Module 4-Induction Flashcards
(167 cards)
1
Q
Identify the MAC level when the patient responds to repeated painful stimuli, airway intervention is needed, ventilation possibly inadequate & CV function is maintained
A
Deep Sedation
2
Q
Identify the MAC level where the patient responds to verbal/tactile stimulation, no airway intervention needed, ventilation is adequate & CV is usually maintained
A
Moderate Sedation
3
Q
Pseudocholinesterase is inhibited by what drugs?
A
Esmolol, Neostigmine, Regland, in burn patients, renal & liver disease
4
Q
Sugammadex is effective against
A
Vecuronium & Rocuronium
5
Q
What ventilation mode is used with ETT placement?
A
Volume Control
6
Q
MOA of Lidocaine
A
Inactivates Na+ channel & is concentration dependent
Prevents action potential
7
Q
What is the onset of Succinylcholine?
A
30 seconds
8
Q
What is the duration of Succinylcholine?
A
7-12 min
9
Q
What is the IV does of Succinylcholine?
A
1-1.5mg/kg IV
10
Q
What is the IM does of Succinylcholine?
A
3-4mg/kg IM
11
Q
When are the effects of Succinylcholine increased?
A
When an anticholinesterase reversal is given
12
Q
How much should you increase Succinylcholine by to give a defasciculating dose?
A
Increase dose by 1.5-2mg/kg or give NDMR 3-5 min prior
13
Q
Non-depolarizers MOA
A
They are competitive antagonists
Prevents initiation of an Action Potential
14
Q
Intubating dose of Atracurium
A
0.5mg/kg
15
Q
Onset of Atracurium
A
3-5 min
16
Q
Duration of Atracurium
A
30-45min
17
Q
How is Atracurium metabolized?
A
Ester Hydrolysis
Non-specific plasma esteraase
Hofmann elimination (pH & temp dependent)
18
Q
Atracurium can cause a
A
Histamine release
19
Q
Onset of Mivacurium
A
3-4min
20
Q
Mivacurium causes this at low doses
A
Histamine release
21
Q
What is the intubating does of Mivacurium?
A
0.2mg/kg
22
Q
What is the duration of Mivacurium
A
15-20min
23
Q
How is Mivacurium metabolized?
A
Pseudocholinesterase
24
Q
Intubating dose of Cis
A
0.1-0.2mg/kg
25
What is the onset of Cis
4-7 min
26
What is the duration of Cis
35-50min
27
How is Cis metabolized?
Hofmann Elimination
28
What is the intubating dose of Vecuronium
0.1mg/kg
29
What is the onset of Vecuronium?
3-4min
30
What is the duration of Vecuronium
25-50min
31
Which NDMR is the fastest?
Rocuronium
32
What is the onset of rocuronium?
1.5-3min
33
What is the duration of Rocuronium?
30-70min
34
What is the standard intubating dose of Rocuronium
0.6mg/kg
35
What is the RSI dose of Rocuronium
1.2mg/kg
36
What are the vent settings when using an LMA?
VC or PSV
37
How much Fentanyl can you administer for induction?
100-200mcg
2-3mcg/kg
38
MAC is a measure of
Potency
39
Propofol lasts for
10 min
40
What is the MAC dose of Propofol?
20-100mcg/kg/min
41
What is the MAC dose of a Ketamine infusion?
0.1-0.3mg/kg/hr
42
What is the bolus dose of Precedex
0.25-0.75 mcg/kg
43
% of Ketamine Pro Binding
12%
44
What is the elimination half life of ketamine?
2-3 hours
45
Distribution half life of Ketamine
11-17
46
What is the distribution half life of propofol
2-4
47
Elimination half life of Propofol
1-5
48
Pro binding % of Propofol
98
49
Distribution half life of Etomidate
2-4
50
Elimination half life of Etomidate
2-5
51
Pro binding of Etomidate
75
52
Propofol, Etomidate & Barbiturates cause
An extension of Cl- opening, causing hyperpolarization
53
What is the percentage makeup of Propofol
10% soybean
2.25% glycerol
1.2% egg lecithin
54
What makes propofol susceptible to bacterial contamination?
The emulsion
55
What is in Propofol that can cause an allergy & also prevents bacterial & fungal growth
0.005% disodium edetate
56
Generic Propofol contains
Sodium Metabisulfite or benzyl alcohol as a preservative
57
What technique should you use when drawing up propofol?
Aseptic
58
When should Propofol be discarded?
After 6 hours
59
Propofol binds to what sub-unit?
Beta 2
60
With Propofol administration, the influx of Cl- hyper polarizes which synaptic membrane?
The post-synaptic membrane
61
Propofol is a ______stimulant
Direct stimulant
62
What causes burning for Propofol
2.25% glycerol
63
What is the dwelling dose of Lidocaine?
20-40mg
64
Propofol has what effects?
Antiseizure
Antiemetic
65
What can help with Propofol burn
Lidocaine
Large bore IV
66
Why dose Propofol cause cloudy urine?
Uric Acid Crystals
67
What are the side effects of Etomidate?
Pain on injection
Myoclonia
N/V
Adrenocortical Suppression
68
There will be a decrease if plasma cortisol for how many hours after Etomidate is given
8-24 hours
69
What enzyme is inhibited with Etomidate administration
11 beta-hydroxylase
70
What is the induction dose of Etomidate
0.2-0.3mg/kg
71
Etomidate will decrease
CRMO2
72
What do we give with Ketamine & why?
Benzos to help with the dissociative, unpleasant feeling
73
Ketamine effects on BIS monitoring
Will increase it due to increased cerebral blood flow
74
What is the onset of Ketamine
30-60sec
75
What is the duration of Ketamine
10-20min
76
What is the MOA of Mg+
NMDA antagonist
77
Which medications can be given for pain control
Mg
Ketamine
Precedex
78
What is the Ketamine dose for pain
0.25-0.5mg/kg IV
79
Why is an antisialagogue given with Ketamine?
Because Ketamine causes increased oral secretions
80
Does Ketamine increase IOP?
Yes, usually at high doses of 6mg/kg, but not with 3mg/kg
81
Benzos will increase
The Cl- channel opening frequency
82
What is the onset of Benzos
30-60sec
83
What is the duration of Benzo
20-60min
84
Midazolam produces what effects
Anxiolytic
Sedative
Hypnotic
Amnestic
Anticonvulsant
85
How are Benzos classified?
Elimination half life
86
Elimination of Diazepam
Greater than 24 hours
87
Elimination 1/2 time of lorazepam
6-24 hours
88
Elimination 1/2 time of Midazolam
Less than 6 hours
89
Benzos provide what type of amnesia?
Anterograde
90
Is Remimazolam organ independent?
Yes, just like Remifentanil
91
What makes Remimazolam susceptible to non-specific tissue esterases
Carboxylic ester moiety
92
Presynaptic effects of Precedex
Sedation
93
Post synaptic effects of Precedex
CV effects
94
MOA of Precedex
Negative feedback
Decreases release of NE
Hyperpolarization
95
What is often seen with Precedex
HOTN
Bradycardia
96
Precedex resembles
Natural Sleep
97
Fentanyl MOA
Mu opioid agonist
98
Celebrex MOA
COX-2 inhibitor
99
Gabapentin MOA
Blockage of Ca+ voltage gated channels
100
Acetaminophen MOA
COX 1 & 2 inhibitors
101
IV onset of Fentanyl
1-2 min
102
Peak time of Fentanyl
3-5 min
103
Duration of Fentanyl
30-60 min
104
Fentanyl goes through
1st pass pulmonary uptake
105
Scopolamine causes antagonism of
Muscarinic acetylcholine (M1) receptors
Blocks impulse from inner ear to medulla
Apply 2-4 hours pre-stimulus
106
What are anticholinergic side effects?
Dry mouth, blurred vision, tachycardia, dry skin, rash
107
How do you treat central anticholinergic syndrome?
Tx with Physostigmine since it crosses the BBB
108
Tylenol has no effect on
PLTs & has no anti-inflammatory effects
109
Tylenol can cause
GI bleed, CV events & hepatic toxicity
110
Celecoxib has the highest risk for
Thrombosis due to COX 2 inhibition
111
Celecoxib increases the risk for
CV events
112
Celecoxib decreases the risk of
GI effects
113
Which 2 neuromuscular blockers are likely to cause anaphylaxis
Succinylcholine
Rocuronium
114
When does the dose of Sch need to be increased?
When given to an MG patient
115
Sch has a higher affinity for
Ach
116
What are some characteristics of Sch (dosage wise)?
Faster onset 30sec
Duration 7-12 min
1-1.5mg/kg IV
117
Make up of Sch drug
2 Ach molecules are fused together
Competitive agonist of Ach
118
What complaint is often associated with Sch
Muscle weakness
119
What complication can potentate Sch
Pseudocholinesterasae deficiency
120
Sch binds what receptors?
Nicotinic, which blocks Na+ channels from opening & enter the cell
121
Non depolarizers like Rocuronium are
Competitive antagonist to Ach
Prevent initiation of action potential
122
What is the onset of Roc
1.5-3min
123
What is the duration of Roc
30-70min
124
What is the intubating & RSI dose of Roc
Intubating: 0.6mg/kg
RSI: 1.2mg/kg
125
Phenylephrine is a
Synthetic non-catecholamine
126
Phenylephrine mimics
NE effects, but is less potent & last longer
127
Phenylephrine causes
DIRECT alpha 1 effects
Bradycardia
128
What is the bolus dose of Phenylephrine
50-200mcg
129
Esmolol is a selective
Beta 1 antagonist
130
Characteristics of Esmolol
Decreases SNS response
Short acting
Decreases anesthetic response
Opioid sparing
Masks light anesthesia
131
What is the bolus dose of Esmolol
0.5-1mg/kg vs 0.2-0.5mg/kg??
132
How is esmolol metabolized?
Ester hydrolysis in the plasma
133
When in clindamycin given?
With Ancef allergy
134
What is the dose of Clindamycin?
600-900 mg Q6H
135
Clindamycini & NMB
Clindamycin will potentiate the effects of NMB
136
When is Vanc given?
PNC allergy 10-15mg/kg
MAX 2g
137
When should vans be infused?
60 min to 2 hours
138
Ephedrine is an
Indirect acting non catecholamine
139
Characteristics of Ephedrine
Alpha & beta effects
Increases HR & BP, CO & contractility
140
When is Ephedrine not effective
Catecholamine depletion
141
What is the bolus dose of ephedrine?
2.5-10mg bolus
142
B:G of Sevo
0.65
143
B:G Des
0.42
144
B:G Iso
1.46
145
B:G N2O
0.46
146
Iso MAC
1.2/1.15
147
Sevo MAC
2
148
Des MAC
6
149
N2O MAC
104
150
What is MAC awake
The alveolar concentration where patient opens eyes
151
MAC awake during induction
0.4-0.5
152
MAC awake during emergence
0.15
153
MAC bar is the
Alveolar concentration required to block autonomic response following painful stimuli
154
Movement is prevented in
95% of the population at 1.3 MAC
155
Awareness & recall are prevented at
0.4-0.5 MAC
156
MAC bar is equal to
1.5 MAC
157
What factors increase MAC?
Red head
Chronic ETOH
INcreased CNS NT activity
Increased Na+
Infants 1-6 months
Hyperthermia
158
What factors decrease MAC
Acute ETOH
Sedation drugs
Hyponatremia
Old age (decreased by 6%/decade after 40)
Extremes of age
Pregnancy
159
What factors have no effect on MAC
Thyroid issues
Potassium
Gender
160
Which drugs are metabolized by Pseudocholinesterase
Ester Locals
Succinylcholine
161
Which drugs are metabolized by non-specific esterases
Remifentanil
Esmolol
Clevidipine
Atracurium
162
Which drugs are metabolized by Hofmann elimination
Cisatracurium
Atracurium
163
Flagyl is what type of drug?
Prodrug that causes a concentration gradient
164
What is the dose of Flagyl
500-1000mg given within 60 min
165
When should Flagyl be avoided/
ETOH patients
166
What is the MOA of Vanc
Inhibits cell wall synthesis
167
Vance can cause what syndrome?
Red man syndrome
