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11/7 Week Learning Points > SAQs > Flashcards

SAQs Flashcards

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1
Q

What is the Frank-Starling Graph Y and X axis?

A

Stroke volume vs. end diastolic sarcomere length

Optimal length 2 micron

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2
Q

How does ACE inhibitor prevent LV remodelling?

A

Vasodilation - reduce preload, reduce after load.

Prevent remodelling

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3
Q

Classify ACE inhibitor

A

Active drug metabolised- captopril
Prodrug - enalapril
Active drug not liver metabolised - lisinopril

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4
Q

How does probenecid increase the duration of action of penicillin

A

Binds to and competes with renal tubular secretion of penicillin

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5
Q

Define renal clearance

A

The volume of blood or plasma which is completely cleared of the unchanged drug by the kidney per unit time

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6
Q

Equation for clearance?

A

Clearance = rate constant x volume of distribution

Higher the Vd, lower the clearance

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7
Q

How does changing the urine pH affect the type of drugs excreted?

A

Acidifying the urine -> increase excretion of basic drugs

Alkalising the urine -> increase excretion of acidic drugs

Increases the ionised fraction

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8
Q

Why do patients with CKD have coagulopathy?

A

Downstream effect of uraemia affecting platelet function

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9
Q

What are the factors that increase aldosterone level?

A 
RAAS / SNS 
Hyperkalaemia 
Hypovolaemia 
HypoNa 
ACTH
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10
Q

How does ACE inhibitor cause hyperkalaemia?

A

Inhibition of aldosterone release -> reduce Na/K+ activity / ROMK placement -> reduce K+ excretion -> hyperK

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11
Q

What is the Volume of distribution if

  • Drug is confined in plasma?
  • Confined in ECF
  • Confined in body water
  • Distributes into fat
A

0.04L/kg, like warfarin
0.2 L/kg, like rocuronium
0.6 L/kg
> 0.6 L/kg, propofol

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12
Q

Why does amiodarone have such a high Vd?

A

extremely lipid soluble and avid protein binding

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13
Q

What are some of the patient factors that affect Vd?

A

Population - neonates, pregnancy increase Vd, elderly reduce Vd
Liver / kidney failure, fluid overload - increase Vd for water soluble drugs

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14
Q

What are the assumptions when calculating the loading dose of propofol?

A

Rate of dispersion equal, or assume single compartment
100% bioavailability
No metabolism or excretion prior to blood sampling

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15
Q

Pharmaceutic features of dexmed

A

No additives, safe in neuroaxial

enatiopure, dextro form

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16
Q

What is the dose of Dexmed for loading and infusion?

A

loading - 0.25 - 1 microg/kg

infusion - 02 - 1 microg / kg / hr

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17
Q

Describe the time course of dexmed

A

Onset <5 mins
Peak < 15 mins
Offset dependent on duration of infusion

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18
Q

Vd and protein binding of dexmed

A

2L/kg

90%

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19
Q

Metabolism of dexmed

A

Liver 2A6 hydroxylation -> metabolites in urine

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20
Q

Action of dexmed on the spinal cord?

A

reduce glutamate and substance P release by nociceptors

reduce activation of WDR projection neurons

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21
Q

CNS effects of dexmed

A 
MAC sparring 
Reduce CMRO2 -> reduce ICP
Affects EEG though rousable 
Opioid sparring 
Prolong neuroaxial blockade 
Anti-shivering
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22
Q

What is the range of pressure for pulmonary wedge pressure?

A

6-12 mmHg

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23
Q

Why is the effect of LA use-dependent?

Study These Flashcards
A

Use = activated Na form -> LA can enter via open Na channels

24
Q

How does sevo increase dead space and EtCO2 to PaCO2 difference?

Study These Flashcards
A

Decrease SVR -> decrease venous return -> reduce preload -> reduce pulmonary arterial pressure

Increase West zone 1, non-perfused alveoli

25
What is the principle of PCA?
user controlled, locked, IV analgesic pump. | Method whereby the patient controls the amount of analgesics received within certain predefined constraints
26
What is the time to peak effect of morph vs. fent? | What is the bolus duration?
Morph - 30 mins, 3 hours Fent - 5 mins, 20 mins Fentanyl is better for the Q5mins protocol
27
For fent and morph - pKa - Degree unionised - T1/2ke0 - Plasma protein binding - Vd
Fent - 8.4, 9% - 7 mins - 83% - 4 Morph - 8, 23% - 17 mins - 35% - 3.5
28
What is the clearance and elimination half time for fentanyl
10-20 ml/kg/hr 2-4 hours Similar to morphine
29
What is the advantage and disadvantage of using morphine PCA
Advantage - long duration, prevents drug level fluctuation Disadvantage - slow onset, risk of dose stacking, less tolerant in elderly population due to side effects. - More histamine release, more delirium/confusion, more PONV
30
What are the causes of incomplete alveolar emptying?
Increased variation in time constants (asthma/COPD) | Decreased expiratory time -> gas trapping
31
How does incomplete alveolar emptying leads to widened EtCO2/PaCO2 gap
Incomplete emptying, particularly slow lung unit with high resistance and high compliance -> low time constant - Reduced ventilation, increased pCO2 - Empties late.
32
Describe the metabolic effect of hypothermia
``` Reduce BMR by 7% for every degree drop Reduce enzymic reaction Reduce ATP hydrolysis Reduce oxidative phosphorylation, Kreb cycle activity, glycolysis Reduce drug metabolism (Hoffmann) ```
33
What is the name of the cold receptor and warm receptor?
Bulbs of Krause (cold) | Bulb of Ruffini (warm)
34
What is non-shivering thermogenesis?
Increases metabolic heat production without mechanical work
35
What is the CVS effects of hypothermia
Electrical - slows conduction, bradycardia, long QT, arrest below 28 degrees, resistant to defibrillation Haemodynamic - vasoconstriction, increase SVR,PVR
36
What is the effect of hypothermia on CNS?
Linear depression of CMRO2, amnesia, apathy, dysarthria, impaired judgement and behaviour, MAC reduction Progressive deterioration of GCS, hallucination Loss of cerebral auto regulation, decline CBF, coma <28 degrees
37
Resp effect of hypothermia
reduce RR, reduce brainstem sensitivity to CO2 (control of ventilation), decrease VO2 Bronchorrhoea, bronchospasm, reduce airway protective reflex. Pulmonary congestion and oedema, apnoea
38
Renal effect of hypothermia
Cold diuresis due to reduced ADH synthesis -> progress to extreme oliguria
39
Haem effect of hypothermia
Coagulopathy due to impaired platelet and factor function Increase blood viscosity -> increase resistance
40
Acid base effect of hypothermia
Alkalosis, increase pH by 0.015 per degree - Decrease water dissociation into H+ and OH- - Reduce metabolic rate and reduced VCO2 - Increase CO2 solubility -> decrease partial pressure
41
Immunological effect of hypothermia
Decrease WBC activity -> increased susceptibility to infection
42
What are the labelling systems of cylinder O2
White body, white shoulder Pin index safety system Outlet melts if heated Bodok seal -> gas tight, non-combustible
43
Pipeline safety features for O2
Socket and hose label, white hose, white screw collar Diameter index safety system (Schrader Probe) Anti-kink tube
44
Safety features of O2 on anaesthetic machine
Pressure regulator down to 4 bar to not damage the machine Flow control valve to reduce pressure to 1 bar Oxygen failure alarm when below 200kPa Low oxygen pressure shut off -> shut off device that terminates the flow of nitrous oxide if the oxygen supply pressure is too low One way valve
45
What is febrile non-haemolytic reaction from RBC?
due to cytokine accumulation of donor blood | fever, malaise, dyspnoea
46
What is graft vs host disease
Donar WBC takes over host bone marrow, especially in the immune compromised Skin - rash Marrow suppression Diarrhoea Prevented by gamma irradiation of blood products
47
What is immunomodulation (TRIM)?
Unclear mechanism of transfusion related immune suppression - Increases post op infection - Increases cancer recurrence
48
How does EMLA patch additive increase the rate of diffusion?
Add sodium hydroxide to increase pH -> increase unionised fraction -> increase diffusion
49
Define complementary in terms of drug interaction
pharmacodynamic profile of each drug covers the shortcomings of both drugs
50
How does the BBB prevent leakage of neurotransmitters to the systemic circulation?
BBB contains AchE, MAO
51
What are the three layers of BBB?
vascular endothelial cells with tight junction basement membrane with negative charge Foot processes by astrocytes
52
CSF contains lower amount of electrolytes except?
Cl, Mg | Na at equal amount
53
What's the point of tightly controlled CSF electrolytes by BBB?
stable ionic environment for neuron function | prevents large fluctuation in volume, following sodium
54
What are the four factors that will increase BBB permeability?
immaturity trauma HTN inflammation
55
How is volume of distribution changed in the elderly?
Reduced central compartment fluid volume Reduced muscle mass Relatively increased fat mass by 20-40% Increase Vd for lipid soluble drugs
56
How is liver metabolic function affected by age?
In elderly - Reduced hepatic blood flow by 10% per decade - Reduced liver mass 20-40% - Decreased enzyme function by 40% at 80yo High extraction ratio drugs more affected Decreased effect of prodrug
57
What is the O2 tension of the ductus venous?
80% SpO2, 30mmHg

11/7 Week Learning Points (4 decks)

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