Term
|
Definition
Midazolam -- benzodiazepine
sedative, anxiolytic, amnesia, anesthetic adjunct
Reversal--> flumazenil (Romazicon)
0.2mg every 1-2 minutes til desired effect (max 3mg over 1hr)
contraindicated in pts with seizure hx |
|
|
Term
|
Definition
Depolarizing neuromuscular relaxant
vial: 20mg/ml
Dose: 1mg/kg |
|
|
Term
|
Definition
Anesthetic
10mg/ml
Induction: 2.0-2.5 mg/kg 70kg: 140-175mg; 80kg: 80-200mg
Sedation: 100-150mcg/kg then 25-75 mcg/kg (70kg: 70-105mg, then 1.8-5.3 mg/min) |
|
|
Term
|
Definition
(Sublimaze)
opiod used for analgesia, anesthesia
50mcg/mL
Can cause respiratory depression, muscle rigidity, N/V, urinary retension, sedation |
|
|
Term
| Infant/Children tube size |
|
Definition
[(Age +4)/2] tube size
multiply by 3 --> insertion depth |
|
|
Term
Succinyl Choline
dose for infant/child |
|
Definition
infant: 2.0 mg/kg
child: 1.0 mg/kg |
|
|
Term
|
Definition
One Way Exhaling Valve Attached To Vacuum
Mask Within A Mask Outer Attached to Vacuum
95-97% Gas Removed By Scavenging
|
|
|
Term
| Can you use anesthetic gases with Nasal hood? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Depth of insertion of Peds ET tube? |
|
Definition
|
|
Term
LMA size.
How Much air into cuff |
|
Definition
small adult 50-70kg size 4
add a 0 to size, subtract 10cc |
|
|
Term
| Contraindications to placement of Combitube |
|
Definition
Pt < 4ft tall
intact gag reflex
known esophageal disease
Laryngeal Foreign Bodies or Pathology |
|
|
Term
| How deep do you insert Combitube? |
|
Definition
| incisors to between black lines |
|
|
Term
| With Combitube which color do you blow up and ventilate through first? |
|
Definition
1. white, connnect circuit and check for breath sounds (in trachea)
2. inflate blue balloon and ventilate |
|
|
Term
| Combitube: what if you can't ventilate? |
|
Definition
Pull it back 2-3cm
it's likely resting against the esophagus |
|
|
Term
| Benzodiazapine mechanism of action |
|
Definition
enhance Cl- channel passageat GABA gate
hyperpolarizes cell
GABA receptors found (nearly) only in CNS |
|
|
Term
Does Versed metabolize to active metabolites?
Diazapam? |
|
Definition
VERSED only one inactive metabolite
Diazepam: metabolized to active metabolites, oxazepam and esmethyldiazepam – prolonged CNS effects |
|
|
Term
|
Definition
Midazolam
Onset: 3-8 Minutes
Duration: 20-35 Minutes
Greater amnesia than diazepam
Faster onset than diazepam, lorazepam
Less pain than diazepam, lorazepam because water soluble |
|
|
Term
|
Definition
Onset: 1-3 Minutes
Duration: 35-60 Minutes
More postoperative sedation than midazolam
Drug of choice in abolishing seizure activity -- due to quick onset
Pain and thrombophlebitis more common than midazolam
Delivery vehicle: Propylene glycol |
|
|
Term
| Contraindications to use of Benzodiazepines |
|
Definition
Narrow angle glaucoma
Pregnancy |
|
|
Term
| Benzodiazepine Drug interactions |
|
Definition
Increase blood concentrations and increase in elimination half-life
- Erythromycin
- Ketoconazole
- Rifampin
- Antiviral Medications
|
|
|
Term
| Mechanism of action with opiods |
|
Definition
| hyperpolarization of cell membranes in CNS and peripheral NS |
|
|
Term
| Opioid Mu-1 Receptor Actions |
|
Definition
| analgesia, euphoria, miosis, urinary retention |
|
|
Term
| Opioid Mu-2 receptor actions |
|
Definition
| analgesia, decreased ventilation, bradycardia, constipation, dependence |
|
|
Term
| Opioid kappa receptor actions |
|
Definition
| analgesia, dysphoria, sedation, miosis |
|
|
Term
| Opioid delta receptor actions |
|
Definition
| analgesia, decreased ventilation, urinary retention, physical dependence |
|
|
Term
|
Definition
|
|
Term
| duration of Fentanyl action |
|
Definition
|
|
Term
|
Definition
Demerol:
Active metabolites: Normeperidine
Lowers seizure threshold
Induces CNS excitability |
|
|
Term
| What is special about Remifentanyl |
|
Definition
Ultra short acting mu agonist
Ester linkage renders it susceptible to hydrolysis by plama and tissue esterases
Rapid speed of onset: 1-2 minutes
Context sensitive T1/2: 3-6 minutes
Intense levels of analgesia of short duration
No residual opioid effects |
|
|
Term
|
Definition
|
|
Term
| Propoxyphene drug interactions |
|
Definition
Warfarin – increased bleeding
Carbamazepine(Tegretol), Metoprolol, Propranolol – increased blood levels of drug |
|
|
Term
| Fentanyl Drug interactions |
|
Definition
| Diltiazem – increased effects of opioid |
|
|
Term
|
Definition
|
|
Term
| Why isn't Vicodin and Codeine working? |
|
Definition
deficiency in CYP2D6
Without CYP2D6, demethylation of codeine and derivatives to morphine cannot occur |
|
|
Term
| Name the Opioid Agonist / Antagonists |
|
Definition
Pentazocine (Talwin)
Nalbuphine (Nubain)
Butorphanol (Stadol) |
|
|
Term
|
Definition
Produce sedative hypnotic effects via interaction with GABA
Depresses reticular activating system
Decrease transmission through sympathetic nervous system ganglia |
|
|
Term
|
Definition
Brevital
Rapid induction – Maximal brain uptake within 30 seconds
Prompt awakening – redistribution to skeletal muscle and fat
Greater hepatic metabolism than other barbiturates |
|
|
Term
| Clinical effects of Methohexital |
|
Definition
Deep Sedation – General Anesthesia
Not Anxiolytic
Hyperalgesic
Excitatory Effects
Respiratory Depression
Increased Heart Rate
Modest Decrease in BP
No Muscle Relaxant Properties |
|
|
Term
| Contraindications with Methohexital |
|
Definition
Porphyria – May Provoke Attack
Epilepsy – Activates Foci
Asthma – Bronchospasm |
|
|
Term
| Adverese reations with Methohexital |
|
Definition
Venous Thrombosis
Extravascular Injection
Intra-arterial Injection
Allergic Reaction 1:30,000 |
|
|
Term
| Is propofol contraindicated with egg allergy? |
|
Definition
|
|
Term
| What is vehicle of Propofol? |
|
Definition
Delivery in oil-in-water emulsion
10% Soybean Oil
2.25% Glycerol
1.2% Egg Phosphatide **Not contraindicated in egg allergy
Generic in metabisulfite vehicle **Does not attenuate vagal nerve stimulation induced bronchoconstriction |
|
|
Term
|
Definition
General Anesthesia
Induction: Adult 1-2.5 mg/kg
Peds 2.5-3.5 mg/kg
Monitored Ansthesia Care
Induction: Slow Injection .5 mg/kg
Incremental Bolus 5mg-20mg |
|
|
Term
| Ketamine Mechanism of action |
|
Definition
Antagonist NMDA Receptor
Agonist Adrenergic Receptors
Antagonist Muscarinic Receptors CNS
Blocks Reuptake of Catecholamines
Agonist at opioid Sigma Receptor |
|
|
Term
| Ketamine Respiratory effects |
|
Definition
Intact Reflexes
Maintenance FRC
Response to Hypercarbia Maintained
Bronchodilator |
|
|
Term
| Ketamine Cardiovascular effects |
|
Definition
Increased HR
Increased BP
Increased CO
Direct Myocardial Depressant |
|
|
Term
| Contraindications to Ketamine use |
|
Definition
Increased ICP
Open Globe
Hypertension***
Illicit Drug Use
Psychiatric Disorders**
|
|
|
Term
| Ideal inhalational anethetic agent |
|
Definition
Sufficient Potency
Nonpungent
No Adverse Respiratory Complications
No Adverse Cardiac Complications
Provide Muscle Relaxation
Minimal Metabolism
No Postemergence Side Effects
Reliable and Simple Delivery System
Economical |
|
|
Term
| What happens with Halothane+Epinephrine |
|
Definition
|
|
Term
| Sevoflurane organ toxicity |
|
Definition
Compound A causes renal injury
with soda lime and less than 2L gas flow
No clinical studies have shown renal dysfunction (BUN, Creatinine) |
|
|
Term
|
Definition
| High concentration of N20 augments uptake of a volatile anesthetic |
|
|
Term
|
Definition
| results from rapid elimination of N20, diluting alveolar oxygen and CO2 |
|
|
Term
|
Definition
1min onset
4min duration
Dose 2-3mg/kg |
|
|
Term
| Action of anticholinesterase |
|
Definition
| inhibit action of cholinesterase so thee is more Acetyl choline to potentiate action potential |
|
|
Term
| Why do we give anticholinergic drug with Anticholinesterase |
|
Definition
| match onset of drugs effect on cardiac anticholinergic and antimuscarinic effects |
|
|
Term
| contraindications to use of Flumazinil |
|
Definition
Chronic Benzodiazepine Therapy
Seizure Disorder
Tricyclic Antidepressant Toxicity |
|
|
Term
| What is a Good(ish) rescue antiemetic |
|
Definition
|
|
Term
| Droperidol black box warning |
|
Definition
Absolute Contraindication QT Prolonged
Torsades des pointes
Initially Seen at >25mg, now reported at lower doses
12 Lead EKG Recommended Preop, 3 hrs postop |
|
|
Term
| What are Phenergan black box warnings |
|
Definition
‘Caution should be used when administering phenergan to pediatric patients 2 years and older because of the potential for fatal respiratory depression.’
‘Do not give with other respiratory depressants’
‘Antiemetics are not recommended for treatment of uncomplicated vomiting in pediatric patients, and their use should be limited to prolonged vomiting of known etiology’
maybe for rescue antiemetic |
|
|
Term
| Serotonin uptake inhibitors |
|
Definition
Ondansetron (Zofran)0.1mg/kg, or 4mg
Dolasetron (Anzemet) 0.35mg/kg, or 12.5mg |
|
|
Term
|
Definition
Bronchial Asthma
ASA / NSAID Sensitivity
Nasal Polyposis |
|
|
Term
| Who has this NSAID-Aspirin triad? |
|
Definition
Severe asthmatics: 20%
2-3% All Asthmatics |
|
|
Term
| What happens with NSAID - Aspirin triad? |
|
Definition
Inhibition of cyclo-oxygenase with a shift to lipoxygenase pathway
Increased production of leukotrienes with sensitivity of the airway
|
|
|
Term
|
Definition
Nephrotoxicity-- daily use for many years, increased if combined with acetaminofen, also assoc with caffeine and codeine
Lithium -- elevates levels
Elevates Methotrexate Levels
Caution if >20mg/week
Displaces Coumadin from plasma albumin
Warfarin + COX-2, Increased INR 16-20%
Warfarin + NSAID, Increased INR 50-80%
Disrupts mucosal protection
Elevates Digoxin Levels
Inhibits cardioprotective benefits of low-dose aspirin
Inhibit Antihypertensive action (with 6+day use) raise BP 5mmHg |
|
|
Term
|
Definition
Allergy
GI Ulcerations
Anticoagulant
Coagulopathy |
|
|
Term
| What is max Acetaminophen dose in Alcoholic |
|
Definition
|
|
Term
| Clinical Features of Malignant Hyperthermia |
|
Definition
Tachycardia (first sign 96%)
Increased ETCO2 (most sensitive sign)
Tachypnea (85%)
Rigidity (80%)
Cyanosis/Skin Mottling (70%)
Increased Temp (30%)
Arrhythmias |
|
|
Term
| What is amt of Dantrolene given |
|
Definition
2.5-10mg/kg
Requires reconstituting of 20mg/60cc (kind of a pain) |
|
|
Term
| Treatment for Malignant Hyperthermia |
|
Definition
Initiate body cooling, Iced IV, NG + ice packs
Consider NaHCO3 -- 1-2 mEq/kg – Need blood gas analysis to more accurately treat
Treat hyperkalemia with insulin, glucose
Treat ventricular dysrhythmias with IV procainamide |
|
|
Term
| What is diagnostic test for MH? |
|
Definition
| caffeine/halothane contracture studies on muscle biopsy |
|
|
Term
| What is Atypical Plasma Cholinesterase |
|
Definition
Enzyme lacks the ability to hydrolyze drugs such as succinylcholine and mivacurium
Dibucaine number permits diagnosis |
|
|
Term
|
Definition
Dibucaine Number: amide local anesthetic that inhibits normal plasma activity by 80%
Reflects the quality of plasma cholinesterase enzyme
Heterozygous – Sux lasts 20 min Incidence 1:480
Homozygous atypical – Sux lasts 60-180 min
Incidence 1:3200
|
|
|
Term
| Management of Laryngospasm |
|
Definition
Lighten or Deepen Anesthetic Plane
Remove Noxious Stimuli
Suction Laryngopharynx
100% Oxygen, Positive Mask Pressure
Succinylcholine |
|
|
Term
| What is laryngospasm dose for succinylcholine? |
|
Definition
Adults (0.1 mg/kg IV) Usually 10-20 mg
Children (1.5 mg/kg IV) plus atropine (0.02mg/kg IV)
No IV: 4 mg/kg IM Deltoid
No IV: 3 mg/kg Submental Intralingual |
|
|
Term
| Define Postobstructive Pulmonary Edema |
|
Definition
Airway Obstruction
Negative Intrathoracic Pressure
Increased Pulmonary Blood Flow
Increased Pulmonary Microvascular Pressure
Pulmonary Edema |
|
|
Term
| Clinical findings of Postobstructive Pulmonary Edema |
|
Definition
Persistant, Often Small Oxygen Desaturation
Wheezing
Rales
Rhonchi
CXR: Bilateral perihilar patchy infiltrates |
|
|
Term
| Treatment of Postobstructive Pulmonary Edema |
|
Definition
Supplemental Oxygen
CPAP
Diuretics
Consider Tracheal Intubation in Medically Compromised
Prompt Recognition results in Resolution in 12-24 Hours
|
|
|
Term
| What causes "chest wall rigidity" |
|
Definition
| Caused by High Dose, Rapid Opioid Administration |
|
|
Term
| What is differential diagnosis for chest wall rigidity |
|
Definition
|
|
Term
| What is treatment for chest wall rigidity |
|
Definition
| Reversal of Opioid (Narcan) |
|
|
Term
| Define Central Anticholinergic Syndrome |
|
Definition
Caused by the use of Drugs with Anticholinergic Properties which cross the Blood-Brain Barrier
Scopalamine
Atropine
Antihistamines
Benzodiazepines
notglycopyrrolate |
|
|
Term
| What are Clinical Manifestations of Central Anticholinergic Syndrome |
|
Definition
Central
Disorientation
Agitation
Hallucinations
Ataxia
Seizures
Peripheral
Tachycardia
Facial Flushing
Hyperpyrexia
Urinary Retention
Decreased Sweating
|
|
|
Term
| What is treatment of Central Anticholinergic Syndrome |
|
Definition
Physostigmine
Centrally Acting Anticholinesterase |
|
|
Term
| What are clinical signs of parasympathetic stimulation |
|
Definition
| Salivation, Sweating, Abdominal Colic, bronchospasm, bradycardia, nausea |
|
|
Term
| What are symptoms of cholinergic crisis? |
|
Definition
| nausea, vomiting, bradycardia or tachycardia, excessive salivation, sweating, bronchospasm, weakness, paralysis |
|
|
Term
| What is treatment of cholinergic crisis? |
|
Definition
Atropine
10mcg/kg IV q3-10min until muscarinic symptoms disappear |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 0.1-0.2mg/kg IV (7-14mg) call it 10mg |
|
|
Term
| How much does an amp of Dextrose raise blood sugar |
|
Definition
| amp of D50 increase 75-100 mg/dl |
|
|
Term
| How does pediatric patient maintain blood pressure? |
|
Definition
|
|
Term
| Chloral Hydrate possible complications |
|
Definition
arrhythmia
laryngeal edema
gastric irritation
hypoglycemia |
|
|
Term
| Pediatric Dose of Oral Versed |
|
Definition
|
|
Term
| Pediatric IM Ketamine dose |
|
Definition
1.5-4.0 mg/kg
Often mixed with Midazolam 0.05-0.10 mg/kg
Can be mixed with Robinul 0.005 mg/kg
However Peak effect IM Robinul = 30 minutes
Peak Effect IV Robinul = 1 minute |
|
|
Term
|
Definition
80% of new Psych prescriptions
Fluoxetine (Prozac)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Sertraline (Zoloft)
Citalopram (Celexa)
Veniafaxine (Effexor)
|
|
|
Term
| Major interactions of SSRIs |
|
Definition
CYP2D6 Inhibitors - Inhibit demethylation of codeine and derivatives to morphine
Delayed clearance of Benzodiazepines metabolized by hepatic oxidation
Oxycodone, Morphine, Dilaudid, unaffected |
|
|
Term
| Commonly used drug with Lithium interaction |
|
Definition
NSAID: enhance renal reabsorption of Lithium and increase levels
Lithium has narrow therapeutic index |
|
|
Term
| Treatment modifications for patient taking TCAs |
|
Definition
drug has anticholinergic effects
Increased heart rate, orthostatic hypotension, arrhythmias
limit epinephrine to 0.05mg (~3 carlules)
avoid Ketamine |
|
|
Term
Side effects of Ginseng
recommendations |
|
Definition
HTN, increased HR, nervousness, insomnia
ask patient to discontinue for 7day prior to appt |
|
|
Term
| Action of St. John's Wort |
|
Definition
Used for depression and anxiety
Inhibits Serotonin, NE & Dopamine Reuptake, Synaptic Uptake of GABA & Binding to GABA Receptors |
|
|
Term
| Side effects of St. John's Wort |
|
Definition
Xerostomia, Headache, Sedation, GI Irritation, Fatigue
Photosensitivity (at high doses)
Interacts with Antidepressants, Vasopressors, and SSRIs
May prolong Anesthesia
Discontinue 2-3 weeks pre-op |
|
|
Term
|
Definition
used for insomnia, anxiety
Decreased uptake of GABA Inhibitory Transmitter -- will have more GABA effects |
|
|
Term
Valerian interactions with our drugs
recommendations |
|
Definition
Increase sedative effects of anesthetics, other CNS depressants, decrease BP
Taper off in weeks before surgery |
|
|
