test 2

Question 1

poorly controlled pain may lead to __ pain states.

Answer 1

chronic

Question 2

what does acute pain do to heart rate, PVR, ABP, myocardial contraction, and myocardial work?

Answer 2

increased

Question 3

what does acute pain due to tidal volume, vital capacity, total lung capacity, etc?

Answer 3

decreased

Question 4

what does acute pain do to gastric emptying, intestinal motility?

Answer 4

decreased, but increased sphincter tone

Question 5

what does acute pain do to platelet aggregation and venostasis?

Answer 5

increased

Question 6

what does acute pain do to immune function?

Answer 6

decreased

Question 7

what does acute pain do to urinary sphincter tone?

Answer 7

increased

Question 8

red flags

Answer 8

preop pain, fear of outcome, catastrophize pain, expect postop pain

Question 9

what enzyme converts arachidonic acid into prostaglandins?

Answer 9

cyclooxygenase COX 1 and 2

Question 10

what enzymes do nsaids work on?

Answer 10

cyclooxygenase 1 and 2 COX 1 and 2

Question 11

What is the role of prostaglandins?

Answer 11

SENSITIZE nociceptors to pain, feel pain at a 4 instead of a 9

Question 12

COX 1 is constituitive, what does that mean?

Answer 12

It is prolific in all body tissues, produced on a daily basis just like insulin

Question 13

COX 2 is inducible, what does that mean?

Answer 13

Not produced on a daily basis, only when induced by inflammation, mediates pain, fever, carcinogenesis

Question 14

What is COX 1 responsible for? and thus what would it do if we inhibited it?

Answer 14

responsible for platelet aggregation, gastic mucosal integrity, and renal function. If we inhibit it we have decreased platelet aggregations (aspirin), gastric irritation (ulcers) and renal microvascular constriction

Question 15

When is celecoxib contraindicated?

Answer 15

hypersensitivity to sulfonamides (sulfa side chain) or ASA, caution in asthmatics d/t conversion of arachidonic acid into lukotrienes, causing bronchoconstriction

Question 16

is toradol selective or non-selective COX inhibitor?

Answer 16

non-selective, therefore caution with coagulopathy, renal failure, ulcer, GI bleed, asthma, risk of postop bleeding

Question 17

limit toradol use to __ days

Answer 17

5

Question 18

your patient weighs >50 kg, how much ofirmev and how often?

Answer 18

4 grams TOTAL per day, divided into 1000mg q 6 or 650 q 4

Question 19

your patient weighs <50 kg, how much ofirmev and how often?

Answer 19

max 75mg/kg/day, divided into 15mg/kg q 6 or 12.5 mg/kg q 4

Question 20

when is ofirmev contraindicated?

Answer 20

liver failure

Question 21

where is mu1 found?

Answer 21

supraspinal, in the periaquad

Question 22

where is mu2 found?

Answer 22

spine and periphery

Question 23

where are opioid receptors found in the spinal cord?

Answer 23

substantia gelatinosa Rexed lamina 2

Question 24

how do opioids work pre and post synaptically?

Answer 24

pre = decrease adenylate cyclase and inhibit calcium channels
post = increase potassium excretion leading to hyperpolarization

Question 25

In time I can please everyone but susie sally

Answer 25

IV, tracheal, intercostal, caudal, paracervical, epidural, brachial, SAB/sciatic/femoral, subcutaneous

Question 26

fentanyl metabolism, metabolites, excretion

Answer 26

liver metabolism by N-dealkylation, inactive metabolites, renal excretion

Question 27

morphine metabolism, metabolites, excretion

Answer 27

hepatic glucuronidation, morphine-3 inactive / morphine-6 active (still asleep at 3 AM but active by 6AM), renal excretion

Question 28

hydromorphone metabolism, metabolites, excretion

Answer 28

liver conjugation, inactive metabolite,

Question 29

ketamine

Answer 29

NMDA antagonist, NMDA receptor at rest remains closed due to magnesium plug.

Question 30

NMDA receptors are activated by

Answer 30

glutamate

Question 31

activation of the a2 receptor (via clonidine or precedex) results in inhibition of ___

Answer 31

adenyl cyclase and decreased cAMP

Question 32

alpha agonists inhibit __ and activate __

Answer 32

``` inhibit = presynaptic calcium channels activate = postsynaptic potassium channels equals hyperpolarized ```

Question 33

where do alpha 2 agonists work in the brain?

Answer 33

locus coeruleus, posterior to the pons

Question 34

who is a poor candidate for a alpha 2 agonist?

Answer 34

depleted catecholamines, elderly, immunosuppressed, young and weak

Question 35

what's the advantage of dexmedetomidine over clonidine?

Answer 35

7-10x more highly selective for alpha2 (1,620:1) vs. clonidine (220:1)

Question 36

side effects of precedex and clonidine?

Answer 36

sedation, hypotension, bradycardia

Question 37

dosing for precedex?

Answer 37

1mcg/kg bolus, infusion 0.2-0.7 mcg/kg/hr

Question 38

PCA bolus dose for morphine

Answer 38

0.5 - 2.5 mg

Question 39

PCA bolus dose for fentanyl

Answer 39

10-20 mcg

Question 40

PCA bolus dose for hydromorphone

Answer 40

0.05 - 0.25 mg (1/10 of the morphine dose)

Question 41

all PCA lockouts are basically

Answer 41

5-10 minutes