Miscellaneous topics 6

Question 1

What are the respiratory presentation of anaphylaxis?

Answer 1

bronchospasm- decreased EtCO2, decreased SaO2, increased peak inspiratory pressure
laryngeal edema
increased mucus production

Question 2

What are the GI effects of anaphylaxis?

Answer 2

abdominal cramping
N/V
diarrhea

Question 3

What are the skin effects of anaphylaxis?

Answer 3

flushing
urticaria (hives)
erythema
pruritus

Question 4

Type 1 is a _____________ mediated reaction

Answer 4

IgE

Question 5

The best lab test to determine if an allergic response has occurred is

Answer 5

tryptase

Question 6

Type 2 is a ______________ mediated reaction

Answer 6

IgG and IgM

Question 7

High risk groups for a latex allergy include

Answer 7

spina bifida/myelomeningocele, atopy, health care workers and allergy to banana, kiwi, mango, papaya, pineapple, and tomato

Question 8

Other common allergens in the OR include

Answer 8

chlorhexidine, protamine, contrast media, colloids, blood products, opioids, hypnotics, and local anesthetics

Question 9

Cisplatin, a chemotherapeutic agent, can cause

Answer 9

acoustic n. injury + nephrotoxicity

Question 10

Vincristine & vinblastine, a chemo drug, can cause

Answer 10

peripheral neuropathy

Question 11

Bleomycin, a chemo drug, can cause

Answer 11

pulmonary fibrosis (keep FiO2 <30%)

Question 12

Doxorubicin, a chemo drug, can cause

Answer 12

cardiotoxicity

Question 13

5-fluorouracil, a chemo drug, can cause

Answer 13

bone marrow suppression

Question 14

Methotrexate, a chemo drug, can cause

Answer 14

bone marrow suppression

Question 15

A history of severe N/V can impact

Answer 15

volume status and electrolyte balance

Question 16

____________ may be a reason to avoid an oral airway, nasal airway, LMA, or esophageal temperature probe.

Answer 16

Mucositis (ulceration of mucous membranes)

Question 17

What are the five key GI hormones?

Answer 17

Gastrin
secretin
cholecystokinin
gastric inhibitory peptide
somatostatin

Question 18

The universal “off” switch for digestion is this hormone:

Answer 18

somatostatin

Question 19

This hormone increases stomach acid and stimulates chief cells to secrete pepsinogen:

Answer 19

gastrin

Question 20

This hormone instructs the pancreas to secrete bicarbonate and the liver to secrete bile:

Answer 20

secretin

Question 21

This hormone slows gastric emptying and stimulates pancreatic insulin release:

Answer 21

gastric inhibitory peptide (K cells)

Question 22

Barrier pressure is reduced by things that

Answer 22

reduce LES tone (cricoid pressure, anticholinergics, pregnancy)
increase intragastric pressure (pregnancy)

Question 23

__________ is increased in the patient with Zollinger-Ellison syndrome

Answer 23

Gastrin (gastrin secreting tumor–> increased stomach acid–> gastric ulceration)

Question 24

Gallbladder pain after a fatty meal is caused by

Answer 24

increased CCK release

Question 25

The treatment for carcinoid tumors is

Answer 25

somatostatin

Question 26

___________ is a drug that increases barrier pressure

Answer 26

metoclopramide

Question 27

Which agent primarily targets the chemoreceptor trigger zone? a. ondansetron b. scopolamine c. dexamethasone d. hydroxyzine

Answer 27

a. ondansetron

Question 28

What are the 6 types of antiemetics?

Answer 28

5-HT3 antagonists Neurokinin-1 antagonists dopamine antagonists antihistamines anticholinergics steroids

Question 29

What type of anesthetic reduces the risk of PONV?

Answer 29

TIVA & regional anesthesia

Question 30

_____________ should be administered during induction to be effective

Answer 30

Dexamethasone

Question 31

Ondansetron should be administered

Answer 31

30 minutes before emergence

Question 32

Dopamine antagonists include

Answer 32

butyrophenones, phenothiazines, metoclopramide

Question 33

Dopamine antagonists can cause

Answer 33

extrapyramidal symptoms

Question 34

These drugs are contraindicated in the patient with Parkinson's disease:

Answer 34

dopamine antagonists

Question 35

Metoclopramide is contraindicated with

Answer 35

bowel obstruction

Question 36

Propofol at _____- produces an antiemetic effect

Answer 36

10-20 mg

Question 37

Ephedrine given ___________ may reduce PONV by

Answer 37

25 mg IM by maintaining BP and cerebral perfusion

Question 38

Transdermal scopolamine is best applied

Answer 38

>4 hours before the induction of anesthesia; lasts for 72 hours

Question 39

The vomiting center resides in the

Answer 39

nucleus tractus solitarius (medulla)

Question 40

Sensory input to the vomiting center arises from

Answer 40

the chemoreceptor trigger zone, GI tract, and vestibular system

Question 41

The GI tract gives rise to these receptors involved in vomiting:

Answer 41

5-HT3 NK-1

Question 42

The CTZ gives rise to these receptors involved in vomiting:

Answer 42

5-HT3 NK-1 DA-2 noxious chemicals

Question 43

The vestibular apparatus gives rise to these receptors involved in vomiting:

Answer 43

H1 M1

Question 44

Patient risk factors for PONV include

Answer 44

female gender nonsmoker history of motion sickness previous episodes of PONV age is loosely associated (youth> elderly)

Question 45

Anesthetic risk factors for PONV include

Answer 45

halogenated anesthetics nitrous oxide (>50%) opioids etomidate neostigmine

Question 46

Surgical risk factors for PONV include

Answer 46

long surgical duration (> 1 hr) GYN procedures laparoscopy breast plastics peds procedures: strabismus, orchiopexy, T&A

Question 47

The most common side effects of ondansetron are

Answer 47

headache and/or diarrhea

Question 48

5HT3 antagonists and butyrophenones can prolong

Answer 48

the QT interval (droperidol has a black box warning for QT prolongation)

Question 49

Motion induced nausea is the result of

Answer 49

M1 & H1 stimulation in the vestibular system of the inner ear

Question 50

Patients undergoing _______ should receive antiemetic agents that target the vestibular system

Answer 50

middle ear surgery

Question 51

Prochloroperazine produces significant

Answer 51

sedation

Question 52

A nonpharmacologic method of reducing PONV is

Answer 52

the P6 acupressure point- pressure point located 3 finger breadths below the wrist on the inner forearm