Obesity.txt

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Author:
drtrouta
ID:
199228
Filename:
Obesity.txt
Updated:
2013-02-10 18:36:27
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Obesity
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Obesity.txt
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  1. Which drugs are dosed on IBW?
    • Propofol (induction)
    • Vec
    • Roc
    • Fentanyl & Sufentanil(maintenance)
    • Remifentanil
  2. Is Propofol dosed in IBW or TBW?
    • IBW for induction
    • TBW for maintenance
  3. Is Thiopental dosed on IBW or TBW?
    TBW
  4. Is Midazolam dosed on TBW or IBW?
    TBW
  5. Is Succinylcholine dosed on IBW or TBW?
    TBW
  6. Is Vec & Roc dosed on IBW or TBW?
    IBW
  7. Is Atracurium/Cisatracuriwm dosed on TBW or IBW?
    TBW
  8. Is Fentanyl/Sufentanil dosed on TBW or IBW?
    • TBW induction
    • IBW Maintenance
  9. Is Remifentail dosed on IBW or TBW?
    IBW
  10. If Vd increased or decreased in obese patients?
    Increased
  11. Is TBW increased or decreased in obese patients?
    Decreased
  12. Is renal clearance increased or decreased in obese patients?
    Increased d/t increased renal blood flow & GFR
  13. Does total blood volume increase or decrease in obese patients?
    Increase
  14. If total blood volume is increased in obese patients, what happens to plasma concentration of drugs?
    Decreased plasma concentrations
  15. What can be done to offset the decrease in FRC?
    Larger TV or increase the rate
  16. What happens to the IA in obese patients who have a decreased FRC?
    It decreases mixing of IA accelerating the rate of increase of drug’s alveolar concentration
  17. Is the FRC increased or decreased on obese patients?
    Decreased
  18. Is the expiratory reserve volume increased or decreased in obese patients?
    Decreased
  19. Is TLC increased or decreased in obese patients?
    Decreased
  20. Does FRC continue to decrease with an increase in BMI?
    Yes
  21. Is PVR increased or decreased?
    Increased
  22. The decrease in FRC causes the obese patient to do what?
    Decrease their ability to tolerate apnea
  23. Is lung compliance and resistance increased or decreased in obese patients?
    Decreased d/t increased fat tissue=increased pulmonary blood volume
  24. What does decreased compliance, decreased FRC, & impaired gas exchange do to the RR of an obese patient?
    Causes rapid, shallow breathing
  25. How does hyperinsulinemia cause HTN in an obese patient?
    Increases Na+ retention
  26. Which 2 drugs of the Fentany family has the largest Vd?
    • Fentanyl (6L)
    • Sufentanil (4L)
  27. What is the duration of hydromorphone?
    3-4 hours
  28. What is the peak of hydromorphone?
    15 mins
  29. What is the onset of hydromorphone?
    10-15 mins
  30. What is the dose of hydromorphone?
    0.5-2mg/dose
  31. What is the duration of remifentail?
    5-10 mins
  32. What is the peak of remifentail?
    1 min
  33. What is the dose of Remifentail?
    0.5 mcg/kg
  34. Of the Fentanyl family, which causes the most bradycardia?
    Sufentanil d/t potentcy
  35. What is the duration of sufentanil?
    30-45 mins
  36. What is the peak of sufentanil?
    3-5 mins
  37. What is onset of sufentanil?
    1 min
  38. What is the dose of Sufentanil?
    0.2-1 mcg/kg
  39. What is the duration of Alfentanil?
    20 mins
  40. What is the peak of Alfentanil?
    1-1.5 mins
  41. What is the onset of Alfentanil?
    90 seconds
  42. What is the dose of Alfentanil?
    5-10 mcg/kg
  43. Of the Fentanyl family, which has the gretest cardioprotective effect?
    Fentanyl
  44. Of all the narcotics, which one has the greatest pulmonary uptake?
    Fentanyl
  45. What is the duration of Fentanyl?
    30-60 mins
  46. What is the peak of Fentanyl?
    5-15 mins
  47. What is the onset of Fentanyl?
    1-2 mins
  48. What is the dose of Fentayl?
    1-5mcg/kg
  49. Which receptors does Morphine work on?
    Mu1 & Mu2
  50. What is the duration of morphine?
    4 hours
  51. What is the peak of Morphine?
    20 mins
  52. What is the onset of Morphine?
    5-10 mins
  53. What is the dose of Morphine?
    0.1mg/kg
  54. T-burg & insufflation can drastically reduce chest wall excursion & reduce chest wall compliance.  True or false
    True
  55. An obese patient has bigger lungs than a normal weighted patient? True or False
    False
  56. Why might regional anesthesia be reduced in an obese patient?
    • reduced up to 20% d/t systemic absorption &
    • reduced volume of epidural space
  57. At what intra abdominal pressure can renal blood flow and UR be reduced?
    >20 mm Hg
  58. What is the most correct dose of Propofol for a 190kg patient with an IBS of 80kg who has no other medical problems?
    a. 150mg
    b. 225mg
    c. 350mg
    d. 400mg
    A
  59. How is Remifentanil dosed in an obese patient?
    IBW
  60. How is Fentanyl & Sufentanil dosed for an obese patient?
    • Bolus - TBW
    • Maint - IBW
  61. How is Roc/Vec dosed in an obese patient?
    IBW
  62. How is succs, Atracurium, & Cis dosed for an obese patient?
    TBW - d/t metabolism
  63. How is Midazolam dosed for an obese patient?
    TBW
  64. How is Propofol dosed in an obese patient?
    • IBW for induction
    • TBW for maint
  65. How long does obese patients have an increased risk of hypoxemia post operatively?
    First 24 hours & 2-5 days post op
  66. Which of the following is false?
    a. OHS is caused by the physical obstruction     of air from entering the lungs.
    b. OSA is defined as airflow obstruction >10     seconds
    c. OSA has a central apnea component
    d. All of the above are false
    A & C
  67. How does OHS differ from OSA?
    conversion from peripheral causes of apea (peripheral) to central
  68. In OHS, central events cause apnea without respiratory effort? True of False
    True
  69. What is a long-term consequence of OSA?
    obesity hypoventilation syndrome
  70. What are the pathologic effects of OSA?
    • daytime fatigue
    • hypoemia/acidosis
    • polycythemia
    • pulmonary HTN
    • Right heart disease
  71. How is OSA treated?
    CPAP or oral appliances
  72. What is hypopnea?
    decreased airflow from baseline that often results in desaturation
  73. How is the severity of OSA defined?
    • number of apneic episodes per hour
    • >5/hr= OSA
  74. How is OSA defined?
    no airflow for >10 seconds
  75. Is LMWH based upon TBW or IBW?
    IBW
  76. Why are obese patients at increased risk for thromboembolic Dz?
    • polycythemia
    • increased intra-abdominal pressure
    • immoblization
  77. A patient presents with morbid obesity & a hiatal hernia.  Which of the following is the BEST selection for this patient based on the info provided?
    a. use of an LMA with rocuronium 1.2mg/kg
    b. use of an ETT with succinylcholine RSI
    c. use of an ETT, muscle relaxant of choice,
        regular IV induction
    d. use of an LMA, succs, & cricoid pressure
    B
  78. Does obesity cause reduced gastric emptying & increased gastric volume?
    No
  79. Which of the following is true:
    A. Obese Patient's have increased TLC
    B. Obese patient's have decreased circulating blood volume
    C. Obese Pt's have increased PVR
    D. Obese patient's have decreased FRC
    C & D
  80. Do you see an increase or decrease in pulmonary vascular pressures?
    increased
  81. Does obesity cause an increase or decrease in blood volume?
    Increased - to support excessive tissue
  82. What type of lung disease does obesity mimic?
    Restrictive Lung Disease
  83. Is TV increased or decreased in obese patients?
    decreased
  84. Weight depedent decreases in TV causes what?
    Increased RR
  85. Do ou see an increased or decreased FRC/TLC in an obese person?
    decreased
  86. What are the 3 primary considerations of a difficult mask ventilation?
    • Increased BMI
    • Lack of teeth
    • Facial hair
  87. What does a BMI >28 cause an increased risk for?
    • CVA
    • CAD
    • DM
  88. What is the BMI range for overweight?
    25-29.9kg
  89. What is the minimum definition of obesity?
    30kg/m2
  90. What is pulmonary HTN in obese patients caused from?
    Chronic arterial hypoxemia & increased pulmonary blood flow

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