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Flashcards in final Deck (178):
1

SUX dose

20 mg/ml

2

Epi CPR dose

1 mg IV/IO every 3-5 min

3

Epi adult and peds dose

adult= 2-10 mcg bolus PRN to effect
1-10 mcg/min infusion PRN to effect

Ped=0.05-10 mcg/kg bolus
0.05-0.5 mcg/kg/min infusion

4

Norepi dose

0.5-12 mcg/min titrated to effect

5

dopamine low

1.2
vasodilation of kidneys brain and viscera

6

dopamine medium

2-10 mcg/kg/min
incresed CO

7

dopamine high

over 10 mcg/kg/min
alpha activity predominates with profound arterial and venous vasoconstriction

8

dobutamine adult and peds dose

adult=2-10 mcg/kg/min titrated
ped=2.5-10 mcg/kg/min titrated

9

Phenylephrine (neo) adult and peds dose

adult= 50-200 mcg
ped= 0.05-0.5 mcg/kg/min

10

hydralazine dose

2.5-5 mg every 15 min (max is 20-40 mg)
for severe HTN give 10-20 mg slow IV push

11

Furosemide dose

2.5-5 mg
for chronic therapy give 20-40 mg

12

Nitroprusside dose

0.5-10 mcg/kg/min (peds get low end)

13

Thiazides dose

500 mg

14

Mannitol dose

12.5-25 grams

15

methylene blue dose

1-2 mg/kg (up to 50 mg) IV push over 3-5min

16

dantolene dose

2.5 mg/kg IV push

17

adenosine dose

6 mg fast IV push
if SVT sill there then give 12mg fast IV push

18

how many mg of heparin is in 1 unit

0.0002mg

19

warafrin dose

5-7 mg/day

20

aspirin dose for complete platelet inactivation

160mg

21

hespan max dose

20 ml/kg

22

FFP dose for warfarin over activity

15 ml/kg

23

FFP dose for AT3 deficiency

20 ml/kg

24

cryo dose

1 unit= 15 ml and 15ml= 250-350 mg of fibrinogen

25

general anesthesia characteristics

unconsciousness
immobility
muscle relaxation
loss of sensation

26

anesthetics work by inhibiting the release of what

excitatory afferent neurotransmitters

27

opiod agonists do what

bind to and stimulate mu and kappa

28

opiod agonists/antagonists do what

bind to delta, mu and kappa but only stimulate kappa

29

opiod antagonists do what

bind to delta, mu and kappa but doesn't stimulate any of them

30

opiod effects on the heart

bradycardia (except mepiridine which causes tachy)

31

opiod effects on the lungs

decrease resp rate and tidal volume. cough suppresant

32

opiod effects on the eyes

miosis and increased intraocular pressure

33

opiod effects on the GI

salivation and vomiting from chemoreceptor trigger zone (CTZ) being stimulated

34

opiod effects on the head

increased intracranial pressure

35

opiod effects on histamine

releases histamine so avoid asthmatics

36

nerurpletpanalgesia=

mix opiods and tranquilizers for a dream like state

37

endogenous opiods are

B-endorphins, dynorphins, and enkephalins

38

most opiods are water soluble except

diazapam (valium)

39

opiods treat what

acute pulmonary edema as seen in CHF

40

pharmacokinetics of barbs

binds to proteins but free/unbound drug enters the brain. HYPOproteinemia causes more free drug so more goes in the brain so a normal dose can cause prolonged unconsciousness or death

41

main use for barbs

rapid anesthetic induction (always intubate)

42

#1 drug for induction is

propofol

43

how is propofol terminated

metabolized by the liver, excreted by the kidneys but terminated through redistribution

44

propofols onset of action and duration of action

onset- 30-60 seconds
duration- 5-10 min

45

propofols appearance

milky

46

propofol inhibits what

GABA

47

propofol has what side effect on the lungs

potent respiratory depressant so administer slowly

48

propofol has what side effect on the liver

causes increased hepatic enzyme activity so prolonged use (epileptics) metabolize it in the liver much faster

49

dissociative anestheics

phencyclidine
ketamine

50

disocciative anesthetics effect on the heart

increase HR, CO, and BP so they make sick hearts work harder

51

disocciative anesthetics effect on the lungs

stable resp rate and tital vol. Apneustic at high doses

52

benzodiazepines (MDL)

midazolam (versed)
diazapam (valium)
lorazapam (ativan)

53

benzdoazapines block what

GABA

54

benzdoazapines reversal agent

flumazenil (anexate)

55

Inhaled halogenated anesthetics (DISH)

desflurane (suprane)
isoflurane (forane)
sevoflurane (Ultane)
halothane

56

Inhaled halogenated anesthetics effects on the heart and lungs

heart= decreased BP
lungs= CO2 retention and acidosis (met and resp)

57

which Inhaled halogenated anesthetics causes coronary steal syndrome

forane
- when dilation steals blood flow from stenotic aresa

58

high vapor pressure
low vapor pressure

high= volatile with precision vaporizer
low= non volatile with a non precision vaporizer

59

high blood gas partition coefiecient
low blood gas partition coefiecient

high= more soluble in blood so SLOW induciton/recovery
low= less soluble in blood so FAST induction /revovery

60

high MAC
low MAC

high= LESS potent so increase setting
low= MORE potent so increase setting

61

deflurane (suprane) MAC=

7.2- 9.8 (LESS POTENT)

62

isoflurane (forane) MAC=

1.3-1.63 (MOST POTENT)

63

sevoflurane (ultane) MAC=

2.34-2.58

64

which halogenated anethestic has the lowest blood gas partition coefiecient

desflurane (one breath anesthetic)

65

most effective tool for changing BP on bypass is

the anesthetic vaporizer

66

max nitrous oxide you can give

80%

67

Beta cells secrete

insulin which decreased blood glucose

68

Alpha cells secrete

glucagon which increased blood glucose

69

Delta cells secrete

somatosatin

70

diabetes insipidus=

doesnt respond to ADH so you have dilute urine

71

diabetes mellitus type 1

insulin dependent= absolute insulin deficiency

72

diabetes mellitus type 2

non insulin dependent= relative insulin deficiency

73

diabetes mellitus type 3

other= side effects of drugs, infection, genetics

74

diabetes mellitus type 4

gestational= 3rd trimester

75

insulin and c-proteins half life

insulin 3-5 min
c-protein 30 min

76

what kind of effect does insulin exhibit on target tissures

ANAbolic

77

insulin is commonly used to treat what on bypass

hyperkalemia (drives K intracellularly)

78

rapid onset/short action insulin

regular insulin (humulin R, novolin R)
insulun lispro (humulog)
insulin aspart (novolog)
insulin glulisine (aprida)

79

intermediate onset and acting insulin

neural protamine hagedorn (humulin N, novolin N)

80

long actin insulin

insulin glargine (lantus)
insuline detemire (levemir)

81

MIC=
MBC=

MIC= min INHIBITORY conc that prevents growth
MBC= min BACTERIOCIDAL conc that kills 99%

82

Antistaphylococcal (DON)

docloxacillin (dynapen)
oxacillin
Nafcillin (nallpen)

83

Broad Spectrum (AA)

ampicillin
amoxicillin

84

Antipseudomonal (PTC)

piperacillin (piperacil)
ticarcillin (ticar)
carbencillin (geocillin)

85

B-lactaminase inhibitors

amoxicillin + CA= Augmentin
ticarcillin + CA= Timentin

86

Aminoglycosides (STAGN)

streptomycin
tobramycin (nebcin)
amikacin (amikin)
gentamicin
neomycin

87

vancomysin treats what

MRSA, MRSE, gram pos

88

antistaphylococcal drugs treat what

gram pos- break down peptidoglycan bonds

89

DOC for precardiac surgery dental prophyllaxis

amoxicillin

90

antipseuomonal drugs treat what

gram neg

91

what does clavulanic acid (CA) do

suicide inhibitor for B-lactaminase

92

aminoglycosides treat what

gram neg

93

which aminoglycoside in the most/least resistane

most= streptomycin
least= amikacin

94

mycin means=

streptomyses sp

95

micin=

micromonospora sp

96

how to aminoglycosides interact with pens, cephs, and vanco

synergistic reaction

97

which type of antimicrobial crosses the blood/placenta barrier and concentrates in the fetal tissue

aminoglysocsides

98

what so glucocorticoids cause

--vasoconstriction and insulin release so its a STRONG insulin antagonists
--decease WBS # and functionality so its an immunosupressive even at a single dose
--supress T cells

99

glucocorticoids are what type of sterois

CATabolic

100

side effects from glucocorticoids are seen what

high doses long term

101

glucocorticoid drugs

prednisone
prednisolone
hydrocortisone (solu-cortef)
dexamethasone (decadron)
methylpredisolone (medrol)

102

calcineurin inhibitors

cyclosporin (sandimmune)
tacrolimus (prograf)

103

mTOR inhibitor

Sirolimus (rapamune)

104

Antiproliferative agents (MAM)

mycophenolate mofetil (cellcept)
azathioprine (imuran)
mycophenolate sodium (myfortic)

105

malignant hyperthermia treatment

stop volatile anesthetic and sux
hyperventilate with 100% 02
give 1-2mg bicarb
give 2.5 mg/kg IV push of Dantrolene and repeat PRN
cool patient
treat arrhythmias (dont use Ca++ channel blockers)
monitor coagulation and electrolytes

106

malignant hyperthermia is caused by what mutation

RYR1

107

Norepi (levophed) effects

increased SVR
decreased HR

108

what is the rate limiting step in the synthesis of Ach

uptake of choline

109

what is the rate limiting step in the synthesis of Norepi

tyrosine getting transported intracellularly and getting hydroxylated in to DOPA

110

after Ach is released by the presynaptic nerve is is rapidly hydrolyzed by what

acetylcholinesterase

111

difference between depolarizing and nondepolarizing NMB

depolarizing= agonist of Ach (sux)
nondepolarizing=antagonists of Ach

112

suz has side effects in what communities

persian jewish
indian hindu

113

after norepi is released by the presynaptic nerve- left overs get metabolized by COMT or MOA- but what happens most commonly

it gets reabsorbed in presynaptic nerve

114

alpha 1 effects

smooth muscle- non cardiac

115

alpha 2 effects

prejunctional neg feed back loops

116

beta 1 effects

heart, lipolysis and renin)

117

beta 2 effects

lungs, skeletal muscle and insulin

118

epi effects on the heart

increase systolic
decrease diastolic

119

dopamine is the DOC for

cargiogenic or septic shock

120

dobutamine is DOC for

short term CHF as seen in pts struggling to separate from CPB

121

phenylephrine (neo) is DOC for

increase SVR and BP on bypass

122

what are ace inhibitors rate limiting side effect

bad coudh

123

loop diuretics DOC

emergency edema

124

what is special about thiazides

promote reabsorption of Ca++ (decrease bone density by 1/3)

125

mannitol test dose

give 12.5 grams IV and if UOP is less than 50ml/hr for 3 hours then avoid

126

#1 rule when giving mannitol

check for precipitates

127

how do you treat methemoglobinemia

give 1-2 mg of methylene blue (up to 50mg) IV over 3-5 minutes, give ascorbic acid and 100% O2

128

when is the gold standard for giving ace inhibitors

after a AMI

129

Na+ channel blockers are known as

membrane stabilizers

130

lidocaine is DOC for

ventricular arrhythmia's especially post-MI

131

amiodarone is DOC for

A-fib

132

what can K+channel blockers cause

torsades de pointed

133

adenosine is DOC for

SVT

134

magnesium sulfate is DOC for

digoxin induced arrhythmias

135

unfactionated heparin and LMWH half life

unfactionated heparin= 1-2 hours
LMWH= 3-7 hours

136

what enzyme does warfain block

vitamin K epoxide reductase

137

how do you reverse lepirudin

you cant- no reversal agent

138

how do you reverse bivalirudun

hemoconcentrator

139

MOA of aspirin

irreversibly binds to COX 1 and modifies COX 2 (once modified- COX 2 produces lipoxins)

140

1 gram of dextran binds to how many mls of water

20-25 ml

141

perfusion trend of moving toward atyrn and away from

thromabte

142

protamine is a mild anticoagulant by inhibiting what factor

5

143

protamine only partially reverses

LMWH

144

protamine has noe effect on what drug

fondaparinux

145

how do you minimize protamine reaction

administer slowly. administer through intra-aortic. administer with steroids and antihistamines

146

vitamine k has to be given slowly or what will happen

anaphylaxis

147

FFP contains

AT3, PC, PS and all factors BUT 3, 4, 8, 12

148

% of t1/2 with 1 half life
% of t1/2 with 3.3 half life
% of t1/2 with 4.3 half life

1 half life= 50%
3.3 half life= 90%
4.3 half life= 95%

149

DOC for exercise induced angina

b-blockers

150

long term angina DOC
short term angina DOC

long- b-blockers
short- nitrates

151

DOC for variant angina

nifedipine (procardia)

152

DOC for liver failure/edema

spironolactone (aldactone)

153

midazolam

(versed)

154

diazapam

(valium)

155

lorazapam

(ativan)

156

desflurane

(suprane)

157

isoflurane

(forane)

158

sevoflurane

(Ultane)

159

regular insulin

(humulin R, novolin R)

160

insulun lispro

(humulog)

161

insulin aspart

(novolog)

162

insulin glulisine

(aprida)

163

neural protamine hagedorn

(humulin N, novolin N)

164

insulin glargine

(lantus)

165

insuline detemire

(levemir)

166

amoxicillin + CA=

Augmentin

167

ticarcillin + CA=

Timentin

168

tobramycin

(nebcin)

169

amikacin

(amikin)

170

hydrocortisone

(solu-cortef)

171

dexamethasone

(decadron)

172

methylpredisolone

(medrol)

173

cyclosporin

(sandimmune)

174

tacrolimus

(prograf)

175

Sirolimus

(rapamune)

176

mycophenolate mofetil

(cellcept)

177

azathioprine

(imuran)

178

mycophenolate sodium

(myfortic)