Basic Principles/Inhaled Anesthetics
Define volume of distribution
(amount of drug in the body)/(serum concentration)
Reminder: it relates amount of drug in the body to the plasma concentration and helps determine the proper dose required to achieve the desired plasma concentration
Which sedative is most likely to cause emergence delirium when used at anesthetic doses?
ketamine
(especially in patients with psychotic disease such as schizophrenia)
Perception of pain to nonpainful stimuli is called __________.
allodynia
Which neuromuscular blocker is most likely to cause histamine release?
atracurium
What is the most common medication for the treatment of hypothyroidism?
levothyroxine (Synthroid)
Define pharmacodynamics
What the drug does to the body (ie. intrinsic sensitivity/responsiveness of the body's receptors to a drug)
Which hypnotic increases the risk of nausea and vomiting?
etomidate
Name the natural (nonsynthetic) opioid that can be chemically modified to create synthetic opioids.
morphine
Which muscle relaxant is most likely to cause bradycardia in children? Why?
succinylcholine via muscarinic stimulation at the sinus node
After a hypophysectomy, the patient begins making high volumes of dilute urine. What drug would be the best intervention?
DDAVP (desmopressin)
The blood:gas parition coefficient of volatile is a measure of what?
solubility
What is the dose of an IM ketamine dart?
4-8 mg/kg
Name the syndrome that is characterized by pain that is greater than would be expected from the injury that causes it. It is associated with acidosis and tissue ischemia.
Complex Regional Pain Syndrome
Reminder: CRPS I occurs in the absence of major nerve injury, while CRPS II is associated with a documented nerve injury
What effect does chronic antiepileptic use have on rocuronium dosing?
need increased dose of rocuronium
Over administration of 0.9% NS will result in what acid-base imbalance?
hyperchloremic metabolic acidosis
Calculate MAC-BAR for sevoflurane.
3.4-4.0
MAC-BAR (1.7-2.0 MAC): Concentration required to block autonomic reflexes to nociceptive stimulus
What is the dosing for flumazenil when reversing a benzodiazepine overdose?
0.2mg (repeated up to 3mg)
Describe the treatment for local anesthetic systemic toxicity (LAST).
airway management, seizure treatment (midazolam), intralipid 20% (1.5 ml/kg bolus followed by 0.25 ml/kg/min infusion), potentially ACLS/CPB
What is the dosing of sugammadex for reversal of a shallow blockade (2/4 TOF)?
2 mg/kg
What is first-line treatment for Parkinson's disease?
levodopa
Name the 3 variables that influence anesthetic uptake of volatile anesthetics.
1. solubility (blood:gas partition coefficient)
2. cardiac output
3. partial pressure difference between alveoli and venous blood (PA-PV)
Which hypnotic is used during an ECT procedure?
Methohexital (Brevital)
(Avoid propofol and benzos, as those agents will shorten seizure duration and increase seizure threshold respectively.)
What is the maximum VOLUME of 0.25% bupivacaine for an 80 kg patient?
80 ml
(0.25% = 2.5 mg/ml; max dose is 2.5 mg/kg = 200 mg; 200/2.5 = 80ml)
Name the metabolite from atracurium that can lower the seizure threshold.
Laudanosine
What drug is likely to be lifesaving in the treatment of an acute carcinoid crisis?
octreotide