TL Deck 4.5 Flashcards by A. Ozumba

Does a high cardiac output affect soluble or insoluble anesthetics more?

It affects soluble anesthetics more

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What is the risk associated with IM administration of ketamine?

Higher risk of laryngospasm than with intravenous (IV) administration.

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In which patients should ketamine be avoided?

Patients with severe coronary artery disease.

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What is the purpose of administering lorazepam with haldol?

To prevent acute dystonia.

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What ECG findings can result from hypokalemia? (7)

Prolonged PR interval
Pseudo-prolonged QT interval
QRS prolongation
ST segment depression
Decreased wave amplitude
Inverted T waves
U waves

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How does long-acting naltrexone affect premedication?

Patients can use premedication, and benzodiazepines can be administered in the same doses.

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What must be done if opioids are required for patients on naltrexone?

Higher doses are needed to overcome the antagonist effect.

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What is a significant cardiovascular effect of methohexital?

Decreased ventricular filling leading to decreased cardiac output.

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What are the adverse effects of methohexital? (4)

Cough
Twitching
Hiccups
Pain on injection

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What is the primary cardiovascular effect of barbiturates during anesthesia induction?

Peripheral vasodilation.

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What does propofol do to the baroreceptor reflex?

Blunts the reflex.

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What is St. John’s wort classified as?

A cytochrome P450 (CYP) 3A4 inducer.

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What should be done before surgery if a patient is taking St. John’s wort?

It is advised to stop taking it 5 days before surgery.

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Which supplements should be discontinued before surgery and for how long?

Garlic/Ginseng - 7 days
Ginkgo - 2 weeks
Kava/Ephedrine - 24 hours

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What is the risk associated with ginseng?

Antiplatelet risk.

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How does digoxin interact with potassium levels?

In hypokalemia, digoxin binds more easily, potentiating toxicity.

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What can potentiate digoxin toxicity?

Hypomagnesemia
Hypercalcemia

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What conditions must be met for NMDA receptor activation? (2)

Glutamate (or glycine) must be bound
The cell must be depolarized

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What is the effect of administering magnesium with ketamine?

It can potentiate the effects of ketamine.

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What do phosphodiesterase III inhibitors include?

Milrinone
Cilostazol

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What is a major effect of ketamine on sympathetic outflow?

Increases sympathetic outflow by inhibiting catecholamine reuptake.

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What is the onset time for epidural 2-chloroprocaine?

Approximately 6-12 minutes.

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What is the current recommendation for failed prophylaxis of PONV?

Use a medication from a class different from that given prophylactically.

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What is the initial fluid resuscitation goal for sepsis treatment?

30 mL/kg of intravenous fluids over the first three hours.

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What conditions decrease lower esophageal sphincter (LES) tone? (3)

* Obesity * Hiatal hernia * Pregnancy

Which anesthetic agents decrease LES tone?

* Inhaled agents * Opioids * Propofol

What should not be given due to the risk of pulmonary shunting?

Particulate antacids. | Mg & Aluminum

What are the active metabolites of morphine and meperidine?

* Morphine - M6G * Meperidine - normeperidine

What is a common side effect of haloperidol?

Prolongation of the QT interval.

What is the modified Aldrete scoring system used for?

To assess patients for readiness for discharge from Phase I of PACU.

What serum magnesium levels indicate muscle paralysis?

>12 mg/dL.

What is the most important predictor of postoperative mortality in liver transplant patients?

Preoperative PaO2 of ≤ 50 mmHg.

What is the difference in elimination between clear liquids and solids?

Clear liquids are eliminated exponentially, solids linearly.

What can cause cephalad movement of the endotracheal tube (ETT)?

* Pneumoperitoneum * Head and neck extention * Trendelenburg position

What is the correct anatomy of the popliteal fossa from medial to lateral?

* Popliteal artery * Popliteal vein * Tibial nerve * Common peroneal nerve

What does LaPlace’s law state?

Tension of the left ventricular wall is proportional to pressure and radius, inversely proportional to wall thickness.

What are the three main determinants of myocardial oxygen demand?

* Wall tension * Heart rate * Contractility

What is the function of aminocaproic acid and tranexamic acid?

Prevent the formation of the tertiary complex between plasminogen, tPA, and fibrin.

What is the arterial blood gas measurement alternative to DLCO?

PaCO2 and PaO2.

What is the selective beta-blocker that causes minimal bronchoconstriction?

Atenolol.

What is the significance of the artery of Adamkiewicz?

It contributes to anterior spinal cord blood supply.

Tramadol MOA?

Weak mu agonist with SNRI properties. ## Footnote O-desmethyltramadol (a metabolite), has greater analgesic potency.

What is the boundary of the adductor canal?

* Vastus medialis laterally * Sartorius anteriorly * Adductor longus or magnus posteromedially

What is the blood supply to the anterior two-thirds of the spinal cord?

Anterior spinal artery.

What is the effect of dexmedetomidine on cerebral blood flow?

Dose-dependent reduction in cerebral blood flow.

What effect do inhaled halogenated anesthetics greater than 0.5 MAC have on cerebral vasculature?

Profound vasodilatory effect

What is the QT interval associated with?

Prolongation by droperidol and haloperidol.

What are the branches of the sciatic nerve?

Common peroneal nerve and tibial nerve.

Where are the common peroneal and tibial nerves located?

Superficial and lateral to the popliteal artery.

What is the artery of Adamkiewicz?

A radicular vessel contributing to anterior spinal cord blood supply, most commonly originating within the T9 - T12 region.

Which nerve roots can be blocked with the interscalene approach?

C5-7 nerve roots.

What is the best application for the supraclavicular block?

Elbow surgery.

What does the infraclavicular block target?

The cords of the brachial plexus.

What is the axillary block best suited for?

Wrist or hand surgery.

What nerve can be easily missed in the axillary block?

Musculocutaneous nerve. | Innervates the anterolateral forearm

What does thrombosis of the anterior tibial artery affect?

Finding a pulse in the dorsalis pedis artery.

What are the two types of nerve fibers that carry nociceptive signals?

Aδ and C fibers.

Which type of nerve fiber is faster, Aδ or C?

Aδ fibers.

What are the properties of Aα fibers?

Proprioceptive properties.

How do Aβ fibers compare to Aα fibers?

Aβ fibers are slower than Aα and have mechanosensitive properties.

What is the mechanism of action of tricyclic antidepressants?

Opioid receptor modulation and serotonin and norepinephrine reuptake inhibition.

What are the risks associated with tricyclic antidepressants?

Antimuscarinic side effects.

What type of receptor does methadone act on?

Mu-opioid receptor and NMDA receptor.

What is the MOA of unfractionated heparin?

Indirect inhibitor of thrombin and factor Xa.

What test is best to document the adequacy of anticoagulation with LMWH?

Anti-Xa assay.

What effect do anticholinergics have on sweating?

Decreased sweating.

What type of medications are first-line for pretreatment of allergy reactions?

Histamine antagonists such as diphenhydramine or hydroxyzine.

How does sodium bicarbonate treat hyperkalemia?

Helps to shift extracellular potassium into the cell by temporarily raising serum pH.

What is the role of calcium gluconate in hyperkalemia?

Cardioprotective; increases resting cardiac membrane potential.

What are treatment options for EPS or acute dystonic reactions?

Anticholinergics (preferred), benzodiazepines, and beta-blockers.

Which agents are NOT used for the treatment of EPS?

Acetylcholinesterase inhibitors (e.g. Neostigmine).

What primary afferent is involved in pulmonary proprioception?

Spindle receptors in bronchial smooth muscle and intercostal musculature.

What does apneic oxygenation allow for?

A longer period of apnea before desaturation begins.

What is a common method to provide apneic oxygenation?

Nasal cannula.

What does respiratory acidosis generally result in?

Formation of arrhythmias.

What is the main difference between oxygen and CO2 movement across the alveolar membrane?

Differences in gas solubility in blood and hemoglobin's affinity for oxygen.

TL Deck 4.5 Flashcards

(76 cards)