Flashcards in Old shit Deck (54):
Opioids in renal failure
No meperidine or morphine
Thiopental CV effects
Decrease BP, increase HR
What barbituate do you use for burst suppression?
Papaverine - vasodilation
Metabolism of beta blockers
emolol - plasma cholinesterases
Midazolam side effect
4th broadest spectrum of coverage
Cardiac arrythmia with lasix
hypo K+ and Mg
NSAIDs mechanism of action
inhibition of COX, blocks both Cox enzymes without specificity
Cox 1 effects
regulator of GI mucusal integrity, platelet aggregation, and renal function
Cox 2 effects
Mediates inflammation, pain, fever
Good stuff comes from Cox2, side effects come from Cox 1
NSAID - Reye syndrome
Side effect of aspirin = multiorgan failure in kids
Sympathomimetic - norepi termination
Effects of Norepi
Increased rate of heart contraction, BP by increasing vascular tone
Effect of volatile anesthetics on pattern of spontaneous ventilation
increased RR, decreased tidal volume
Clinidine effects what receptors
Beta-blockers least likely to cause airway resistance
What is a beta-1 agonist?
Ioproterenol affects what receptor
Uptake: increase inspired partial pressure
Increase fresh gas flow
What does nitropursside do to cGMP?
Antihypertensive and LA toxicity
Insulin duration of action
Which neuromuscular blocking drug causes histamine release?
Which NMBD is good for renal failure?
Which NMBD is good for pseudochilinesterase deficient patients?
What does insulin do?
Carry glucose across cell membrane = decreased serum glucose and also carries K+ intracellular
= hypoglycemia, and hypokalemia
Molecular structure of insulin
2 amino acids joined by 3 disulfide bonds
IV elimination time of insulin
Insulin is metabolized by
kidney and liver (50% 1st pass metabolism)
Duration of action of insulin
Type I Diabetics have what relationship with insulin?
Don't produce insulin
Type II Diabetics have what relationship with insulin?
Resistant to insulin
Rapid acting insulin
Onset: 5-15 min
Duration 4-5 hr
Onset: 30 min
Duration 5-8 hrs
Intermediate acting insulin
Isophane - Neutral Protamine Hagedorn (NPH) preparation
Onset: 2-5 hr
Duration: 10-14 hr
Duration 24 hr
What insulin preparation goes to effective level and just stays there for ~24 hrs? (no peak effect)
1U of insulin lowers blood glucose by how much?
What is the goal glucose level in the OR?
To determine U/hr of glucose for basal/infusion rate
U/hr = (glucose - 100)/40
In the OR, to determine the bolus treatment of glucose in units/hr
Units/hr = glucose/150
Which preparation of insulin is inhaled?
Side effects of insulin injections
HYPOGLYCEMIA - poses serious s/e irreversible brain damage
Initial symptoms of hypoglycemia
Diaphoresis, tachycardia, hypertension
Oral drugs for treatment of Type II diabetics
Sulfonlyurea mechanism of action
stimulate insulin secretion - hypoglycemia a risk
Biguanides mechanism of action
inhibit glucose production by the liver
Side effect of Metformin (Biguanide)
How much insulin dose should a diabetic take the morning of surgery?
What should we do the the IV bag for diabetics intraop?
Add 10-20 meq KCL to each liter of IV fluid
A pt with Type 2 diabetes is seen in pre-op. The pt denies any cardiac symptoms. Which of the following is the STRONGEST predictor of diabetic cardiomyopathy?
A. A1C levels
B. Left ventricular EF
C. Male sex
A. A1C levels
An elevated A1C level reflects chonically poor glycemic control. It is an independent predictor of the development of cardiomyopathy and heart failure.
Diabetic cardiomyopathy is characterized by diastolic dysfunction, EF is usually > 50%
Women have 3x increase for heart failure
Albuminuria is an associated finding