APC Exam #1

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pharmschool
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136219
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APC Exam #1
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2012-02-18 22:33:35
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  1. Natural source for NMBA
    Chondodendron tomentosum
  2. Natural preparation of Curare involves boiling it in water and then evaporating it to a paste. This implies that:
    Curare is both heat stable and water soluble
  3. These drugs bind competitively to the cholinergic receptors on the motor end-plate, and thus antagonize the action of ACh
    depolarizing NMBA (succinylcholine)
  4. True or False? NMBAs have no affect on pain or sensory perception
    True!
  5. Significant Adverse Effects of NMBAs
    1. Hypotension due to autonomic ganglionic blockade & histamine release

    2. Tachycardia due to vagal blockade (vagolysis)
  6. This compound contains a benzenesulfonic acid and is a mixture of 10 isomers
    Atracurium
  7. The chirality of this bisbenzylisoquinoline-compound provides that the structure is a mixture of isomers

    This compound has the shortest half-life of the bisbenzylisoquinolines and it also does not undergo hepatic degradation like the other two. However, it does cause moderate histamine release which the other two do not.
    Mivacurium
  8. This monoquaternary, monotertiary, semisynthetic bisaminosteroid contains two piperidine rings as side chains. Caution must be used when using this compound in patients with hepatic impairement.
    Vecuronium
  9. This monoquaternary, monotertiary, semisynthetic bisaminosteroid contains a pyrrolidine and morpholine ring as side chains. Caution must be used when using this compound in patients with hepatic impairment
    Rocuronium
  10. This bisquaternary, semisynthetic bisaminosteroid contains two piperidine rings as side chains. This compound has the longest duration of action and must be used cautiously in patients with renal failure.
    Pancuronium
  11. The objective of general anesthesia is:
    reversible neronal blockade in CNS
  12. This compound is the only incomplete anesthetic
    Nitrous Oxide
  13. This inhalation anestheic's ADVANTAGES include: good muscle relaxation, low incidence of arrhythmias, low
    incidence of liver/kidney toxicity.

    DISADVANTAGES are: hypotension, respiratory depression, seizures in at high concentrations
    Enflurane
  14. This inhalation anesthetic's ADVANTAGES include: good muscle relaxation, cardiac output maintained, no
    arrhythmias, low incidence of liver/kidney toxicity, no seizures

    DISADVANTAGES are: more pungent odor that enflurane, hypotension, respiratory depression
    Isoflurane
  15. This inhalation anesthetic has the same advantages as isoflurane; more rapid induction and easier control of anesthetic depth.

    All halogens in this compound are fluorine.

    DISADVANTAGES are: pungent odor → airway irritation and reactivity, hypotension, respiratory depression
    Desflurane
  16. This inhalation anesthetic has the same advantages as desflurane; little odor

    All halogens in this compound are fluorine.

    DISADVANTAGES are: significant metabolism to inorganic fluoride → potential kidney toxicity, chemical instability when exposed to soda lime (CO2 removal), hypotension, respiratory depression
    Sevoflurane
  17. Barbiturates and benzodiazepines (and perhaps other agents) produce CNS depression by interacting with or mimicking ______________, a major inhibitory neurotransmitter at many levels of the neuroaxis from the spinal cord to the cerebral cortex.
    GABA
  18. These IV anesthetics have poor analgesic and muscle relaxant activity. May produce severe respiratory depression. Used primarily as induction anesthetics to promote rapid movement through Stage II.
    Barbiturates
  19. How long should aspirin or NSAIDS be held prior to surgery?
    at least 10-14 days
  20. How long should cardiovascular meds, opioids, BZDs, or antidepressants be held prior to surgery?
    Do not hold these meds prior to surgery: risks > benefits
  21. How long should warfarin be held prior to surgery?
    at least 4-5 days
  22. How long should Pradaxa be held prior to surgery?
    1-2 days prior
  23. How long should alternative meds be held prior to surgery?
    At least two weeks
  24. What are the three legs of Virchow's triad?
    • 1. Venous Stasis
    • 2. Injury
    • 3. Hypercoagulable State
  25. What are the three scenarios when Enoxaparin should be used over Heparin for DVT prophylaxis?
    • 1. Hip replacement
    • 2. Knee replacement
    • 3. Trauma patients
  26. What are the two consequences of ulceration in the GI tract?
    • 1. Risk of bacteria translocating across the gut
    • 2. Hemorrhage from erosion through surface vessels
  27. What are the two independent risk factors for SRMD bleeding in ICU patients?
    • 1. Respiratory failure requiring MV > 48 hours
    • 2. Coagulopathy: platelet count < 50,000
  28. What is the agent of choice for SRMD?
    H2RA

    **Use a PPI if patient has an acid problem --- example, blood in the gut**
  29. What is the agent of choice for SSI prophylaxis?

    If allergy to this drug?
    1. Cefazolin 1 gram IV q8h

    2. Vancomycin if PCN allergy
  30. Who gets perioperative beta blocker prophylaxis?
    Only patients who are on a beta blocker at home
  31. Normal Range for MAP
    65-90 mm Hg
  32. Normal range for cardiac output (CO)
    4-7 L/min
  33. Normal range for cardiac index (CI)
    2.8-3.6 L/min/m2
  34. Normal range for central venous pressure (CVP)

    [right ventricular preload]
    8-12 mm Hg
  35. Normal range for PCWP

    [left ventricular preload]
    6-12 mm Hg
  36. normal range for systemic vascular resistance (SVR)

    [left ventricle afterload]
    800 - 1400 dyne/sec/cm-5
  37. 120-Normal range for pulmonary vascular resistance (PVR)

    [right ventricle afterload]
    120 - 250 dyne/sec/cm-5
  38. Clinical indicators for hypovolemic shock:
    • CI = low
    • SVR = high
    • PCWP = low
  39. Clinical indicators for cardiogenic shock:
    • CI = low
    • SVR = high
    • PCWP = high
  40. Clinical indicators for septic shock:
    • CI = low
    • SVR = low
    • PCWP = low
  41. Two examples of Crystalloids:
    NSS and Lactated Ringer
  42. Three examples of Colloids:
    Albumin, Hetastarch, Blood
  43. Which vasopressor is used for hypotensive patients that are tachycardic?
    Phenylephrine
  44. Two inotropic agents include:
    Dobutamine and Milrinone
  45. This inotrope is used in patients with Cardiogenic shock and Arrhythmias because it has no effect on beta cells
    Milrinone
  46. Vasopressor of choice for septic shock:
    Norepinephrine
  47. Vasopressor of choice for cardiogenic shock:
    Dobutamine
  48. Primary use of succinylcholine:
    to facilitate intubation
  49. Major side effect of succinylcholine:
    Hyperkalemia --- need to be aware of renal patients (patient's who have a high serum K level)
  50. Disadvantage to Panuronium:
    • 1. Hepatic metabolism and renal excretion
    • 2. Causes CV side effects: increased HR and BP (tachycardia)

    **Do not use in patients with Tachycardia**
  51. Vecuronium is not a vagolytic, meaning...
    it could be used in patients with good kidney and renal fxn, and possibly those that are tachycardic
  52. Rocuronium undergoes biliary excretion, meaning...
    it can be used in patients with poor renal function
  53. Atracurium does not need dose adjusted for renal or hepatic impairment, but...
    a major downfall is that it causes hypotension and seizures as side effects, so for these reasons, it is not used as commonly
  54. The advangate of Cisatracurium over Atracurium:
    it does not cause seizures as a side effect
  55. The test for NMBA monitoring is:
    "the train of four" procedure

    ** 2 thumb twitches = ideal level of sedation**

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