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1
Q

bOhr effect

A

bOhr Oxygen Offloading ( hgb decreased affinity for Oxygen when pH is low and Co2 in high at tissues)

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2
Q

nitrous oxide tank values

A

750 psig 1500 L

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3
Q

oxygen tank values

A

2200 psig. 660L

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4
Q

phosgene effects

A

gas used in WW2, colorless odorless, immidiately damages lung epithelium

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5
Q

Drugs that don’t cross placenta (He is going nowhere soon)

A

Heparin, Insulin, Glycopyrolate, non-depolarizing, succ

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6
Q

Risk factors for post dural puncture headache

A

women, < age 40, vaginal delivery, multiple attempts, cutting needle

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7
Q

action of nitrous oxide

A

increases cGMP levels in cells –> smooth muscle relaxation

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8
Q

St. Johns Wart _____P450

A

induces 3A4 and 2C9 , decreases levels of cyclosporine and warfarin

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9
Q

action of Ginkgo herbal supplement

A

inhibits platelets

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10
Q

hexamethonium

A

blocks neuronal ganglion nicotinic receptors–blocks both sympathetic and parasympathetic transmission at ganglia

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11
Q

febrile post transfusion reactions

A

caused by pyrogenic cytokines released by donor leukocytes

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12
Q

TRALI cause

A

antibodies from donor blood attack HLA of recipient–> non cardiogenic pulmonary edema

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13
Q

carboprost

A

prostaglandin, used for uterine atony, contraindication: asthma…carbOprOst –> brOnchOspasm

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14
Q

methylergometrine

A

ergot, used for uterine atony, can cause HTN

metHYIERgometrine causes bp to go HYIER

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15
Q

drugs that can cause exacerbations of porphyria

A

barbituates, sulfonamides, ethyl alcohol, ergots, etomidate

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16
Q

respiratory centers in brainstem

A

DIVE—> dorsal medulla =inspiration, ventral medulla = expiration

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17
Q

changes to arterial wave form as you move peripherally

A

widening of pulse pressure, softening of dicrotic notch, MAP stays the same

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18
Q

propofol infusion syndrome

A

lactic acidosis, cardiac failure, renal failure, rhabdomyolysis, hyperkalemia, hypertriglyceridemia, hepatomegaly, and pancreatitis.

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19
Q

plasma osm equation

A

Posm = (2 * [Na]) + ([glucose] / 18) + ([BUN] / 2.8)

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20
Q

lambert-eaton syndrome

A

inhibits P-type calcium channels inhibiting release of Ach from nerve terminal

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21
Q

botulism toxin effect

A

inhibits SNARE proteins inhibiting binding of vesicles containing Ach at nerve terminal

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22
Q

drugs that inhibit hypoxic pulmonary vasoconstriction

A

Other vasodilating drugs such as nitroglycerin, nitroprusside, ACE-inhibitors, angiotensin receptor blockers, and calcium channel blockers. Volatile gases > 1.5 MAC

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23
Q

drugs that cause direct cerebral dilation

A

Calcium channel blockers, nitroglycerin, hydralazine, nitroprusside, and adenosine

24
Q

Mechanism of ketamine

A

NMDA antagonist (glutamate receptor) which leads to indirect agonism of GABA

25
SVR equation (dynes)
SVR = 80 * (MAP - RAP) / CO
26
carotid sinus vs carotid body receptors
CbC- carotid body: chemo receptors | carotid sinus- baroreceptors (sinus infection=pressure)
27
anesthesia dolorosa
complication of neurolytic blocks for the treatment of trigeminal neuralgia, pain in area that lacks sensation, no effective treatment
28
morphine metabolites
morphine-3-glucoronide (causes seizures in renal failure) | morphine-6- glucoronide: active metabolite (provides analgesia and can prolong effects in renal failure)
29
hydromorphone metabolites
hydromorphone-3-glucoronide: causes seizures in renal failure, no analgesia (morphine metabolite 3-G also causes seizures)
30
carotid body innervated by _____
CN IX ...CbC (chemoreceptor)
31
aortic chemo receptors innervated by _____
CN X
32
codeine metabolized by ____ to morphine
cyp 2D6
33
benefits of leukoreduction of blood products
decreased CMV transmission, decreased febrile reactions
34
indication for irradiated blood products
BMT recipients
35
nerve to block for upper extremity tourniquet pain
intercostobrachial
36
factors found in cryoprecipitate
vWF, fibrinogen, fibronectin, factor VIII and XIII
37
actions of metcloperamide on stomach
increases LES tone, increases gastric emptying
38
effects of hypocalcemia on EKG
prolonged QT, narrow QRS, flattened T waves
39
reynolds number (for predicting turbulent flow).
velocity x density x diameter // viscosity R> 4,000 likely turbulent flow. VISCOSITY ON BOTTOM
40
Hering-Brewer reflex
stretch of receptors in lungs prevents over inflation by triggering expiration
41
2nd messenger for NO
cGMP (increases levels)
42
order of sensitivity to local anesthetics
small myelinated > large myelinated > small unmyelinated
43
effect of lower temp on pO2 and pCO2
more soluble in cooled blood = lower pO2, and pCO2m and higher pH
44
time constant =
capacity of circuit / FGF
45
dabigataran
direct thrombin inhibitor, reversed by iduracuzimab
46
andexanet alpha
reversal for DOACs eliquis and Xarelto (im the alpha)
47
stop ticagrelor _____ days before surgery clopidigrel? prasugrel?
ticagrelor: 5-7 days clopidigrel: 7 days prasugrel: 7-10 days
48
dabigatran mechanism
direct thrombin inhibitor, does not require monitoring
49
argatraban
direct thrombin inhibitor, run as infusion in patients who can't have heparin, monitored with PTT, hepatically cleared
50
fondaparinux
indirect Xa inhibitor that works via ATIII, daily injection, long acting, used in people who can't have lovenox
51
VACTERL malformations
vertabra, anal, cardiac, TE fistula, renal, limb
52
time interval during which vasospasm is MOST likely to develop after a subarachnoid hemorrhage?
2- 14 days
53
what determines potency of local anesthetics
``` lipid solubility (enhances diffusion) bupivicaine> lidocaine > mepivicaine ```
54
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
55
what determines duration of local anesthetics?
protein binding. higher protein binding = longer duration. Adding epinephrine can prolong block

Anesthesia (5 decks)

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