Brain Dumps Flashcards by Abbie Barkley

Which gas has the highest MAC?

N2O

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Which gas does not have an etheral odor?

Halothane

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TV x RR =

minute ventilation

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What is the portion of breath which goes to the mouth, pharynx, and tracheobronchial tree but does not enter alveoli called?

Anatomic dead space

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The flow of anesthesia is:

PA –> Pa –> PBr

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What is commonly used as the first gas in second gas effect?

N2O

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What mode of ventilation do you lose the protective mechanism?

Mechanical

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A Blood:gas partition coefficient of 0.5 =

the concentration of inhaled anesthetic in blood is ½ that of alveolar gases when partial pressure is equal in both phases

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oil:gas of 150 =

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What stage of anesthesia do you want?

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What stage does divergent gaze occur

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What gas would you avoid in a pt with history of seizures?

Enflurane

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What clinical scenario would you give succ (renal, head injury, burns)?

Renal

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CBF of volatiles

Halo > Enflu > Iso = Des

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SVR decrease:

Iso > Des > Sevo

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HR increase:

Des > Iso > SEvo

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Do limit for exogenous Epi:

6 mcg/kg

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Which would you avoid in head injury?

Ketamine

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What causes MH?

Increase and continuous leaking of Ca from Ryanodine receptors of sarcoplasmic reticulum

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What would be your pick for NMBD for patient with chronic renal disease? Answers between Roc and Nimbex  must know dose

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Most MH deaths are d/t ____ and _____.

DIC and delayed Dantrolene treatment

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Increased massestor tone is sign of?

MH after Sux

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Datronlene dose?

2.5 mg/kg every 5-10 minutes

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MOA – Etomidate

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26. MOA – Valium or propofol

27. The LA least likely to cause fetal ion trapping

28. Definitions of efficacy and potency

29. Non ionized vs ionized

30. More binding to plasma poteins  less Vd (what affects)..

ND NMBD bind to protein and are poor lipid soluble  high plasma concentration and low Vd

31. What occurs during phase II?

Conjugation

32. Ester drugs are metabolized by ?

Hydrolysis

33. # of ½ lives vs. concentration of drug

34. Effective TI for anesthesia :

LD1/ED99

35. LD1/ED99 requires ______

vigilance

36. Match receptor types (full agonist/antagonist/etc)

37. 1st order vs 0 order elimination

38. 65% is total body water, 35% is non-water mass

39. Osmolarity formula?

Which anesthetic would you not use in a GI case?

Roc

Which agent has the greatest Vapor pressure?

N20 does NOT decrease Bp

How is sevo broken down?

Phase 1 or phase 2????

Which is NOT correct regarding Zero Order?

Constant fraction

Giving a beta agonist causing tachy?

Upregulation/downregulation

Halothane—

dose dependent ¯ CO

. The ability of the pulmonary vasculature to constrict in response to regional hypoxemia/ Nitrous inhibits HPV

3. Ionization pick 3: a. Determines degree of diffusion b. Nonionized drugs are lipid soluble -> can absorb c. Ionized drugs are lipid soluble -> cannot absorb

4. 94% half time: 4 Half Times

8. A medication has low lipid solubility = low volume distribution.

15. B:G similarities: desflurane = sevoflurane

16. Lipid and maybe oil solubility: book says parallel: think both items were 100:150 option

17. GABA ligand – Etomidate

18. GABA A agonist – Propofol

19. Exerts effects on opioid receptors, monoaminergic, muscarinic, NA & CA, NMDA? Ketamine

29. Zero order elimination: a. Decreases linearly with time. b. Rate of elimination is constant regardless of plasma concentration.

30. Three sodium ions ejected and 2 potassium ions entered in the NA-K pump

31. NA-K pump: Pick 2 maybe a. Na/K transporter b. Responsible for transmembrane electrical potential

40. Cerebral Metabolic O2 Requirements: Isoflurane = Desflurane= Sevoflurane > Halothane

44. HPV pick 2: a. The ability of the pulmonary vasculature to constrict in response to regional hypoxemia b. Nitrous inhibits HPV.

1. What antiepileptic drug should be used with caution in patients with diabetes? a. Carbamazepine b. Gabapentin c. Valproic acid d. Ethosuximide

VALPROIC ACID

2. A young, healthy patient you’re assessing preoperatively begins to have a nonconvulsive generalized seizure. You, as the astute SRNA you are, know that you would NOT administer which medication? Test Question by Bo S. Davis a. Phenobarbital b. Ethosuximide c. Lamotrigine d. Valproate

PHENOBARBITAL

3. A CRNA performs a train of four to detect the amount of twitches present. Upon stimulation, there are four twitches. As a knowledgeable CRNA, they administer a reversal agent due to what percentage of receptors being blocked? a. 85% or less b. 75% or less c. 95% or less d. 90% or less

75% OR LESS

Which statements are true regarding Felbamate? (Select 3) a. Concomitant administration of carbamazepine or phenytoin may decrease plasma concentrations of felbamate b. Felbamate can slow the metabolism of phenytoin, phenobarbital, and valproic acid c. In receiving phenytoin, carbamazepine, or valproic acid the dose of the drugs should be increased by 20% to 30% to prevent toxic effects d. in receiving phenytoin, carbamazepine, or valproic acid the dose of the drugs should be decreased by 20% to 30% to prevent toxic effects

A, B, D a. Concomitant administration of carbamazepine or phenytoin may decrease plasma concentrations of felbamate b. Felbamate can slow the metabolism of phenytoin, phenobarbital, and valproic acid d. in receiving phenytoin, carbamazepine, or valproic acid the dose of the drugs should be decreased by 20% to 30% to prevent toxic effects

5. An astute CRNA performs a train of four after giving Rocuronium. 2 out of 4 twitches were detected. With this knowledge, what dose of Sugammadex would the CRNA give a. 5 mg/kg b. 3 mg/kg c. 2 mg/kg d. 8 mg/kg

2 MG/KG

6. Your patient has a large amount of secretions so you administer an anticholinergic. As an SRNA, you should monitor for all of the following common side effects EXCEPT for: a. Tachycardia b. Urinary retention c. Mydriasis d. Miosis

MIOSIS

7. The SRNA is aware that a higher dose of non-depolarizing NMBD may need to be administered to which of the following patients? (select 3): A) Patient with a twenty-year history of generalized seizures controlled with anticonvulsants B) Patient who takes phenytoin 5mg/kg/day C) Patient scheduled for a CABG with a pre-op K+ of 4.0 D) Patient scheduled for a parathyroidectomy with a pre-op Ca++ of 12.3 E)Patient who takes gabapentin 30mg/kg/day for partial seizures

A, B, D A) Patient with a twenty-year history of generalized seizures controlled with anticonvulsants B) Patient who takes phenytoin 5mg/kg/day D) Patient scheduled for a parathyroidectomy with a pre-op Ca++ of 12.3 Rationale: Chronic use of anticonvulsants, hyperparathyroidism and hypercalcemia decrease potency of NMBDs (Slide 20, NMBD ppt). Patients receiving phenytoin have higher dose requirements for nondepolarizing NMBDs. Phenytoin induces hepatic enzymes and it is likely that metabolism and elimination of NMBDs is increased. Phenytoin may also produce mild blocking effects at the neuromuscular junction leading to upregulation of aCh receptors

8. When reviewing a patient's chart who had an anaphylactic reaction during anesthesia administration, which element is of most concern as to what caused the reaction? a. The use of latex gloves b. Penicillin administration c. Rocuronium administration d. Neostigmine administration e. Thiopental administration

ROCURONIUM ADMIN ii. Rationale: NMBD accounts for 58.2% of allergic reactions with latex (16.7%) and antibiotics (15.1%) following behind. Although standard doses of Rocuronium do not release histamine, it still accounts for 43.1% of anaphylaxis in front of succinylcholine at 22.6%. Thiopental accounts for 1/30,000 allergic reactions (pg 176).

9. You are assessing your patient pre-op and learn that they have been taking phenytoin. Which of the following actions would you be most concerned with? a. induction b. intubation c. emergence d. administering IV sedation

INTUBATION Rationale: Phenytoin causes gingival hyperplasia in 20% of patients.

10. Epinephrine is the prototype sympathomimetic. Its natural functions upon release into the circulation include regulation of all of the following EXCEPT? a. Myocardial contractility b. Bronchial smooth muscle tone c. Glycogenolysis d. Stimulates insulin secretion

STIMULATES INSULIN SECRETION Rationale: Epinephrine can inhibit peripheral glucose uptake, which is also due in part to inhibition of insulin secretion

12. During the preoperative assessment, the patient tells the SRNA she takes Baclofen regularly at home. The SRNA knows the mechanism of action of Baclofen is (Choose 2): a. Acts as an Agonist at GABAb receptors in the ventral horn of the spinal cord b. Acts as an Agonist at GABAb receptors in the dorsal horn of the spinal cord c. Centrally acting analeptic that also acts peripherally on chemoreceptors augmenting breath efforts d. Provides analgesic effects through presynaptic and postsynaptic processes e. Acts as an Antagonist at GABAb receptors in the dorsal horn of the spinal cord

B & D b. Acts as an Agonist at GABAb receptors in the dorsal horn of the spinal cord d. Provides analgesic effects through presynaptic and postsynaptic processes Rationale: Baclofen is a GABAb receptor AGONIST in the DORSAL horn of the spinal cord. Baclofen also provides analgesic effects through postsynaptic G-proteins and presynaptic inhibition of glutamate and substance P.

13. Prior to surgery, the SRNA is reviewing Mrs. Wilson’s labs and notices that her total serum concentration of calcium is 7.8 mg/dL (low), but her ionized calcium is 4.8 mg/dL (normal) and she exhibits no signs of hypocalcemia. What other clinical conditions would the SRNA expect Mrs. Wilson’s lab work to exhibit that would explain this calcium shift? CHOOSE 2 a. hypomagnesemia b. hyperkalemia c. hypophosphatemia d. hypoalbuminemia

C & D HYPOPHOSPHATEMIA AND HYPOALBUMINEMIA Rationale: Total plasma calcium consists of (1) calcium bound to albumin, (2) calcium complexed with citrate and phosphorus ions, and (3) freely diffusible ionized calcium. As would be expected, total plasma calcium decreases with low serum albumin and with hypophosphatemia. It is the ionized calcium, and not the total plasma calcium, that produces the physiologic effects of calcium. Therefore, hypoalbuminemia and hypophosphatemia typically are not associated with signs of hypocalcemia.

14. Patient X comes in for YZ surgery. When reviewing Patient X chart, you notice that Patient X has a history of seizures and is on Carbamazepine for management of their seizures. Which 3 medications should you avoid administering to prevent facilitating Carbamazepine toxicity? A. Diltiazem B. Heparin C. Erythromycin D. Cimetidine

A, C, D DILTIAZEM, ERYTHORMYCIN, & CIMETIDINE

15. During the postoperative period what drugs should be avoided when treating nausea for a patient with Parkinson’s disease? Choose 2 a. Promethazine b. Ondansetron c. Dramamine d. Metoclopramide e. Propofol

A & D PROMETHAZINE AND METOCLOPRAMIDE 1. Rationale: Parkinson’s patients should avoid Dopamine receptor antagonist antiemetics such as Prochlorperazine (Compazine), Promethazine (Phenergan), and Metoclopramide (Reglan) because they can worsen the symptoms of Parkinson’s disease.

16. When reviewing the patient history and lab results, the SRNA discovers that the patient has liver impairment but still needs his antiepileptic drug. What is the safest drug for the patient with liver impairment would an astute SRNA recommend? A. Lamotrigine B. Phenobarbital C. Levetiracetam D. Valproic acid

C - LEVETIRACETAM The pharmacokinetic profile of levetiracetam is favorable, with the absence of hepatic metabolism and minimal protein binding (Flood pg 345). It is thus excreted by the Kidney and not metabolized by the liver.

17. A 60-year-old female patient with a history of Diabetes Mellitus and Coronary Artery Disease is started on a continuous Epinephrine infusion. The provider anticipates that the patient may have lab values that exhibit which of the following effects of this sympathomimetic drug ? (Choose 2) a. Hyperglycemia b. Hyperkalemia c. Hypokalemia d. Hypotension e. Hypoglycemia

A & C HYPERGLYCEMIA & HYPOKALEMIA Rationale: Epinephrine induced hypokalemia may contribute to cardiac dysrhythmias which can stimulate the sympathetic nervous system. Conversely, it also may stimulate the release of potassium from the liver, tending to offset the decrease in extracellular concentration of potassium produced by entrance into the skeletal muscle. Infusions of epinephrine usually increase concentrations of glucose, cholesterol, phospholipids, and low density lipoproteins.

18. Patient X has a history of Parkinson’s Disease. The patient has just started taking their prescription of Levodopa. Knowing the most common side effects of Levodopa in the first few weeks, what would be the greatest concern for this patient? a. Hypertension b. Constipation c. Falls d. Depression

FALLS

19. The patient was experiencing hypotension during the case, so you administered Phenylephrine. You miscalculated the dose to administer and now the patient is experiencing a hypertensive crisis. The blood pressure is not coming down on its own. Which medication will you NOT give to the patient? a. Nitroglycerin b. Nitroprusside c. Metoprolol d. Phentolamine

METOPROLOL beta-1 receptor blockers are contraindicated in the treatment of Phenylephrine induced hypertensive crisis because they reduce CO and can cause cardiac collapse. Vasodilating drugs such as nitroprusside or nitroglycerin may be helpful as well as Phentolamine.

20. Which of the following does the SRNA know to be true regarding epilepsy with pregnant women? Choose two. a. Significant teratogenicity can occur within the first 8 weeks of pregnancy if harmful antiepileptic drugs are taken. b. Lamotrigine and valproate carry more than double the risk of giving birth to a fetus with a congenital malformation. c. Clobazam is safe to administer during labor. d. The hypoalbuminemia associated with pregnancy is due to a progressive increase in central volume leading to a toxic therapeutic plasma concentration.

A & C a. Significant teratogenicity can occur within the first 8 weeks of pregnancy if harmful antiepileptic drugs are taken. c. Clobazam is safe to administer during labor. Rationale: Significant teratogenicity can happen if medications are given within the first 8 weeks of pregnancy. Carbamazepine and valproate have more than double the risk of fetus with congenital malformations. Lamotrigine has rates of congenital malformation comparable to the general population. Clobazam may be added as needed, especially during labor. In pregnancy, hypoalbuminemia is due to a progressive increase in central volume which offsets the effect of hypoalbuminemia.

21. The SRNA knows that giving a standard dose of Phenytoin to which of the following patients can have the potential for toxicity? (SELECT 3) a.) The patient in the Stepdown Unit with hepatic failure b.) The malnourished patient in the ICU who is septic and on a Norepinephrine drip c.) The patient that is in the PACU post craniectomy d.) The patient that is in the ICU with Renal Failure

A, B, & D a.) The patient in the Stepdown Unit with hepatic failure b.) The malnourished patient in the ICU who is septic and on a Norepinephrine drip d.) The patient that is in the ICU with Renal Failure Rational: Patients that are malnourished, has hepatic failure, or has renal failure all run the risk for hypoalbuminemia. Norepinephrine can also cause a loss of protein-free fluid into the extracellular space.

22. Which of the following chronic use of the medications should not be discontinued before surgery? Choose two. a) Levodopa b) Isoniazid c) Cimetidine d) Baclofen

A & D LEVODOPA & BACLOFEN

A hospitalized 60 year old male patient with a history of parkinson’s disease has been taking levodopa for a year for the management of his symptoms and is scheduled for gastric surgery this evening. When reviewing this patient’s chart and performing the pre-anesthesia assessment, what lab results and/or assessments would the SRNA expect to see related to levodopa? (Choose 3) a) A positive ketoacidosis test. b) Black urine in the patient’s urinal. c) The patient reports nausea. d) Elevated liver transaminase concentration. e) The patient reports stopping all routine meds in preparation for surgery.

A, B, D a) A positive ketoacidosis test. b) Black urine in the patient’s urinal. d) Elevated liver transaminase concentration. RATIONALE: Urinary metabolites of levodopa cause false positive ketoacidosis test and turn urine red then black upon exposure to air. Increased liver transaminase concentrations occasionally occur with levodopa. Nausea is a symptom of levodopa only within the first few weeks of taking it and this medication should not be discontinued before surgery, so these would be incorrect.

A 68 year old male presents to the emergency department with a new onset of seizures. His health history includes uncontrolled hypertension, atrial fibrillation, coronary artery disease, and sleep apnea. After verifying the history with the patient, which antiepileptic medication would you NOT want to start the patient on? a) Phenobarbital b) Gabapentin c) Phenytoin d) Carbamazepine

D - CARBAMAZEIPINE Rationale: Carbamazepine’s rare, but life threatening side effects include hypertension. With the patient already having uncontrolled hypertension, along with other cardiac issues, the patient is at a higher than normal risk for his blood pressure to get even worse, thus increasing his risk for having a cerebral infarction.

25. What side effects can be seen if a patient is taking both Levodopa and a monoamine oxidase inhibitor concurrently? Choose two: a) hyperthermia b) nausea c) diarrhea d) hypertension e) confusion

A & D HYPERTHERMIA & HTN Rationale: Monoamine oxidase inhibitors can exaggerate the peripheral and central nervous system effects of levodopa.

. On preoperative assessment, the 29-year-old patient tells the SRNA he has been taking phenobarbital for the past five years for seizures. The SRNA should consider which of the following for patients taking long-term phenobarbital? a. The risk for overdose and hypotension is increased with anesthetics. b. Phenobarbital is short-acting, and the patient will require four doses that day. c. The patient may require additional anesthetic/MAC doses for effective anesthesia. d. Phenobarbital decreases the metabolism of many lipid soluble drugs

C - The patient may require additional anesthetic/MAC doses for effective anesthesia. Rationale: Chronic use of phenobarbital increases tolerance to sedation medication. Phenobarbital is a long-acting medication and typically requires two doses per day. Increased anesthetic doses and MAC may be required. Phenobarbital is an example of a hepatic microsomal enzyme inducer that can accelerate the metabolism of many lipid soluble drugs.

. Select all that is true regarding Amphetamine: a. Ingredient in some weight loss medications b. Should be stopped 1 week before procedure c. Is a direct acting general agonist d. Releases stored catecholamines e. Is used to treat narcolepsy and ADHD

A, D, E a. Ingredient in some weight loss medications d. Releases stored catecholamines e. Is used to treat narcolepsy and ADHD Amphetamine’s MOA - INDIRECT general agonist and releases stored catecholamines. Used for narcolepsy, obesity, and ADHD. Can be found in ADHD and weight loss medications. Should be stopped 72 hours before the procedure.

. A patient with diagnosed Parkinson’s disease comes in with continued tremors, skeletal muscle rigidity, bradykinesia, and disturbances in posture. The patient has been taking Levodopa as prescribed since the diagnosis. What could be the cause of the patient’s ongoing symptoms? A. Patient needs increased dose of Levodopa B. Patient has been consuming Pyridoxine C. Patient takes Tolcapone at home with Levodopa D. Patient has been taking Isocarboxazid for depression

B - PATIENT HAS BEEN CONSUMING PYRIDOXINE Rational: Pyridoxine (Vitamin B) in doses as low as 5 mg can abolish the therapeutic efficacy of Levodopa by enhancing the activity of pyridoxine- dependent dopa decarboxylase and thus increasing the metabolism of levodopa in the circulation before it can enter the CNS.

The CRNA is completing a history and physical examination during pre-op. The patient explains that he takes medications for seizures and has been feeling sleepy and lethargic lately. He expresses that his doctor during the last visit increased his dose because of possible tolerance. Which of the following medications could be causing these symptoms? A. Felbamate B. Clobazam C. Clonazepam D. Gabapentin

C - CLONAZEPAM rationale – Major antiepileptic drugs used to treat epilepsy are clonazepam, felbamate and clobazam. Clonazepam causes patients to develop tolerance and sedation as a common side effect. Felbamate is reserved for patients with uncontrolled seizures. Clobazam does not cause significant sedation and can be used for long-term d/t tolerance, being relatively uncommon.

30. An astute SRNA is about to begin induction on a trauma patient. The patient is status post-MVC. He presents with the following manifestations. Which of these are contraindicated for the administration of atracurium? Choose 2. A. History of Asthma B. Liver Failure C. Biliary Obstruction D. Head Bleed

A & C HX OF ASTHMA & BILIARY OBSTRUCTION

31. You are on call as a CRNA, you receive a difficult airway call to the Neurological ICU. As you arrive to the room you are apprised of the situation. The patient, a 23 year old male, had a frontal lobe injury sustained in a moped accident two weeks ago (closed head injury), and has been largely immobilized and under sedation for the past two weeks. In weaning sedation over the last 48 hours, the patient was able to self-extubate overnight. The overnight resident physician opted not to re-intubate. You observe that the patient is hypoxic with SaO2 saturations in the low to mid 80’s. The patient is in four point restraints, a C-Collar, on a non-rebreather at 15L and high flow nasal cannula at 15L. The patient is restless, hyper-salivating and unable to protect his airway. The neuro intensivist is at the bedside and has requested your assistance in placing the endotracheal tube. The neuro intensivist orders rapid sequence intubation (RSI) and calls out the drugs he wants given for induction. Which drug that he orders gives you, the astute CRNA, pause? A. Rocuronium, 1.0 mg/kg B. Etomidate, 0.4 mg/kg C. Fentanyl, 2 mcg/kg D. Succinylcholine, 1.0 mg/kg E. Propofol, 2.0 mg/kg F. Lidocaine, 2.0 mg/kg

D - SUCCINYLCHOLINE 1 MG/KG

A patient diagnosed with Parkinson’s Disease admits to abruptly stopping his daily dose of Levodopa because it was still making him feel dizzy when getting out of bed. His wife states his mentation has been more “off” than usual. You are concerned with Parkinsonism-hyperpyrexia. What other clinical presentations would you find? (Select 3) A. A temperature of 101 degrees F B. Vomiting C. Diaphoresis D. Increased tremor and stiffness E. Shivering

A, C, D A temperature of 101 degrees F C. Diaphoresis D. Increased tremor and stiffness RATIONALE: Parkinsonism-hyperpyrexia syndrome has a similar clinical presentation to neuroleptic malignant syndrome with rigidity, pyrexia, autonomic instability, and a decreased level of consciousness.

Which class of CCB produces the greatest dilations of the peripheral arterioles? 1. Phenylalkylamines 2. Dihydropyridines 3. Benzothiazepines

2 - DIHYDROPYRIDINES

Which drugs have depressant effects on the cardiac action potential at the SA node and slows movement of the cardiac impulses through the AV node? (Select 2) 1. Nicardipine 2. Diltiazem 3. Nifedipine 4. Verapamil

2 & 4 - DILTIAZEM & VERAPAMIL

You are prepping a patient for the OR and they have SVT. You know from Dr. Hammon’s class that _____ is the first line medication. 1. Nicardipine 2. Verapamil 3. Metoprolol 4. Diltiazem

4 - DILTIAZEM

A patient has the following ABGs: pH 7.25, PCO2 38, HCO3 18. Which drug might be influenced by these findings? 1. Amrinone 2. Dobutamine 3. Norepinephrine 4. Milrinone

4 - MILRINONE

Which sympathomimetic is most beneficial in a patient with SVT and hypotension? 1. Epinephrine 2. Dobutamine 3. Phenylephrine 4. Ephedrine

3 - PHENYLEPHRINE

What is true regarding phosphodiesterase inhibitors? 1. Increases preload and afterload 2. Increases wall tension and myocardial O2 consumption 3. Causes smooth muscle relaxation in arterial and venous beds 4. Decreases preload and afterload 5. Causes smooth muscle relaxation in arterial beds and constriction in venous bed

3 & 4 3. Causes smooth muscle relaxation in arterial and venous beds 4. Decreases preload and afterload

Which drug is a selective antagonist at presynaptic a2 receptors that leads to enhanced release of norepinephrine from nerve endings and has been used in male patients suffering from ED or impotence?

Yohimbine

2. Which drug with tamsulosin decreases the clearance?

Cimetidine

3. Correct dosage for phenoxybenzamine:

0.5-1 mg/kg (1 mg/kg)

4. Which drug does not interfere with digoxin?

Clonidine

_____________ can cause paradoxical HTN & bradycardia that resembles phenylephrine with large IV boluses (0.25 – 1 mcg/kg over 3 – 5 minutes)

5. Dexmedetomidine

Typical initial dose of esmolol

0.5 mg/kg

7. What is the full therapeutic effect of esmolol?

5 minute

8. What does of esmolol to give to protect against increases in both HR and SBP that might be detrimental to those with Tetralogy of Fallot?

150 mg

9. With 1 mg/kg followed by 250 mcg/kg/min of esmolol you would ________ the dose of propofol

DECREASE

10. What is the drug of choice to treat beta blocker OD?

Glucagon? - Glucagon 1-10 mg IV followed by 5 mg/hr

Common side effects of labetalol?

Orthostatic hypotension, bronchospasm possible

12. Patient with preexisting cardiac conduction abnormalities may experience greater ________ with concurrent administration of beta blockers or digoxin

degrees of AV heart block

_________ can cause hyperkalemia. Slows the inward movement of K hyperK in pts treated with verapamil may occur after small amounts of exogenous K infusion

13. Verapamil

14. Which drugs are endogenous?

Epi, Norepi, Dopamine

15. Dobutamine causes

cAMP

________- causes the most arrhythmias

16. Dopamine

_________-is stored in the postganglionic sympathetic nerve endings

17. Norepinephrine

18. Use __________cautiously in patients with RV failure

norepinephrine

_______- is an indirect-acting synthetic sympathomimetic that stimulates alpha and beta adrenergic receptors

19. Ephedrine

20. Which sympathomimetic drug can be given orally?

Ephedrine

21. What is the dosage of ephedrine?

5 – 10 mg

22. Which sympathomimetic drug causes reflex vagal effects and can be used to slow HR in the presence of hemodynamically significant SVT?

Phenylephrine

23. Which is true of PDE III inhibitors?

Both arteriolar and venous beds

24. What produces the physiological effects of calcium?

Ionized calcium

27. The SRNA is aware that a higher dose of non-depolarizing NMBD may need to be administered to which of the following patients? (select 3): a. Patient with a twenty-year history of generalized seizures controlled with anticonvulsants b. Patient who takes phenytoin 5mg/kg/day c. Patient scheduled for a CABG with a pre-op K+ of 4.0 d. Patient scheduled for a parathyroidectomy with a pre-op Ca++ of 12.3 e. Patient who takes gabapentin 30mg/kg/day for partial seizures – gaba is zero protein binding

A, B, D

28. Epinephrine is the prototype sympathomimetic. Its natural functions upon release into the circulation include regulation of all of the following EXCEPT? a. Myocardial contractility b. Bronchial smooth muscle tone c. Glycogenolysis d. Stimulates insulin secretion

29. During the preoperative assessment, the patient tells the SRNA she takes Baclofen regularly at home. The SRNA knows the mechanism of action of Baclofen is (Choose 2): a. Acts as an Agonist at GABAb receptors in the ventral horn of the spinal cord b. Acts as an Agonist at GABAb receptors in the dorsal horn of the spinal cord c. Centrally acting analeptic that also acts peripherally on chemoreceptors augmenting breath efforts d. Provides analgesic effects through presynaptic and postsynaptic processes e. Acts as an Antagonist at GABAb receptors in the dorsal horn of the spinal cord

B & D

30. Prior to surgery, the SRNA is reviewing Mrs. Wilson’s labs and notices that her total serum concentration of calcium is 7.8 mg/dL (low), but her ionized calcium is 4.8 mg/dL (normal) and she exhibits no signs of hypocalcemia. What other clinical conditions would the SRNA expect Mrs. Wilson’s lab work to exhibit that would explain this calcium shift? CHOOSE 2 a. hypomagnesemia b. hyperkalemia c. hypophosphatemia d. hypoalbuminemia

C & D

31. A 60-year-old female patient with a history of Diabetes Mellitus and Coronary Artery Disease is started on a continuous Epinephrine infusion. The provider anticipates that the patient may have lab values that exhibit which of the following effects of this sympathomimetic drug ? (Choose 2) a. Hyperglycemia b. Hyperkalemia c. Hypokalemia d. Hypotension e. Hypoglycemia

A & C

32. Which of the following does the SRNA know to be true regarding epilepsy with pregnant women? Choose two. a. Significant teratogenicity can occur within the first 8 weeks of pregnancy if harmful antiepileptic drugs are taken. b. Lamotrigine and valproate carry more than double the risk of giving birth to a fetus with a congenital malformation. c. Clobazam is safe to administer during labor. d. The hypoalbuminemia associated with pregnancy is due to a progressive increase in central volume leading to a toxic therapeutic plasma concentration.

A & C

all NMBD are quaternary ammonium compounds and are structurally related to acetylcholine except

tubocurarine-

atracurium causes _____release

histamine

Cisatracurium and rocuronium _____ cause histamine release with appropriate doses

does not

Inhalation anesthetics potentiate the NMBD effect?

Des > Sevo > Iso > Halothane; or Des > Sevo > Iso > Nitrous

Which does not prolong NMBD?

LA given in small doses (hypothermia, MagSulfate, LA in large doses, quinidine all potentiates)

Anaphylactic reactions immunoglobulin antibodies are fixed to ______

mast cells

In anaphylactic reactions what immunoglobulin is it?

IgGE

Which drug causes black/red urine with positive ketones?

Levodopa

Pt with hx of Parkinson’s dz and on levodopa has pre op labs that show abnormal BUN. What do you do?

Increase fluids to help decrease BUN

Which drug has the longest time to max block intermediate NMBD?

Cisat

Which drug is the shortest acting intermediate NMBD?

Rocuronium

What is the elimination half-time of ethosuximide?

20-60 hours

Which lobe controls sense of touch, response to pain & temperature, and understanding of language?

Parietal lobe

A patient on carbamazepine, which drug will cause a toxic effect?

Erythromycin (cimetidine, propoxyphene, diltiazem, verapamil, isoniazid, erythromycin)

Why is felbamate not used? choose two.

Significant life-threatening effects, hepatotoxicity

How does valproic acid exert its effect?

Sodium ion channel

Where is dopamine located in the brain (select three):

Basal ganglia, caudate nucleus, putamen

side effects of levodopa?

Nausea and orthostatic hypotension

What are we worried about administering large doses of anticholinergics?

Slow gastric emptying such that absorption of levodopa from the GI tract is decreased

What is the duration of hydralazine?

1-8 hours

What is the onset of hydralazine?

5-20 minutes

What is the duration of Pitocin?

20-60 minutes

What antiepileptic has a greater than 50% effect on fetus?

valproate

What is a succinylcholine dart?

1cc atropine, 2 cc succ

What is the homozygous typical butyrylcholinesterase dibucaine number:

70 – 80 (Table 12.2 in NBD and reversal agents chapter).

Clinically, phenylephrine mimics what?

Norepi

Which medication can you add to local anesthetics to make them last longer?

Epi

lidocaine peak.

What drug is safe to give to a laboring mom with a history of seizures?

clobazam

Something about which drug has minimal beta effects and it was Phenylephrine

What does alpha 1 do in pancreas?

Decrease insulin production

. What does beta 2 do in the liver? .

Gluconeogenesis

Onset of neo?

Almost immediate

Which drug mimics norepi but less potent and longer duration?

Neo

What drug is selective beta blocker with duration of 10-15 mins?

Esmolol

Which of the following is true about labetalol?

Nonselective beta blocker with some alpha 1 blocking with duration up to 2 hours, and contraindications COPD and bronchospasm

Explain neo double dilution.

Hydrolysis by plasma esterase with no CNS effects and doesn’t cross placenta?

Esmolol

Normal propofol dose?

1.5-2.5 mg/kg

normal peds propofol dose?

2.5-3.5 mg/kg

Normal fentanyl dose?

1 mcg/kg

What is ephedrine usually diluted to?

5 mg/mL

Identify where C fibers terminate. Picture.

. a-delta NT?

Glutamate

Which of the following is true of a delta?

Myelinated, well localized, sharp pain

antidote for anticholinergic poisoning?

Physostigmine

anticholinesterases choose true.

Cross BBB and metabolized by plasma esterase

clonidine chooses three.

BBB for ob, periop analgesia and anesthesia; hemodynamic instability for limiting factor of epidural use; hypotension and bradycardia main problems

. anticholinergics se?

nausea, bronchoconstriction, diarrhea

which would you use anticholinesterase for?

Choose three. Paralytic ileus, reduce eye pressure in glaucoma, Alzheimer’s

secondary afferent neuron in dorsal horn

How to reverse anticholinergic effect?

Increase Ach at muscarinic receptors

Which of the following is true about atropine?

Block Ach allowing increased HR, competes with Ach at SA node.

Where are muscarinic receptors NOT located?

Brain

Which of the following is NOT true about M6G?

increases permeability to BBB, lesser DOA

baclofen postsynaptic MOA

in neuraxial, central acting nonopioid drugs choose two.

Bypass BBB, increases CSF concentration

depolarizing drug that desensitizes endplate nicotinic receptor?

Suxx

Suxx choose two

: transient potassium increases and 2 Ach molecules bound together

Which of the following is SE of opioids?

Histamine release

Which crosses lipid solubility?

Fentanyl and sufentanil

2 racemic mixtures?

Mepivacaine and bupivacaine

S enan question

Atypical cholinesterase will slow metabolism of which drug?

Chloroprocaine

Atypical butyl will inhibit normal butyl activity by more than 80%

Which of the following is C/I with glaucoma, CNS depressants, protease inhibitors and pregnancies with DOA 15-80 mins?

Versed

Etidocaine compared to lidocaine is 50-fold.

Procaine with chloroprocaine, c is longer duration

. Adding epi to lidocaine do?

Increases duration, decreases absorption by 30%

2 mcg/kg dex epidural for ortho lower limb surgery

Droperidol fourth ventricle

LA bind to voltage gated sodium channels

Pregnancy with LA more rapid onset of conduction blockade

Slight slowing of HR, slight dry mouth, no sweating with 0.5 mg atropine

Most for addiction?

Mu 2

Most for resp depression?

Mu 2

What will you monitor for giving Narcan?

V-Fib

Brain Dumps Flashcards

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