Term
|
Definition
|
|
Term
| most common cause of heparin resistance |
|
Definition
| antithrombin III deficiency |
|
|
Term
| what three problems can administration of protamine cause |
|
Definition
1. systemic hypotension
2. pulmonary HTN
2. allergic reactions |
|
|
Term
| max recommended dose of protamine in 10 minutes is? |
|
Definition
| 50 mg of protamine is max |
|
|
Term
| why does protamine have all the bad cardio and pulmonary side effects? |
|
Definition
| the culprit is histamine release!!!! |
|
|
Term
| is protamine or heparin acidic and basic |
|
Definition
| protamine is STRONGLY BASIC and heparin is strongly acidic |
|
|
Term
| what is the name for the type of reaction between heparin and protamine |
|
Definition
|
|
Term
| discontinue warfarin how many days prior to surgery |
|
Definition
| discontinue 3-5 days prior to surgery |
|
|
Term
| why is vitamin K not the right drug to reverse warfarin emergently |
|
Definition
| it takes 3-6 hours to begin working and 4-24 hours to return PT to normal range |
|
|
Term
| what dose of vitamin K do you give to reverse coumadin |
|
Definition
|
|
Term
| name three clinically useful GPIIb / IIIa antagonist |
|
Definition
1. abciximab
2. eptifibatide (integrillin)
3. tirofiban (Aggrastat) |
|
|
Term
| how long after major surgery should you wait to restart heparin |
|
Definition
|
|
Term
| when should metformin be discontinue before surgery, or day of surgery? |
|
Definition
| metofromin will not cuase hypoglycemia during fasting periods of 1-2 days. There is no risk of lactic acidosis with metformin in patients iwth a fucntioning liver and kidneys. Do not restart metformin until after there is no more risk lactic acidosis development. |
|
|
Term
| where does lasix work on the nephron |
|
Definition
| on the thick ascending limb of the loop of henle |
|
|
Term
| what receptor in the nephron does lasix work on |
|
Definition
|
|
Term
| three major side effects of lasix are |
|
Definition
1. deafness from damage to cranial nerve VIII
2. hypovolemia
3. hypokalemia |
|
|
Term
| how does lasix cause a decrease in BP |
|
Definition
| lasix causes prostaglandin to be released from the kidneys which causes venodilation. This equates to decrease preload and lower BP |
|
|
Term
| spironolactone works primarily on what segment of the renal tubule |
|
Definition
| acts primarily as a competitive antagonist of aldosterone at the collecting duct. |
|
|
Term
| what does spironalactone do to K, Na and H20 |
|
Definition
| Spiractolone competes with aldosterone. Causes increase H20 and Na excretion while preserving K so it increases serum K. |
|
|
Term
| a renal failure patinet that needs diuresis will respond best to what diuretic and why |
|
Definition
| best responds to mannitol since this drug does not depend on the healthy state of the kidney. |
|
|
Term
|
Definition
| it is a weak diuretic. Works by inhibiting carbonic anhydrase. |
|
|
Term
| diamox may do what to K, Na, and other ions |
|
Definition
| diamox will result in excretion of bicarb and potassium. So H20 loss. |
|
|
Term
| diamox acts on what part of the nephron |
|
Definition
|
|
Term
| thiazide diuretics work where on the nephron |
|
Definition
| at the distal tubule on Na/Cl pumps. |
|
|
Term
| potassium sparing diuretics work where on the nephron |
|
Definition
| inhibit renal sodium channels in the late distal tubule and collecting ducts. |
|
|
Term
| BNP works where in the nephron |
|
Definition
| inner medullar colelcting duct |
|
|
Term
| top three antimicrobials to be involved in a allergic reaction are |
|
Definition
1. pcn
2. cephalosporin
3. vancomycin |
|
|
Term
| what herbal can potentiate the effects of barbiturates |
|
Definition
|
|
Term
| which herbal can decrease effect of barbiturates |
|
Definition
|
|
Term
| which herbal may prolong effects of anesthetics |
|
Definition
|
|
Term
| which supplement may enhance benzo effects |
|
Definition
|
|
Term
| cyclosporine and tacrolimus are what class of immunosuppresants |
|
Definition
| calcineurin inhibitors resulting in inhibition of T lymphocyte proliferation. |
|
|
Term
| tacrolimus does what to some of our drug metabolism |
|
Definition
|
|
Term
| how many grams of salt are in 0.9% NS |
|
Definition
|
|
Term
| acid + acid = more ionized or nonionized |
|
Definition
acid + acid = more nonionized
acid + base = more ionized. |
|
|
Term
What happens when a weak acid is
injected into an acidotic patient? |
|
Definition
| More drug is nonionized; as pH falls, the nonionized fraction increases (acid + acid =nonionized). |
|
|
Term
Will the eNS actions of barbiturates be
intensified or diminished in the patient who is acidotic? Explain. |
|
Definition
| The eNS actions of barbiturates will be intensified in patients who are acidotic (acid + acid = nonionized). More barbiturate is nonionized at lower pH, so greater amounts cross the blood:brain barrier. |
|
|
Term
| Propofol, a weak acid, has a pK. of 11.0. Is propofol mostly ionized or mostly unionized at normal physiologic pH 7.4? Will the dominant form readily cross membranes or not? |
|
Definition
Since the normal physiologic pH 7.4 is less than the pK. 11.0 ofpropofol,
the body environment is an acidic environment for the weak acid propoI
fol. Remember, the pK. of a given substance is "dividing mark" for acidic
and basic environments. The mnemonic is "acids + acids -7 more unionized':
therefore propofol will be mostly nonionized at physiologic pH 7.4.
I
The unionized form of a substance is lipid-soluble and thus readily crosses
membr |
|
|
Term
| What agents used in anesthesia are weak bases |
|
Definition
Weak bases include: all local anesthetics; all opioids (fentanyl, alfentanil,
morphine, etc); benzodiazepines (diazepam, midazolam, etc); etomidate;
and ketamine. |
|
|
Term
| What happens to the amount of weak base in ionized form as pH decreases? As pH increases? |
|
Definition
.As pH decreases, the amount of weak base in ionized form increases. (Rule:
base + acid more ionized). Conversely, as pH increases, the amount of
weak acid in ionized form increases. (Rule: base + base = more nonionI
ized). |
|
|
Term
base + base =
acid + baser =
acid + acid =
more ionized or more nonionized |
|
Definition
base + base = more non-ionized
acid + baser = more ionized
acid + acid = more nonionized |
|
|
Term
|
Definition
| bumex is a loop diuretic and can treat HF with underlying renal disease. Acts primarily at the loop of henle. |
|
|
Term
| whats the big risk of mannitol in lung patients |
|
Definition
| mannitol can fluid shift lots of h20 to the itnravascular fast and this may cause pulmonary edema in patients. |
|
|
Term
| phenothiaxines and thioxanthenes work by |
|
Definition
| antagonism of dopamine in basal ganglia and limbic system |
|
|
Term
|
Definition
|
|
Term
| whats so great about 2nd generation anti-psychotics in regards to side effect profile |
|
Definition
selective dopamine antagonism that spares the extrapyramidal tract
Example is risperidone |
|
|
Term
| therapuetic level of lithium is |
|
Definition
|
|
Term
| what does lithium do to our anesthetic drugs |
|
Definition
1. prlongs depolarizing and non-depolarizing drugs
2. lowers MAC |
|
|
Term
| what is the duration of action and onset of granisetron |
|
Definition
| 24 hours. Onset is 1 hour. |
|
|
Term
|
Definition
| antiemetic that is a Histamine blocker. |
|
|
Term
| Anti-emetic dose for droperidol |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
a gatric prokinetic due to its selective peripheral cholineergic agonism
AND
acts as a doparminergic receptor antagonist. |
|
|
Term
| whats one drawback for reglan with our anesthetic |
|
Definition
| may interfere with plasma cholinesterase |
|
|
Term
| onset and duration of action of reglan |
|
Definition
onset: 10 minutes
duration: 2-4 hours |
|
|
Term
| aprepitant is what kind of job |
|
Definition
| A substance P antagonist that antagonizes neurokinin I. Needs to be given 4 hours prior to surgery. |
|
|
Term
antacids have two categories
1. particulate
2. non-particulate
which one is for aspiration prophylaxis. |
|
Definition
|
|
Term
| non-particulates may cause what electrolyte abnormality |
|
Definition
|
|
Term
| side effects of ranitidine (zantac) related to anesthesia meds |
|
Definition
| inhibits p450 which prolongs benzos, decrease serum digoxin, increase duration of depolarizing and nondepolarizing drugs, can cause bronchosapsms in adults. |
|
|
Term
| name four nociceptive substances that activate pain |
|
Definition
1. substance P
2. bradykinin
3. histamine
4. serotonin |
|
|
Term
| whats the difference between complex reigonal pain syndrome I and II |
|
Definition
| Same but CRPS II you have a confirmed nerve injury. |
|
|
Term
|
Definition
there are trigger points, often begins after a acute muscle injury.
- YOU CAN compress and TRIGGER these areas |
|
|
Term
| lower back pain, and cerfical pain that is sharp and aching, may shoot out, is called |
|
Definition
|
|
Term
| name for when perceived increase in pain intensity over time when a given painful stimulus is given repeatedly above a critical rate |
|
Definition
|
|
Term
| tagamet and cimetidine has what kind of structure |
|
Definition
|
|
Term
| Who regulates the herbal industry |
|
Definition
|
|
Term
|
Definition
| aldosterone is released as part of the RASS system and response. Binds to adlosterone receptors on the collecting ducts and causes reabsorption of NA nd excretion of K. |
|
|
Term
| myofascial syndrome most commonly occurs where |
|
Definition
|
|
Term
| which local is least necrotic to muscle when treating myofascial syndrome |
|
Definition
| give procaine b/c bupivicaine is most toxic to muscle. |
|
|
Term
| does histamine cross the BBB |
|
Definition
| NOOOOOOO. but if you give anti-histamine drugs they may cross the brain. |
|
|
Term
| what can benadryl an antihistamine treat related to side effects from giving a dopamina antagonist to a parkinson patient |
|
Definition
| antihistamine can treat extrapyridmal sx |
|
|
Term
| whats the difference between dopamine and acetylcholine in movement in the pyridmal tract |
|
Definition
| dopamine enhances movement and AcH slows movement. |
|
|
Term
| in parkinsonian disease whats up with AcH and dopamine |
|
Definition
| these patients have bradykinesia. They have too much AcH and not enough dopamine. So give dopamine agonist or AcH antagonist. (can give benadryl) |
|
|
Term
| treat tardive dyskinesia with |
|
Definition
| in tardive dyskinesia there is too much dopamine and too little AcH. Treat with anti-dopamine drug. |
|
|
Term
| mneumonic for corticoids in adrenal cortex |
|
Definition
Go find rex, make good sex.
G: Zona glomerulosa
F: Zona fasiculata
R: Zona reticularis
M: Mineral coritcoids
G: Glucocorticoids
S: Sex hormones |
|
|
Term
| four major effects of glucocorticoids |
|
Definition
1. inhibit inflammation
2. raise WBC
3. cause immunosuppresion
4. cause increase blood glucose. |
|
|
Term
|
Definition
|
|
Term
| SQ regular insulin peaks how long |
|
Definition
|
|
Term
| Major determinate of where your spinal height will be is |
|
Definition
|
|
Term
| major determinate of height of your epidural is |
|
Definition
|
|
Term
| a post dural puncture causes pain due to cerebral hypotension and its stretching on what cranial nerve? How would you asses for this |
|
Definition
| ABducens nerve XI. Which helps you move your eyes lateral. So patient may only have central forward stare |
|
|
Term
| how long after a retrobulbar block would you see retrobulbar block syndrome |
|
Definition
|
|
Term
| how would you know there was a retrobulbar hemorrhage |
|
Definition
| because almost immediately the yee is anesthetized and protrudes when it should take 10 minhutes to onset. |
|
|
Term
| the lower the pKa the faster or slower onset of action |
|
Definition
|
|
Term
| safe doses of bupivicaine and lidocaine without epi |
|
Definition
lidocaine: 4-5 mg/kg
bupivicaine: 3 mg/kg |
|
|
