Clinical Foundations

Front 1

Two most oxidizing reactive species

Back 1

Hydroxyl radical (OH.)
Peroxynitrite (ONOO.)

Front 2

What is a free radical?
Why are they a problem?

Back 2

An unpaired electron.
Electrons like to be in pairs. They grab electrons from something else, causing a chain reaction leading to oxidative stress.

Front 3

6 sources of oxidative stress

Back 3

1. Mitochondria
2. Respiratory burst/inflammation
3. ischemia/reperfusion
4. ionizing radiation
5. transition metals (Fe, Cu, Mn)
6. Some enzymes, like Xanthine oxidase

Front 4

What is the main intracellular source of RNOS?

Back 4

Mitochondrial electron transport chain

Front 5

Within the Mito ETC, which complexes are important and which one contains UBQuinone?

Back 5

Complex I, Complex III

Complex III has the UBQ

Front 6

Which enzyme is very important in ischemia nad reperfusion?

Back 6

xanthine oxidase

Front 7

What two endogenous sources of RNOS produce H2O2?

Back 7

Activated neutrophils
Fatty acid oxidation

Front 8

Why is Coenzyme Q so important in the ETC with regard to production of RNOS?

Back 8

Some electrons transorted by CoQ directly reduce molecular oxygen and produce superoxide anion. Superoxide anion is produced, therefore, in high quantities in Complex III of the mito ETC.

Front 9

What would happen in a patient with a NADPH oxidase deficiency?

Back 9

Chronic, persistent infections

Front 10

What are the paired reactions that produce hydroxy radical in the presence of excess metals? Which metals are usually used in this process?

Back 10

Haber-Weiss (H202 --> Oh.)
Fenton (O2. --> O2)

Iron and copper.

Front 11

Excess ROS can affect _______, the second enzyme in the Kreb's Cycle and stop production of ATP.

Back 11

Iconitase

Front 12

______ ______ initiates a toxic chain reactionin plasma membranes of cells that kinks phospholipid tail structure, causing disordered packing and a collapse of cell structure, and eventually, ____ ______.

Back 12

Hydroxyl radical, cell lysis

Front 13

Oxidative damage destroys membranes in the following ways:

Back 13

Structure, packing, integrity

Front 14

Early stage oxidation of lipids produces _____ __________, while late stage/further oxidation produces ________.

Back 14

lipid hydroperoxide
aldehydes

Front 15

During oxidation, tyrosine is transformed into _______________ with an ______ and ___________.

Back 15

nitrotyrosine
NOx (NOS), peroxynitrite

Front 16

Peroxynitrite usually attacks _________.

Back 16

Proteins

Front 17

Oxidative species generally attach ________, _________, etc.

Back 17

Mitochondria, NADPH oxidase

Front 18

Both nitrosative and oxidative stress can lead to the formation of ___________.

Back 18

Peroxynitrite

Front 19

Lipid peroxidation of ________ acid produces ____________.

Back 19

arachidonic, isoprostanoids

Front 20

COX2 is present constutively in thse tissues:

Back 20

vascular endothelium, kidney

Front 21

COX1 is present constiutively in the following tissues:

Back 21

Most. Mediates housekeeping functions.

Front 22

Small amounts of ROS act as _______ ______ and can act to trigger ________. This is a _____ thing.

Back 22

transduction signals, defenses
good

Front 23

We must preserve minimum amounts of _____ _______ for the health of the animal.

Back 23

free radicals

Front 24

Mitochondria have their own enzymes, namely:

Back 24

Superoxide dismutase
Glutathione peroxidase

Front 25

Membrane contain mainly Vitamin ___ and a little bit of Vitamin ___. Both are liposoluble.

Back 25

E, A

Front 26

Glutathione peroxidase changes a _______ radical into _______.

Back 26

hydroxyl, H202

Front 27

Oxidative damage causes:
1. Membrane lipid ________
2. Protein _____________ and __________
3. DNA ________

Back 27

peroxidation
cross-linking, fragmentation
fragmentation

Front 28

Co-factors for superoxide dismutase

Back 28

Cu and Zn in the cytoplasm
Mn in mitochondria

Front 29

First line enzyme defenses

Back 29

Catalase
Superoxide dismutase
Glutathione peroxidase

Front 30

Which enzyme requires Selenium as a cofactor?

Back 30

Glutathione peroxidase

Front 31

What are second line enzymatic defenses against free radicals?

Back 31

Dehydroascorbate reductase
Phospholipase A2

Front 32

Name 3 major antioxidants

Back 32

Vitamin E (alpha-tocopherol)
Vitamin C (ascorbate)
Glutathione

Front 33

Superoxide dismutase changes _____ into _____.

Back 33

O2. , H2O2

Front 34

Catalse changes _____ into ______ and ____.

Back 34

H2O2, H20, O2

Front 35

Vitamin E is recycled via Vitamin ___, so maximum antioxidant capacity of Vitamin E is determined by this other vitamin. Must consider the _____ of these two.

Back 35

C, ratio

Front 36

Glutathione peroxidase is very important in two processes:

Back 36

H202 --> water and oxygen
repairing oxidized lipids

Front 37

Glutathione provides the _____ power to convert lipid peroxidases to their loss toxic ______.

Back 37

reducing, alcohols

Front 38

Healthy cells have _____ [GSH]/[GSSG] ratios, while oxidatively damaged cells have ____ ones.

Back 38

high, low

Front 39

1. Vitamin E quenches ________ radical.
2. ________ radical diffuses to aqueous interface.
3. The same radical as above is regenerated by ______ ___
4. _______ regenerates the answer to #3,

Back 39

1. peroxyl
2. Tocopheryl
3. Vit C
4. Glutathione

Front 40

When removing lipid hydroperoxide, ________ ___ clips damaged fatty acids and ______ is the ultimate source of electrons.

Back 40

Phospholipase A2, glutathione

Front 41

Deficiencies involved in White Muscle Disease

Back 41

Selenium deficiency (from soil)
Vitamin E deficiency (from forage)

Front 42

Common species for White Muscle Disease. However, it is prominent in many large animals in Northern California.

Back 42

Sheep

Front 43

______ leaks out of muscle in White Muscle Disease, causing the white color. This is a very ____ protein.

Back 43

Myoglobin, large

Front 44

Glutathione peroxidase is important in repairing membrane damage. In White Muscle Disease, due to a lack of GP's _______, there is no one taking care of the membrane damage which causes muscle lysis and cell death and the leakage of the major protein giving the muscle coloration for which the disease was given its name

Back 44

cofactor

Front 45

Loss of myoglobin in muscles means that no ___ will be taken up. When this occurs, the only ATP being produced by the muscle is through _______.

Back 45

O2, glycolysis

Front 46

This type of anemia is most common in cats due to the high content of ____ in their hemoglobin.

Back 46

Heinz Body (hemolytic), SH groups

Front 47

Cat hemoglobin is more prone to oxidation due to its greater tendency to:

Back 47

Disassociate into dimers (somehow due to the SH group content)

Front 48

The cat ______ is less efficient in removing _____ Bodies.

Back 48

spleen, Heinz

Front 49

Cats have lower activity of _____ ______ for drug conjugation, etc.

Back 49

glucuronyl transferase

Front 50

What are some of the triggers for Heinz Body hemolytic anemia in cats

Back 50

Onions (high thiosulfates)
Oxidative stressing drugs (Propofol, acetominophen)

Front 51

Diagnose Heinz Body anemia in cats via ______ and _____.

Back 51

Decreased PCV, Heinz Bodies in RBC under microscopy

Front 52

What is the treatment for Heinz Body Anemia in cats?

Back 52

Vitamin E, Vitamin C, N-Acetyl Cysteine (NAC)

Front 53

What does NAC do?

Back 53

recursor for glutathione synthesis, so it increases the synthesis of ENDOGENOUS glutathione

Front 54

What is the purpose of adding Vit E to HBA tx for cats? Vit C?

Back 54

Increased scavneging of lipid peroxidation

Better recovery of Vitamin E

Front 55

What causes the hemolysis of the RBCs in Heinz Body anemia of cats?

Back 55

RBCs more prone to breakage due to tons of polymerized, oxidized Hb inside of them

Oxidative damage to RBC itself can also contribute

Front 56

Vitamin E and C protect cell membranes, while glutathione helps to:

Back 56

repair the damage that is already there

Front 57

Which oxidative disease that we learned about is X-linked and decreases NADPH formation?

Back 57

Glucose--phsphate dehydrogenase deficiency

Front 58

Which species does G6PDD affect?

Back 58

Horses, cattle

Front 59

Decreasing NADPH decreases the ability to reduce _________, which reduces the formation of _____ which causes fragility of ______.

Back 59

glutathione, GSH, RBCs

Front 60

This pathway is the only means for RBCs to generate NADPH due to their lack of _______. This is why RBCs are so sensitive to G6PDD.

Back 60

Pentose Phosphate Pathway, mitochondria

Front 61

With G6PDD, if there is no oxidative stress, patients are ________. When oxidative stress, infection, or ingestion of fava beans is introduced, they are at risk for severe _____ _________ ______.

Back 61

asymptomatic

acute hemolytic anemia

Front 62

In what two discussed conditions do Hb aggregates and Heinz bodies form?

Back 62

Heinz Body hemolytic anemia in cats

Glucose-6-phosphate dehydrogenase deficiency in cattle and horses

Front 63

GSH acts as a ________ buffer. When it is low, Hb and other large proteins form ________ via ______ bonds. This occurs in G6PDD.

Back 63

sulfhydryl
aggregates, disulfide

Front 64

Name for aggregates of Hb

Back 64

Heinz Bodies

Front 65

What is the common disposal form of Copper?

Back 65

Cu-MT

Front 66

Which species is especially susceptible to copper toxicity due their decreased disposal of it?

Back 66

Sheep

Front 67

Which two metals are commonly associated with oxidative stress because they are redox active metals?

Back 67

Copper, iron

Front 68

Which practice causes oxidative stress to many sheep? Due to the wounds they may be treating for, ____ can get into the bloodstream and cause hemolysis.

Back 68

Sheep dips

Copper

Front 69

GSH deficiency in sheep is enhanced by _____ ___ and ____.

Back 69

Brassica crops, kale

Front 70

1. Breed of sheep with genetic susceptibility to GSH deficiency due to low GshA
2. Breed of sheep with genetic susceptibility to GSH deficiency due to an amino acid transport defect

Back 70

1. Tasmanian Merino
2. Finnish Landrace

Front 71

Ischemia is defined as:

Back 71

condition suffered by organs and tissues when deprived of blood flow, mostly the effects of inadequante oxygen and nutrients

Front 72

Reperfusion injury occurs due to:

Back 72

burst of ROS and oxidative stress from mitochondria and other sources once blood flow is restored which causes damage to the vascularized tissues.

Front 73

Examples of sequelae from reperfusion injury:

Back 73

Brain damage
Cardiac arrest

Front 74

Sequelae from reperfusion injury are often _____ term.

Back 74

Long

Front 75

Major categories of issues caused by reperfusion injury (4)

Back 75

Circulatory failure
Immune response
Adrenal dysfunction
Coagulopathies

Front 76

Outcome of cell injury from ischemia/reperfusion, whether reversible or irreversible, depends on:
1. ____, ________, and _____ of injury as well as
2. ____, ______, and ______ of the cell

Back 76

1. Type, duration, severity
2. Type, state, adaptability

Front 77

If damage to a cell involves _______ or ______, it is considered irreversible.

Back 77

Apoptosis, necrosis

Front 78

Most susceptible organs to low oxygen

Back 78

Brain, heart

Front 79

Ischemia/anoxia preferentially causes ______.

Back 79

Encephalopathy

Front 80

3 sources of RNOS in ischemia-reperfusion:

Back 80

1. Mitochondrial ETV
2. Xanthine oxidase
3. activated neutrophils

Front 81

Ischemia causes large quantities of ATP to be broken down to ______.

Back 81

Xanthine

Front 82

Shock definition and what causes it

Back 82

Inadequate cellular ATP

Inadequate tissue perfusion and cellular oxygenation, affecting multiple organ systems

Front 83

Shock can either be due to a deficiency of the delivery of _______/substrates to the cells or due to a deficiency/inability of cells to ________ oxygen.

Back 83

oxygen, utilize

Front 84

Two main components of oxygen delivery to tissues

Back 84

1. Cardiac output
2. O2 content of arterial blood

Front 85

Formula for cardiac output

Back 85

Heart rate x Stroke volume

Front 86

3 determinants of stroke volume

Back 86

Preload
Afterload
Contractility

Front 87

Preload is affected by _____ volume.

Back 87

Plasma

Front 88

When you have ________ or acute blood/volume loss, stroke volume _____.

Back 88

Hypovolemia, decreases

Front 89

2 factors that arterial oxygen content is dependent on

Back 89

1. Hb concentration
2. % saturation of Hb with O2

Front 90

Loss of ___ ______, ______, and _______ all contribute to reduced oxygen delivery to tissues.

Back 90

blood volume, hemoglobin, oxygen

Front 91

Effects of reperfusion injury:
1. Local vaso________
2. _______ : excess coagulation activated by injured endothelial cells and release of tissue factor (TF)
3. Regional mal________
4. _________ radical formation

Overall effect: ____ ______ _______

Back 91

1. constriction
2. thrombosis
3. perfusion
4. superoxide

direct cellular damage

Front 92

When cell hypoxia occurs, a proinflammatory state can occur which includes _______ activation and _______ release. This contributes to cell injury and eventually causes _____ ______ and failure.

Back 92

neutrophil, cytokine
organ dysfunction

Front 93

Lack of ATP from shock leads to membrane pump failure. Which is the main pump affected and why?

Back 93

Na-K ATPase because it requires lots of ATP

Front 94

In shock:
1. Membrane potential becomes ____ _______
2. Calcium _____ the cell
3. Calcium ______ enzymes causing _____ of the cell
4. Calcium damages _______ and causes dysfunction

Back 94

1. more positive (or less negative)
2. enters
3. activates, digestion
4. mitochondria

Front 95

Calcium is cyto_____ and pro-_______ and increases free radical formation.

Back 95

toxic, apoptotic

Front 96

When you lose Na-K ATPase function, membrane potential becomes more positive which means it is slightly __________.

Back 96

depolarized

Front 97

6 main types of shock

Back 97

Hypovolemic
Distributive
Cardiogenic
Obstructive
Hypoxic
Metabolic

Front 98

In hypovolemic, distributive, cardiogenic, and obstructive forms of shock, blood is not getting to _____. Basically it is ____ dysfunction.

Back 98

cells, CV

Front 99

For hypoxic and metabolic forms of shock, there is a lack of ______, but delivery is ______.

Back 99

substrate, normal

Front 100

In this type of shock, cells are sometimes dysfunctional. Even if substrates are present, the cells cannot utilize them.

Back 100

Metabolic

Front 101

2 examples of obstructive shock

Back 101

Pulmonary emboli
Cardiac tamponade

Front 102

Most common clinical scenario for distributive shock.

Back 102

Sepsis

Front 103

3 Lab indicators of CV failure

Back 103

Increased lactate
Metabolic acidosis concurrent with high lactate
Decreased central (or mixed) venous O2 tension

Front 104

When CV failure is present, you will often see:
1. _____ mentation
2. ____ MM color
3. ______ CRT
4. _____ HR
5. _______ pulse quality
6. ______ gradient between core and extremity temps

Back 104

1. depressed
2. pale
3. increased (usually)
4. decreased
5. reduced
6. increased

Front 105

Most common form of shock (general category)

Back 105

Hypovolemic

Front 106

Hypovolemic shock leads to a decrease in ______, then decreased stroke volume, then decreased _____ ______, and then decreased DO2.

Back 106

preload, cardiac output

Front 107

____ acitvation provides immediate compensation in hypovolemic shock, while _____ activation provides delayed compensation.

Back 107

Sympathetic nervous system, RAAS

Front 108

As compensation, the SNS activates and causes both arteries and veins to _______. In horses, they can also contract their _____ and activate this reserve in RBCs.

Back 108

constrict, spleen

Front 109

Activation of the RAAS ultimately leads to an increase in _________ ___ and the release of ________. The overall effect is retention of ___ and _____ at the level of the kidney and vaso_______.
Additionally, urine would become ______ to retain plasma volume and thirst would _____.

Back 109

angiotensin II, vasopressin
Na, water, constriction
concentrated, increase

Front 110

Physiologic Responses to Hypovolemia:
1. Net movement of _______ fluid back into _____ circulation.
2. Tissues extract ____ O2 per unit blood.
3. O2 Extraction Ratio ______
4. If hemorrhage is the cause of hypovolemia, bone marrow will _____ production of RBCs and _____ production will be increased to assist with this.

Back 110

1. lymphatic, venous
2. more
3. increases
4. increase, EPO

Front 111

What % calculation would reflect an increase in O2 extraction ratio

Back 111

> 30%

Front 112

Name 6 perfusion parameters that would indicate the diagnosis of shock. Which other parameter can be used in large animals?

Back 112

1. Decreased mentation
2. Tachycardia
3. Prolonged CRT
4. Cold extremities
5. Decreased pulse quality
6. Pale MMs

Jugular refill time as an indirect indicator.

Front 113

Perfusion reflects _______ _______, while dehydration assess volume of the _____ _______.

Back 113

intravascular volume, interstitial space

Front 114

Define hypovolemia (reduced perfusion)

Back 114

A deficiency of blood volume

Front 115

Define dehydration

Back 115

Deficiency of extracellular, extravascular water

Front 116

Measuring for hypovolemia/perfusion is done via perfusion parameters. Dehydration is assessed with ____ _____, MM ____, and _____ quality.

Back 116

skin turgor, moisture, corneal

Front 117

Normal blood volume of an adult animal is _______ % of body weight for most domestic species. The exception is the ____ which has a % of body weight blood volume closer to ___%.

Back 117

8-10, cat, 5

Front 118

How much blood loss must occur before you see significant clinical changes/signs

Back 118

15%

Front 119

At what % of blood loss does death usually occur?

Back 119

40%

Front 120

Distributive shock can be described as inappropriate ________. It includes septic shock/SIRS shock, anaphylactic shock, and neurogenic shock.

Back 120

Vasodilation

Front 121

Early septic shock can have a large element of compensation. This can result in compensatory shock, aka _________ ______.

Back 121

Hyperdynamic shock

Front 122

Hyperdynamic shock can be characterized by:
1. _____ MMs
2. ____ CRT

Back 122

1. Bright red
2. decreased

Front 123

Compensation mechanisms present in early septic shock include:
1. _____ CO
2. _________ from vasodilation causing decreased total peripheral vascular resistance

BP = CO x PVR (periph vasc resist)

Back 123

1. Increased/high
2. Hypotension

Front 124

Anaphylaxis target organs:
1. Dog -
2. Cat -
3. Horse -
4. Ruminants and pigs -

Back 124

1. liver/GI (splanchnic)
2. lung/upper airway
3. GI and lung
4. lung

Front 125

With neurogenic shock (spinal cord injury), you will see ______ dysfunction from spinal cord injuries _____ to the thoracic level and loss of sympathetic tone causing _______ and _______.

Back 125

autoomic, crnaial
vasodilation, bradycardia

Front 126

In distributive shock, you can often get _________ of perfusion, causing some areas to be overly perfused and others to be under perfused.

Back 126

maldistribution

Front 127

In late sepsis, you see "___________ shock" where cardiac output _______ and decreased myocardiacal function can occur. This stage is similar to _______ shock (a DIFFERENT broad category).

Back 127

hypodynamic, decreases

Cardiogenic

Front 128

In sepsis, there can be an additional component of hypoxic shock due to _______ dysfunction.

Back 128

mitochondrial

Front 129

Define SIRS

Back 129

Excessive inflammation beyond homeostatic or compensatory mechanisms - now damaging.

Front 130

Most common cause of SIRS in veterinary species

Back 130

Sepsis (infection)

Front 131

6 causes of non-septic SIRS (not associated with infection)

Back 131

1. Endotoxemia
2. Severe hypoxia
3. Severe tssue trauma
4. Thermal injury
5. Multiple blood transfusions
6. Pancreatitis

Front 132

Define sepsis in terms of SIRS

Back 132

Sepsis = SIRS + infection

Front 133

What is the difference between sepsis an severe sepsis?

Back 133

In sepsis, you have SIRS and infection, but in severe sepsis you have sepsis AND organ dysfunction AND hyoperfusion

Front 134

Define septic shock in terms of a formula

Back 134

Sepsis + fluid-refractory hypotension
(aka vasopressor dependent shock)

Front 135

For a diagnosis of SIRS, you need to have 2 or more of the following 4 things going on:

What is the other caveat that need to be filled in order for this diagnosis to work?

Back 135

1. Fever or hypothermia
2. Tachycardia
3. Tachypnea (hyperventilation)
4. Leukocytosis or leukopenia or >10% bands

These things must be DUE TO the underlying disease condition. For instance, if you have fever due to heat stress from hot outside temperatures, this can't count towards your diagnosis.

Front 136

Why do you often have a leukopenia with severe sepsis?

Back 136

White cells have been marginated and are in the periphery.

Front 137

End/net result of SIRS is inadequate ____ delivery or uptake --> shock --> multiple _____ ______ (______) --> can lead to death

Back 137

O2, organ dysfunction (MODS)

Front 138

Hallmark of cardiogenic shock

Back 138

Myocardial dysfunction

Front 139

Clinical picture of cardiogenic shock:
1. ______ hypotension seen via poor perfusion parameters
2. Volume ______ seen via things like pulmonary _____ and _________ or even third space _______.

Back 139

1. Arterial
2. overload, edema, cardiomegly, effusions

Front 140

What is cardiac tamponade and what form of shock can it be associated with?

Back 140

Cardiac tamponade is the acute development of pericardial effusion, caused by things like trauma or aortic root dissection.

Obstructive shock

Front 141

In severe cases of cardiac tamponade you may see a phenomenon known as ______ ________ which has a complex pathophysiology but is manifested as _____ aortic systolic pressure during ______.

Back 141

pulsus paradoxus
decreased, inspiration

Front 142

Describe electrical alternans and explain a hypothesis behind this phenomenon.

Back 142

Electrical alternans is alternating amplitudes of the QRS wave. It is hypothesized that this would be due to the heart sloshing around in fluid changing the directionality of the electrical current slightly.

Front 143

Tension pneumothorax can be a cause of ______ shock. _____ intrapleural pressures cause collapse of the cranial and caudal vena cava which results in inadequate _______ _______.

Back 143

obstructive, increased, venous filling

Front 144

What is the treatment for tension pneumothorax?

Back 144

Continuous emergency decompression of pleural air ia suction

Front 145

With hypoxic shock, blood _____ and ____ are normal. However, there is a deficiency of _____.

Back 145

volume, flow, oxygen

Front 146

3 ways to have low substrate with hypoxic shock

Back 146

Low PaO2
Low SaO2
Low Hb concentration (severe anemia)

Front 147

5 causes of severe hypoxemia

Back 147

1. Low PiO2 (NOT FiO2)
2. V/Q mismatch
3/ Diffusion Impairment
4. Hypoventilation
5. Right to left shunt

Front 148

2 main causes of hypoxic shock

Back 148

Severe hypoxemia
Severe anemia

Front 149

2 major causes of metabolic shock

Back 149

Impaired O2 utilization
Severe hypoglycemia

Front 150

Metabolic shock due to hypoglycemia. Common or uncommon?

Back 150

Common

Front 151

What causes metabolic shock due to hypoglycemia in neonates?

Back 151

If neonates don't nurse, they don't have sufficeint glycogen and fat stores to meet energy substrate needs. They become septic and go into metabolic shock due to hypoglycemia.

Front 152

4 causes of adults going into metabolic shock due to hypoglycemia

Back 152

Sepsis
Hypoadrenocorticism (Addison's)
Liver failure
Insulinoma

Front 153

Saturation of oxygen in the arteries is determined by:

Back 153

Partial pressure of oxygen in arteries

Front 154

3 determinants of arterial O2 content

Back 154

[Hb]
O2 binding capacity to Hb
SaO2

Front 155

3 H's for anesthetic concern for all species

Back 155

Hypotension
Hypoventilation
Hypothermia

Front 156

Major anesthetic concerns that are most concerning in large animals

Back 156

Handling
Hypoxemia/decreased partial pressure O2
Myopathy/neuropathy

Front 157

Major anesthetic concerns most concerning in ruminants

Back 157

Bloat
Regurgitation/aspiration

Front 158

Prevent hypothermia:
1. Provide ____ support
2. ____ necessary areas only
3. ______ surfaces
4. ______ wetting
5. _____ respiratory gases if possible

Back 158

1. heat
2. Clip
3. Insulate
4. Minimize
5. Warm

Front 159

Consequences of hypothermia:
1. ______ anesthetic requirement
2. _____ heart rate
3. _____ recovery
4. _________ during recovery which can make patient uncomfortable and increase O2 requirements
5. ____ infection rates
6. ______ hospitalization times

Back 159

1. decrease
2. decrease
3. slow
4. shivering
5. increase
6. increase

Front 160

Which species is most susceptible to malignant hyperthermia and what triggers it?

Back 160

Pigs

Exposure to inhalants.

Front 161

2 iatrogenic sources of hyperthermia in anesthetized patients

Back 161

1. Excessive thermal support
2. Excessive muscle effort from ight anesthesia and increased breathing effort

Front 162

Hyperthermia is often associated with _____ administration in cats.

Back 162

opioid

Front 163

Parameters detecting hypotension:
Systolic BP < ___ mmHg
Mean BP < ___ mmHg

Back 163

90, 70

Front 164

Pediatric animals have ______ normal blood pressures than adult animals.

Back 164

lower

Front 165

Major organs ______ blood pressure to a large extent, but once blood pressure drops below _____ mmHg they are completely dependent on pressure gradient for flow.

Back 165

autoregulation, 60-70

Front 166

A dog is considered bradycardic if their HR drops below ____, while a cat is bradycardic when it drops below ____. Horses are bradycardic when they get below ____.

Back 166

60, 100, 20

Front 167

Basic management principles of managing hypotension

Back 167

Assess and reduce anesthetic depth if possible
Assess and increase HR if necessary
IV fluid bolus

Front 168

Standard rate for fluid administration under anesthesia WITHOUT complications

Back 168

5-10 mL/kg/hr IV

Front 169

If animal turns hypotensive, give bolus of how much:

Back 169

10-20 mL/kg IV

Front 170

What is the advantage of using isotonic crystalloids in anesthesia fluids?

Back 170

They can be given rapidly without altering osmolality or serum electrolytes too much

Front 171

What is the purpose of fluid administration in an uncomplicated anesthesia patient?

Back 171

Make up for insensible losses and vasodilation from inhalant. Helps maintain preload.

Front 172

Most common cause of a hypertensive measurement under anesthesia

Back 172

Incorrect cuff size (artifact)

Front 173

What is the ONLY way to measure ventilation

Back 173

PaCO2

Front 174

2 things inhalants do with regard to the body's ability to regulate ventilation

Back 174

1. Increase level of CO2 brain needs to see to tell animal to breathe more
2. Dulls animal's physiologic response to increasing CO2 levels

Front 175

Hypoventilaton causes a respiratory ______.

Back 175

Acidosis

Front 176

What is a measure that approximates PaCO2 in the absence of large amounts of alveolar dead space

Back 176

Expired PCO2

Front 177

Manual breaths will have what affect on PaCO2?

Back 177

It will remain unchanged

Front 178

When apnea occurs, say the first two steps of what you should do

Back 178

1. Don't panic
2. Check for the presence of a pulse!!

Front 179

Apeneic threshhold is ______ by general anesthesia, so sometimes patient's don't know they need to breathe.

Back 179

decreased

Front 180

Apnea is pretty common during _____ and is most common with this drug: _____, especially if given quickly.

Even though common, never forget to check for a pulse/HR!!

Back 180

induction, propofol

Front 181

Describe the balancing act between providing manual breaths and having an apneic patient.

Back 181

You want to have oxygen and anesthetic on board, so you should give a few breaths. But PaCO2 must rise high enough to facilitate spontaneous breathing by the patient, so you don't want to give too many.
1-2 bpm is okay for giving manual breaths.

Front 182

Reasons for pre-oxygenation of an anesthesia patient

Back 182

Delays onset of hypoxemia because takestime to desaturate

Elevated PaO2 with increased FiO2

Front 183

ANY recumbant large animal will have some degree of _________ _________ under anesthesia, indicating hypoxemia as a concern.

Back 183

V/Q mismatch

Front 184

Hypoxemia in anesthetized large animals is especially exacerbated by _____ abdominal pressure such as GI distension, non-fasted status, and pregnancy.

Back 184

increased

Front 185

Hypoxemia can be seen in small animals when they have underlying _____ _______ and due to V/Q mismatch.

Back 185

pulmonary diseases

Front 186

The direct measurement for hypoxemia is _____, but the approximation is ____.

Back 186

PaO2, SpO2

Front 187

What is the limitation in the approximation of SpO2 for PaO2?

Back 187

Once Hb is saturated, you won't be able to tell how high PaO2 is going. So, PulseOx only gives a measure of O2 in the blood when it is below 100 (aka Hb has begun to desaturate).

Front 188

What are the two ways to manage hypoxemia when under anesthesia

Back 188

1. Supplemental O2
2. Ventilatory support (IPPV)

Front 189

What is the goal of IPPV for a potentially hypoxemic patient?

Back 189

Aim to re-expand collapsed alveoli. This is sometmes very difficult to accomplish.

Front 190

Causes of myopathies and neuropathies for large animals under anesthesia

Back 190

Poor positioning
Poor padding/support
Poor perfusion (hypotension)

Front 191

What are the proper ways to position a large animal patient during anesthesia

Back 191

Squarely

If in lateral recumbancy, down forlimb forward and upper limbs supported.

Front 192

At what point is post-op lameness significantly increased in terms of length of anesthetic procedure?

Back 192

>2hrs

Front 193

Do NOT intubate a ruminant under ____ anesthesia because they will actively ______.

Back 193

light, regurgitate

Front 194

Ruminants can ______ regurgitate at any time.

Back 194

passively

Front 195

2 common repercussions of regurgitation under anesthesia for ruminants

Back 195

Aspiration pneumonia
Airway obstruction

Front 196

_____ dramatically reduces the risk of complications from regurgitation in ruminants.

Back 196

Fasting

Front 197

Proper positioning to prevent aspiration in ruminants

Back 197

Pharynx up, muzzle down

Front 198

Do NOT move an anesthetized ruminant until you have intubated and ______ ___ _____.

Back 198

inflated the cuff

Front 199

With ruminants you often remove the ET tube when?

Back 199

When they are up and swallowing and often ith the cuff inflated

Front 200

What is another term for bloat in ruminants

Back 200

Ruminal tympany

Front 201

In ruminal tympany, there is progressive distension of the _____. This leads to reduce lung ____ and ______ causing hypoventilation and V/Q mismatch. It also leads to decreased venous return which ______ cardiac output.

Back 201

rumen
volume, compliance
decreases

Front 202

What can ruminants not do when recumbant or anesthetized which causes them to bloat?

Back 202

eructate

Front 203

Fasting dramatically reduces the following anesthetic risks in ruminants

Back 203

Regurgitation
Bloat

Front 204

What species, other than ruminants, can bloat under anesthesia?

Back 204

Horses - usually cecal, very uncommon, devastating

Dogs - usually stomach

Front 205

What should you start with when making up an anesthetic plan?

Back 205

Anticipated concerns/problems

Front 206

5 Things to Include in an Anesthetic Plan

Back 206

1. Management techniques
2. Drugs, dosages and routes
3. Monitoring
4. Support
5. Analgesia Plan

Front 207

List the anesthetic concerns you would anticipate for ANY anesthetized patient

Back 207

Hypothermia
Hypoventilation
Hypotension
Pain

Front 208

Absolute indications for emergency lap following a stab wound (4)

Back 208

Peritonitis
Shock
Evisceration
Spinal cord injury

Front 209

Define a non-therapeutic laporatomy

Back 209

A lap where a lesion is found, but you cannot do anything to correct the problem surgically. You can, however, take samples and treat it as a diagnostic procedure.
Common result of an exploratory lap.

Front 210

When is an exp lap result negative?

Back 210

A negative lap is when there are no visible lesions found

Front 211

2 most useful tests for a patient with post-traumatic hematuria

Back 211

IV pyelogram
CT

Front 212

For non-operative treatment of a stab wound, what clinical monitoring is used

Back 212

Serial physical exam

Front 213

Evisceration of what organ is NOT an absolute indication for abdominal surgical intervention

Back 213

Omentum

Front 214

Absolute indications for diagnostic laporatomy to rule out diaphragmatic disease (3)

Back 214

1. Omentum herniation through chest wall
2. Air under diaphragm
3. Persistent left upper quadrant tenderness

Front 215

A pure transudate is caused by a decrease in _____ pressure, while a modified transudate is caused by an increase in _______ pressure.

Back 215

oncotic, hydrostatic

Front 216

What mechanism causes the formation of an exudate?

Back 216

Increased capillary permeability (aka inflammation)

Front 217

Neutrophils are present in 2 out of 3 effusion classifications. They may or may not be present in a:

Back 217

Pure transudate

Front 218

What is the range for total protein in a modified transudate?

Back 218

2.5-5 g/dl

Front 219

How would you test for:
1. Uroabdomen
2. Chylous effusion
3. Pancreatitis
4. Bile peritonitis
5. Sepsis

Back 219

1. Creatinine
2. Triglycerides
3. Amylase, lipase
4. Bilirubin
5. pH, glucose, lactate

Front 220

"Normal" peritoneal fluid is characteristically low in cells and protein. It is an ______ of _____.

Back 220

Ultrafiltrate, plasma

Front 221

Hydrostatic pressure is the force of pressure within ____ ______ and pushes things ___ of them.

Back 221

blood vessels, OUT

Front 222

Oncotic pressure is accomplished through _____ ______ and pulls fluid ____ the blood vessels.

Back 222

plasma proteins, INTO

Front 223

5 absolute indications for surgical intervention via abdominal laporatomy

Back 223

GDV
Bile peritonitis
Uroabdomen (but ID source of leak via IV pyelogram or CT first)
Intra- or extra-cellular bacteria in abd fluid
Ingesta

Front 224

Would dog bite injury be an indication for surgical thoracic exploration?

What factors would make things especially urgent

Back 224

Yes.

Flail chest or a sucking chest injury

Front 225

Absolute indications for surgical thoracic exploration (2)

Back 225

Biliary effusion
Urothorax

Front 226

2 main goals of shock resuscitation

Back 226

1. Rapidly restore systemic and regional perfusion to prevent ongoing cellular injury
2/ Prevent development of end organ failure

Front 227

The most important thing to do in shock resuscitation is to treat the _____ _____.

Back 227

Underlying problem

Front 228

What would you change in the resuscitation plan for nonhemorrhagic v. hemorrhagic hypovolemic shock?

Back 228

Both would recieve fluid therapy, but you may consider blod products for hemorrhagic

Front 229

Describe the resuscitation plan (general) for septic shock

Back 229

Antimicrobials (v bacteridical, borad spectrum while waiting for C&S) and hemodynamic support in the form of fluids.

May need pressors if fluid refractory and inotropes if there is myocardial dysfunction

Front 230

Resuscitation protocol for anaphylactic shock

Back 230

Epi, antihists, corticosteroids, fluids

Front 231

Describe the treatment components of pulmonary embolism

Back 231

Oxygen, anticoagulants, treating the underlying cause (sepsis? etc)

Front 232

Differentials (general) for underlying cause of cardiac tamponade

Back 232

Septic
Neoplastic
Idiopathic

Front 233

Treatment components for cardiac tamponade

Back 233

Evacuate fluid
Treat underlying cause

Front 234

Treatment components for hypoxic shock

Back 234

Oxygen
Treatment of underlying cause
Mechanical ventilation

Front 235

What is the treatment for hypoglycemia when this is the cause of metabolic shock?

Back 235

IV dextrose

Front 236

Cytopathic hypoxia is a ______ problem to treat. There are some experimental treatments with ________, but mostly you must treat by maximizing ______ and hoping that the hypoxia is in a ______ stage.

Back 236

difficult, antioxidants, perfusion, reversible

Front 237

2 phases of fluid therapy

Back 237

Replacement
Maintenance

Front 238

When in the replacement phase of fluid therapy, you are working to replace the ______ losses.

Back 238

ECF

Front 239

Maintenance fluids are to maintain hydration in an already _____ patient.

Back 239

hydrated

Front 240

What are the 4 components of TROL when performing replacement fluid therapy

Back 240

Type
Rate
Objective
Limits

Front 241

Osmolality of the ECF

Back 241

280-300

Front 242

Isotonic crystalloids have _____ osmolality than plasma, while hypertonic crystalloids have ______ osmolality than plasma (______).

Back 242

similar
greater, >300

Front 243

Colloids consist of ____ molecular weight particles dissolved in water. They exert ____ pressure.

Back 243

large, oncotic

Front 244

In a patient with hypoalbuminemia, you should expect a ______ level of fluid will exit the ________ compartment, especially if the hypoalbuminemia is acute in onset.

Back 244

greater, intravascular

Front 245

2 components of ECF

Back 245

Plasma
Interstitium

Front 246

______ _____ govern the movement of water between plasma and interstitial space. ___ of the volume distributes to the interstitium, while _____ distributes within plasma.

Back 246

Starling's forces, 3/4, 1/4

Front 247

Hypertonic crystalloids and colloids are both rapid ____ _________.

Back 247

plasma expanders

Front 248

Hypertonic crystalloids are adminstered in ____ volume and _______ borrows water from the _____ and ______ to expand the plasma volume.

Note the length of effect.

Back 248

small, temporarily, interstitial, intracelluar

Short-lived

Front 249

4 Isotonic Crystalloid Choices

Back 249

LRS
Normosol-R
Plasma-Lyte 148 or A
Normal saline (.9%)

Front 250

3 benefits of hypertonic saline as the fluid of choice

Back 250

Increased cardiac contractility (CO increased)
Anti-inflammatory
Neutrologic benefits (decreased ICP)

Front 251

3 Potential adverse effects of hypertonic saline administeration (which 2 are the most important)

Back 251

*Hypernatremia
*hyperosmolality
Potentiation of uncontrolled hemorrhage via the transient rise in BP

Front 252

What are the two subcategories of colloids?

Back 252

Natural
Synthetic

Front 253

What is one major indication/possible indication for the use of colloids?

Back 253

Hypoalbuminemia

Front 254

2 synthetic colloid choices and what is their chemical composition

Back 254

hetastarch
dextran

These are polysacchirides

Front 255

Synthetic colloids should NOT be used in ______ ____ patients or patients with _______ ______.

Back 255

critcally ill, kidney dysfunction

Front 256

Two methods for determining how much fluid to administer in replacement therapy

Back 256

Determining a deficit volume from a determined % dehydration

Fluid challenge method

Front 257

When using the "determine deficit" method of fluid replacement, you calculate the deficit with this formula ___________ and then replace over a period of _____ hours.

Back 257

% dehydration * BW (in kg)

4-6

Front 258

First percentage of dehydration that can be detected clinically

Back 258

5%

Front 259

Describe the fluid challenge method

Back 259

Incremental boluses are adminterested with reassessment following each one until the hypovolemia is treated or until the risks of edema, etc. outweigh the benefits of correcting the volume deficit.

Front 260

How large is an isotonic crystalloid bolus in the fluid challenge method

Back 260

10-20 mL/kg

Front 261

Most hypovolemic animals need ____ isotonic crystalloid boluses during the fluid challenge method of replacement therapy, while most ambulatory animals need _____ boluses.

Back 261

2-4, 1-2

Front 262

After each bolus of fluid challenge you reassess the following 2 things:

Back 262

Perfusion parameters
Urine output

Front 263

Isotonic crystalloid boluses in fluid challenge replacement are given over _____ minutes

Back 263

5-30

Front 264

How often would a hypertonic crystalloid bolus be given during fluid challenge replacement? Colloids?

Back 264

Once total

Once per day

Front 265

Hypertonic crystalloid boluses in fluid challenge replacement are around ____ mL/kg, while colloids are ______ mL/kg

Back 265

4
3-5-10

Front 266

In general, if an animal ______ during fluid administration, sufficient fluids have been administered.

Back 266

urinates

Front 267

A _____ in heart rate and a _____ in blood lactate can both indicate that fluid therapy has been effective

Back 267

decrease, decrease

Front 268

Blood pressure reaching above ___ mmHg indicates that end organ perfusion is being accomplished.

Back 268

60

Front 269

Administration of antioxidants may benefit a patient when administered _____ to injury. This is an area of very active research.

Back 269

prior

Front 270

5 Antioxidants Used Clinically in Vet Med

Back 270

1. Vit C
2. Vit E
3. Selenium
4. DMSO
5. Mannitol

Front 271

A hollow organ is one with a ____, _____, or _____.

Back 271

tube, pouch, cavity

Front 272

What is term for an opening into a tube?

Back 272

Ostium

Front 273

The term for the lack of an opening is ______ and this can include a NORMAL opening being present (no pathology, ie an ______ anus)

Same answer for both blanks.

Back 273

Imperforate

Front 274

Define atresia

Back 274

Abnormal closure or absence of a normal orifice/passage

Front 275

Suffix describing making a cut or opening into something that you will later close

Back 275

-otomy

Front 276

Suffix describing the creation of a new opening that you will leave open

Back 276

-ostomy

Front 277

-ectomy implies _____ _______ of tissue

Back 277

surgical removal

Front 278

-pexy implies ______ ______ of an organ. Most commonly this is done in ________, but can also be done for bladders and colons.

Back 278

surgical fixation, stomach

Front 279

List the hollow organs of the abdomen

Back 279

Stomach
SI
LI
Gallbladder
Ureters
Urinary bladder
Reproductive tract (uterine horns, uterus)

Front 280

List the hollow organs of the thorax

Back 280

Heart
Esophagus
Trachea

Front 281

3 assessments that can be made with contrast studies of hollow organs

Back 281

Look for leakage
Look for obstructions and strictures
Assess diameter and size

Front 282

2 very important diagnostics to consider when talking about hollow organs

Back 282

Rads
Fluoroscopy

Front 283

Standrad contrast material used:
When is this material contraindicated?

Back 283

Barium
When perforation of gut may be suspected - causes irritation

Front 284

What would indicate extravasation on a radiographic contrast study of the upper GI tract?

Back 284

Loss of smooth margins along intestinal walls (barium coats GI mucosa)

Front 285

How could you diagnose hydronephrosis and assess the ureters (which contrast method?)

Back 285

Fluoroscopy

Front 286

Which hollow organ sample(s) is (are) routine and do not require sedation?

Back 286

Cystocentesis

Front 287

What is usually the goal when performing a cystocentesis?

Back 287

Obtain a clean sample of urine for a culture and sensitivity (free catch could have secondary contamination)

Front 288

What diagnostic samples of hollow organs are routine but require sedation or anesthesia?

Back 288

Tracheal wash, transtracheal wash, bronchoalveolar lavage

Front 289

Cholecystocentesis and nephrocentesis are sampling procedures for hollow organs that are possible but are ____ ______.

Back 289

not routine

Front 290

Which structures are used during surgery to visualize the retroperitoneal space and which sides does each assist with?

Back 290

Right side - use mesoduodenum
Left side - use mesocolon

Front 291

Hollow organs have the following 4 tissue layers of their walls

Back 291

Mucosa, submucosa, muscularis, serosa

Front 292

Which of the 4 hollow organ tissue layers is not very prominent in the esophagus?

Back 292

Serosa

Front 293

Which is the holding layer for hollow organ surgery?

Back 293

Submucosa

Front 294

In hollow organ closure, __________ patterns are used in small animals to avoid narrowing of lumens. Therefore, in general, this pattern is used for organs with ____ lumen size.

Back 294

appositional, small

Front 295

When lumen size is not a concern and you are concerned with suture ______, use an _____ pattern. Large animals and stomachs are situations that would fit for this pattern.

Back 295

security, inverting

Front 296

Which suture pattern would NOT be routinely used for bowel closures?

Back 296

Everting

Front 297

What is the most important goal when choosing a suture closure for hollow organs?

Back 297

LEAK PROOF!

Front 298

What are two appropriate suture patterns for the internal closure (mucosa + submucosa) of a gastrotomy?

Back 298

Simple interrupted
Simple continuous

Front 299

4 basic surgical principles to remember when performing a gastrotomy

Back 299

Stay sutures
Lap sponges (placed all around sx site)
Intraperitoneal irrigation
Clean/dirty instrumentation

Front 300

What is used for intraperitoneal irrigation?

Back 300

Saline

Front 301

2 indications for a gastrotomy

Back 301

FB removal
Gastric biopsy

Front 302

When doing a 2 layer closure of a hollow organ, which wall layers are group together?

Back 302

Mucosa + submucosa (inner, holding layer)
Serosa + muscularis

Front 303

The stomach wall is _____ than the intestinal wall and you would general perform a ___ layer closure on this organ.

Back 303

thicker, 2

Front 304

What is the appropriate outer layer pattern style for a 2 layer gastrotomy closure?

Back 304

Inverting (Lembert, Connell, Cushing)

Front 305

When dealing with the intestines, what are the 3 most important surgical principles?

Back 305

Delicate tissue handling
Respect the blood supply
Protect against leakage of intestinal contents

Front 306

2 indications for an enterotomy

Back 306

FB removal
Intestinal biopsy

Front 307

Basic technique for opening during an enterotomy (3 steps)

Back 307

Milk content orad and aborad
Incise with #11 blade
Extend incision with blade or scissors

Front 308

With an enterotomy, ______ closure is common, but when there is small lumen diameter, should consider a _____ closure.

Back 308

Longitudinal, transverse

Front 309

Because the intestinal wall is so much ____ than the stoamch wall, a ___ layer closure can be very effective.

Back 309

thinner, 1

Front 310

Full thickness is not always necessary for an enterotomy closure, but it is EXTREMELY important to include the ______ in the closure.

Back 310

Submucosa

Front 311

4 indications for intestinal resection and anastomosis (RNA)

Back 311

FB with significant intestinal damage/compromise
Intestinal trauma
Intestinal neoplasia (LARGE margins necessary)
Intussusception

Front 312

RNA technique (5 steps)

Back 312

1. Ligate blood vessels (careful consideration necessary)
2. Incise mesentery
3. Milk contents orad and aborad
4. Incise intestines (use forceps or fingers to obstruct intestinal lumen)
5. Suture cut intestinal ends

Front 313

With an intussusception, an RNA is _____ indicated.

Back 313

Sometimes

Depends on if there is necrosis/compromise to the intestinal segment. Need to assess each situation indivudally.

Front 314

One common complication to RNA closures is that there may be a ______ size ______.

Back 314

luminal, disparity

Front 315

4 indications for cystotomy

Back 315

Stone removal
Tumor removal/cystectomy
Bladder biopsy (uncommon)
FB retrieval (urinary cath chewed off)

Front 316

3 basic surgical principles to follow for a cystotomy

Back 316

Stay sutures (placed in apex and on either side of the trigone)
Lap sponges
Prevent urine leakage

Front 317

Describe the flushing procedure you would use during a cystotomy on a male dog when trying to remove stones

Back 317

Flush retrograde first! his tries to push any stones stuck in urethra up into the bladder. Suction as you go. Flush normograde next. Always finish with a retrograde flush.

Use spoon to scoop stones up.

Front 318

Which is the only hollow organ that goes back to 100% pre-op strength post-operatively?

Back 318

Bladder

Front 319

What types of suture should be used for a bladder closure?

Back 319

Absorbable

Front 320

Number of layers needed to close for a cystotomy

Back 320

1 or 2

Front 321

Possible suturing patterns that could be used for closing a bladder

Back 321

Simple continuous
Simple interrupted

Front 322

Define drug interaction

Back 322

When one drug affects the activity of another drug and leads to either an increased or decreased effect
or
both drugs produce a new effect together that neither could produce on its own

Front 323

2 examples of increased effects from drug interactions

Back 323

Additive effect: sum of the effects
Synergistic effect: greater than sum of effects

Front 324

With increased effects from drug interactions, you could be increasing the ______ effect or increasing the liklihood of ____ effect. It's not 100% good or bad, it just depends on the situation.

Back 324

therapeutic, adverse (toxic)

Front 325

Decreased effects from drug interactions can also be termed an _______ effect.

Back 325

Antagonistic

Front 326

Adverse drug reactions generally happen: expectadely or unexpectadely?

Back 326

Unexpectadely

Front 327

Drug interactions can occur with another ____, with a carrier (______), or with a ______.

Back 327

drug, (solvent), receptacle

Front 328

When there is drug compatibility, reaction is _____, but when there is drug incompatibility, a reaction is ______.

Back 328

absent, present

Front 329

Changes in _____ or formation of ______ can indicate an expiration of shelf-life in some drugs.

Back 329

color, precipitate

Front 330

Purple pain is a drug used in _______ and when it has decomposed it turns from purple to ____.

Back 330

racehorses, green

Front 331

Drug incompatibility could change the _____ or ____ composition of a drug.

Back 331

Chemical, physical

Front 332

Penicillins are destroyed at ____ pH.

Back 332

low

Front 333

Altering the pH at which insulin is diluted can significantly change the rate of ______ of the drug.

Back 333

release

Front 334

Calcium + ______ solution ---> precipitate

Back 334

carbonate

Front 335

________ + iron preparations of the Ca in milk --> precipitate

Back 335

Tetracycline

Front 336

2 drugs incompatible with heparin

Back 336

Aminoglycosides
Beta-lactams

Front 337

_______ inactivates aminoglycosides.

As an antidote for one case, ______ can be used to bind to gentamicin in a _______ dependent manner when gentamicin is overdose.

Back 337

Penicillins

Ticarcillin, concentration

Front 338

______ -soluble durgs like diazepam bind to ______ containers.

Back 338

Lipid, plastic

Front 339

Some drugs, like ______, bind to certains glasses and plastics.

Back 339

insulin

Front 340

_________ bind to glass.

Back 340

Aminoglycosides

Front 341

2 drugs that need to be protected from UV light. How is this accomplished.

Back 341

Diazepam, furosemide

Brown bottle

Front 342

The net effect of food on drug absorption depends on the ____ of the drug.

Back 342

pKa

Front 343

Binding to ______ contents and being labile to pH or enzyme conditions can affect drug-diet interactions.

Back 343

luminal

Front 344

Choices for answers: tetracyclines (ie: doxy) or ampicillin

Food will minimally impair absorption of _______, but reduces absorption of __________ much more greatly.

Back 344

Tetracycline, ampicillin

Front 345

Lipid-soluble drugs are more rapidly and completely absorbed when they are delivered in a ______ vehicle.

Back 345

Lipid

Front 346

_______ interactions can be either additive, synergistic, or antagonist and they occur when one drug changes the action of another drug.

Back 346

Pharmacodynamic

Front 347

2 drug combinations with additive effects

Back 347

Sulfamethoxazole & Trimethoprim (aka: TMS) - both block at separate sites in the metabolic folic acid pathway in microorganisms

Propofol + Sevoflurane : both drugs target the same receptor (GABAa) but at different subunits (Prop: beta2 subunit ;; Sevo alpha1 subunit)

Front 348

Full name for the GABAa receptor

Back 348

Gamma-aminobutyric Acid receptor

Front 349

When two drugs effect a different spot in the same pathway or when they affect a different subunit of a common receptor, they are mostly likely to have an ______ effect from their interaction.

Back 349

Additive

Front 350

3 mechanisms by which you could get a synergistic drug-drug reaction

Back 350

When they act at the same receptor

When they act at a common cellular site

When they act at different sites but have the same physiologic effect

Front 351

The interaction of phenobarbital and clorazepate has a ________ effect.

Back 351

Synergistic

Front 352

Cardiac glycosides, like _______ plus diuretics can trigger _______ which is an example of a ______ effect of a drug-drug interaction.

Back 352

digoxin, hypokalemia, synergistic

Front 353

Augmentation is another drug-drug interaction that can occur when drugs have different, but similar _____ ___ ______ at the ___ receptor.

Back 353

Mechanisms of action, same

Front 354

Two combinations with Penicillin which can have synergistic effects

Back 354

Penicillin + Streptomycin
Penicillin + Probenecid

Front 355

Definition of ______ antagonism: a drug antagonizes the effect of another drug through a chemical reaction ______ action on the receptor.

Back 355

chemical, without

Front 356

An antacid decresing the absorption of a weak acid in the stomach is an example of chemical ______.

Back 356

Antagonism

Front 357

Physiologic antagonism is when the effect of a drug is antagonized by another drug by acting on ___ _______ types of receptors.

Back 357

two different

Front 358

Example of physiologic antagonism:
Acetylcholine, which acts at _________ cholinoreceptors of the intestinal smooth muscle and intiates ______ and norepinephrine which ______ the intestinal smooth muscle via _______ receptors.

Back 358

muscarinic, contraction

relaxes, adrenergic

Front 359

3 subtypes of antagonistic drug reaction

Back 359

Chemical
Physiologic
Pharmacologic

Front 360

Two subtypes of pharmacologic antagonism

Back 360

Competitive and non-competitive

Front 361

In pharmacologic antagonism, one drug antagonizes another drug by action at the _____ receptor.

Back 361

Same

Front 362

Xylazine and _______ are an example of drugs that show pharmacologic antagonism which allows the latter to be an antidote for overdosing xylazine. Subtype: _______.
Which receptor is involved?

Back 362

Yohimbine
Competitive
pre-synaptic alpha2 adrenergic

Front 363

3 Important pharmacoKINETIC interactions

Back 363

Altered drug metabolism
Drug transporter
Protein binding

Front 364

Pharmacokinetic interactions between drugs mean that one drug alters the disposition of another. Using the ADME model to remember the dispositional changes that can occur, what does each letter in the acronym stand for?

Back 364

Absorption
Distribution
Metabolism
Excretion

Front 365

The ________ form of a drug is more lipid soluble AND more readily absorbed from the ____ ______ than the _______ form.

Back 365

non-ionized, GI tract, ionized

Front 366

Ketoconazole cannot be absorbed when an _____ is given at the same time because ketoconazole is _____ and the pH is increased by the latter drug.

Back 366

Antacids, acidic

Front 367

When given orally, about ___ of digoxin is metabolized by ______ _______. When given in conjunction with antibiotics, the antibiotics kill off many of these metabolizing agents, so digoxin concentration is _______ and can increase the incidence of toxicity.

Back 367

40%, intestinal flora (normal microbiota), increased

Front 368

5 possible ways to alter GI tract absorption of drugs

Back 368

1. Alter pH
2. Alter bacterial flora
3. Form drug chelates/complexes
4. Induce mucosal damage
5. Alter GI motility

Front 369

Antineoplastic agents, such as cyclophosphamide, vincristine, and procarbazine damage the intestinal ______ which inhibits the absorption of many drugs, such as digoxin.

Back 369

mucosa

Front 370

Main carrier protein that carries insoluble drug

Back 370

Albumin

Front 371

Which drug is able to bind to proteins is dependent on the drug's _____ for the plasma protein.

Back 371

Affinity

Front 372

A drug with increased affinity can _____ ____ another drug from being protein bound, increasing the concentration of free drug for the latter.

Back 372

knock off

Front 373

____ of warfarin, under non-interacting conditions, is bound to plasma proteins. _______ can displace warfarin.

Back 373

99%, sulfonamides

Front 374

2 components that affect drug distribution in cow's milk

Back 374

Lipid solubility
Transportation by ABC transporters

Front 375

What does ROSC stand for?

Back 375

Return of spontaneous circulation

Front 376

A crash cart should be _____ stocked and easily _____. It should be in the same place at all times and in the areas of greatest liklihood of arrest.

Back 376

regularly, accessible

Front 377

Most likely place for an animal to arrest

Back 377

ICU

Front 378

What are two cognitive aids that are useful in a CPR situation

Back 378

Dosing charts (gives mL of drug based on weight)
CPR algorithm (step by step so you don't forget things)

Front 379

You need to review your CPR training every __ months.

Back 379

6

Front 380

Within the CPR team, there needs to be one _____ who assigns tasks but does not perform them. A _____ communication system is best, where you ask for a task to be done by NAME and then that person announces to the entire room when the action has been completed.

Back 380

leader, closed

Front 381

What are the 3 basic components of basic life support

Back 381

Assess the ABCs
Recognize an arrest situation
Be fast!

Front 382

If you do not know for sure that a patient has arrested, but you think they might have, what should you do?

Back 382

Start CPR!

Front 383

When establishing an airway, either place or ______ placement of intubation.

Back 383

verify

Front 384

3 step intubation process

Back 384

Intubate airway
Inflate cuff
Tie in the ET tube

Front 385

What are two options if intubation proves difficult but you still need to give airway support

Back 385

In the field, mouth to snout ventilation is an option.

A tight fitting facemask can work if you are in a hospital or dealing with an exotic species like rabbits.

Front 386

When assisting breathing, you should aim for ____ bpm and a short inspiratory time of ___ sec. This approximates a tidal volume of ~ 10 mL/kg, or just enough to see the chest rise.

Back 386

10, 1

Front 387

In the best case scenario, you will acheive ______ % of normal cardiac output when performing chest compressions.

Back 387

25-30

Front 388

What is the MOST important aspect of CPR?

Back 388

Optimal chest compressions!

Front 389

Initiate chest compressions ________, even if that happens to be before you establish an _____ or are able to facilitate _____.

Back 389

ASAP (immediately), airway, breathing

Front 390

Ideal compression rate during CPR for both cats and dog, regardless of size

Back 390

100-120 compressions/min

Front 391

_____ pumping is when you use direct compression and mimic normal heart function. _____ pumping is when you press on the chest wall and use the heart as a _____ ______.

Back 391

Cardiac

Thoracic, passive conduit

Front 392

_____ style compressions are ideal for medium-->large-->giant dogs, while ____ style compressions are great for small dogs, cats, and other small species.

Back 392

Thoracic, cardiac

Front 393

How far should your compression depth go?

There is a linear relationship between depth and ____

Back 393

1/3 to 1/2 of the thoracic depth

mean arterial pressure (MAP)

Front 394

When doing compression, remember to let up all the way because ___ _____ _____is key to re-establish _____ pressure. If you lean on the chest you are impeding ______ return and compromising cardiac output.

Back 394

full elastic recoil, negative

venous

Front 395

Direct cardiac massage is _____ effective than closed chest compressions.

Back 395

more

Front 396

Indications for direct cardiac massage (5)

Back 396

1. Already in the abdomen
2. Already in the chest
3. Ineffective closed chest CPR
4. Giant breed dog
5. Pleural, pericardial, or rib disease present

Front 397

How long should one cycle of CPR be?
How often should you rotate compressors?

Limit interruptions to _____ seconds to interpret ____.

Back 397

2 minutes
Rotate compressor every cycle (every 2 minutes)
10-15, ECG

Front 398

What are a few ways to determine efficacy of compressions?

Back 398

A pulse greater than compression rate = ROSC

Doppler flow probe

Front 399

What should you be cautious about when using Doppler flow probes to indicate compression efficacy?

Back 399

Motion artifact and venous flow can complicate the reading

Front 400

What are a few complications of detecting a pulse in a CPR patient

Back 400

Inexperienced personnel detect movement as pulse

It is very fine and delicate and can be hard to pick up

May interpret retrograde venous flow as arterial

Front 401

There is strong evidence to support the idea that a sudden increase in ____ _____ _____ indicates ROSC.

Back 401

end tidal CO2

Front 402

End tidal CO2 is a measure of _____, not ______.

Back 402

circulation, ventilation

Front 403

____ horses can be revived with CPR due to their squishy rib cage, but _____ horses are very unlikely to be resuscitated with CPR.

Back 403

Young, adult

Front 404

What are the 3 components of advanced life support?

Back 404

Drugs
ECG
Fluids

Front 405

Name the possible routes of drug admin, in order of preference, during advanced life support

Back 405

1. IV
2. IO
3. Intratracheal
4. Intrathoracic: LAST resort - high risk of pneumo, etc

Front 406

Death causes vaso______, so the hallmark set of drugs in life support are ______ which cause vaso______ aid in elevating aortic _____ pressure.

Back 406

dilating, vasopressors, constriction, diastolic

Front 407

What is the prime determinant of ROSC and what is the formula you use to find it?

Back 407

MPP: Myocardial Perfusion Pressure

MPP = Aortic Diastolic Pressure - Right Atrial Pressure
MPP = ADP - RAP

This corresponds to the pressure gradient driving blood flow to the heart.

Front 408

What are the 3 main life support drugs

Back 408

Epinephrine
Vasopressin
Atropine

Front 409

Epinephrine is used in life support for its ___ agonism which causes vasoconstriction, although its ____ activity may be detrimental. Routinely, we use a low dose of _____ mg/kg every ____ minutes.

Back 409

alpha1, beta1, .01, 3-5

Front 410

Epinephrine is not recommended at high doses (.1 mg/kg) because although it does accomplish higher ____ rates, it also results in higher incidences of ____ ____.

Back 410

ROSC, brain death

Front 411

Which receptor does vasopressin work at?

Back 411

V1

Front 412

Epinephrine has _____ and _____ effects on the heart, whereas vasopressin does not.

Back 412

inotropic, chronotropic

Front 413

______ remains responsive in acidic pHs while _____ does not.

Back 413

Vasopressin, epinephrine

Front 414

Dose and time frame for vasopressin during CPR

Back 414

.8 mg/kg q 3-5 minutes

Usually give epi first then the second drug is "chef's choice"

Front 415

Regarding the use of Atropine during CPR, many studies show _____ benefit and at high levels it may be _______.

Back 415

no, detrimental

Front 416

Due to high ____ ___ in cats and dogs, a low dose of Atropine (_____ mg/kg) administered _____ time may help with asystole and PEA.

Back 416

vagal tone, .04, one

Front 417

3 Common ECG Patterns to see in a CPR patient

Back 417

Asystole
Ventricular fibrillation
PEA: Pulseless Electrical Activity

Front 418

Asystole is the _____ of electrical activity and can be confused with ____ ________ _______.

Back 418

absence, fine ventricular fibrillation

Front 419

Treatment for asystole seen on ECG during CPR

Back 419

Improve chest compression technique,etc

Epi

Front 420

In ventricular fibrillation, you have no _______ mechanical activity, just random groups of myocardial cells firing off chaotic and uncontrolled ______ activity.

This is _____ to see during CPR because then you can use a _________.

Back 420

coordinated, electrical

good, defibrillator

Front 421

During electrical defibrillation, all cells are ______ at once, allowing a ______ cell to drive rhythm.

Back 421

Depolarized, pacemaker

Front 422

For what two ECG patterns is electrical defibrillation the treatment of choice

Back 422

V-fib

Pulseless v-tach

Front 423

When performing electrical defibrillation, continue _____ until paddles are charged, use copious amounts of ______ _____, place paddles on each side of heart unless it is a giant breed where you can place them on the same side, and perform the defibrillation at the end of ______.

BE CAREFUL!

Back 423

compressions, coupling gel, exhalation

Front 424

Immediately following electrical defibrillation you should start _______ because recurrent ______ ______ is extremely common.

Back 424

compression, ventricular fibrillation

Front 425

When using an electrical defibrillator, it is best to shock and then undergo a full _____ ______ cycle of ______ before shocking again if it was unsuccessful. Sequential shocks no longer recommended.

Back 425

2 minute, compressions

Front 426

With pulseless electrical activity, there is electrical activity within the _____, but no meaningful ______ present. The heart has more _____ _____ than it does when there is asystole.

Back 426

heart, contraction
energy substrate

Front 427

What is the treatment for PEA?

Back 427

Improve myocardial O2 delivery via good quality chest compressions

Front 428

When a patient is hypovolemic, fluid therapy raises _____ pressure over ______ ______ pressure which is a good thing during CPR. But if the patient is not hypovolemic, it does the opposite and that isn't a very good thing.

Back 428

aortic, right atrial

Front 429

How will fluid therapy differ in an ER v. ICU patient undergoing CPR?

Back 429

An ER patient can get 1/2 to a full shock dose of LRS, while an ICU patient should only have flush given following drug doses IV.

Front 430

When you have effective chest compressions, how long do you go before quitting if ROSC has not occurred? If the chest compressions are ineffective?

Back 430

30 minutes
20 minutes

Front 431

What are 3 reasons/CPA outcomes that could be the reason patients who obtain ROSC do not survive to discharge?

Back 431

MODS
Anoxic brain injury
Ischemia-reperfusion injury

Front 432

______ and _____ are both bad following CPR. One leads to decreased oxygen delivery (hypo) and one leads to increased production of ROS (hyper).

Back 432

Hypoxemia
Hyperoxemia

Front 433

During PCA care, titrate SpO2 to ____ - ____ % to prevent hypo- or hyper- oxemia and to prevent neurologic complications.

Back 433

94-98

Front 434

Summary/key points for CPR:
1. ____ ventilation rates
2. Most important thing in CPR: _____ _______ of high quality
3. ___ ______ cycles with breaks of no more than _____ seconds.
4. Change ______ every 2 minutes or sooner if tired

Back 434

1. Slow
2. Chest compressions
3. 2 minutes, 10-15
4. compressors

Front 435

This drug cannot be used in food animals, must be administered with gloves on, needs extended dosing intervals in cats due to glucoronidation metabolism, and has bacterial microflora in the gut that could decrease absorption of other drugs administered in conjunction with it. Name it.

Back 435

Chloramphenicol

Front 436

In ruminants, chloramphenicol has a high incidence of ______ NO2 --> NH2 which means it is ionized at ____ pH. This has what effect on drug absorption in the GI tract.

Back 436

reduction (ruminants have lots of nitroreductase enzymes)
low
No effect on GIT absorption

Front 437

Even though ruminant nitroreductases do not effect the _______ of chloramphenicol in the GI tract, it definitely decreases the ______ of the drug in these species.

Back 437

absorption, efficacy

Front 438

Chloramphenicol is a potent p450 ______ which could cause a decreased _____ of a second dose. How do you take this into account with your drug regimen?

Back 438

inhibitor, clearance

Increase dosing interval

Front 439

Chloramphenicol is mainly metabolized via _______ in the _______. A patient with disease of the organ would have slowed metabolism of the drug that would need to be taken into account (or maybe avoid the drug altogether).

Back 439

glucoronidation, liver

Front 440

Since Chloramphenicol is a ______, biologic activity is dependent on its metabolism to its metabolite form. Liver disease would, therefore, reduce the biologic activity of the drug. Kidney disease in a patient being administered Chloramphenicol would not affect efficacy, but since glucoronide derivatives are ______ in the kidneys, it would affect ______ rates.

Back 440

prodrug

excreted, clearance

Front 441

Liver is the main area of drug metabolism, but these other 4 areas are important as well:

Back 441

1. WBCs
2. Skin
3. Lung
4. GIT

Front 442

_____ is the major metabolizing enzyme in phase I metabolism, which is an _______ process.

Back 442

CYP450, oxidation

Front 443

Two drugs administered together may have the effect of either _____ or _____ enzymes. Not all drugs have these effects.

Back 443

inducing, inhibiting

Front 444

____ administration of drugs leads to a higher incidence of ____ ____ metabolism in the liver and GIT which can cause loss of dose and decreased action of the drug, especially if one is an enzyme inhibitor or inducer.

Back 444

Oral, first pass

Front 445

Why is acetominophen counterindicated in cats at all doses?

Back 445

Acetominophen is mainly metabolized via glucoronidation and cats don't do that so good, so they are really susceptible to downstream liver toxicity from this drug.

Front 446

Procainamide is used in the treatment of _______ _______ because it lengthens the ____ interval, but it's efficacy is questionable in _____.

Back 446

ventricular arrythmias, QRS, dogs

Front 447

Cats do not perform _______ metabolism well, while dogs do not perform ______ metabolism well. This is why dogs have far reduced efficacy from Procainamide.

Back 447

glucoronidation, acetylation

Front 448

Where does active tubular secretion occur in the kidneys?
With drug clearance, a drug combines with a specific _____ in this area in order to pass through.

Back 448

Proximal tubules

Protein

Front 449

________ in the proximal tubules of the kidneys are involved in renal clearance of drugs. Drugs with similar reactivities can _____ for these and affect another drug's clearance.

Back 449

Transporters, compete

Front 450

With regard to renal excretion of drugs, what kinds of compounds will compete with each other for transport?

Back 450

Like compounds.
Weak acids compete with weak acids, bases with bases, etc.

Front 451

Excretion and reabsorption of drugs in the renal tubules occurs via ______ diffusion which depends on concentrations and ____ solubility.

Back 451

passive, lipid

Front 452

With regard to renal clearnace of drugs, ______ drugs are reabsorbed at a lower rate than ______ drugs. (Ionization status)

Back 452

Ionized, non-ionized

Front 453

Common enzyme inducers (3) and their selectivities:

Back 453

Rifampin (relatively non-selective)
Phenobarbital (selective)
Glucocorticoids (semi-selective)

Front 454

Common enzyme inhibitors (3) and their selectivities:

Back 454

Cimetidine (not selective)
Azoles (not selective)
Chloropromazine (selective)

Front 455

Cytochrome p450 monooxygenases are a superfamily of ______ which are primarily involved in ______ reactions. Cytochrome p450 has MANY ______.

Back 455

proteins, oxidation
isotypes

Front 456

There is a _____ amount of variation in drug blood concentrations between individuals.

Back 456

large

Front 457

As prevalence increases, positive predictive value _____.

Back 457

Increases

Front 458

What are the components of a primary survey

Back 458

A-airway
B-breathing
C-circulation
D-disablity/dysfunction

Front 459

Severe pain is classified as an ______.

Back 459

Emergency

Front 460

Seizures are ______, not emergent cases. Same as with arterial ______.

Back 460

Urgent, hemorrhage

Front 461

When evaluating a patient's airway, you need to make sure it is _____.

Back 461

patent

Front 462

When evaluating breathing, if the patient is NOT breathing, you need to immediately _____. If they are breathing, you need to evaluate whether the animal is in ______ ______.

Back 462

ventilate, respiratory distress

Front 463

Afterload is defined as the force that opposes _____ f blood.

Back 463

ejection

Front 464

The most common reason for a decreased stroke volume

Back 464

Preload

Front 465

During hypovolemia, dogs most often have an ______ heart rate, while a cat may very likely have a ______ heart rate.

Back 465

increased, decreased

Front 466

2 main things you are looking for with disability and dysfunction

Back 466

spinal cord trauma
traumatic brain injury

Front 467

When there is a traumatic brain injury, what is the most important thing to do?

Back 467

Raise the head

Front 468

Triage is about identifying patients with the most _____ life-threatening conditions and treating them ____.

Back 468

acutely, first

Front 469

Define sedation

Back 469

Mild depression of CNS

Front 470

Chemical restraint is used more commonly in ____ animals and produces a state of ______ with minimal physical restraint necessary while minimiing the need for _________.

Back 470

compliance, monitoring

Front 471

Analgesia definition implies a _______ patient, whereas antinociception is the blocking of the nociceptive pathway somwhere along the way.

Back 471

Conscious

Front 472

3 main components of general anesthesia

Back 472

Immobility
Unconsciousness
Amnesia

Front 473

________ is a nonessential, but clinically and ethically desirable component of general anesthesia.

Back 473

Antinociception

Front 474

General anesthetics, along with other effects, depress the _____ which prevents conscious responses to noxious stimulus when under anesthesia.

Back 474

cortex

Front 475

In large animals, chemical restraint is great because it avoids putting the animal in ________ and the associated risks of that. However, you should alway be preapared to progress to ________ _______ if necessary.

Back 475

recumbancy,
general anesthesia

Front 476

Chemical restraint safety being greater than general anesthesia for personnel and patient is debated because the animal is still ______.

Back 476

conscious

Front 477

ASA Status:
1 = _______ patient
2 = _____ systemic disease
3 = ______ systemic disease
4 = ______ systemic disease that is ____-______
5 = ______ and will not survive without procedure
E = added to any ASA status to indicate _____

Back 477

1. healthy
2. mild
3. severe
4. severe, life-threatening
5. moribund
E. emergency

Front 478

What is the limitation to ASA status?

Back 478

It only considers the patient condition, no other relevant factors

Front 479

What is an alternative risk assessment to ASA status that takes into account patient and non-patient factors?

Back 479

Operative risk

Front 480

What is the major disadvantage to using operative risk assessment when determining anesthetic risk of a patient?

Back 480

Subjectivity

Front 481

What are some non-patient factors that could be taken into consideration for anesthesia?

Back 481

Extent and difficulty of procedure
Skill and experience of staff

Front 482

Anesthesia abolishes physiologic ______ mechansisms, so systemic abnormalities should be _____ prior to anesthesia if at all possible.

Back 482

compensation, corrected

Front 483

When stabilizing a patient for anesthesia, you should prioritize the _________ parameters and should balance the need to stabilize with the risk of _____ the procedure.

Back 483

cardiopulmonary, delaying

Front 484

2 reasons for pre-anesthesia fasting

Back 484

1. Minimize risk of vomiting and regurgitation
Reduce size of GI tract (especially for large animals because tis improves cardiopulmonary function under GA

Front 485

If a large animal is not fasted before anesthesi, you run the risk of increased _______ pressure, which can transfer to the _____ ______ and reduce _____ ______.

Back 485

abdominal, blood vessels, venous return

Front 486

What is the one species that, depending on ambient temperature, should be taken off water for 24 hours prior to a procedure requiring anesthesia?

Back 486

Ruminants

Front 487

Which class of animals should NEVER be fasted or taken off water prior to anesthesia? Why not?

Back 487

Neonates. They typically do not vomit or regurgitate and we don't want to take away their energy/food

Front 488

How long should cats, dogs, and horses be fasted before anesthesia? Ruminants?

Back 488

Cats and dogs 8-12hrs
Horses 12 hours
Ruminants 24-48 hours

Front 489

When an animal is anxious, there is heightened ____ activity, which can enhance ____ sensation in the patient.

Back 489

CNS, pain

Front 490

Sedation provided as a pre-medicant for anesthesia can help to smooth _______ and _______ periods.

Back 490

induction, recovery

Front 491

It is easier to _______ pain than it is to _____ it, so providing analgesia ________ can improve analgesic _____ greatly.

Back 491

prevent, treat
pre-emptively, efficacy

Front 492

Providing analgesia prior to anesthesia can blunt ______ responses and make the anesthesia period much smoother for monitoring and maintenance of appropriate depth.

Back 492

autonomic

Front 493

Autonomic responses to pain include an _____ heart rate, an _______ blood pressure, and either a ______ respiratory rate or _____.

Back 493

increased, increased, increased, apnea

Front 494

Most analgesic drugs _____ the dose needed for induction, although there is some species dependence with it.

Back 494

reduce

Front 495

Why is reducing the dose of maintenance anesthetic necessary in a patient with pre-medication beneficial?

Back 495

You can reduce overall CV and respiratory depression

Front 496

Which species is at highest risk for death due to post-operative anesthetic complications? Where/when do these deaths occur?

How can you help with this problem?

Back 496

Horses. Recovery stall accidents, etc.

Horses can be sedated for their recovery period to ease the transition

Front 497

Pre-medication can counter unwanted effects from co-administered ____ and from the _____ itself.

Back 497

drugs, procedure

Front 498

Name the two commonly used anticholinergic pre-medicant drugs

Back 498

Atropine, Glycopyrrolate

Front 499

Anticholinergics are parasympatho______ so they ____ heart rate, broncho_______, ______ secretions and GI motility and cause ______ of the pupils.

Back 499

lytics, increase, dilate, decrease, mydriasis (dilation)

Front 500

What class of pre-medicant drugs is not generally used in horses due to their GI effects. What would be a possible exception?

Back 500

Anticholinergics.

Spasmatic colic cases.

Front 501

What are two ideal pre-medicant properties that anticholinergics like Atropine and Glycopyrrolate do not have?

Back 501

Sedation
Analgesia

Front 502

Atropine v. Glycopyrrolate
Atropine has a ______ onset and lasts _____. Glycopyrrolate is the anticholinergic of choice in _____ because they have high levels of atropine _______ which degrade atropine quickly in their systems.

Back 502

faster, longer
rabbits, esterases

Front 503

The major indication for use of anticholinergics as a pre-medicant is to reduce or prevent ______ mediated ______, but can also be used as an _______ especially in cats and inhibits the muscarinic effects of other drugs.

Back 503

vagally mediated, bradycardia, antisecretalogue

Front 504

6 Cons of Anticholinergic Use

Back 504

1. Sinus tachycardia
2. Dry mouth
3. Thickned secretions
4. Reduced LES tone
5. Redued GI motility
6. Prolonged effects on autonomic balance

Front 505

______ decrease alertness and increases tolerance in patients but has variable levels of response by individual. It is commonly administered in combination with opioids due to an enhanced effect. It is also mildly anesthetic sparing.

Back 505

Acepromazine

Front 506

Acepromazine causes vaso_______ by blocking the ____ receptors.

Back 506

dilation, alpha1

Front 507

You should avoid Acepromazine in intact male _____ due to the risk of ________. You should also avoid it in ______ due to the risk of syncope.

Back 507

horses, priapism

Boxers

Front 508

Acepromazine does NOT provide ______ and is not reversible. It does however have a ____ duration of action.

Back 508

analgesia, long

Front 509

Diazepam and midazolam are examples of ________ which can be given as a pre-medicant fo anesthesia patients.

Back 509

Benzodiazepines

Front 510

6 possible pros of administering benzodiazepines as pre-medicant in anesthesia patients

Back 510

1. Anxiolytic
2. Amnestic
3 Mscle relaxant (can be given with ketamine)
4. Anticonvulsant (good in patients predisposed to seizures)
5. Mild drug sparing
6. Sedation (there are some very important variations here in species an age)

Front 511

Benzodiazepines are sedative for _____ and ____ patients, as well as in these two species of animal: ______ and _____. However, in healthy ____ and ______ it could cause excitment instead of sedation and in other healthy species, is unreliable in this facet.

Back 511

pediatric, sick
sheep, goats
cats, horses

Front 512

Are Benzodiazepines analgesic?

Back 512

No

Front 513

4 Physical Exam Parameters that can be used to assess Dehydration

Back 513

Skin turgor
MM moisture (aka tear film)
Body weight
Eye position

Front 514

Skin turgor is greatly affected by ____. An ____ animal may not show a difference in skin turgo even if mild dehydration is present, while a _______ animal may have decreased skin turgor even though they are in their normal hydrated state. This is because skin turgor is affected by the animals _____ content.

Back 514

BCS, obese, cachexic, fat

Front 515

Total body water is ________ in neonates than in adults, so a finding of dehydration should be considered more ____ in them than it would if seen exactly the same in an adult animal.

Back 515

greater, severe

Front 516

Which mucous membranes are plausible to use to be able to assess dehydration?

Back 516

Gums, nicitinic membrane, preputial or vulvar

Front 517

If you are administering fluid at a sufficient rate but you are seeing no improvement in dehydration parameters and here is no evidence of hemorrhage or edema, the fluid is likely being lost to the _____ because once it is there, it can't be reclaimed by the ______

Back 517

gut , interstitium

Front 518

When assessing dehydration, pull the lower eyelid down and you should see a little bit of fluid pooling there if the patient is not dehydrated. This is called the _______ _____.

Back 518

Lacrimal lake

Front 519

Sunken eyes are associated with decreased _____ of _______ tissues. This is not generally seen with mild dehydration in _______ but can be seen once it becomes moderate to severe. This dehydration parameter can be influence by many, many thing.

Back 519

volume, periorbital
mammals

Front 520

Day to day changes in body weight are generally caused by gain or loss of _____.

Back 520

Fluid

Front 521

3 things that can affect day to day body weight changes that can complicate your assessment of fluid retention or loss

Back 521

Different scales being used
Third space losses
Changes in monitoring equipment

Front 522

_______ is more sensitive than skin turgor for low grade dehydration. A dehydrated patient will have one of > _____.

Back 522

USG, 1.030

Front 523

_______ is a sign of low total body water, NOT a sign of dehydration.

Back 523

Hypernatremia

Front 524

% dehydration * BW in kg gives yu the amount of ______ you have in fluid deficit

Back 524

liters

Front 525

Every dehydrated patient has a change in ____ voume, but not every ______ patient is going to be dehydrated.

Back 525

blood, hypovolemic

Front 526

The larger the deficit of fluid, the _____ it should be corrected.

Back 526

Faster

Front 527

___ hours is the absolute shortest amount of time over which you can fix dehydration. You must give water time to diffuse around ______ so that it is not urinated out. ____ is the typical length of replacement time in a patient without cardiac disease.

Back 527

2-3, interstitium, 4-6

Front 528

Excessive fluid therapy/providing it too quickly can put a patient at risk for ____.

Back 528

CHF

Front 529

Length of fluid replacement in dogs:
Dog with no heart murmur: ____ hours
Dog + heart murmur + TXR wnl: ___ hours
Dog + heart murmur + CV changes: _____ hours

Back 529

4
6
12-24

Front 530

Any cat greater than 5 years old should be considered to have _______ CV disease even if there is no murmur or arrhythmias noted. Baseline for cats of this age is ___ hours for fluid replacement therapy.

Back 530

subclinical, 6

Front 531

A patient with KNOWN heart disease should have any fluid deficits replaced over a period of ____ hours.

Back 531

12-24

Front 532

Which type of fluid should never be used for the purpose of fixing dehydration?

Back 532

D5W

Front 533

If rapid correction of deficit in fluids is planned, you wil usually NOT add ____ to the plan.

Back 533

Potassium

Front 534

Maintenance fluids take into account ____ production and insensible losses which include _____ and ____ losses.

Back 534

urine, respiratory, fecal

Front 535

Normal ongoing losses for maintenance fluid therapy by species:
Dog formula: ______
Cat formula: ______

How much fluid does this calculate out for you?

Back 535

Dog: 132* BW^(3/4)
Cat: 80* BW^(3/4)

This gives you 24 hours worth of fluids (in mL). Divide by 24 to get the hourly rate.

Front 536

What is the advantage of using metabolic / allometric scaling formulas for calculating maintenance fluids?

It is more beneficial in ____ than in _____.

Back 536

It allows the formula to be used for very large and very small patients.

Dogs, cats

Front 537

Average daily losses of:
Na: _____ mEq/L
K: ______ mEq/L

Back 537

40-60
15-20

Front 538

Generally, for the replacement of average daily losses (maintenance), isotonic crystalloids have too ___ sodium and too ____ potassium.

Back 538

much (kidneys compensate)

little

Front 539

Do NOT exceed ____________ of K supplementation unless there is severe, prolonged hypokalemia.

Back 539

.5 mEq/kg/hr

Front 540

Usually, when we are giving prolonged fluid therapy, we add ____ to the regimen.

Back 540

K+

Front 541

Abnormal ongoing fluid losses can include:

Back 541

Vomiting
Diarrhea
Polyuria
Cavitary effusions

Front 542

For general abnormal losses from the GI tract, you would replace the fluids with _____ _______ and _______ potassium.

Back 542

isotonic crystalloids, supplemental

Front 543

For puppies, kittens, and pocket pets, this is a useful and plausible route of adminstration for fluids.

Back 543

Intraosseous

Front 544

When is subcutaneous fluid adminstration appropriate?

Back 544

Mild dehydration
Outpatient dehydration management
Venous access not available

Front 545

If you don't ____ ___ _____, it didn't happen.

Back 545

write it down

Front 546

The submucosa has a lot of _____ which helps it to hold _____ very well.

Back 546

collagen, suture

Front 547

Another term for dermal sutures

Back 547

ubcuticular sutures

Front 548

2 other terms for subcutaneous sutures and where are these located

Back 548

Hypodermal, subcutis sutures

Located below the dermis

Front 549

For reptiles, you want to use an _____ suture pattern on their scales. If you don't do this, they won't grow back.

Back 549

everting

Front 550

Wound types:
1. Incised wounds are clean and ______.
2. Laceratons are ragged and _____.
3. Puncture wounds have a ____ opening.
4. Penetrating wounds _____ a _____ _____.
5. Abrasion are ____ thickness
6. Shearing/avulsion
7. Degloving
8. Burn wounds

Back 550

1. straight
2. traumatic
3. small
4. enter, body cavity
5. partial

Front 551

Length of the golden period

Back 551

6 hours

Front 552

Number of colony forming units per gram of tissue is considered important in determining whether contamination progresses to infection. What is the threshold for development of infection?

Back 552

10^5 cfu

Front 553

3 phases of wound healing

Back 553

Inflammation, Proliferation, Mturation

Front 554

What does granulation tissue consist of (cells/structures)

Back 554

Capillaries
Fibroblasts
Macrphages

Front 555

An adherent primary layer for a bandag will allow for _____ during removal of bandage.

Back 555

Debridement

Front 556

Non-occlusive bandages maintain wound _____ an dprotect it from the _____.

Back 556

hydration, environment

Front 557

Where is the panniculus muscle located?

What important vasculature structures are located within this region?

Back 557

Hypodermis

Direct cutaneous artery and vein

Front 558

With first intention wound management is the same as _____ wound closure and you close prior to granulation tissue formation.

Second intention wound management implies _____ wound management.

Third intention wound management is the same as _____ closure and you wait to close until after granulation tissue has formed.

Back 558

primary
open
secondary

Front 559

During wound healing,
contraction is accomplished by _______ while migration is accomplished by ________ ____.

Back 559

myofibroblasts
epithelial cells

Front 560

Systemic factors that can affect wound healing

Back 560

Hypoxemia
Anemia
Hypovolemia
Hypothermia
Hypotension
Disease processes

Hypothermia especially a problem in extremiies due to peripheral vasoconstriction

Front 561

With regard to wound healing, uremia can be a complication because it interferes with cellular _____ nad ____ ____ division.

Back 561

metabolism, epithelial cell

Front 562

2 disease processes that make metabolic negative balance and can cause problems with wound healing

Back 562

Uremia
Liver disease

Front 563

______ is a common cause of chronic, non-healing wounds in humans and may predispose animals to wound _____.

Back 563

Diabetes, infection

Front 564

Hyperadrenocorticism, aka _______, can inhibit ___ ____ of wound healing due to excessive amounts of glucocorticoids. This could decrease host resistance and predispose the patient to _____.

Back 564

Cushing's, all phases
infection

Front 565

3 nutritional factors that can affect wound healing

Back 565

Hypoproteinemia
Vitamin C (which is necessary for collagen synthesis)
Zinc (necesary for epith cell and fibroblast multiplication)

Front 566

2 drug classes that, when administered, can affect wound healing

Back 566

NSAIDs (dec inflammation, minimal effects on other two phases)
Corticosteroids (prolonged admin/effect affects all stages of healing and delays healing time)

Front 567

How many days will you be waiting if you decide to opt for secondary closure of a wound?

Back 567

abut 5 days, giv or take
Tis s when granulation tissue has formed

Front 568

When is second intention healing most appropriate?

Back 568

When there is excessive tissue (skin or muscle) loss, etc.

Front 569

In horses, wounds on the ____ and ____ heal better than wounds on the _____.

Back 569

Head, trunk extremities

Front 570

What is exuberant granulation tissue above the skin edges referred to as in horses?

Back 570

Proud flesh

Front 571

Pain _____ be measured.

Back 571

Cannot

Front 572

Pain scoring systems are an attempt to assess pain in patients and are heavily focused on ______ and less focused on _______ parameters.

Back 572

behavior, physiologic

Front 573

4 general signs of pain that can help in your asessment

Back 573

Loss of normal behaviors
Expression of abnormal behaviors
Reaction to touch
Physiologic parameters

Front 574

Pain scoring should never be used to ____ a patient analgesia that is likely in pain.

Back 574

deny

Front 575

Should you wake up a patient in order to assess pain status?

How often post-op should you reassess for pain?

Back 575

No!

every 2-6 hours

Front 576

One-dimensional pain scoring systems focus primarily on ___ ______.

Back 576

Pain intensity

Front 577

2 main examples of one-dimensional pain scoring system

Back 577

Pre-emptive pain scoring system
DIVAS (dynamic and interactive visual analog scale)

Front 578

DIVAS pain scoring uses a _______ for a particular procedure or conditon and then places the patient somewhere along it.

Back 578

continuum

Front 579

3 steps in a DIVAS evaluation for pain assessment

Back 579

1. Observe animal from afar
2. Interact with animal
3. Note behaviors and responses and assign a score

Front 580

Multidimensional pain scoring systems examine the intensity of pain as well as sensory and affective qualities of pain. 2 main examples for post-sx acute pain scoring.
Which species are these 2 examples relevant for?

Back 580

Glasgow Composite Measures Pain Scale - dogs only
CSU Pain Scale - cats and dogs

Front 581

When approaching an exp lap in a male dog, you must go ________ through the skin and SQ. You remain on ______ all the way on the body wall.

Back 581

peripreputial, midline

Front 582

List the abdominal muscles, from most external to most internal:

Back 582

1. Rectus abdominus
2. External abdoinal oblique
3. Internal abdominal oblique
4. Transverse abdominus

Front 583

Which 3 abdominal muscles contribute to the aponeuroses of the linea alba

Back 583

Ex abd oblique
Internal abd oblique
Transverse abdominus

Front 584

2 surgical approaches acceptable for entering the abdomen through the linea alba

Back 584

1. Stab incision
2. Paint technique

Front 585

_____ _____ can be removed during an exp lap to increase visualization, but it is vascular so you may need to _____ it.

Back 585

Falciform ligament, ligate

Front 586

Retraction for an exp lap is accomplished by __ - _____ retractors, aka ______ retractors.

Back 586

self-retaining, Balfour

Front 587

Name the 6 lobes of the liver

Where is the gallbladder located?

Back 587

Left lteral, left medial, quadrate, right medial, right lateral, caudate

GB is in the fossa between the quadrate and the right medial lobe of the liver

Front 588

The liver is more mobile on its ___ side than on its ___ .

Back 588

left, right

Front 589

Which two veins should you assess when assessing the liver and what do they drain?

Back 589

Caudal vena cava: renal veins and pelvic limbs
Portal vein: spleen, pancrease, intestines

Front 590

Where does the omentum attach?

Back 590

Greater curvature of stomach

Front 591

When doing an exp lap, don't **** with the _____ too much! IT DOESN'T LIKE IT!

Back 591

Pancreas

Front 592

Which ligament can make full oral to aboral evaluation of the GI tract difficult?

Back 592

Duodenocolic

Front 593

3 reasons to touch the pancreas during an exp lap

Back 593

Suspiscious of ancreatic mass
Pancreatic incisional biopsy
Partial pancreatectomy

Front 594

Which elements of the urinary tract are located retroperitoneally?

Back 594

Kidneys, ureters

Front 595

The _____ can often have undiagnosed masses pror to surgery, so it is very important to evaluate them closely.

Back 595

bladder

Front 596

Which adrenal gland is easier to find? Which vein can be used as guidance?

Back 596

Left, phrenicoabdominal

Front 597

Should you palpate the adrenal glands during an exp lap? What would be on reason to be careful?

Back 597

yes, pheochromocytomas

Front 598

The spleen is attached on the ___ side of the body, but it is very ______, so position could change a bit.

Back 598

left, mobile

Front 599

2 ligamentous attachments to the spleen

Back 599

Gastrosplenic ligamnt
Phrenicosplenic ligament

Front 600

Irrigation is _____ necessary for abdominal exploratory surgeries. When removing the sterile saline, get as much fluid as possible out and suction until the fluid is relatively ____.

Back 600

not always, clear

Front 601

Describe the types of sutures you would use for the closure of an exp lap

Back 601

Monofilament
Absorbable OR non-absorbable

Front 602

Which number blade is elongated and triangular and is good for stab incisions.

Back 602

No. 11

Front 603

Which blade has a crescent-shaped end, can be used as a suture cutter, and is sometimes known to be sed for feline declawing.

Back 603

No. 12

Front 604

Which blade is commonly used in large animals and is a larger version of a very common small animal blade size.

Back 604

No.22

Front 605

Standard forcep type for soft tissue handling in small animals.

Back 605

Brown Adson

Front 606

Which forceps have rat-toothed ends?

Back 606

Adson

Front 607

Most delicate option for surgical forceps

Back 607

DeBakey forceps

Front 608

Brown Adson forceps are also called:

Back 608

tumb or tissue forceps ooften

Front 609

Which forcep type has a "negative profile" and serrated tips and is used to pack and pull bandage material out of wounds?

Back 609

Dressing forceps

Front 610

Mayo scissors have a _____ blade to handle lenght ratio than other surgical scissors.

Back 610

Smaller

Front 611

Which types of scissors should never be used for cutting sutures or tough tissues and are characterized by long slender handles and short blades?

Back 611

Metzenbaum scissors

Front 612

These two scissors types are used for fine, meticulous work (ie: neurovascular bundles). Which one has pointy tips and which one has blunt tips?

Back 612

Iris and tenotomy

Iris = pointy
Tenotomy = blunt

Front 613

Which vector forces are exerted when performed a push cut?

Back 613

Torque and shearing

Front 614

4 classifications for surgical clamps

Back 614

Hemostatic
Right-angle clamps
Crushing clamps
Atraumatic clamps

Front 615

Hemostatic clamp types (5)

Back 615

Mosquito
Carmalt
Kelly
Crile
Pean

Front 616

Crushing clamp types (2)

Back 616

Allen forceps
Allis forceps

Front 617

Atraumatic clamps (2)

Back 617

Doyen forceps
Babcock forceps

Front 618

3 types of needle holders

Back 618

Castroviejo needle holders: the little delicate ones
Olsen-Hegar needle holders
Mayo-Hegar needle holders

Front 619

4 appropriate ways to hold needle holders

Back 619

Tripod grip
Palm grip
Thenar grip
Pencil grip

Front 620

2 circumstances where a palm grip on needle holders is appropriate

Back 620

Suturing cow skin
Suturing a tendon

Front 621

2 circumstances when pencil grip on needle holders is most appropriate

Back 621

Suturing a very small blood vessel
Suturing the conjunctiva of an eye

Front 622

Which is the most appropriate grip style for needle holders during general skin suturing?

Back 622

Tripod

Front 623

When doing a continuous suture pattern on fascia, how should you hold your needle holders?

Back 623

Thenar grip

Front 624

Standard size for scalpel blade handle. What is an alternative if you want a long one?

Back 624

#3, #3L

Front 625

Standard needle holder type

Back 625

Mayo-Hegar

Front 626

Which type of needle holders have scissors as part of their jaw?

Back 626

Olsen-Hegar