Your patient experiences pain after the surgeon injects lidocaine into an infected area, the reason is
What is the infected area is acidotic, so drug ionizes
100
Causes tachycardia
What is desflurane
100
ionized vs. nonionized
What is nonionized is the pharmacologically active rapidly absorbed lipid soluble form of the drug, ionized is the pharmacologically inactive form, water soluble
100
total dose of atropine in a code
What is 3mg
100
ED50
What is the effective dose necessary to produce its effect in 50% of the patients
200
Maximum safe dose of bupivicaine
What is 3mg/kg
200
Good for inhalation induction with children
What is sevoflurane
200
Degree of ionization is a fuction of
What is the drugs Pk and the pH of the surrounding fluid, ie when the ph and the Pk are equal, then 50% of the drug is ionized, and 50% is nonionized (Pka)
200
how does amiodarone work
What is
-effects cardiac Na and K channels, alpha and beta receptors
-prolongs repolarization and refractoriness in SA, AV nodes, atrial and ventricular myocardium and HIS purkinje system
200
noncompetitive antagonist vs competetive antagonist
What is
noncompetitive causes a conformational change in the receptor that causes a diminished receptor response when exposed to agonist
comptetitive-reversible, antagonist can be displaced off of receptor when large amount of agonist given
300
5 signs of local anesthetic toxicity in the awake patient
What is metalic taste in the mouth, ringing in the ears, numbness around the lips, arrhythmias, seizures
300
Patient is very labile, which agent is the most titratable
What is desflurane
300
3 things that effect passage of a drug through a cell membrane
What is
-pH of the drug's environment
-degree of ionization
-Pka dissasociation constant
-protein binding
-molecular weight
-lipid solubility
300
how does vasopressin cause vasoconstriction
What is a nonadrenergic peripheral vasoconstrictor that acts directly on smooth muscle of the GI and vascular bed by stimulating vasopressin 1 receptors
300
name two types of receptor channels
What is
-G CHON coupled channel
-ligand gated ion channel
-voltage gated ion channel
-enzyme mediated channel
400
the antidote for local anesthetic toxicity
What is intralipid
400
the mechanism of bowel distention with N20
What is nitrogen enters air filled spaces 30 x faster than air can get out
400
Redistribution is
What is VRG (brain, heart, kidneys, liver) receives 75% of the CO, when the plasma concentration decreases in the VRG, the drug redistributes to less perfused, inactive tissue sites such as muscle and fat
400
Your patient has pulseless VT, you have done
shock-cpr-epi
shock-cpr-epi/vasopressin
shock-cpr.......what agents do you then consider
What is
amiodarone 300mg IV
lidocaine 1-1.5mg/kg
magnesium 1-2mg
400
What does context refer to in context sensitive half time
What is duration of infusion
500
NaHCO3 is added to bupivacaine for this reason
What is it makes the pH of the environment in which it is injected more alkalotic, thus there is more nonionized form of the drug available which speeds onset
500
MAC is
What is the percentage anesthetic necessary to prevent movement in 50% of individuals at skin incision
500
What are distribution 1/2 time phases
What is
alpha-distribution out of the central compartment to the peripheral compartment
beta-elimination phase where a gradual decrease in plasma concentration of the drug reflects elimination from the vascular compartment by liver and kidneys
500
After you intubate during a code, do you still have to do 30:2?
What is no, just do continuous cpr with 80-10 breaths per minute, don't hyperventilate
500
Two physiologic states that will change the pharmacokinetics of a drug
What is
-hypovolemia
-hypothermia
-hepatic disease
-renal disease