coexisting disease Flashcards by Sarah Horvath

what are the s/s for thyroid storm?

high fever, tachycardia, agitation, severe dehydration

How well did you know this?

Not at all

Perfectly

in a patient with hyperthyroidism, propranolol may exacerbate ___ following SAB

hypotension

How well did you know this?

Not at all

Perfectly

patient with hyperthyroidism has an ____ response to prossors.

exaggerated

How well did you know this?

Not at all

Perfectly

pheochromocytoma secretes excessive catecholamines including ____ and ____

norepinephrine and epi

How well did you know this?

Not at all

Perfectly

pheochromocytoma: neuroendocrine tumor of the adrenal glands or ____ tissue that failed to involute

extra-adrenal chromaffin

How well did you know this?

Not at all

Perfectly

a patient with a pheochromocytoma - anesthetic plan?

elective C-section

- preop therapy with a-blockers followed by b-blockers

How well did you know this?

Not at all

Perfectly

B-blockade without prior A-blockade results in

unopposed a-stimulation, severe HTN

How well did you know this?

Not at all

Perfectly

T/F: Pregnancy has no consistent effect on the course of bronchial asthma

TRUE

How well did you know this?

Not at all

Perfectly

T/F: Bronchial asthma may be exacerbated during pregnancy d/t bronchoconstriction

FALSE: Bronchial asthma may improve during pregnancy d/t bronchodilation

How well did you know this?

Not at all

Perfectly

anesthetic plan for pt with bronchial asthma?

continuous labor epidural

How well did you know this?

Not at all

Perfectly

Why is an epidural preferable to spinal in bronchial asthmatic patient?

gradual onset- tolerate intercostal muscle weakness. reports of bronchoconstriction following SAB

How well did you know this?

Not at all

Perfectly

avoid H2 blockers (cimetidine, ranitidine) because it increases sensitivity to ___ that causes ____

histamine, spasm

How well did you know this?

Not at all

Perfectly

avoid GETA in asthmatic pt because ETT can trigger ____

bronchospasm

How well did you know this?

Not at all

Perfectly

which drug on induction will cause bronchial relaxation

ketamine

How well did you know this?

Not at all

Perfectly

which IH should you avoid in asthmatic?

desflurane

How well did you know this?

Not at all

Perfectly

T/F paraplegia causes an increased incidence of preterm labor

TRUE

How well did you know this?

Not at all

Perfectly

Paraplegia - consider autonomic hyperreflexia if lesion is above what spinal level?

How well did you know this?

Not at all

Perfectly

Autonomic hyperreflexia - triggers

stimulation of skin, distention of hollow viscus (bladder, uterus)

How well did you know this?

Not at all

Perfectly

Autonomic hyperreflexia s/s

pilomotor erection, sweating, flushing, headache, severe HTN, bradycardia

How well did you know this?

Not at all

Perfectly

paraplegic patient - avoid ___ d/t risk of hyperkalemia

succinylcholine

How well did you know this?

Not at all

Perfectly

anesthetic plan for paraplegia: early ____ to prevent ____

early epidural analgesia to prevent hyperreflexia

How well did you know this?

Not at all

Perfectly

which pattern of MS is characterized by attacks that appear abruptly and resolve over several months?

exacerbating remitting

How well did you know this?

Not at all

Perfectly

what are the 2 general patterns of MS

exacerbating remitting and chronic progressive

How well did you know this?

Not at all

Perfectly

how does MS manifest?

neurological defects that present as pyramidal, cerebellar, or brainstem symptoms

How well did you know this?

Not at all

Perfectly

T/F the etiology for MS is unclear

TRUE. but possible link to previous exposure to vial agent that may trigger autoimmune response. [loss of myelin in CNS]

motor weakness, impaired vision, ataxia, bladder/bowel dysfunction, and labile emotions are characteristic of what disease?

How is MS treated?

symptomatically and by immunosuppression. often tx is marked by relapses and regression

T/F Pregnancy has no effect on progression Multiple Sclerosis

TRUE.

T/F Pregnancy decreases the risk of relapse of MS

FALSE - slight increase

T/F MS relapses are most often seen in the postpartum period

TRUE. approx 3x higher rate than non-pregnant

T/F Pregnancy does not have an overall negative effect on long-term outcome of MS

TRUE

MS - anesthetic plan should have a careful assessment of which two areas

neurological and respiratory

What is the concern with MS and neuraxial anesthesia?

- potential neurotoxic exposure of demyelinated spinal cord. | - concerns over relapse of symptoms

For an MS patient, do not exceed concentrations of >____% bupivacaine infusions.

0.25

T/F SAB is recommended over epidural for MS pt

FALSE - Epidural better tolerated than SAB for MS patient, however SAB has been successfully employed. CSE technique well tolerated with IT opioids

T/F GA Is contraindicated with MS

FALSE - but avoid succs with severe musculoskeletal involvement

What can happen with a dural puncture with a patient with a brain tumor?

brain herniation and death

Brain tumor patient: ____ blocks for first stage labor, ___ block for 2nd stage labor

b/l lumbar sympathetic blocks for first stage, pudendal block for second stage

Brain Tumor C section: GETA with generous narcs to blunt reflexes during laryngoscopy and avoid sudden inc in ___ and ____

BP and ICP

T/F Pseudotumor Cerebri - benign intracranial HTN is not mass related, and epidural or spinal block is okay

TRUE

T/F Epilepsy is shown to have an increased risk of convulsions with use of local anesthetics

FALSE. proceed as normal

Myasthenia Gravis is usually treated with anticholinergic agents such as ____ or ____

neostigmine or edrophonium

T/F women are 3 times more likely to develop MG than men

TRUE

Pregnancy can exacerbate MG symptoms, causing cholinergic crisis, which requires dose adjustment of ____

neostigmine

MG contraindicated drugs

-ABX: gentamycin, kanamycin, streptomycin, plymyxin, colistin, tetracycline, lincomyicn Tocolytics: Mag sulf Cardiac meds: quinidine, propranolol Beta Adrenergics: Ritodrine, Terbutaline Others: Quinine, Penicillamine, Lithium

IV dose of neostigmine is given in ratio of __:__ to oral dose

30:1. monitor fetal HR!

In an MG patient, ____ anesthesia is preferable to ____.

regional, general

MG patient is highly sensitive to which agents

depolarizing and NDNMB. intubation doses 1/2 to 1/3 normal

T/F MG patient is more resistant to effects of opioids and LA agents.

FALSE. more receptive to effects of opioids and LA.

Cholinergic crisis should be treated with which drug?

atropine - IV & IM

profound muscle weakness, resp failure, loss of bladder/bowel function, disorientation, diplopia are symptoms of?

Cholinergic Crisis (MG)

Normal Hgb= HgbA, Sickle Cell =

HgbS

Heteroxygous "sickle trait" =

HgbAS

Homozygous =

HgbSS

which Two forms of sickle cell dz have a higher incidence off preeclampsia?

HgbSS or HgbSC

6 things to avoid in sickle cell patient

hypoxia, HoTN, dehydration, hypothermia, acidosis, tourniquets

Sickle Cell: prefer epidural with adequate bolus with ___ prior to block

warmed IVF

Sickle Cell: spinal or epidural?

epidural. decreased risk of HoTN.

what is the most common hereditary coagulation abnormality

VonWillebrand Disease

VonWillebrand Disease: what is the most common type? how do you tx?

type 1, Rx with DDAVP 0.3mg/kg

Tachphylaxis can occur with DDAVP therapy at >___hr

T/F Neuraxial blockade is a relative contraindication to sickle cell, although can be considered if coagulation times are monitored and appropriately treated

TRUE

Factor V Leiden: variant of human coagulation factor __ that cannot be activated by ___ and therefore causes a ___coagulability disorder

V C hyper

Factor V Leiden: Patient on lovenox very early in pregnancy is converted to heparin at week __ to facilitate neuraxial blockade

Factor V Leiden: if prophylactic LMWH dose- hold >__hours before block

Factor V Leiden: if therapeutic LMWH dose- hold >__hours before block

Rheumatoid Arthritis - what are the resp concerns

restrictive lung dz, possible pleural effusions

RA - what is the preferred anesthetic

continuous labor epidural, but may fail d/t arthritis. for c-section, can use epidural or spinal. avoid potential difficult airway, may need awake fiberoptic intubation

SLE: Early implementation of ___ anesthesia is recommended

regional

T/F Due to the incidence of valve disorders and vegetation on SLE patient, prophylactic antibiotics are always recommended.

FALSE. only required if pt is high risk for endocarditis. (previous IE, unprepared cyanotic heart disease, implanted prosthetic devices, cardiac transplantation with cardiac valvulopathy)

vocal cord palsy is seen with which disorder

SLE

Maternal Addiction to amphetamines has what effect on catecholamines?

depletion. limited response to indirectly acting sympathomimietics such as ephedrine.

Maternal Addiction to amphetamines increases or decreases MAC for GA? what is the consequence?

increases. increased IH = inc risk for uterine atony.

Maternal Addiction - which drug can decrease plasma cholinesterase?

cocaine - prolongs duration of 2-chloroprocaine and succinylcholine

the vasoconstrictive effects of cocaine have what effect on the fetus?

decreased uteroplacental blood flow

Chronic cocaine - preferred anesthetic for C section

neuraxial - less HoTN - exaggerated HTN, tachycardia with ETT, severe tachyarryhtmias with GA

T/F There is little evidence that HIV or antiretroviral drugs increase the incidence of pregnancy complications, or that pregnancy alters the course of infection

TRUE

Pharyngeal lymphatic hypertrophy can create a potentially difficult airway in the patient with ___

HIV

Hypotension d/t decreased afterload will reverse a ____ shunt, with resulting ___ shunting and cyanosis.

L-->R, R-->L beware SAB!

cardiac output is highest in pregnancy when?

~80% above baseline immediately following delivery, this will be stressful for patient with cardiomyopathy

How does alcohol affect pregnancy/

increased risk of hemorrhage d/t esophageal varies, clotting abnormalities d/t hepatic dz, cardiomyopathy, neuropathy, increased gastric volume, acidity

Which drug causes an increased risk of PTL, abrupt placentae, congenital abnormalities, growth retardation, LBW?

cocaine

T/F Chronic cocaine use can cause increased clotting

FALSE - causes thrombocytopenia

coexisting disease Flashcards

(83 cards)