre-hepatic: inc indirect bili (hemolysis, resolution hematoma)
intra-hepatic: hypoTN, TPN, hypoxia, ischemia, drugs, hepatitis, sepsis (inc AST/ALT)
post-hepatic: inc direct bili: gallstones, biliary stricture, bile leaks
34
tx for HIT
stop heparin and start argatroban or bivalirudin
35
heparin-induced thrombocytopenia caused by what Ab?
Ab against complexes of platelet-factor 4 and heparin
-ab bind to plts -> activate plts -> thrombosis and consumptive thrombocytopenia
36
4T score for HIT
1. thrombocytopenia (30-50%)
2. timing of thrombocytopenia (5-10 d after heparin start)
3. thrombotic complications
4. lack of other causes of thrombocytopenia
37
dx of HIT
serotonin-release assay is the gold standard
-ELISA for plt factor 4 antibody
38
hemophilia A factor def and inheritance pattern
VIII
X-linked recessive
39
hemophilia B factor def and inheritance pattern
IX
X-linked recessive
40
Hemophilia C factor def and inheritance pattern
XI
autosomal recessive
41
symptoms in hemophilia A and B
spontaneous bleeding in joints, m, orangs
42
symptoms in hemophilia C
NO spontaneous bleeding -> initial steps in hemostasis unaffected -> amplification of thrombin response and resistance of clot affected
**more clinically relevant in trauma or surgery
43
Acquired hemophilia: how? dx? tx?
assoc w/ pregnancy, cancer or connective tissue d/o
-antibodies against factor VIII
-symp: subcutaneous bleeding w/ soft tissue hemoatomas
-labs: prolonged PTT, no correction of low factor VIII mixing study
-tx: bypass agent recombinant activated factor VII, or prothrombin complex concentrate
long term: immunosuppression
44
What's in prothrombin complex concentrate
factors II, VII, IX, X
Vitamin K dpt clotting factors
45
Promote sickling intraop
hypothermia
hyperthermia
hypoxemia
hypotension
hypovolemia
acidosis
46
Hct goal for Sickle cell dx prior to surgery
30-40%
47
Recs for sickle cell dx prior to surgery
-have baseline hct and hg -> ideally w/ hematologist
-exchange transfusion recommended to get HbS proportion < 30%
-advanced type and cross due to large titer of antibodies, can take hours
48
lupus anticoagulant effect on blood test
increase in PTT (b/c phospholipid in test binds with it)
**actually prothrombotic
49
clotting cascade
50
What's in cryo?
fibrinogen
fibronectin
vwF
factors VIII and XIII
51
liver dx what lab changes first?
Prolonged PT due to dec in factor VII
52
what type of transfusion reaction is assoc w/ leukopenia
TRALI
53
pathophys in TRALI
antibodies from donor attack neutrophils/leukocytes in recipient -> agglutination of leukocytes in pulm circulation => TRALI
54
RF for TRALI
critically ill pts
-chronic alcohol or tobacco abuse
-s/p liver transplant
-mechanical vent w/ high peak airway pressures
-pts with positive fluid blanace
55
How to dec incidence of TRALI?
leukoreduction
-having male plasma donors (less risk of HLA antibodies)
56
Timeframe for TRALI
new acute lung injury/ARDS w/i 6 hours of transfusion
57
What blood components most assoc w/ TRALI
apheresis plt conc
high plasma-volume plasma
whole blood
**plasma or whole blood from female donors higher**
58
Blood tests for TRALI
CBC
bili
haptoglobin
direct antiglobulin test (Coombs)
HLA antigen typing
59
r value: TEG measurement and how to tx
initial clot formation
tx: clotting factors (FFP)
60
K value: TEG measurement and how to tx
time to reach certain clot strength
tx: clotting factors or fibrinogen
61
alpha angle value: TEG measurement and how to tx
speed of clot formation
tx: clotting factors or fibrinogen
62
Max amplitude value: TEG measurement and how to tx
strength of clot
tx: plt count, plt function, and/or fibrinogen
63
LY30 value: TEG measurement and how to tx
fibrinolysis
tx: TXA or aminocaproic acid
64
Coagulation by hypothermia on TEG
will show up normal b/c blood sample is heated to 37!
65
what does vWF do"?
forms linkages b/c plts and subendothelial structures, and acts as a carrier for factor VIII
66
How does desmopressin work for vWD?
most effective for mild bleeding or bleeding ppx for minor surgeries
-causes release of vWF from endothelial cells -> improves plt function and shortens bleeding time
67
PPx for major surgery for vWD type 1, bleeding despite desmopressin, or significant bleeding tx
factor VIII-vWF concentrate
68
First like ppx and tx for vWD type 2 and 3
factor VIII-vWF concentrate
69
Difference b/w types of vWD
vWD type 1: quanitative, dec vWF production, shorted factor VIII 1/2 life
type 2: qualitative, issues w/ plt binding
type 3: quantitative, complete absence of vWF, severe factor VIII def
70
1st line for treatment of hemophilia A w/ minor bleeding or minor surgery
Desmopressin
71
Tx for active bleeding in hemophilia A
Cryo
-high concn of factor VIII and fibrinogen
72
tx for Hemophilia A pts if they do not respond to exogenous human factor VIII infusions
-have anti-factor VIII antibodies
-tx: porcine factor VIII, recominant factor VIIa or recombinant factor IIa
(b/c it will activate the extrinsic and common pathway)
73
Def of heparin resistance
-ACT < 480 after 500U/kg IV heparin
-ACT < 400 at anytime during CPB
74
Which coag factors does antithrombin III inactivate
IIa (thrombin)
VII, IX, X, XI, XII
75
Tx for heparin resistance
FFP
antithrombin 3 (cocentrate or recombinant)
76
RF for heparin resistance
AT levels < 60^ of normal
plts > 300k
preop heparin therapy
use of LMWH
age > 65
77
What is HgA made of?
2 alpha and 2 beta
adult Hg
78
What is HgF made of?
2 alpha and 2 gamma
fetal Hg
79
what causes febrile nonhemolytic transfusion reaction?
release of cytokines due to WBC leakage (IL-1)
80
way to prevent febrile nonhemolytic transfusion rxn?
leukoreduction
81
MOA acute hemolytic transfusion reaction
Recipient antibodies targeting donor RBCs
82
how quickly does acute hemolytic transfusion rxn occur and symp?
immediately or w/i a few minutes
-fever, chills, flank and back pain, hypoTN -> renal failure, jaundice, DIC
83
dx post transfusion HTN, elvated CVP, resp distress, no fever
TACO
-give diuretics
84
what blood product most likely to give citrate toxicity?
FFP
85
hypocalcemia EKG
prolonged QT
narrow QRS
flattened T waves
86
How does Hg compensate w/ anemia
R shift of oxy-Hg dissocation curve
-due to inc 2,3 DPG
-inc acidosis (lactic)
87
Body compensations for chronic anemia
inc cardiac output (inc SV due to dec afterload b/c dec blood viscosity)
-inc symp tone (inc HR and contractility)
-R shift of oxy-Hg dissocation curve
88
Teardrop shape on TEG indicates
inc fibrinolysis
89
Parts of a TEG
90
What is LY30 on TEG
percent lysis at 30 minutes
91
What does R value represent on TEG
initial clot formation
92
K on TEG
time to certain clot strength (20 mm)
93
alpha angle on TEG
speed of clot formation
94
MA on TEG
strength of clot
-maximum width
95
A1c for DM dx
higher than 6.5%
96
What is fructosamine?
test in DM that is a shorter time span than Hg A1c (only 1-2 weeks compared to 3 months)
-used in pts with dec RBC lifespan (hemolytic anemia, SCD)
97
Inheritance pattern for vWD type I
autosomal dominant
98
Inheritance pattern for vWD type II
auto dom
99
Inheritance pattern for vWD type III
auto rec
100
severe vWD PTT
prolonged due to insuff factor VIII
101
SE of desmopressin admin for vWD
hypoNa and water retention b/c structurally similar to ADH
102
Timing of desompressin admin
-takes 30 minutes to work, can only repeat dosing every 12 hrs or risk of tachyphylaxis (depletion of stores)
103
tx of type I vWD
DDAVP
104
tx of type II vWD
trial of DDAVP, avoid if known type IIB
105
tx of type III vWD
vWF concentrate
106
tx of acquired vWF def
trial DDAVP -> if nothing vWF concentrate
107
tx of Ab-mediated acquired vWF def
IVIG
108
if unable to acquire concentrated vWF, what is tx for extensive bleeding w/ vWD?
cryo! much more vWF than FFP
109
Acquired met-Hg causes
topical anesthesics (esp benzocaine)
-dapsone (tx leprosy)
-antimalarials
-inhaled nitric oxide
-rasburicase (dec uric acid)
-nitrate and nitrites
-aniline dyes
110
tx for metHg
methylene blue
111
tx for metHg if G6PD def
ascorbic acid
(vit C)
112
tx for metHg if taking serotonergic meds
ascorbic acid
(vit C)
113
MOA Met-Hg
ferrous iron (Fe2+) converted to ferric (Fe3+) -> reduces O2 carrying capacity of Hg and dec delivery to tissues
114
awake pt with blood loss acid-base status
metabolic acidosis (lactate from dec perf)
compensatory resp alk (hyperventilate! awake person lol)
115
MOA Factor V Leiden d/o
resistance to activated protein C -> protein C can't cleave factor V or VIII -> factor V procoag inc production of thrombin -> hypercoagulable
116
1st clot w/ factor V Leiden tx
unfractionated heparin or LMWH immediately -> warfarin or DOAC for minimum 3-6 months
INR goal: 2-3
117
When do pts with factor V Leiden need long-term therapy?
-2 or more spontaneous thromboses
-1 spontaneous thrombosis if pt has factor V Leidin + another prothrombotic mutation
-one spont life-threatening thrombosis (near fatal PE)
-one spot thrombosis at unusual side (cerebral or mesenteric v)
118
Prothrombotic mutations
Antithrombin Def
protein S def
factor V Leiden
119
Type I HIT symp and timiing
mild thromboctopenia, no thrombosis
-2-5 days of heparin
-heparin binds to plts at GPIb receptors -> release of ADP -> plt aggregation
120
Type II HIT
5-9 days after heparin admin
-more severe, pts < 100k, thrombosis
-antibodies to heparin-plt factor 4 complex
121
gold standard for HIT dx
heparin-induced serotonin release assay
122
MOA bivalirudin
direct thrombin inhibitor
123
CI to bivalirudin
renal failure (20% renally cleared)
124
treatment for CN toxicity
amyl nitrate and sodium nitrate
hydroxocobalamin
125
goal for factor replacement for hemophilia before mild and major surgery
mild > 40%
major 100%
126
in pts with hemophilia A but factor VIII inhibition antibodies, tx?
PCC or recombinant factor VII
127
Hemophilia: PTT, PT, bleeding time, plt count
PTT prolonged
PT norm
bleeding time norm
plts norm
128
vWD PTT, PT, bleeding time, plt count
PTT prolonged
PT normal
bleeding time prolonged
plts normal
129
DIC PTT, PT, bleeding time, plt count
PTT prolonged
PT prolonged
bleedging time prolonged
plts dec
130
Vit K def PTT, PT, bleeding time, plt count
PTT prolonged
PT prolonged
bleeding time normal
plts normal
131
Multiple myeloma MOA
cancer of plasma cells (WBC resp for Ab prod)
-proliferation of tumor cells in bone marrow inhibit RBC prod -> normocytic normochromic anemia
-inc expression of RANKL -> activates osteoclasts and causes bone destruction -> bone pain, fx, hyperCa
-renal failure from hyperCa, excretion of Ab light chains
-neuro symp: infiltration in peripheral n, hyperCa lethargy and confusion, damage to vertebrae cause compression
-freq infxns (overprod ineffective Ab and immunosupp from chemo)
132
When does monitoring with enoxaparin need to occur?
extreme BMIs (high or low)
renal impairment
pregnant patients
**factor Xa activity
133
tx for antithrombin III def
ATP3 or FFP (incl AT3)
134
4T's for HIT
1. Thrombocytopenia
2. Timing of reduced plt count
3. presence of Thrombosis
4. exclusion of other causes of thrombocytopenia
135
MCC of mortality from transfusion
TACO
136
signs of TACO
new onset resp distress
inc brain natriuretic peptide
inc CVP
L heart failure
pulm edema on radiology
137
How to confirm acute hemolytic transfusion reactions
direct antiglobulin test
138
How to prevent anaphylaxis w/ blood
for pts with IgA def
-washed RBCs
139
morbidly obese pts have inc risk of
bioactive mediators -> abnormal lipids, insulin resistance, inc inflammation, coagulopathies
140
obese pts coagulopathy
higher levels of fibrinogen, factor VII, factor VIII, vWF, plasminogen activator inh 1 -> hypercoag
141
obese pts cardiac output
higher cardiac output -> blood volume must also reach adipose tissue
142
what does vWF do??
plasma protein that assists plts to adhere to sites of vascular injury and stabilizes clotting factor VIII
143
which factor interacts w/ vWF?
factor VIII -> vWF prevents degradation of factor
144
Which meds promote stabilization of clots?
aminocaproic acid
tranexamic acid
topical clotting products (oxidized regenerated cellulose or topical thrombin)
145
What's in cryo?
factor VIII
factor XIII
fibrinogen
vWF
146
Hemorrhage in vWD
vWF-factor VIII concentrates
DDAVP
Cryo
antifibrinolytics
topical clotting products
147
best way to reduct cerebral ischemia during circulatory arrest
hypothermia
-dec cerebral metabolic consumption of O2 -> longer ischemic time
148
target temp w deep hypothermic circulatory arrest
15-19 C
149
Dec in brain metabolism w/ change in temp
dec 1 C -> 6-7% dec in CMRO2
150
Butyrylcholinesterase responsible for metabolism of what
succinylcholine, mivacurium, ester local anesthetics
151
Dibucaine number
% of inhibition of butyrylcholinesterase enzyme by dibucaine
-normal: 80% activity should be inhibited
-heterozygous atypical: inhibit 60% activity
-butylcholinesterase def inhibits 20% of activity
152
how do opioids dec ventilation
activation of mu receptors in ventrolateral medulla
153
renal compensation for acute resp acidosis
10 CO2 = 1 bicarb
154
renal compensation for chronic iresp acidosis
10 CO2 = 4-45 bicarb
155
N/V intrathecal v IV opioids
same
156
pruritis intrathecal v IV opioids
higher pruritis w/ intrathecal
157
what fibers to intrathecal opioids affect
C and A-fibers
158
which inhaled anesthetic potentiates NMB most?
DES
Des > sevo > iso > nitrous oxide
159
which abx prolong roc?
aminoglycosides
clindamycin
polymyxins
tetracyclines
160
affect of anticonvulsants on NMB?
phenytoin AND carbamazepine
acute: potentiation
chronic: attenuation
161
Lithium and effect on NMB
potentiate
162
local anesthetics and effect on NMB
potentiate
163
Why changes w/ roc from phenytoin/carbamazepine?
acutely: potentiates roc b/c dec ACh release
chronically: causes upregulation of ACh receptors
164
Which NMB are unaffected by phenytoin?
Mivacurium and Atracurium
(metabolized by pseudocholinesterase)
165
Pancuronium metabolism
excreted renally , minor metabolism from liver
166
Effects of pancuronium besides NMB
metabolite 3-OH-pancuronium -> vagolytic and sympathomimetic effects
-counteract bradycardia effects w/ high-opioid dosing
-blocks reuptake of NE
167
What to do if Ace inh hypoTN after induction
168
Methylene blue and SSRIs
CI! methylene blue is an MAO inhibitor -> serotonin syndrome
169
Methylene blue and vasoplegia
methylene blue can block vasodilatory effects of nitric oxide (inhibits guanylate cyclase)
170
Best way to avoid protamine reactions
infuse it slowly for greater than 5 minutes
171
Why do get protamine reactions?
release of nitric oxide from endothelial cells
mast cell degranulation
histamine release
-rapid infusion causes formatino of large protamine-heparin complexes that deposit in pulm circulation
172
Type I protamine rxn
mild hypoTN w/ normal filling and airway pressures
-give volume, vasoactive meds, and slow infusion
173
Type II protamine rxn
mod-severe hypoTN w/ anaphylactoid features
174
Type III protamine rxn
complexes deposit in pulm circulation -> release of vasoactive mediators -> severe hypoTN, inc pulm a pressures, and possible RV failure
175
Which class of local anesthetic more likely to give allergic reaction?
Esters b/c PABA
176
If allergic to amide local anesthetic, what is pt most likely allergic to?
Methylparaben (preservative)
177
Preservative in lidocaine w/ epi vials that can elicit allergic rxn?
Sulfites: Na metabisulfite
178
if pt has -caine allergies but needs sutures what to give?
1% diphenhydramine
179
Normal dibucaine number
70-80
180
homozygous atypical dibucaine number
50-50
181
pseudocholinesterase def dibucaine number
20-30
182
Why is thiopental so quick on and off?
Highly lipid soluble
highly protein bound
high nonionized fraction
redistributes rapidly from central to peripheral compartments
183
Why prolonged effect of thiopental in elderly pts?
slower redistribution
reduction in hepatic metabolism and renal clearance
184
What would cause thiopental to have a larger heart and brain conc in a single dose?
volume depletion
low serum albumin (less protein bound)
acidosis (nonionized fraction increases)
185
How are barbiturates biotransformed?
hepatic oxidation -> inactive water soluble metabolite excreted in urine
186
Methohexital v thiopental which cleared my liver faster?
Methohexital (greater hepatic extraction)
187
CI to barbiturates
acute intermittent porphyria b/c hepatic enzyme induction
(exp phenobarbital b/c renally excreted unchanged)
188
half life of barbiturates and children
shorter 1/2 life b/c inc hepatic clearance
189
why can't you use liposomal bupi and licocaine together?
will disrupt liposomal barrier in bupi -> LAST
** can be done if lidocaine injxn 20 minutest before liposomal bupi
190
what affects duration of action of local anesthetics?
drugs lipophilicity
degree of tissue protein-binding
co-admin of additives (epi)
191
dilution of liposomal bupi
avoid w/ water or hypotonic solution (disrupts liposome)
192
Ketamine effect on chronically ill pts
ketamine has direct negative inotropic effects -> hypoTN and dec cardiac output b/c no compensatory sympathetic response
193
What meds to avoid during pheochromocytoma surgeries?
ketamine
ephedrine
meperidine
desflurane
(all cause inc catecholamine release)
194
Selective alpha 1 antagonists
Prazosin
Doxazosin
Terazosin
195
Phenoxybenzamine MOA
non-selective alpha 1 and alpha 2 blocker
-long acting
**can get worsening tachycardia and HTN due to alpha 2 effects blocked
196
Phentolamine MOA
non-selective alpha 1 and 2 blocker
short acting (10-15 min)
**can get worsening tachycardia and HTN due to alpha 2 effects blocked
197
Mirtazapine MOA
selective alpha 2 blocker
tx depression
198
how long after sugammadex does a pt need a 2nd form of BC?
7 days
199
Possible SE of sugammadex
-bradycardia!
-anaphylaxis/hypersentivity rxn
-inactivation of hormonal contraceptives
-inc PT/INR, PTT (1 hr)
-
200
Hypocalcemia EKG changes
narrow QRS duration
prolonged QT
201
Hypercalcemia EKG changes
wide QRS, short QT
-J waves in severe hyperCa
202
HypoK EKG
narrow QRS, prolonged QT
flattened/inverted T and U waves
203
hyperK EKG
wide QRS
peaked T waves
prolonged PR
204
acid-base changes from acetazolamide
hyperchloremic metabolic acidosis
-can't reabsorb bicarb -> wasting of Na and bicarb -> inc reabsorption of Cl
205
What dose of methadone inc risk of prolonged QT most likely
> 120 mg/day
206
What abx can't be used w/ methadone?
Ciprofloxacin (fluoroquinolone) -> prolongs QT
207
What antiemetics can be used w/ methadone?
Dexamethasone
Aprepitant
Palonosetron
-don't prolong QT
208
codine to morphine
0.15
209
Hydrocodone to morphine
1
210
Oxycodone to morphine
1.5
211
Fentanyl mcg/hr to morphine
2.4
212
Hydromorphone to morphine
4
(2mg hydromorphone = 8 morphine)
213
Methadone to morphine
1-20mg/day : 4
21-40mg/day: 8
41-60mg/day: 10
>61-80: 12
214
Remifentanil metabolism
nonspecific tissue and blood esterases
215
Esmolol metabolism
RBC esterases
216
What does pseudocholinesterase metabolize?
succ
mivacurium
ester local anesthetics
cocaine
heroin
217
What can lower pseudocholinesterase activity?
severe liver dx
plasmapheresis
ACE inh
pregnancy
organophosphates
218
What medication can cause significant prolongation of succ?
Echothiophate
-up to 2 weeks after d/c
219
What medications for ventricular tachycardia?
Phenytoin or Lidocaine
-binds to VG Na channels -> prolongs phase 0 of ventricular depolarization -> prolong QRS and shortens repolarization
220
Phenytoin effects other than anti-epileptic
-termination of ventricular arrhythmias
-induce P450 in liver
-gingival hyperplasia
-at start enhance NMB
-chronic dec NMB
221
Class 1 antiarrhythmics work where?
Na channel blocker
-widens QRS and targets ventricle
222
Class 2 antiarrhythmics work where?
phase 4: K rectifier
beta blockers: propranolol, metoprolol
-slows conduction through the AV node
223
Class 3 antiarrhythmics work where?
Phase 3
potassium channel blockers: amiodarone, sotalol
224
Class 4 antiarrhythmics work where?
phase 2: calcium channel blocker
verapamil, diltiazem
225
what block? identify structures
interscalene
226
Common side effects of interscalene n block
-phrenic n blockade 100%
-horners syndrome (blockade of sympathetic chain)
rare: PTX, RCLN injury
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Most to least likely locations for last
IV > intercoastal > caudal > epidural > brachial plexus and sciatic
