NAGELHOUT EXAM QUESTIONS AND CORRECT
ANSWERS
How long before the procedure should pts with complicated medical conditions
be seen? - ANSWER 1 week before the scheduled procedure
Objectives of the pre-op interview: - ANSWER Meet goals of pre-op
assessment
Provide pre-op education to pt and family
Informed consent
Aquaint pt and family to the surgical process
Eval pt social situation and support network
Motivate pt to comply to preventive care strategies
What familial tendencies for diseases should be investigated when they come up
in pre-op interviews? - ANSWER atypical plasma cholinesterase
MH
porphyria
glycogen storage diseases(glucose6phosphate dehydrogenase deficiency)
Intaoperative concerns regarding ACE inhibitors - ANSWER Hypotension w
or w/o bradycardia that may be refractory to pressors
Intraoperative concerns regarding diuretics - ANSWER Hypovolemia and
hypokalemia
, Intaoperative concerns regarding antidysrhytmics - ANSWER cardiac
depression, prolonged NMB
amiodarone-hypotension and atropine resistant bradycardia requiring pacing
INtraoperative concerns regarding MAOis - ANSWER HTN secondary to
indirect acting sympathomimetic drugs causing release of NE; excitatory state
(from meperidine) or depressive phenomena secondary to opioid administration
AVOIND KNOW TRIGGER SUCH as MEPERIDINE
Intraoperative concerns regarding TCAs - ANSWER a-adrenergic blocking
activity and potentiation of sympathomimetic effects of epi and NE, resulting in
HTN crisis; card arrhythmias; lowers seizure threshold
Intaoperative concerns regarding SSRI - ANSWER Serotoniergic potentiation
with GI symptoms, HA and agitation
Intraoperative concerns regarding lithium: - ANSWER T wave smoothing,
vent arrhythmias, myocarditis; sinus dysfunction can lead to extreme atropine
resistant sinus brady cardia; dehydration will lead to increases in lithium blood
levels
What drugs should be continued pre operatively morning of surgery? -
ANSWER B blockers
CCB in chronic CCb pts with normal or slightly impaired EF
Antiarrhythmics
SSRI to avoid withdrawal
Lithium
ANSWERS
How long before the procedure should pts with complicated medical conditions
be seen? - ANSWER 1 week before the scheduled procedure
Objectives of the pre-op interview: - ANSWER Meet goals of pre-op
assessment
Provide pre-op education to pt and family
Informed consent
Aquaint pt and family to the surgical process
Eval pt social situation and support network
Motivate pt to comply to preventive care strategies
What familial tendencies for diseases should be investigated when they come up
in pre-op interviews? - ANSWER atypical plasma cholinesterase
MH
porphyria
glycogen storage diseases(glucose6phosphate dehydrogenase deficiency)
Intaoperative concerns regarding ACE inhibitors - ANSWER Hypotension w
or w/o bradycardia that may be refractory to pressors
Intraoperative concerns regarding diuretics - ANSWER Hypovolemia and
hypokalemia
, Intaoperative concerns regarding antidysrhytmics - ANSWER cardiac
depression, prolonged NMB
amiodarone-hypotension and atropine resistant bradycardia requiring pacing
INtraoperative concerns regarding MAOis - ANSWER HTN secondary to
indirect acting sympathomimetic drugs causing release of NE; excitatory state
(from meperidine) or depressive phenomena secondary to opioid administration
AVOIND KNOW TRIGGER SUCH as MEPERIDINE
Intraoperative concerns regarding TCAs - ANSWER a-adrenergic blocking
activity and potentiation of sympathomimetic effects of epi and NE, resulting in
HTN crisis; card arrhythmias; lowers seizure threshold
Intaoperative concerns regarding SSRI - ANSWER Serotoniergic potentiation
with GI symptoms, HA and agitation
Intraoperative concerns regarding lithium: - ANSWER T wave smoothing,
vent arrhythmias, myocarditis; sinus dysfunction can lead to extreme atropine
resistant sinus brady cardia; dehydration will lead to increases in lithium blood
levels
What drugs should be continued pre operatively morning of surgery? -
ANSWER B blockers
CCB in chronic CCb pts with normal or slightly impaired EF
Antiarrhythmics
SSRI to avoid withdrawal
Lithium
