True Learn Flashcards
bOhr effect
bOhr Oxygen Offloading ( hgb decreased affinity for Oxygen when pH is low and Co2 in high at tissues)
nitrous oxide tank values
750 psig 1500 L
oxygen tank values
2200 psig. 660L
phosgene effects
gas used in WW2, colorless odorless, immidiately damages lung epithelium
Drugs that don’t cross placenta (He is going nowhere soon)
Heparin, Insulin, Glycopyrolate, non-depolarizing, succ
Risk factors for post dural puncture headache
women, < age 40, vaginal delivery, multiple attempts, cutting needle
action of nitrous oxide
increases cGMP levels in cells –> smooth muscle relaxation
St. Johns Wart _____P450
induces 3A4 and 2C9 , decreases levels of cyclosporine and warfarin
action of Ginkgo herbal supplement
inhibits platelets
hexamethonium
blocks neuronal ganglion nicotinic receptors–blocks both sympathetic and parasympathetic transmission at ganglia
febrile post transfusion reactions
caused by pyrogenic cytokines released by donor leukocytes
TRALI cause
antibodies from donor blood attack HLA of recipient–> non cardiogenic pulmonary edema
carboprost
prostaglandin, used for uterine atony, contraindication: asthma…carbOprOst –> brOnchOspasm
methylergometrine
ergot, used for uterine atony, can cause HTN
metHYIERgometrine causes bp to go HYIER
drugs that can cause exacerbations of porphyria
barbituates, sulfonamides, ethyl alcohol, ergots, etomidate
respiratory centers in brainstem
DIVE—> dorsal medulla =inspiration, ventral medulla = expiration
changes to arterial wave form as you move peripherally
widening of pulse pressure, softening of dicrotic notch, MAP stays the same
propofol infusion syndrome
lactic acidosis, cardiac failure, renal failure, rhabdomyolysis, hyperkalemia, hypertriglyceridemia, hepatomegaly, and pancreatitis.
plasma osm equation
Posm = (2 * [Na]) + ([glucose] / 18) + ([BUN] / 2.8)
lambert-eaton syndrome
inhibits P-type calcium channels inhibiting release of Ach from nerve terminal
botulism toxin effect
inhibits SNARE proteins inhibiting binding of vesicles containing Ach at nerve terminal
drugs that inhibit hypoxic pulmonary vasoconstriction
Other vasodilating drugs such as nitroglycerin, nitroprusside, ACE-inhibitors, angiotensin receptor blockers, and calcium channel blockers. Volatile gases > 1.5 MAC
drugs that cause direct cerebral dilation
Calcium channel blockers, nitroglycerin, hydralazine, nitroprusside, and adenosine
Mechanism of ketamine
NMDA antagonist (glutamate receptor) which leads to indirect agonism of GABA
SVR equation (dynes)
SVR = 80 * (MAP - RAP) / CO
carotid sinus vs carotid body receptors
CbC- carotid body: chemo receptors
carotid sinus- baroreceptors (sinus infection=pressure)
anesthesia dolorosa
complication of neurolytic blocks for the treatment of trigeminal neuralgia, pain in area that lacks sensation, no effective treatment
morphine metabolites
morphine-3-glucoronide (causes seizures in renal failure)
morphine-6- glucoronide: active metabolite (provides analgesia and can prolong effects in renal failure)
hydromorphone metabolites
hydromorphone-3-glucoronide: causes seizures in renal failure, no analgesia (morphine metabolite 3-G also causes seizures)
carotid body innervated by _____
CN IX …CbC (chemoreceptor)
aortic chemo receptors innervated by _____
CN X
codeine metabolized by ____ to morphine
cyp 2D6
benefits of leukoreduction of blood products
decreased CMV transmission, decreased febrile reactions
indication for irradiated blood products
BMT recipients
nerve to block for upper extremity tourniquet pain
intercostobrachial
factors found in cryoprecipitate
vWF, fibrinogen, fibronectin, factor VIII and XIII
actions of metcloperamide on stomach
increases LES tone, increases gastric emptying
effects of hypocalcemia on EKG
prolonged QT, narrow QRS, flattened T waves
reynolds number (for predicting turbulent flow).
velocity x density x diameter // viscosity R> 4,000 likely turbulent flow. VISCOSITY ON BOTTOM
Hering-Brewer reflex
stretch of receptors in lungs prevents over inflation by triggering expiration
2nd messenger for NO
cGMP (increases levels)
order of sensitivity to local anesthetics
small myelinated > large myelinated > small unmyelinated
effect of lower temp on pO2 and pCO2
more soluble in cooled blood = lower pO2, and pCO2m and higher pH
time constant =
capacity of circuit / FGF
dabigataran
direct thrombin inhibitor, reversed by iduracuzimab
andexanet alpha
reversal for DOACs eliquis and Xarelto (im the alpha)
stop ticagrelor _____ days before surgery
clopidigrel?
prasugrel?
ticagrelor: 5-7 days
clopidigrel: 7 days
prasugrel: 7-10 days
dabigatran mechanism
direct thrombin inhibitor, does not require monitoring
argatraban
direct thrombin inhibitor, run as infusion in patients who can’t have heparin, monitored with PTT, hepatically cleared
fondaparinux
indirect Xa inhibitor that works via ATIII, daily injection, long acting, used in people who can’t have lovenox
VACTERL malformations
vertabra, anal, cardiac, TE fistula, renal, limb
time interval during which vasospasm is MOST likely to develop after a subarachnoid hemorrhage?
2- 14 days
what determines potency of local anesthetics
lipid solubility (enhances diffusion) bupivicaine> lidocaine > mepivicaine
what determines speed of onset of local anesthetics
pKa
lower pKa = higher number of non-ionized molecules = penetrate lipid membrane faster. Can increase speed of onset by adding bicarbonate
what determines duration of local anesthetics?
protein binding. higher protein binding = longer duration. Adding epinephrine can prolong block
