PEDicures
OBscenities
Potent Potables
Relax, Don't Do It
PACU IQ
100
A child with cerebral palsy received succinylcholine, a nondepolarizing muscle relaxant, volatile anesthetic and opioids. Of these agents, which is most likely to require an increased dose to achieve standard pharmacologic effect?
What is nondepolarizing muscle relaxants
100
Your patient that has had 3 prior cesarean deliveries, is actively contracting and the OB wants to proceed with repeat c/s. Her BP is 175/95 and HR 125bpm. She reports taking methamphetamine earlier that day. She also refuses neuraxial anesthesia. This is one preferred medication to treat her hypertension.
What is nitroglycerin Avoid ketamine, beta blockers, and ephedrine
100
This herbal agent used for "sleep disturbance/insomnia" should be stopped on a taper over several weeks prior to surgery
What is Valerian
100
This agent impairs calcium-dependent muscle contraction, which rapidly halts the increases in metabolism and secondarily results in a return to normal levels of catecholamines and potassium - as seen in patient’s with abnormal ryanodine receptors (RyR1 isoform).
What is Dantrolene
100
Your patient cannot be discharged home due to confusion. She also is tachycardic, hyperthemic, dry and has dilated pupils. This agent was most likely given in the preoperative area.
What is scopolamine patch
200
Your patient with tetralogy of Fallot is under anesthesia and is showing signs of a hypercyanotic episode ("tet spell"). This agent is most likely to be successful in treating it.
What is phenylephrine (or beta blocker)
200
During a cesarean complicated by an inverted uterus (or retained placenta), the OB requests more uterine relaxation. What agent(s) can be used.
What is nitroglycerin .... or increase volatile anesthetic (except N2O), Magnesium, tocolytics
200
This agent used for "anxiety" can increase GABA and may decrease requirements for general anesthesia
What is Kava
200
35yo female is scheduled for thymectomy due to worsening myasthenia gravis. She takes pyridostigmine daily, and her recent PFTs showed vital capacity of 2.5L. Besides continuing her anticholinesterase therapy perioperatively, what dose (increase or decrease) of nondepolarizing muscle relaxants should be considered?
What is decrease
200
Your same patient, can be treated with this agent for suspected anticholinergic toxicity.
What is physostigmine
300
Which of the following congenital heart lesions is most likely to cause a decrease in the rate of an inhalational induction of anesthesia? a) ventricular septal defect b) transposition of the great arteries c) patent ductus arteriosus d) critical aortic stenosis
What is transposition of the great arteries (right to left shunt) also: TOF, hypoplastic left heart, truncus arteriosus, tricuspid atresia, pulmonary atresia
300
This tocolytic agent is most likely to be associated with an increased risk of hypoglycemia in the neonate
What is terbutaline (beta agonist)
300
True or False: In patients taking Garlic, Ginseng, Gingko, Ginger and Saw Palmetto, neuraxial anesthesia should be avoided?
What is False
300
This agent is contraindicated in a patient with Guillain-Barre syndrome.
What is succinylcholine
300
Your patient who is on several anti-hypertensive medications did not take any of them for 2 days prior to a 12 hour elective spine surgery. In PACU, he denies pain but his BP is 220/120. Which home medication (and class of medication) was most likely discontinued causing rebound hypertension?
What is clonidine (central alpha agonist), or any beta-blocker
400
A 6yo patient with an intracranial tumor presents for a 1-hour MRI. He has received dexamethasone to reduce swelling and appears in no acute distress. If the patient is allowed to breathe spontaneously during the procedure, this agent is most likely to maintain sedation and avoid increases in ICP.
What is dexmedetomidine infusion (precedex)
400
This agent that can be used to treat postpartum hemorrhage can cause an acute increase in pulmonary artery pressures therefore making it relatively contraindicated in pulmonary hypertension
What is 15-Methylprostaglandin F2alpha (Hemabate)
400
This herbal agent used to treat "depression" can inhibit warfarin anticoagulation, and induces hepatic metabolism of opioids, benzodiazepams and serotonin receptor antagonists.
What is St. John's Wart
400
This neuromuscular blocking agent is unique in that it's recovery index is not altered by aging.
What is atracurium (cisatracurium)
400
While transferring your cardiac patient from the OR to ICU with a full cylinder of oxygen, the elevator becomes stuck. The flow setting is on 10L/min of oxygen. Assuming the rate is unchanged, the cylinder supply with most likely last:
What is ~65 minutes
500
This is the maximum FiO2 that can be administered to the mother without increasing the risk of retinopathy of prematurity in the fetus in utero.
What is 1.0 (placenta maintains fetal paO2 ~ 45)
500
A stat cesarean is called for fetal distress, the patient is induced by RSI with ketamine, fentanyl and succinylcholine. Isoflurane is used for maintenance. Of these medications, which agent is LEAST likely to transfer across the placent?
What is succinylcholine
500
This agent is used as an "energy booster", but can also decrease platelet aggregation, cause HTN and hypoglycemia.
What is Ginseng
500
This amount of time is usually required for up-regulation of nicotinic ACh receptors that can cause resistance to nondepolarizing neuromuscular blockers following a burn covering >35% of a patient's body.
What is 48-72 hours
500
This opiate is the best choice for postoperative analgesia in patients with end-stage renal disease.
What is fentanyl Metabolites: Morphine --> ______ Hydromorphone --> ______ Meperidine --> ______
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