UBP 2 Flashcards
(27 cards)
What are the main categories of drugs that account for the majority of perioperative anaphylactic reactions?
Neuromuscular relaxants (non-depolarizing and depolarizing) and antibiotics (cephalosporins and penicillins)
Other drugs include protamine, chlorhexidine latex, Ester local anesthetics, and amides with preservative.
What effect do NMBDs have in elderly patients?
Delayed onset (up to 1 minute) due to circulatory changes
Due to changes including; decreased cardiac output and increased circulation time.
What BIS value is associated with a low probability of consciousness under general anesthesia?
A BIS value between 40 and 60
This has been shown to reduce the risk of awareness in patients administered propofol.
What is the primary process involved in Phase 1 metabolism of drugs?
Increases polarity of lipophilic drugs by inserting a polar group or removing a non-polar group
This occurs via hydrolysis, oxidation, or reduction reactions involving the cytochrome P450 enzyme family.
What does Phase 2 metabolism involve?
Enzymatic conjugation of drugs to create highly water-soluble molecules for excretion.
Addition of hydrophilic molecules (e.g., glucuronic acid, acetate, sulfate, amino acids, glutathione)
What is the predominant enzyme class involved in Phase 2 metabolism?
Transferases
What is the characteristic of Phase 3 elimination?
Energy-dependent (i.e., ATP) excretion into bile
How many half-lives of the first NMBD are required before the duration of blockade resembles that of the second drug?
3 half-lives
What is the most common cause of mortality from transfusion?
TRALI
Most commonly seen with the transfusion of plasma-rich products (e.g., FFP).
Which blood component is most commonly associated with bacterial sepsis?
Platelets
What is the diagnostic criterion for OSA via polysomnography?
Greater than or equal to 15 events/hour or greater than or equal to 5 events/hour in symptomatic patients
What is the recovery characteristic of a bolus dose of etomidate?
Rapid recovery due to redistribution
Advanced age requires a dose reduction due to decreased central volume of distribution and hepatic clearance.
How does alkalinization affect lidocaine mixtures that include epinephrine?
Accelerates the onset of action by increasing the unionized fraction
What effect can alkalinization have on injection pain?
Decreases the burning caused by injection by increasing the pH of the drug
What are the known effects of dextrans?
Anti-thrombotic effects and increased likelihood of hematoma when combined with other anticoagulants
List the benzodiazepines from longest to shortest duration.
Diazepam > lorazepam > temazepam > midazolam
What does the AHA recommend for post-cardiac arrest patients who remain comatose after ROSC?
Targeted temperature management (TTM) between 32 and 36° C for 24 hours
What is the mechanism of action of etomidate?
GABA-A receptor agonist leading to neuronal hyperpolarization and depression of the reticular activating system
What are the effects of lower and higher doses of etomidate?
- Lower dose: Augmentation of GABA-A chloride current by positive modulation
- High doses: Direct activation of GABA-A receptor in absence of GABA
What are the primary mechanisms for inactivating dopamine, epinephrine, and norepinephrine?
Monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT)
What is the primary mechanism for termination of norepinephrine?
Active reuptake
How is rocuronium primarily eliminated?
By the liver with a small fraction (10%) eliminated in the urine
What is the reported incidence of accidental dural puncture with an epidural needle?
Between 0.5% and 1.5%
What is the purpose of the line isolation monitor (LIM)?
To prevent macroshock (NOT microshock)
