Exam 2 Review Cards Flashcards
(212 cards)
1
Q
Vasoactive substances: Vasodilators (PDN)
A
Prostaglandins E and I2
Dopamine
Nictric Oxide
2
Q
Vasocative Substances: Vasoconstrictors (ATEA)
A
Angiotensin II
Thromboxane
Endothelin
Adrenergic Stimulation
3
Q
Types of Acute kidney Failure
Prerenal is ______%, Intra-renal _____% and Post renal _______
A
70
20-30
10
4
Q
In pre-renal the BUN/Cr ratio is
A
> 20 (greater than)
5
Q
In Intral renal the BUN/Cr ratio is
A
< 20
6
Q
The FENA is prenal when it’s _______in adults and _____in infants
A
<1% in adults and 2.5% in infants
7
Q
The FENA is renal if it’s __________
A
2%
8
Q
Pre-Renal Failure is caused by (LEDD)
A
Loss of ECF , cardiac failure, sepsis
Diminished perfusion
Decreased GFR
Exacerbated by NSAIDs, ACEI, ARBs
9
Q
IntraRenal Failure in infants? adults?
A
Infants = Birth asphyxia, sepsis, cardiac surgery Older= trauma, sepsis, hemolytic uremic syndrome
10
Q
Pre-Renal AKI can cause intrarenal
A
AKI
11
Q
Intrarenal Obstruction can be caused by _______
A
Acute Glomerulonephritis
12
Q
Drugs causing intrarena failure (3)
A
Aminoglycosides
Amphotericin B
Nephrotoxins including radiocontrasts
13
Q
POST RENAL FAILURE is characterized by
A
Characterized by SUDDEN ANURIA
14
Q
POSTRENAL Failure –> Intrarenal cause
A
Tumor Lysis syndrome
Myoglobinuria
hemoglobinuria
Meds (Acyclovir, ciclofovir)
15
Q
Ureter failure causes by
A
Stones
External compression from lymph nodes/ tumor
urethra
16
Q
Urethra obstruction caused by
A
BPH , kidney stones, obstructed urinary catheter, Bladder stone, Bladder, Ureter or renal malignancy.
17
Q
For dialysis know
A
Input and output from last dialysis
Know dry weight and Actual weight
18
Q
What should you assess after surgery?
A
Assess pulmonary function
19
Q
When should dialysis be?
A
The day before and NOT THE DAY OFF
20
Q
Indications for dialysis (VOPS)
A
Volume overload refratory to DIURETICS
Overt signs of uremia, Pericarditis, and Encephalopathy
Persistent Hyperkalemia
Severe Metabolic Acidosis
21
Q
When is dialysis recommended?
A
BUN approaching 100mg/dL
Studies showed 60mg/DL may be better
22
Q
Peritoneal dialysis ________compared with HD
A
Less effective compared with HD
Risk of PERITONITIS
23
Q
What is the primary cause of Metabolic acidosis?
A
the INABILITY of PROXIMAL RENAL TUBULE to increase AMMONIUM FORMATION
24
Q
Kidney is unable to form ________in metabolic acidosis?
A
New bicarbonate
25
With kidney issues, there is EXCESS
Phosphate
Sulfate
Organic acids
26
In kidney, there is __________
SECONDARY HYPERPARATHYROIDISM
27
Hypocalcemia is defined by
Decreased CALCIUM absorption because of deficiency of Vitamin D
28
Infants are unable to Increase this electrolytes
PHOSPHATE EXCRETION
29
Do not give to infants ________enema? why?
Phosphate containing enema
| Can lead to Life threatening
30
Phosphate containing enema can cause
HYPERPHOSPHATEMIA + HYPOCALCEMIA
31
Most common complication of CRF
hypertension
32
Infants with CRF are at risk for both
Hypertension and Hypotension
33
Renin activates
Angiotensin I --> Converted to Angitotensisn II --> A powerful vasoconstrictor --> may need more antihypertensive or less
34
TX of HTN with nicardipine
0.5- 5 mcg/kg/min max 20mg/hr
35
Pt with chronic HTN have a tendency of _______ you must _______
Tanking BP after induction ; Preload with NS
36
HTN --> Volume Afterloard
Increase Preload + Afterload
37
Kidney issues lead to what type of Anemia
Normocytic Normochromic Anemia
38
Fenoldopam will
Increase GFR without the HTN associated
39
Fenoldopam is a
dopamine-1 receptor agonist
40
1st line therapy for Acute HTN dose and (max)
Labetalol 0.1-0.4 mg/kg/hr q 10min Max 40mg
41
Renal Hormones
Renin, Angiotensin, ANP (vasopressin)
42
What is serum osmolality tightly regulated by?
Vasopressin (ADH)
43
ADH is released in response to
INCREASED PLASMA OSMOLALITY
44
ADH synthesized by
Hypothalamus and stored in posterior pituitary
45
ADH binds to receptors where? Increasing the ____________
In collecting duct; permeability of the tubules to water and leading to increased water resorption and concentrated urine
46
Neonates are unable to
Conserve water
47
Aldosterone binds to receptors on
Cells in the distal nephron , increase the secretion of potassium in the urine
48
NEONEATES are less efficient at
excreting potassium loads
49
Acidosis : an increase in K+ by ________meQ for every decrease in pH of ______
0. 5mEq
| 0. 1
50
Dopamine on GFR
Increases
51
Dexmetetomedine on GFR
Increases
52
Fenoldopam on GFR
Increases
53
Meds requiring excretion are
Hydrophyllic
| Highly ionized
54
Examples of meds needing excretion
```
PCN
Aminoglycosides
Cephalosporins
Vanco
Digoxin
```
55
Meds dependent on Renal Elimination
```
Vec
Roc
Atropine
Glycopyrrolate
Neo
```
56
Which medication takes longer to work with renal patients
Rocuronium
57
Meds that do accumulate and HAVE METABOLITES
MORPHINE
| MEPEREDINE
58
Meds that do not accumulate and HAVE NO METABOLITES
Fentanyl
| Sulfentanyl
59
For patients with renal disease, decrease dose by
30-50%
60
What about reversal Agent -->
SUGAMMADEX
Contraindicated with renal failure
RENALLY SECRETED
61
No Metabolites with this medication
PRECEDEX
62
Which medication is renal protective ?
Propofol
63
The functional unit of the liver is the
Hepatic acinus
64
The hepatic acinus centered in the
Portal track and extends into 3 concentric zones (zones of Rappaport)
65
The central zones are _______are more active in _______
1,2 , OXIDATIVE PROCESS
66
The distal zone is ________ more susceptible to
3, Ischemic and toxic injury
67
The Hepatic triad is the
Bile duct
Branch of the portal vein
Hepatic artery
68
Enzymes inhibition is when
Competing for same enzymes
69
Enzyme inhibitors are (GFQS)
Grapefruit juice
Fluoxetine
Quinidine
Sulfaphenazole
70
Enzymes induction is when
There is ENHANCED EXPRESSION
71
Enzymes inducers are (RPP, TCC)
```
Rifampin
Phenytoin
Phenobarbital
Tobacco smoke
Chronic Alcoholism
Carbamezapine
```
72
What is the most abundant enzymes in the human liver
CYP3A4
73
50% of drugs metabolized by
CYP3A4
74
Halothane induced Hepatitis--> Halothane inhibits______
Inhibits PROTEIN SYNTHESIS and SECRETION which is an
Early indicator of HEPATIC cytotoxic injury
Give SEVOFLURANCE
75
Halothane is broken down to
15-20% to TRIFLUOROACETYL Acid Chloride
76
What does Increases in liver enzymes indicate
Drug-induced INJURY
77
Are liver enzymes good indicators of liver function
NO
78
Indicators of liver functions tests
PT> 15 sec
INR> 1.5
or both
79
Liver enzymes: ALT vs AST which one specific to Liver
ALT
80
Other Tests for enzymes
hypoalbuminena
Hypoglycemia
AMS
81
Clearance
Decrease plasma clearance and prolong effects
82
Ketamine is metablized via
Methylation
83
Metabolism of this drugs is minimally affected by liver dysfunction
Ketamine
84
Pt with liver disorder, best medication to give is
Ketamine
85
What determines the concentration of an opioid?
HEPATIC clearance
| PROTEIN binding
86
Damaged liver not as efficient because
Decrease first pass effect
| Decrease drug clearance
87
Liver disease affect _______Which is how _____is metabolized
GLUCURONIDATION; morphine
88
Perfusion limited clearance drugs are (MeLiPenMor)
Meperidine
Lidocaine
Pentazocine
Morphine
89
When is MAC the highest
@ 6 months
90
MAC is highest in ____Than ____
Children; adults
91
Age related MAC changes are related to (3) MGD
```
Maturational changes in CBF
GABA class A receptors changes
Developmental shifts in regulation of chloride transportes
```
92
IMPORTANT MAC for potent volatile anesthetics is _______in neonates but may be ________
Increased in neonates but may less in SICKER NEONATES and premies
93
ETOMIDATE Dose
0.2 - 0.3 mg /kg/ IV
94
What is the dose of diazepam
0.1 -0.3 mg/kg
95
Diazepam is contraindicated in
Less than 6 months
96
What is the half life of Diazepam
80 hours
97
What is FA/FI
the rate of increase or equilibration of the partial pressure of alveolar to inspired anesthetic (wash-in)
98
FA/FI is the function of
The Rate of delivery of anesthetics to AND UPTAKE FROM THE LUNGS
99
Six factors that determine the wash-in of inhaled anesthetics
```
Inspired Concentration
Alveolar Ventilation
Functional Residual Capacity
Cardiac Output
Solubility
Alveolar to venous partial-pressure gradient
```
100
The factors that determine DELIVERY OF ANESTHETICS to the LUNGS
Inspired concentration
Alveolar Ventilation
Functional Residual Capacity
101
The factors that determine REMOVAL (UPTAKE) from the lungs
Cardiac output
Solubility
Alveolar to venous partial pressure gradient
102
Wash in ______Related
inversely related to their solubilities in blood
103
FA/FI is inversely related to
Changes in CO
104
There is a rapid
rapid rate of increase of FA/FI in neonates
105
What most happen for the rate of FA/FI to increase toward equillibration?
For the rate of FA/FI to increase toward equillibration, the RATE OF DELIVERY of ANESTHETIC to the lungs must substantially exceed its UPTAKE FROM THE LUNGS.
106
When the ratio is 1
Inspired and alveolar partial pressure have EQUILLIBRATED
107
FA/FI mostly affects
Soluble agents
108
Opposite reactions of FA/FI in pediatric
Increase CO speeds up FA/FI
| More CO goes to vessel rich groups
109
Wash out curve follow
Exponentional decay
| Exact oppposite of wash in curves
110
Wash out similar in _______and more rapid in ________
Children and adults
| Neonates and infants.
111
Nonrebreathing circuits lack and there 's
Unidirectional valves and theres minimal work of breathing
112
In NRB there is no ____________rebreathing is highly dependent on
Fresh gas flow
113
Wht is the minimum FGF
5L min
| 2-3 MV
114
Expiration
Exhaled gas push down expiratory limb and collects in reservoir bag and open exp valve (APL)
115
All NRB are convenient
Lightweight and easily scavenged
116
Use MAPLESON D Circuit in children
< 10 kg
117
Bain circuit
FGF tubing directed within inspiratory limb
FGF enters NEAR MASK
Add more head and humidity.
118
Minimum ABL calculation
MABL = EBV * (Starting Hct - target Hct/ Starting Hct)
119
EBV premature
100ml/kg
120
EBV full term
90 ml/kg
121
EBV 3-12 months
80 ml/kg
122
EBV 1 year +
70 ml/kg
123
Which medications is contraindicated for seizure disorder
Ketamine (cerebral excitation)
124
Meperidine dose _________--> Long infusions---->_____________ ---> Seizures
1-2mg/kg
| Normeperidine
125
Methohexital dose IV
1-2mg/kg
126
Methohexital dose rectal
20-30mg/kg/PR
127
Ketamine IV dose
1mg/kg
128
Ketamine PO and rectal dose
6-10mg/kg
129
Ketamine IM dose for sedation
3-4 mg/kg
130
Ketamine IM dose for GENERAL INDUCTION
6-10mg/kg
131
Propofol dose
3mg/kg
132
Midazolam dose IV/IM
0.1mg/kg
133
Midazolam dose intranasal
0.2mg/kg
134
Fentanyl lollipops
15-20 mcg/kg
135
Midazolam PO/ or Per rectum
0.5 mg/kg
136
Reglan dose PO , IV
0.2mg/kg
137
Glycopyrrolate dose IV, and IM
5-10MCG/kg IV ; 10mcg/kg IM
138
Zofran dose
0.1mg/kg IV
139
Fentanyl dose is
1 MCG/kg
140
Succinylcholine dose is
1-2mg/kg IV
| 4mg/kg IM
141
Succinylcholine dose for laryngospasm
0.1 mg/kg IV
| 4 mg/kg IM
142
Atracurium dose is
0.5mg/kg IV
143
Cistracurium dose is
0.15mg/kg IV
144
Vecuronium dose
0.1mg/kg
145
Rocuronium dose is _______IV and _____IM
0. 6 - 1.2mg/kg IV
| 1. 8 mg/kg IM
146
Neogstimine dose is
0.02-0.025 mg/kg
147
Sugammadex dose is
2mg/kg
148
RSI give _______of _____Prior to succinylcholine
Atropine
| 0.02mg/kg
149
Morphine half life
2 - 3.5 hours
150
Hydromorphone and oxycodone half life
2-4 hours
151
Methadone Half life
22-25 hours
152
Meperidine half life
3-5 hours
153
Codeine half life
3 hours
154
Fentanyl half life
2-3 hours
155
Atracurium maintenance dose during anesthesia with N2O
0.30mg/kg
156
Atracurium maintenance dose during anestheisia with halothane
0.20mg/kg
157
Atracurium suggested dose for Tracheal intubation
0.5 - 0.6 mg/kg
158
Cisatracurium maintenance dose for anesthesia with N2O
0.10 mg/kg
159
Cisatracurium dose for tracheal intubation
0.10 mg/kg
160
Vecuronium dose for tracheal intubation
0.10 - 0.15 mg/kg
161
Vecuroinum maintenance dose for anesthesia with N2O
0.08 mg/kg
162
Neogstimine maintenance dose
(0.02-0.06mg/kg ) + atropine (0.01 - 0.02mg/kg)
163
2 medications with doses in Mcg
Fentanyl
| Glycopyrrolate
164
True emergencies list (MINB)
NEC --> if free air in abdomen
Bilateral Stenosis with (choanal atreasia)
MALROTATION and MIDGUT VOLVULUS
INCARCERATED or STRANGULATED HERNIA
165
GI pathology not an emergency unless
compromised blood flow
166
Fentanyl half life with premies
6-32 hours
167
Which opioid has the longest half life
Methadone.
168
OMPHALOCELE (FWB) Cause location, associated symptoms)
| Bowel is
Failure of gut to migrate from yolk sac to abdomen
Within umbilical cord
Beckwith wiedeman syndrome (macroglosia, gigantism, hypoglycemia, hyperviscosity, CHD, estrophy of bladder)
Bowele looks and functions normally
169
GASTROCHItis Causes, location and associated sx (OPE)
Bowel is
Occlusion of Omphalomesenteric actery
PERIUMBILICAL
Exposed gut inflammation, edema, dilation and foreshortened
Functionally abnormal
170
Metabolic derangements in GI disorders are (HAT)
HypeRKALEMIA
Anemia
Thrombocytopenia
171
Most susceptible injury of micropremie is
PERIVENTRICULAR WHITE MATTER
172
Neonatal brain has
Greater brain weight in proportion to body weight.
173
Bilious EMesis seen in (DMH)
```
Duodenal atresia (congenital absecense or complete close of a partion of the lumen of the duodenum)
Malrotation and midgut volvulus
Hirschprung disase : absence of parasympathetic ganglion in large intestine
```
174
NON-Bilious emesis seen in
HYPERTROPHYIC PYLORIS STENOSIS
175
CNS effects : anesthetics
Both neuroprotective and neurotoxic
176
Choanal Atresia is Developmental failure of
nasal cavity to communicate c/ nasopharynx
177
Choanal Atresia may be• Associated c/ other congenital anomalies
• CHARGE syndrome TP
• VATER
```
Coloboma
Heart disease
Atresia choanae
Retarded growth
Genital anomalies
Ear anomalies)
```
* Treacher-Collins
* Pfeiffer
```
Vertebral defects
Anal atresia
Tracheoesophageal fistula c/
Esophageal atresia
Radial and renal anomalies
```
178
Most common TEF classification
| Gross classification and VOGT type:
Gross classification C, Vogt type 3B
consists of blind proximal esophageal pouch (atresia) with a distal TEF just above the carina
80%–90% of cases
179
Litigation of PDA Controversial procedure due to conflicting evidence why?
• Ibuprofen works just as well s/complications • Paracetamol being used c/ equal
effectiveness
1/3 develop severe cardiovascular instability • Increased risk of chronic lung disease, ROP, and neurosensory impairment after ligation
180
• Medical management of Litigation of PDA:
| Class of medication________such as _______and _______
cyclooxygenase inhibitor, such as indomethacin or ibuprofen
181
For treatment of PDA, Indomethacin in premies may cause:
Thrombocytopenia
Renal failure,
Hyponatremia
Intestinal perforation
182
Surgical correction of PDA
Left thoracotomy with manual retraction of lung
183
Hard to distinguish_____From _____
| What is done to distinguish?
PDA from aorta
Monitoring BP and pulse ox on right arm (preductal) and oximetry on the foot (postductal) will assist surgeon to identify the correct vessel to be ligated
184
```
To identify correct vessel ?
A_________ placed on perceived PDA
• If aorta is clamped →
• If PA is clamped →
• Successful PDA ligation →
```
Temporary clamp
loss of post ductal oximetry
↓in both oximeters and ↓ETCO2
↑MAP (↑DBP) + NO changes in pulse oximeters
185
Transcatheter occlusion of PDA
Similar _________
Can be done where _________
More _________
Coils or occlude device
• Similar efficacy to traditional surgery
• Can be done in NICU c/ echo guidance
• More rapid recovery of resp function
186
Most common complications of Transcatheter occlusion of PDA (FLA)
* Femoral artery thrombosis
* Left pulmonary artery stenosis
* Aortic coarctation
187
Appropriate selection of Isoflurane
☺ Less myocardial depression than Halothane
☺ PRESERVATION OF HEART RATE
☺ CMRO2 reduction rate
188
DESFLURANE anesthetic selection
Increased incidence of coughing, laryngospasm,
secretions
☺ Concern of hypertension and tachycardia from
sympathetic activation
189
Appropriate selection of SEVOFLURANE
Can cause bradycardia during induction
less pungent than ISO
MOST SUITABLE FOR INDUCTION
190
Mida + keta
100% peaceful separation
191
HR normally unaffected by desflurane unless
| • Attenuated by
inspired concentration↑ suddenly
| opioid administration
192
ETOMIDATE with induction
Cardiac stable, less apnea than propofol, quickly redistribute
193
Improve platelet count (DRE)
- DIALYSIS
- RBCs
- EPO
194
Ketamine can cause:
Decrease ventilation and airway reflexes
| obstruction. apnea, aspiration
195
Gastrochisis there is
Extreme evaporative volume loss and Hypothermia
| KEEP COVERED WITH saline soaked dressings
196
Hypertrophic PYLORIC STENOSIS is associated with
HYPOKALEMIA
HYPOCHLOREMIA
Metabolic ALKALOSIS
197
More soluble
Halothane
198
Less soluble
Nitrous Oxide (N2O)
199
From top to bottom chart
```
N
D
S
I
H
```
200
Lipid soluble agents 3
Midazolam
Propofol
Ketamine
201
Concern with giving fentanyl to fast
Chest wall rigidity
| GLOTTIC rigidity
202
Alfentanyl and sufentanyl can cause
Parasympathetic Response
| Bradycardia and Hypotension
203
Contraindications for Ketamine
```
COIS
Can't use for EEG
Open globe injury
Increased ICP
Seizures
```
204
Patient with LIVER issues give this medication (anest)
SEVOFLURANE
205
Dual blood sources of the liver
Portal vein 70% drains spleen and intestine
| Hepatic Artery
206
Sevo is metabolized to
Formyl Fluoride 2-5 %
207
Which medication does not break down to TFA
Sevoflurane
208
When a patient has TEF
Look for other anomalies as well
209
FROM MOST TO LEAST METABOLIZED (hid)
Halothane
Isoflurane
Desflurane
210
Fentanyl lack these needed anesthesia properties
areflexia
211
Peritubalar secretes in response to hypoxemia
Erythropoietin
212
Calculate weight based on age
2 x age (yrs) + 9
