Anaesthesia_Final_Frca

Front 1

Substance with same chemical formula but different spatial arrangement

Back 1

Chiralty (Handness)
Enantiomers
4 Carbon chiral centre

Front 2

Enantiomers that move differntly to polarized light

Back 2

Optical isomers
Right --> Dextro
Left--> Levo

Front 3

If substance is viewed from front ( largest group to smallest)

Back 3

Rectus--> if Smallest molecule arrangement is clockwise

Sinister--> if Smallest molecule arrangement is anticlockwise

Front 4

Achiral substances are

Back 4

All Natural occuring substances (Levorotatory)
Sevoflurane
Lidocaine

Front 5

Propofol
( 2,6 Di-Isopropyl Phenol )

Back 5

Soyabean 10%, Glycerol 2%, EggPhosphatidite 1.2% (pH 7-8.5)
pKa =11
Vd= 228ml/kg, 800L (imm,SS)
t1/2= 3m , 30-60 min, 4-8 h
(a,b1,b2)
Cx t1/2= 16m, 40m (2,8 hrs)
Protein= 98%
CL= 2500 ml/min

Front 6

Ketamine
(Phencyclidine derivative)

Back 6

P-agonist--> k, d P-antagonist mu
pH 3.5-5.5
Protein 25%
t1/2 2.5-3 h
Hepatic, Norketamine 1/3 potent
Avoid in porphyria

Front 7

Etomidate
(Carboxy Imidazole)

Back 7

Propylene glycol 35%
Vd = 2- 4 L /kg
Protein 75%
t1/2 = 4 min , 4 h
Easter hyd & Liver
Inhibit 17aHO & 11-b HO

Front 8

Thiopentone

Back 8

Nitrogen
pH 10.4
Vd = 2.5 L /kg
Protein 85 %
t1/2 = 1-2 min , 10 h

Front 9

Volatile agents:
MAC:

Back 9

Halothane 0.75
Enflurane 1.6
Isoflurane 1.1
Sevoflurane 1.8
Desflurane 6-7
N2O 105
Xenon 70

Front 10

Volatile agents:
Blood:Gas

Back 10

Halothane 2.5
Enflurane 1.9
Isoflurane 1.4
Sevoflurane 0.64
Desflurane 0.42
N2O 0.47
Xenon 0.17

Front 11

Volatile agents:
Metabolism
(Percent)

Back 11

Halothane 20%
Enflurane 3%
Isoflurane 0.2
Sevoflurane 3-5
Desflurane 0.02 %
N2O 0.004%
Xenon 0%

Front 12

Volatile agents:
Toxicity

Back 12

Floride (Sevo>Enf) --> Tox > 50
Comp A(Vinyl ether): sevo (5x Baralime)
CO
Hepatitis (Hal)

Front 13

Halothane Metabolism

Back 13

Oxidation: TFAA--> Liver protein

Reduction:

Front 14

Volatile agents:
CVS

Back 14

Isoflurane: Dec SVR, Inc HR , <>CO
Des: same as iso
Sevo: less Dec SVR , <>HR
Xenon: Cardiostabble

Front 15

Volatile agents:
CNS

Back 15

CSF: only Des increase it
AutoR: Sevo, Iso better than other

Front 16

Volatile agents:
Uterus

Back 16

N2O and Xenon does not relax uetrus

Front 17

Nirtous Oxide:

Back 17

x25 to Nitrogen
Opioid receptors / Stimulate decending norepi pathway
-ve ino & chronotropic
Inc sympathetic
Inh Methinine synth ( cobalt)
Inc PVR

Front 18

Muscle relaxants
( non depolarizing)

Back 18

Benzyl Isoquinolinnes
Aminosteroids

Front 19

Isomers? Metabolism?
Atracurim:
Mivacurium:
Cis-Atracurium

Back 19

Atracurium:
16 ismomers
45% Hofman, 45 Hep, 10 Renal

Front 20

Pancuronium metabolism ? duration?

Back 20

60 % renal 75 minutes

Front 21

Rocuronium metabolism ?

Vecuronium Metabolism ?

Back 21

- Mainly hepatic
Duration not inc in renal failure

- Both hepatic and renal 30%
slightly inc in renal failure

Front 22

Sugamadex

Back 22

alpha cyclodextrin
2 mg/kg @ 2 twitches
4 mg/kg @ PTC >2
16 mg/kg @ 3 min after IV dose

Front 23

Succinyl choline
( choline ester of succinic acid)

Back 23

> 10mg/kg Phase II block
90 % PCE 10% Renal
Ch 3
Dec Pseudo-->Liver, Renal, Pregnancy , Hypothyroid, Drugs
Most common cause of anaphylaxis under anaesthesia

Front 24

Pseudocholineestrase:
EuEu
EaEu , EaEa
Es , Ef etc

Back 24

Chromosome 3
Hetero Z 1:500 ( 30 minutes)
Homo Z 1:3200 ( several hours)

Front 25

What is a difference bw opiate & opioid.

What is OP1 , OP2, OP3, ORL1

Back 25

opioid--> natrually occuring

OP1 = delta ( Enkephalin)
OP2 = keppa (Dynorphin)
OP3 = mu (Endorphin)
ORL1 = Orphanin FQ

Front 26

Mechanism of action of Opioid receptors

Back 26

Gi --> dec cAMP
Dec presynaptic Ca
Inc post synaptic K

Front 27

Diamorphine

Back 27

Diamorph--> 6-Mono acyt morphine-->morphine
2 x potent than morph

Front 28

( Phenyl piperidines)
Fentanyl:

Alfentanyl:

Remifentanyl:

Back 28

Fentanyl
t1/2: 30m, 50m (2h inf) , 300m (8h inf)

Alfentanyl
t1/2: 10m, 50m (2h inf )

Remifentanyl:
4.5m , 9m (8h inf) , Tissue estrases.

Front 29

Other Opioids

Back 29

Codeine-> Natural
DHC-> Synthetic
Hydrocodone->Cancer pain
Oxycodone-> inc oral BA

Front 30

Tramadol

Back 30

Racemic
o-DMT > high potency
R+--> weak mu
S- > Na S updatke inhibition

Front 31

Handerson Hasselbach eq

Back 31

pH=pKa + log (Hco3/H2CO3)
pKa=pH - log (Base/Acid)

at 7.4:
pKa 8.4 --> 1:10 or ( 90% ioniz)
pKa 9.4 --> 1:100 or ( 99% ioniz)

Front 32

Onset of action of LA ?

Back 32

1. low pKa --> less ionized
2. Diameter & Mylination

Lidocaine / Prilocaine (pka 7.7)
(exception Ch procaine ,9.1)

5% drug reaches inside.

Front 33

Potency of LA ?

Back 33

Lipid solubility.

Prilo>Lido>Ropi>Bupi>Etido (highest)

Front 34

Duration of action of LA ?

Back 34

Protein binding ( a1 glycoprotein ).
Lipid solubility.
Blood flow.
Adjuvants.

Other: ( liposomes, emulsions, suspensions)

Front 35

Mepivacaine (Methyl Amide)
Ropivacaine (Propyl Amide)
Bupivacaine (Butyl Amide)

Back 35

Duration: M=100 , R=150, B=175m

Lipid solubility: M=1x ,R=7x, B=20x

Protein bind: 77, 95 , 96 %

Max dose: 2mg/kg

Front 36

Lidocaine

Back 36

100 minutes
pKa 7.7
Protein 66%
Lipid 1x
3mg/kg and 7 mg/kg max

Front 37

Etidocaine

Back 37

200 minutes
94 % protein
Lipid 50x

Front 38

Duration of LA block and blood flow charactertistics

Back 38

Tracheal>Intercostal>Caudal>Paracervical.

Epidural>Bracheal>Sciatic>Femoral>Local

Front 39

Toxicity of LA depends upon

Back 39

1. Type of drug
2. Dose and blood flow ( blood conc. B>2-4 & L>10-12 ug/ml)
3. Protein binding and pH (low)
4. Pulmonary seq (prilocaine)
5. Allergy (PABA)
6. Methaemo (Prilocaine)

Front 40

Intralipid 20%

Back 40

provides Carnitine Acyl carnitine translocase

Dose: 1.5 ml/kg bolus then 15 ml/kg/hr.
2x bolus every 5 min and inc infusion to 30 ml/lk/hr (max dose=12 ml/kg)

Front 41

LA adjuvants

Back 41

HCO3--> 1ml per 10ml Lidocaine or 20 ml Bupivacaine

Adrenaline--> 5 mcg/ml

Carbonization--> inc duration

Front 42

Additives to LA are _____

Back 42

Opioids
Adrenaline
Clonidine, Dexmetedomidine
Ketamine
Magnessium
Neostigmine
Midazolam, Baclofen
NSAIDS
Amitriptyline

Front 43

Is Phentolamine selective alpha blocker ?

Onset and duration of action

Back 43

No. it block a1& a2 at 3:1 ratio

Onset: 1-2 min Duration: 15-20 min

Dose 1-5 mg

Front 44

GTN causes vasodilation by decreasing Ca by which mechanism?

Nitroprusside toxicity occurs when dose exceeds _____

Back 44

1.Inc G cyclase--> inc GMP

2. 1.5 u/kg/min or total 1.5 mg/kg

Sod TS, Cobalt edetate,Cobalamine

Front 45

Tri metaphan is a ____ blocker.
It also has ___ blocking properties and cause some direct vasodilation.

_____ release & reflex _____ is a problem

Back 45

Ganglion blocker.

alpha blocking.

Hitamine release , reflex tachycardia

Front 46

Hydralazine causes vassodilation by dec Ca throgh______.

Back 46

cGMP pathway.

Front 47

Esmolol t1/2 is ______

Its dose is _______u/kg/min

Back 47

9 minutes

50-100 u/kg/min

Front 48

Labetalol has a:b blocker properties with ratio of ______.

Its Half life is____ hours

Dose is ___mg boluses or ____mg/kg/hr.

Back 48

1:5 alpha:beta

4 hours

50 mg , 1-2 mg/kg/hr

Front 49

Propranolol is given IV in___ mg increments up to ___ mg

Back 49

1 mg
5 mg

Front 50

Clonidine is a ____ derivative

Clonidine a2:a1 ratio is _____.

Clonidine also act on ___ receptors.

Its half life is ____ h

It is given as max infusion____ug/hr or ____ug/day

Back 50

Imidazoline

200:1

Imidazole receptors, sedation.

14 h.

30 ug/r , 750 ug/day

Front 51

Uses of Clonidine

Back 51

anti pressor response 5u/kg
Analgesia adjuvant 2u/kg
Antisialogogue.
Sedation / Anxiolysis
Alcohol withdrawl
Shivering
Neuropathic pain
Migraine, ADHD, Tourette synd

Front 52

Epidural adjuvant dose of clonidine is __ ug

Back 52

2 ug/kg
no a2 receptors on perepheral nerves.

Front 53

Cardiac Myocytes:
RMP of ___ is due to outward __ current and it is called phase___.

Depolarization is caused by __ in phase __

Phase 1 is brief repolarization due to opening of ___ and closure of ___

Phase 2 (Pletau) phase due to slow___ current.

Repolarization in phase 3 is caused by___

Absolute refractory period is ____, while relative refractory period is ____

Back 53

-90 mv , outward K current, phase 4

Na opening, phase 0

phase 2 and early phase 3, late phase 3

K channels, Na channels

Ca

K channel opening

Front 54

Pacemaker cells:
in phase 4 RMP is __ which gradually become +ve due to ___

Phase 0 is due to ____

There is no phase 1 or 2.

Back 54

- 60 mv

Inward Na and Ca current

Ca influx

Front 55

The two antiarrythmic classifications are_____ and _____

Back 55

Vaugan-Williams 1970
Sicilian Gambit (Euro S Card).

Front 56

Class Ia ___ refractory period
Class Ib___ refractory period
Class Ic___refractory period

Na channel blocking potency of Ia Ib Ic is ____

Back 56

Increase, decrease, <>

v C>A>B

Front 57

Class Ia drugs are_______(name)

Class Ib drugs are______

Class Ic drugs are______

Back 57

Quenidine, Procainamide, Disopyramide.

Lidocaine,Mexilitine,Phenytoin

Fecanide , Propafinone

Front 58

Class 2 drugs are ___ blockers

Class 3 prolong______

Class 4 block ___

Back 58

beta

repolarization

Ca channels, MgSO4

Front 59

Adenosine open ___ channels at AV node.

Its duration of action is ___ sec

Back 59

K channels

30 seconds

Front 60

Digoxin inhibit ____ thus increasing Na concentration.

This lead to secondary inhibition of _____

Back 60

inhibition of Na/K ATPase

inhibition of Ca out / Na in

Front 61

Hyperkalemia ____ cells by inreasing outward ____ current thus decreses the slope of phase 4

Back 61

hyperpolarize , outward K

Front 62

Oxprenolol and Pindolol have ___

Nadolol is ____ soluble

Back 62

ISA activity

water soluble.

Front 63

Ca channel blockers:

Phenyl alkyl amine is ______

Dihydropyridine is_______

BenZothiazepine is _____

Ca channel blockers potentiate_____

Back 63

Verapamil

Nifedipine

DiltiaZem

potentiate NMB

Front 64

Ephidrine inhibits NA breakdown by inhibiting______

It acts ______

Its duration is ___ minutes

Can cause____acidosis

Back 64

MAO

Both directly and indirectly

60 minutes

Fetal acidosis

Front 65

Phenylephrine also has some weak ___ activity.

Duration is ___

Back 65

weak beta

60 minutes

Front 66

Metaraminol is a direct and indirect SM with strong ____ and weak ____ activity.

Duration is___

Back 66

strong alpha , very weak beta

25 minutes.

Front 67

Inotropes increases Ca by inc in ____ which activates Kinase A (phosphorilation of Ca channels)

Back 67

cAMP

Front 68

AcH , Adenosine acts on G__
Beta agonist acts on G__
Alpha a1 & endothelin acts on G__
Alpha a2 acts on G__

Back 68

Gi--> dec cAMP
Gs--> Inc cAMP
Gq-->PLC-->P kinases
Gi--> dec cAMP

Front 69

Dobutamine acts on ___ more than ___ receptors but has no ____ activity

Back 69

B1 more than B2

No Dopamine

Front 70

DopExamine acts on renal (excretory) dopamine and ____ receptor.

It is a ionodilator

Back 70

B2

Front 71

PD III inhibitors and Glucagon works by increasing ______ which is independent of beta receptors.

Back 71

cAMP

Front 72

Lumbosacral plexus
( Sacral part)

Back 72

SGluteal N--> L4-L5-S1
IGluteal N--> L5-S1-S2
Sciatic N--> L4-S4
Post Fem CN --> S1,2,3
Pudendal--> S1,2,3

Front 73

Lumbosacral plexus
(Lumbar part)

Back 73

Iliohypogastric-->L1
Ilioinguinal-->L1
Geneto femoral-->L1-L2
Obtruator-->L2,3,4
Lateral cutaneous N-->L2,3,4

Front 74

Oxygen toxicity and duration:

Back 74

50 % indefinite use
60 % 36 h
80% 24 h
100% 12 h

Front 75

Kings College Paracetamol referal criteria

Back 75

INR > 2 (1d) >3 (3d)
Cr >200
Hypotention
pH < 7.30 or HCO3 <18
Hypoglycemia

Front 76

Haemofiltration / Dialysis

Back 76

HF--> upto 20,000 MW
HD--> small molecules
Flow 150-200 ml /min ( 700 max)
UF = 25-40 ml /min

Front 77

Delirium in ITU

Back 77

60-80 % incidence
Hyperactive
Hypoactive ( inc mortality)

Diagnosis:
1. Intensive care delirium screening checklist
2. Confusion assessment method for ICU

Front 78

MAO inhibitors

Back 78

MAO A--> Selegiline
MAO A-B--> Isocarboxazid, phenelzine, Tranylcypromine

Reversible--> Moclobemide

Hold 24 h for reversible
Hold 2 weeks for irreversible

Front 79

Lithium

Back 79

Level 0.8-1.2 mEq/L
Hold 24 h before surgery

Front 80

Digoxin

Back 80

Level 0.8-2 ng/ml

Front 81

Pacemaker Code

Pace maker should be checked within 3 months of elective surgery

Back 81

1. Pace AVDO
2. Sense AVDO
3. Trigger TIDO
4. RM
5. Prog Simp/Multi

Front 82

ICD code

Back 82

1. Shock chamber
2. Ant Tachycardia P chamber
3. Sense
4. Anti Bradycardia P chamber

Front 83

Chronic renal failure
(Stages)

Back 83

1. >90
2. 60-90
3. 30-60
4. 15-30
5. <15 or on dialysis

Front 84

Kings College referal criteria
(Paracetamol poisoning)
Day 2

Back 84

Day 2:
pH < 7.30
INR > 3
Cr > 200
Hypoglycemia
Encephalopathy

Front 85

Kings College referal criteria
(Paracetamol poisoning)
Day 3

Back 85

Day 3:
pH < 7.30
INR > 4.5
Cr > 200

Encephalopathy

Front 86

Kings College referal criteria
(Paracetamol poisoning)
Day 4

Back 86

Day 4:
pH
INR > 1.5
Cr > 250

Encephalopath

Front 87

Classification of Acute Liver
Failure

Back 87

Fulminant:
0-8 weeks ( Jaundice->Enc)
0-2 weeks (if preexisting liver disease)

Hyper acute: 0-7 d
Acute: 8-28 d
Sub acute: 4w to 26 w