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Flashcards in Old shit Deck (54):
1

Opioids in renal failure

No meperidine or morphine

2

Thiopental CV effects

Decrease BP, increase HR

3

Thiopental pharmacokinetics

redistribution

4

What barbituate do you use for burst suppression?

Thiopental

5

Papaverine - vasodilation

anastomosis

6

Metabolism of beta blockers

emolol - plasma cholinesterases

7

Midazolam side effect

Decreased BP

8

Anitmicrobial cephalosproin

4th broadest spectrum of coverage

9

Cardiac arrythmia with lasix

hypo K+ and Mg

10

NSAIDs mechanism of action

inhibition of COX, blocks both Cox enzymes without specificity

11

Cox 1 effects

regulator of GI mucusal integrity, platelet aggregation, and renal function

12

Cox 2 effects

Mediates inflammation, pain, fever
Good stuff comes from Cox2, side effects come from Cox 1

13

NSAID - Reye syndrome

Side effect of aspirin = multiorgan failure in kids

14

Sympathomimetic - norepi termination

reuptake

15

Effects of Norepi

Increased rate of heart contraction, BP by increasing vascular tone
Reflex bradycardia
No beta-2

16

Effect of volatile anesthetics on pattern of spontaneous ventilation

increased RR, decreased tidal volume

17

Clinidine effects what receptors

alpha-2

18

Beta-blockers least likely to cause airway resistance

Atenolol

19

What is a beta-1 agonist?

Norepi

20

Ioproterenol affects what receptor

Beta-2

21

Uptake: increase inspired partial pressure

Increase fresh gas flow

22

What does nitropursside do to cGMP?

upregulates

23

Antihypertensive and LA toxicity

Verapamil

24

Insulin duration of action

30-60 min

25

Which neuromuscular blocking drug causes histamine release?

Atracurium

26

Which NMBD is good for renal failure?

Cisatracurium

27

Which NMBD is good for pseudochilinesterase deficient patients?

Roc

28

What does insulin do?

Carry glucose across cell membrane = decreased serum glucose and also carries K+ intracellular
= hypoglycemia, and hypokalemia

29

Molecular structure of insulin

2 amino acids joined by 3 disulfide bonds

30

IV elimination time of insulin

5-10 min

31

Insulin is metabolized by

kidney and liver (50% 1st pass metabolism)

32

Duration of action of insulin

30-60 min

33

Type I Diabetics have what relationship with insulin?

Don't produce insulin

34

Type II Diabetics have what relationship with insulin?

Resistant to insulin

35

Rapid acting insulin

Lispro
Onset: 5-15 min
Duration 4-5 hr

36

Short-acting insulin

Regular Insulin
Onset: 30 min
Duration 5-8 hrs

37

Intermediate acting insulin

Isophane - Neutral Protamine Hagedorn (NPH) preparation
Onset: 2-5 hr
Duration: 10-14 hr

38

Long-acting insulin

Ultralente
Onset: slow
Duration 24 hr

39

What insulin preparation goes to effective level and just stays there for ~24 hrs? (no peak effect)

Glargine

40

1U of insulin lowers blood glucose by how much?

25-30 mg/dL

41

What is the goal glucose level in the OR?

<180

42

To determine U/hr of glucose for basal/infusion rate

U/hr = (glucose - 100)/40

43

In the OR, to determine the bolus treatment of glucose in units/hr

Units/hr = glucose/150

44

Which preparation of insulin is inhaled?

Exubera

45

Side effects of insulin injections

HYPOGLYCEMIA - poses serious s/e irreversible brain damage

46

Initial symptoms of hypoglycemia

Diaphoresis, tachycardia, hypertension

47

Oral drugs for treatment of Type II diabetics

Sulfonlyureas, Biguanides

48

Sulfonlyurea mechanism of action

stimulate insulin secretion - hypoglycemia a risk

49

Biguanides mechanism of action

inhibit glucose production by the liver
Ex: Metformin

50

Side effect of Metformin (Biguanide)

Lactic acidosis

51

How much insulin dose should a diabetic take the morning of surgery?

1/2 dose

52

What should we do the the IV bag for diabetics intraop?

Add 10-20 meq KCL to each liter of IV fluid

53

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
Albuminuria

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

54

How is Metformin excreted?

Renal