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102 Cards in this Set
- Front
- Back
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Which agent has antimuscarinic action? |
Pancuronium
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If a high dose of mivacurium is administered rapidly, you will see?
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hypotension and tachycardia
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Acetylcholine is released from the terminal of each of the following neurons except:
a. sympathetic preganglionic neuron innervating the adrenal medulla. b. sympathetic postganglionic neuron innervating the gi tract. c. parasympathetic postganglionic neuron innervating the pupil of the eye. d. motor nerve innervating skeletal muscle. |
b. sympathetic postganglionic neuron innervating the gi tract.
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Side effects of ritodrine include each othe following except?
a. hypokalemia b. hyperglycemia c. tachycardia d. diarrhea |
d. diarrhea
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The effects of ephedrine are due mostly to its?
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stimulation of the nerve terminal to release norepinephrine.
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Low levels of circulating epinephrine cause?
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increased HR and SBP
Decreased DBP and SVR |
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Prazosin works by blocking (antagonizing)?
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vascular alpha 1 receptors without increasing the release of norepi from sympathetic postganglionic nerves
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Non selective beta blockade produces?
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a decrease in HR
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Selective beta blockade produces?
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bronchodilation
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Esmolol works primarily by competitively antagonizing what receptors?
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B1
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Labetalol works primarily by competitively antagonizing what receptors?
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A1, B1, B2
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An overdose of beta blocker may be treated with?
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glucagon
dobutamine atropine |
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Neostigmine reverses nondepolarizing neuromuscular blockade because it?
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indirectly stimulates nicotinic receptors
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Agents with antimuscarinic actions include?
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Pancuronium
atropine ipratropium |
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Trimethaphan is?
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ganglionic blocker used to tx HTN
releases histamine metabolized by pseudocholinesterase blocks nicotinic receptors at autonomic ganglia |
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Proprioception is carried by?
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A alpha and A beta fibers
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Pain and temp are carried by?
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A delta and C fibers
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An important stimulus for aldosterone release from the adrenal cortex is?
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high serum potassium
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What nerves originate in the interomediolateral horn of the spinal cord?
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sypmathetic preganglionic neurons
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What nerves pass through the gray rami communicans?
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Sympathetic postganglionic neurons
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Somatic sensory neruons are?
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afferent and enter the cord via the dorsal horn
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What spinal cord tract modulates pain?
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Dorsolateral
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What spinal cord tract recieves pain?
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Lateral spinothalamic
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Pain afferent nerve fibers enter the dosal cord and ascend or descend 1-3 segments in what tract before enting and synapsing in the dorsal horn?
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Tract of Lissauer
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C fibers synapse in what layers of the dorsal horn?
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Rexed's lamina 2 and 3
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Pain transmitted from teh periphery by A delta fibers terminate primarily in Rexed's lamina?
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1 and 5
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The neurotransmitter released from A delta fibers is?
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glutamate
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The neurotransmitter released form C fibers is?
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Substance P
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What substance decreases the release of substance P in the spinal cord?
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Enkephalin
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Where does epidural morphine work?
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In the substantia gelatinosa
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What brain region controls events in the substantia gelatinosa?
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Periventricular/periaquaductal gray
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What area of the brain mediates spinal anaglesia after administration of an IV opiod?
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Periventricular/periaquaductal gray of brianstem
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Which fontanelle closes at about 2 years of age?
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Posterolateral
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The pt with an intracranial pressure that suddenly has risen to 30mmHg will exhibit?
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Cushings Triad
Increased MAP (HTN) Bradycardia Irregular respirations |
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Which cranial nerve controls the lateral rectus muscle?
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Abducens
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Another name for cerebral steal is?
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Luxury perfusion
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Would hypo or hyperventilation cause the Robin Hood Effect?
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Hyperventilation->increased CO2->cerebral vasoconstriction so good vessels constrict and more blood flow goes to already maximally dilated ischemic areas.
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Muscles for chewing are controlled by cranial nerve?
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5 Trigeminal nerve.
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Which cranial nerve controls motor activity of the larynx and pharynx?
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Vagus
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With first degree heart block..
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PR interval is >0.20 sec and is constant from beat to beat
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Describe second degree Mobitz type I (Wenckebach)
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progressive increase in PR interval from beat to beat until finally the QRS complex and a beat is dropped
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Describe second degree Mobitz Type II block.
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sudden appearance of a nonconducted p wave.
P waves are normal, but some are not followed by QRS. |
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Describe third degree (complete) heart block.
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P waves have no fixed relationship to the QRS complexes. (Ps and QRS' doing there own thing)
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Describe sinus arrhythmia.
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During inspiration there is an increase in HR.
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Subendocardial ishcmia and injury produce?
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st segment depression >1mm
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Transmural injury produces?
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st segment elevation >1mm
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SV=
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CO/HR
60-90ml |
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SI=
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SV/BSA
40-60ml/m2 |
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SVR=
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80(MAP-CVP)/CO
900-1500 dynes/sec/cm-5 |
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68 y/o pt shows ecg signs of myocardial ischemia with PCWP=18mmHg, bp 105/60, HR=80. How should pt. be tx?
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decreased bp and increased PCWP= heart failure.
Give phenylephrine to increase BP and coronary perfusion Give Nitro to decrease venous return Give +inotrope to increase contractility |
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68 y/o pt shows ECG signs of myocardial ischemia with PCWP=10mmHg, BP 140/85, HR 75. How should pt be tx?
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Hemodynamics are normal
Give CCB or nitro |
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68 y/o pt shows ECG signs of myocardial ischemia with PCWP=8mmHg, BP 136/76, HR 115. How should pt be tx?
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HR is increased
give Beta blocker |
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68 y/o pt shows ECG signs of myocardial ischemia with PCWP=20mmHg, BP 160/105, and HR 60. How should pt be tx?
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Increased BP and PCWP
Increase anesthetic depth or give nitro |
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68 y/o pt shows ECG signs of myocardial ischemia with PCWP=10mmHg, BP 80/40, and HR 70. How should pt be tx?
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Decreased BP
Decrease Anesthetic depth Give phenylephrine to increase BP and coronary perfusion |
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What lead is the best for detecting ishemia?
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V5
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Where on the ECG can you detect hypertrophy?
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increased R, V1, V6
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Where on ECG can you detect an inferior MI?
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leads 2, 3, AVF
supplied by RCA |
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Where on ECG can you detect an anterior MI?
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1, AvL and V1-V4
supplied by LCA |
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Where on ECG can you detect an anteroseptal MI?
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leads V1-V4
supplied by LAD |
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Where on ECG can you detect a lateral MI
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leads 1, AV1, V5-6
supplied by LCX |
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Nitric oxide stimulates the production of what second messenger?
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cyclic GMP
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The area under the arterial waveform divided by time is a measure of?
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MAP
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Describe management of AR?
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Maintain normal HR
Avoid tachycardia-promotes myocardial ishchemia Avoid bradycardia-will increase regurgitant volume Maintain preload Decrease afterload to favor forward flow Avoid myocardial depression |
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Management of MR includes?
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Increase HR
Avoid bradycardia-increases regurgitant volume Maintain Preload Decrease afterload to favor forward flow Inotropes to increase contractility Avoid myocardial depression |
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Management of AS includes?
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Maintain slow HR (60-90)
Avoid bradycardia and tachycardia (SV is fixed) Maintain preload Maintain afterload Maintain contractility |
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Management of MS includes?
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Maintain slow HR (60-90)
Avoid tachycardia Maintain preload, afterload and contractility |
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Management of hypertrophic cardiomyopathy includes?
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Maintain HR
Keep preload full Afterload increased Contractility decreased |
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Obstruction with hypertrophic cardiomyopathy will be worsened by?
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increased contractility
decreased preload decreased afterload |
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What agents impair PLT aggregation by impairing cyclo-oxygenase?
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ASA
NSAIDs |
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What clotting factor is considered the physiologic initiator of the coagulation cascade?
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3 tissue factor or thromboplastin
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What two phramacological agents inhibit plasmin?
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Aproptinin
Amicar *plasmin is responsible for breaking down fibrin |
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Transfused blood is deficient in what 2 coagulation factors?
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V
VIII *and PLTs |
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What antiplatelet agents prevent ADP induced platelet aggregation?
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Plavix
Ticlopidine * are anti ADP agents |
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Aproptinin and Amicar work by?
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inhibiting plasmin. When plasmin is inhibited, fibrin that is formed breaks down slowly so bleeding is decreased.
Used for repeat cardiac operations. |
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PAO2-PaO2 gradient is?
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5-15mmHg on room air
may be as much as 100 when breathing 100% O2 |
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PaCO2-PACO2 gradient is?
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2-10mmHg
is independent of inspired O2 concentration |
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PAO2-PaO2 gradient with age is?
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0.21 * (age + 2.5)
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PaO2/PAO2 ratio is?
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>0.75
is not affected by changes in inspired O2. |
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You can estimate the PaO2 in a healthy pt by?
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%O2*5
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You can estimate PAO2 by?
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%O2 * 6
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Central chemoreceptors are stimulated directly by?
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Hydrogen ions
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Peripheral chemoreceptors are morse sensitive to?
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decreased PaO2 (<60mmHg)
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What respiratory center in the pons participates in shutting off inspiration?
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Pneumotaxic center
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Compare PACO2 in the base with PACO2 in the apex when the pt is in the prone position.
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PACO2 is the same in the base as the apex in the prone position.
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ADH release is triggered by?
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Increased osmolality
hypotension stress Pain CPAP, PEEP, volatile agents |
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What is urine volume and osmolality when ADH release is inhibited?
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In absence of ADH, distal tubule and collecting duct are impermeable to water so a large volume of dilute urine is formed.
*ADH->reabsorption of H2O |
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What hormone controls extracellular fluid volume?
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Aldosterone.
Aldosterone is the most important hormone for regulating extracellular fluid volume. It increases Na reabsorption and K secretion and excretion |
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What hormone controls extracellular sodium concentration?
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ADH
ADH leads to reabsorption of H2O. |
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Spironolactone acts primarily on what segment of the renal tubule?
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collecting duct.
Spironolactone is an K+ sparing diuretic that competitively inhibits aldosterone (aldosterone incrases Na reabsorption, K+ secretion and excretion) |
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The chronic renal failure pt has a tendency for increased bleeding, in part becasue of the production of defective?
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VWF
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The most common severe morbidity complicating obstetric anesthesia is?
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placenta accreta
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This is a free floating valve.
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cylinder valve
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This valve has a special "diaphragm" which identifies its function.
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First stage regulator
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Whe waste gas scavenging system has an adjustment know and when you turn the knob you regulate?
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flow
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The BIS reading is a derived number (from EEG signal processing) that correlates with the level of?
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hypnosis
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Which system has the ambu bag as a component?
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semi-open system
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Which system is the everyday anesthesia system?
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semi-closed system
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Diagnosis of Hypovolemia is made by?
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Hypernatreia
urine osmolality >450 urine Na <10 Increased Hct metabolic acidosis Bun:Creatinine ratio >10:1 PAOP <8 CVP >12 |
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Hallmark laboratory finding in hyperparathyroidism is?
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serum Ca >5.5mEq/L
ionized Ca >2.5mEq/L |
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The reaction that occurs with the CO2 absorber between soda lime and carbon dioxide is?
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CO2+H2O-->H2CO3
H2CO3+2NaOH--> Na2CO3+2H2O+heat |
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Organ function decreases by how much each year over age 40?
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Organ function decreases 1% per year over age 40.
Ex. 70 year old has organ function decreased by 40% |
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What syndrome is the only one associated with an ascending motor weakness that typically follows an infectious process?
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Guillian-Barre Syndrome.
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