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Flashcards in PBR2 Deck (65):
1

amiloride mechanism

potassium sparing diuretic, directly decreases cGMP gated sodium channel activity, decreases lithium entry into tubular cells (reverse lithium-induced nephrogenic DI)

2

spironolactone/eplerenone

potassium sparing diuretics that competitively inhibit mineralocorticoid receptor

3

pacemaker indication

long QT, SA/AV node disease, reduce outflow obstruction with HOCM, treat dilated CM, mobitz type II because usually progresses to complete

4

ultrasound

attenuate least - water (echo lucent)

5

L5 distribution

lateral aspect of knee, dorsum of foot

6

dose dependent effects on SSEPs

barbs, propofol, volatiles, benzos, nitrous

7

leak for neonate ETT

15-25 cm H2O

8

type II error

failing to reject the null when it is actually false

9

barb use with aneurysm clipping

indicated when prolonged vessel occlusion is unavoidable and when EEG slowing occurs with occlusion - reduces metabolic activity (ischemic protection)

10

nitrous and CMRO2

increases metabolic rate, vasodilator - increases ICP

11

CBF and PaO2

CBF remains constant at a PaO2 greater than 50

12

Higher chance of latex allergy

mango, kiwi, chestnut, avocado, passion fruit, and banana

13

NMB recovery signs most reliable

sustained head lift for 5 seconds, sustained leg lift for 5 seconds, sustained handgrip for 5 seconds, maximum inspiratory pressure 40 to 50 cm H2O or greater

14

CCB and dantrolene

lethal ventricular fibrillation due to hyperkalemia in anesthetized swine

15

Garlic, ginkgo, and ginseng how long to wait

Garlic 7 days, ginseng 24 hours, and Ginkgo lasts 36 hours

16

rapid shallow breathing index

RSBI = respiratory rate/tidal volume; less than 100/105 with max FiO2 0.4

17

Phenoxybenzamine and pheo

Reduction in mortality is potentially reduced from 40-60% to 0-6% with the preoperative implementation of alpha-adrenergic receptor blockade, typically performed 10-14 days prior to surgery

18

Protein binding in preg

Maternal and fetal albumin levels are comparable; as opposed to alpha-1-acid glycoprotein which is at much higher levels in maternal plasma; bound to albumin more likely to cross placenta

19

Decreased preeclampsia risk

Cigarette smoking

20

LIM can detect

high current fow >2mA

21

most anesthesia drugs transported across placenta

via diffusion

22

increase intraocular pressure

hypercapnea, decreased PaO2, elevated CVP, succhinylcholine, some anticholinergics (IV atropine does not)

23

acquired antithrombin deficiency

nephrotic syndrome, cirrhosis, DIC (may have resistance to heparin)

24

pulmonary artery rupture risk

age >60, pHTN, hypothermia, anticoagulation, overinflation of balloon

25

compartment syndrome symptoms

sensory deficits before motor, manifest distal to involved compartment

26

brain dead and acetylcholine

lack release of endogenous acetylcholine - need to use direct agonists like isoproterenol to treat bradycardia

27

RBC salvage contraindications

ruptured AAA, infection, GI perforation, malignancy (can use for patient with alloantibodies which may make transfusion difficult)

28

HOCM treatment

CCB, beta blockers

29

ass with increased K after suc

massive trauma, encephalitis, ruptured cerebral aneurysms, metabolic acidosis & hypovolemia

30

additional amiodarone se

thyroid dysfunction (drug has lots of iodine), peripheral neuropathy, bradyarrhythmias

31

lidocaine arrhythmia use

useful for ventricular not supraventricular

32

brain death criteria

coma, absent motor activity, absent brain stem, absence of ventilatory effort despite CO2 60 or 20 above baseline

33

zero lumbar drain

phlebostatic axis at level of right atrium

34

classic hemodynamics of constrictive pericarditis

equalization of ventricular diastolic pressure

35

jet ventilation risks

barotrauma, pneumothorax, gastric distention, hypoxia

36

R (reaction time)

time zero to the beginning of clot formation, signifies contributions of the intrinsic and extrinsic coagulation cascades, and the final common pathway to fibrin formation ((1-3 minutes is normal for use of Tissue Factor activator, 7-14 minutes for Celite, Kaolin)

37

K (coagulation time)

measure of speed of clot formation and strengthening, equal to the time from amplitude 2mm to 20mm, relies on fibrinogen

38

alpha angle

measure speed of clot formation, this relies on fibrinogen, normal is 45-55 degrees.

39

MA (maximal amplitude)

measures maximal clot strength, equal to the max width of TEG, represents clot strength as determined by platelet number and function, as well as fibrin cross-linking to form a stable clot, normal is 50-60mm; after MA measures clot lysis

40

continuous wave Doppler vs pulsed wave

continuous uses 2 crystals and prevents determination of maximal velocity; pulsed uses 1 crystal and high velocities are often measured as negative (aliasing)

41

circumflex branch leads

I and aVL

42

V1 uses

ileus, abd distention, esophageal varices, shock, Vfib/PEA

43

V2 uses

DI and vWF def

44

hypocalcemia

prolonged QT and ST, inverted T, bradycardia

45

wall tension equation

= (pressure x radius)/(2 x wall thickness)

46

heparin rebound after protamine

heparin can bind to protein which protects it from binding with protamine, when these dissociate can get rebound

47

HOCM presentation

dyspnea, angina, dizziness, sinus tachy, double-impulse peripheral pulse, hypotension, low JVP, heart failure stigmata, murmurs (LV obstruction and MR)

48

CPB and coagulation

platelet dysfunction common cause of post CPB bleeding - return to norm 2-4 hr post

49

recombinant factor VIIa

binds onto tissue factor and initiates coagulation by amplifying factor IX and X leading to thrombin generation, used to decrease massive hemorrhage

50

antibiotics - no NMB

PCN and cephalosporins

51

Hering Breuer reflex

when pulmonary stretch receptors sense overinflation - inspiration is inhibited so expiration can occur

52

high frequency ultrasound

poor penetration (cannot be used for deep structures)

53

ultrasound attenuation

proportional to frequency and path length of ultrasound wave

54

morphine IV:PO conversion

1:3

55

most common postpartum foot drop

lumbosacral trunk damage - weakness of ankle dorsiflexion and dermatome L5 sensory loss - 2/2 head compression by pelvic brim by head

56

increased potassium with suc

hypovolemia and metabolic acidosis, severe abd infections, closed head injury, major trauma, neuromuscular disease

57

garlic discontinued

1 week before surgery

58

valerian root discontinued

tapered over several weeks or will see symptoms similar to benzo withdrawal

59

ginseng drug interaction

interferes with warfarin anticoag - may need more warfarin to achieve same results

60

herbals interfere with coag

ginger, gingko, ginseng, garlic, saw palmetto

61

kava/valerian

potentiate sedation

62

echinacea

interfere with effectiveness of immunosuppressants

63

st. john's wort

induction of cytochrome p450, delayed emergence

64

GBS treatment

plasmapheresis - can have hypotension and pulmonary edema, IVIG - less side effects, corticosteroids do not help

65

myasthenia clue

disease >6 yrs, pyridostigmine >750 mg daily, preop vital capacity <3 L, pulmonary disease unrelated to myasthenia