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134 Cards in this Set

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  • Back
What is MAC?
minimum alveolar concentration = smallest concentration of inhalation agent at which 50% of patients will not move with incision
What does a small MAC mean?
more lipid soluble = more potent
Speed of induction is inversely proportional to ____
Which inhalation agent is fastest but has high MAC (low potency), also minimal myocardial depression?
Nitrous oxide
Which inhalation agent is slow, higest degree of cardiac depression and arrhythmias; least pungent; which is good for children?
What are the sx of Halothane hepatitis?
fever, eosinophilia, jaundice, increased LFTs
Which inhalation agent can cause seizures?
Which inhalation agent is good for neurosurgery but has higher cost?
Which inhalation agent has less myocardial depression, fast onset/offset, less laryngospasm; higher cost?
Which induction agent is a fast acting barbituate with side effects of decreased cerebral blood flow and metabolic rate, decreased blood pressure.
sodium thiopental
Which induction agent has very rapid distribution and on/off; amnesia; sedative. Not an analgesic. Metabolized in liver by plasma cholinesterases. Do not use in patients with egg allergy.
What are the side effects of propofol.
hypotension and respiratory depression
Which induction agent has dissociation of thalamic/limbic systems; places pt in a cataleptic state (amnesia, analgesia). No respiratory depression.
What are the side effects of Ketamine?
hallucinations, catecholamine release (increased carbon monoxide, tachycardia), increased airway secretions, and increased cerebral blood flow
When is ketamine contraindicated?
pts with a head injury
Which induction agent has fewer hemodynamic changes; fast acting. Continuous infusions can lead to adrenocortical suppression.
What is the last muscle to go down and 1st muscle to recover from paralytics?
What is the first muscle to go down and the last to recover from paralytics?
neck muscles and face
What is the only depolarizing agent?
What is the 1st sign of malignant hyperthermia?
increased end-tidal CO2
Tx for malignant hyperthermia?
Dantrolene inhibits Ca release. cooling blankets, bicarb, glucose
Do not use succinylchoine in pts with what?
burn pts, neurologic injury, neuromuscular disorders, spinal cord injury, massive trauma, acute renal failure
What can happen if pt with open-angle glaucoma gets succinylcholine?
it can become close angle glaucoma
Atypical pseudocholinesterases
cause prolonged paralysis with succinylcholine (Asians)
How do nondepolarizing paralytic agents work?
inhibit neuromuscular junction by competing with acetylcholine
Which paralytic undergoes Hoffman degredation. Can be used in liver and renal failure. Histamine release.
Which paralytic is fast, short acting; degradation by plasma cholinesterases. Histamine release.
Which paralytic is fast, intermediate duration; hepatic metabolism.
Which paralytic is slow acting, long-lasting; renal metabolism. Most common side effect is tachycardia.
What two drugs can be given for reversing nondepolarizing agents and what is their MOA?
Neostigmine and Edrophonium, they block acetylcholinesterase, increasing acetylcholine
___ or ___ should be given with neostigmine or edrophonium to counteract the effects of generalized acetylcholine overdose
atropine or glycopyrrolate
Local Anesthetics work by increasing action potential, preventing ____
Na influx
How much lidocaine can you use?
0.5 cc/kg
Relative length of action of bupivacaine, lidocaine, procaine
bupivacaine > lidocaine > procaine
Name conditions where you cannot use epinephrine with local anesthetics.
arrhythmias, unstable angina, uncontrolled hypertension, poor collaterals (fingers, toes, penis, nose, and ear), uteroplacental insufficiency
How to tell the difference between the amides and the esters?
Amides all "i" in the first part of the name: lidocaine, bupivacaine, mepivacaine

Esters: tetracaine, procaine, cocaine
What is the biggest difference between the amides and the esters?
Amides rarely have allergic reactions. Esters have increased allergic reactions secondary to PABA analogue
Name 4 opioids?
Morphine, fentanyl, Demerol, codeine
Where are the opioids metabolized and excreted?
metabolized in liver and excreted by kidneys
Avoid use of narcotics in patients on MAOIs can cause ____
hyperpyrexic coma
Morphine, Demerol and Fentanyl which one causes histamine release?
Fentanyl is ___x the strength of morphine
sufentanil, alfentanil, remifentanil
very fast-acting narcotics with short half-lives
Versed, Ativan, Valium what are their generic names and short or long acting
Versed (midazolam) short acting
Ativan (lorazepam) long acting
Valium (diazepam) long acting
Morphine in epidural can cause ___
respiratory depression
Lidocaine in epidural can cause ___
decreased HR and BP
Tx for acute hypotension and bradycardia with epidural?
turn epidural down; fluids; phenylephrine; atropine
T-___ epidural can affect cardiac accelerator nerves
Epidural contraindicated with ___, ____ -> can get inadvertent spinal anesthesia.
hypertrophic cardiomyopath, cyanotic heart disease
Good for pediatric hernias, and perianal surgery.
Caudal block
Epidural and spinal complications
hypotension, headache, urinary retention, abscess/hematoma formation, neurologic impairment
High spinal can cause ____
respiratory depression
Spinal headache tx and what makes worse?
rest, increased fluids, caffeine, analgesics; blood patch to site persists >24 hrs.

Headache worse sitting up.
What two conditions are associated with them most postoperative hospital mortality?
CHF and renal failure
May have no pain or EKG changes; can have hypotension, arrhythmias, increased filling pressures, oliguria, bradycardia
Postop MI
Patients who need cardiology workup.
Angina, previous MI, shortness of breath, CHF, walks <2 blocks due to SOB or CP, FEV1 <70%, aortic stenosis murmur, PVCs > 5/min, age > 70, patients undergoing major vascular surgery
List the ASA classes with description
I - healthy
II - mild disease without limitation (controlled HTN, obesity, DM, older age)
III - severe disease (angina, previous MI, poorly controlled HTN, DM with complictions, moderate COPD)
IV - severe constant threat to life ( unstable angina, CHF, renal failure, liver failure, severe COPD)
V - moribound (ruptured AAA, saddle pulmonary embolus, ascending aortic dissection with HF)
VI - donor
E - emergency
Biggest risk factors for postop MI
age > 70, DM, previous MI, CHF and unstable angina
Best determinant of esophageal vs. trachael intubation?
end-tidal CO2
Intubated patient undergoing surgery with sudden transient rise in ETCO2. Most likely Dx? Tx?
alveolar hypoventilation

increase tidal volume (most likely due to atelectasis) or increase respiratory rate
Intubated patient with sudden drop in ETCO2. List 3 likely reasons
disconnected from vent, PE or significant hypotension
ET tube should be placed ___ cm above carina
Most common PACU complication
Roughly ___ of the total body weight is water (men); ___ have a little more body water, ____ have a little less
2/3, infants, women
2/3 of water weight is located where? and the other 1/3?
intracellular (mostly muscle), extracellular
2/3 of extracellular water is located where? and the other 1/3?
interstitial, plasma
What determines plasma/interstitial compartment osmotic pressures? what about intracellular/extracellular?
proteins, Na
Most common cause of volume overload? what is the first sign?
iatrogenic, weight gain
What is the meqs in 0.9% NS?
Na 154 and Cl 154
Lactated Ringer's has the ionic composition of plasma, what is it?
Na 130, K 4, Ca 2.7, Cl 109, bicarb 28
How to calculate plasma osmolarity and what is the range of normal?
(2 x Na) + (glucose/18) + (BUN/2.8)

How to estimate volume replacement in cc/kg/hr
4 cc/kg/hr for first 10 kg
2 cc/kg/hr for second 10 kg
1 cc/kg/hr each kg after that

(110 cc/hr for 70 kg man)
What is the best indicator for adequate volume replacement?
urine output
During open abdominal operations, fluid loss is ___ L/hr unless there are measurable blood losses
0.5-1.0 L/hr
Usually do not have to replace blood lost unless it is >____ cc
Insensible fluid losses is ___ cc/kg/day, 75% skin, 25% respiratory (pure water)
IV replacement after major adult GI surgery:
During operation and 1st 24 hours use ____.
After 24 hrs switch to ___
5% dextrose will stimulate ___, resulting in amino acid uptake and protein synthesis (also prevents protein catabolism)
D5 1/2 NS with 20 mEq K
D5 1/2 NS @ 125 /hr provides 150 g glucose per day (____ kcal/day)
Stomach secretes ___ L/day
Biliary system secretes ___ mL/day
Pancreas secretes ___ mL/day
Duodenum secretes ____ mL/day
Normal K+ requirement is ___ mEq/kg/day
Normal Na+ requirement is ___ mEq/kg/day
Which bodily fluid has the highest concentration of K+
Primary electrolyte(s) lost in the:
Small Intestine?
Large Intestine?
Stomach H+, Cl-
Pancreas HCO3-
Bile HCO3-
Small intestine HCO3-, K+
Large intestine K+
Gastric losses should be replaced with which fluid?
D5 1/2 NS with 20 mEq K+
Pancreatic/biliary/small intestine losses should be replaced with which fluid?
LR with HCO3-
Large intestine (diarrhea) losses should be replaced with which fluid?
LR with K+
GI losses should generally be replaced ___ ?
UO should be kept at least ___ cc/kg/hr; should not be replaced usually a sign of normal postoperative diuresis?
Normal range of K+
Initial finding of hyperkalemia on EKG?
peaked T waves
Tx for hyperkalemia:
____ membrane stabilizer for heart
____ causes alkalosis, K enters cell in exchange for H
____ K driven into cells along with glucose
___ binder
___ if refractory
Calcium gluconate
10 U insulin and 1 ampule of 50% dextrose
EKG with hypokalemia?
t waves disappear
Hypokalemia tx: may need to replace ___ before you can correct K+
Normal range of sodium?
What are the sx of hypernatremia?
restlessness, irritibility, ataxia, seizures
Correct hypernatremia with ___ slowly to avoid ___
D5W, brain swelling
Formula for total body water?
0.6 x patient's weight
Formula for total free water deficit
TBW x (([Na+]/140) -1)
Formula for water requirement in hypernatremia
Water requirement = (desired change in Na+ over 1 day x TBW) / desired Na+ after giving the water requirement

For a 70 kg man with Na 165 = (16 x 42)/149 = 4.5 L
In hypernatremia change Na at ____ mEq/h
Sx of hyponatremia
headaches, delirium, seizures, nausea, vomiting
Formula for Na deficit in hyponatremia
Na deficit = 0.6 x weight in kg x (140 - Na)
What is the first tx for hyponatremia? second? third?
water restriction, diuresis, NaCl replacement
Why is Na corrected slowly In hyponatremia and what is the rate?
avoid central pontine myelinosis, 1 mEq/h
What is the formula for correcting Na in pseudohyponatremia caused by hyperglycemia?
for each 100 increment of glucose over normal add 2 points to the Na value
What is the normal Ca range?
Most common malignant cause of hypercalcemia?
breast CA
What drug causes retention of Ca2+ and should not be given to patient with hypercalcemia?
thiazides (also LR contains Ca2+)
What is the tx for hypercalcemia?

For malignant disease?
NS at 200-300 cc/hr, Lasix

mithramycin, calcitonin, alendronic acid, dialysis
Main sx of hypercalcemia?
lethargic state
Sx of hypocalcemia?
hyperreflexia, Chvotstek's sign (tapping on face produces twitching), perioral tingling and numbness, Trousseau's sign (carpopedal spasm), prolonged QT
In hypocalcemia, may need to correct ___ before being able to correct Ca
Protein adjustment for Ca
(4.0 - serum albumin) * 0.8
Normal range of Mg
Sx of hypermagnesemia? What type of pts?
lethargic state

burn, trauma and dialysis pts
Tx for hypermagnesmia
Signs and sx of hypomagnesmia are similar to what?
Formula for anion gap and normal range
Na - (HCO3 + Cl)

Mnemonic for anion gap acidosis

methanol, uremia, diabetic ketoacidosis, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates
Normal gap acidosis usually due to loss of ____/____

Seen with?

ileostomies, small bowel fistulas
Tx for metabolic acidosis is underlying cause; keep pH > ___ with bacarbonate; severely decreased pH can affect ____
7.20, myocardial contractility
Metabolic alkalosis is usually the result of ____
contraction alkalosis
Nasogastric suction results in what electrolyte abnormality and what is the urine?
hypocholoremic, hypokalemic, metabolic alkalosis

paradoxical aciduria
Why is there hypokalemia in nasogastric suction?

and why is there paradoxical aciduria?
Loss of water causes kidney to resorb Na in exchange for K (Na/K ATPase)

Na+/H- exchange activated in an effort to absorb water along with K+/H- exchanger in an effort to resorb K+
Henderson-Hesselbach equation

pH = pK + log [HCO3−]/[CO2]

A pH of 7.4 has a ratio of base to acid (HCO3- to CO2) of ____
What is the best test for azotemia?
What is the formula for FeNa
(urine Na/Cr)/(plasma Na/Cr)
In Pre renal failure. What is the FeNa? urine Na? BUN/Cr ratio? urine osmolality?
FeNa <1%
BUN/Cr >20
urine osmolality >500 mOsm
In contrast dye induced ARF: What best prevents renal damage? What are 2 others?
volume expansion, HCO3-, N-acetylcysteine gtt
Myoglobin is converted to ____ in acidic environment which is toxic to renal cells. Tx?
ferrihemate, alkalinize urine
In tumor lysis syndrome there is increased ___ and ___ and decreased Ca. This can result in increased BUN and Cr, EKG changes. Tx?
phosphate and uric acid

hydration, allopurinol (decreased uric acid production), diuretics, alkalinization of urine