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Flashcard 1435822591244



Tags
#cfa #cfa-level-1 #economics #has-images #microeconomics #reading-14-demand-and-supply-analysis-consumer-demand #section-3-utility-theory #study-session-4
Question
indifference curves will generally be [...] and [...] , and they cannot cross. These are the only restrictions we place on indifference curve maps.
Answer
strictly convex

negatively sloped


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indifference curves will generally be strictly convex and negatively sloped, and they cannot cross. These are the only restrictions we place on indifference curve maps.

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Indifference curves cannot touch
he same indifference curve, she must be indifferent between these two bundles as well. But because bundle c contains more of both wine and bread than bundle b, she must prefer c to b, which violates transitivity of preferences. So we see that <span>indifference curves will generally be strictly convex and negatively sloped, and they cannot cross. These are the only restrictions we place on indifference curve maps.<span><body><html>







Flashcard 1613878922508

Tags
#cfa-level-1 #corporate-finance #understanding-cashflow-statements
Question

[...] involve liability and owner's equity items

Answer
Financing Activities


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Subject 1. Classification of Cash Flows and Non-Cash Activities
amples are: Sale or purchase of property, plant and equipment. Investments in joint ventures and affiliates and long-term investments in securities. Loans to other entities or collection of loans from other entities. <span>Financing Activities These involve liability and owner's equity items, and include: Obtaining capital from owners and providing them with a return on (and a return of) their investments. Borrowing money from creditors and repaying the amounts







Flashcard 1625083481356

Tags
#has-images #reading-6-tvm
Question

  • rs = [...]
  • m = [...]
  • N = [...]
Answer
rs = the quoted annual interest rate

m = the number of compounding periods per year

N = the number of years.


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subject 3. The Future Value and Present Value of a Single Cash Flow
. When you calculate these amounts, make sure that periodic interest rates correspond to the number of compounding periods in the year. For example, if time periods are quoted in quarters, quarterly interest rates should be used. <span>When compounding periods are other than annual r s = the quoted annual interest rate m = the number of compounding periods per year N = the number of years. Example 2 An analyst invests $5 million in a 5-year certificate of deposit (CD) at a local financial institution. The CD promises to pay 7% per year, compounded semi-a







Flashcard 1625129618700

Tags
#reading-6-tvm
Question
All other factors being equal, the present value of an annuity due is equal to [...]
Answer
the present value of an ordinary annuity multiplied by (1 + r)


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Subject 4. The Future Value and Present Value of a Series of Equal Cash Flows (Ordinary Annuities, Annuity Dues, and Perpetuities)
e present value of a regular annuity of (N - 1) period. Use the above formula to calculate the second part and add the two parts together. This process can also be simplified to a formula: Note that, <span>all other factors being equal, the present value of an annuity due is equal to the present value of an ordinary annuity multiplied by (1 + r). Hint: Remember these formulas - you can use them to solve annuity-related questions directly, or to double-check the answers given by your calculator. A perpe







Flashcard 1678115736844

Question
The phrase [...] analysis of drug absorption and distribution describes onset time and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.
Answer
pharmacokinetic


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The phrase pharmacokinetic analysis of drug absorption and distribution describes onset time and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.</s

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Flashcard 1678116785420

Question
The phrase pharmacokinetic analysis of drug absorption and distribution describes onset [...] and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.
Answer
time


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The phrase pharmacokinetic analysis of drug absorption and distribution describes onset time and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.

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Flashcard 1678117833996

Question
The phrase pharmacokinetic analysis of drug absorption and distribution describes onset time and [...] of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.
Answer
magnitude


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The phrase pharmacokinetic analysis of drug absorption and distribution describes onset time and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.

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Flashcard 1678118882572

Question
The phrase pharmacokinetic analysis of drug absorption and distribution describes onset time and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the [...] response.
Answer
tissue


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The phrase pharmacokinetic analysis of drug absorption and distribution describes onset time and magnitude of drug response. Drug elimination kinetic analysis describes the dura- tion of the tissue response.

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Flashcard 1678119931148

Question
2 Antagonists (drugs) that possess the property of weak affinity for the same receptor protein are
Answer
atropine, esmolol


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Antagonists that possess the property of weak affinity for the same receptor protein (e.g., atropine, esmolol) are competitive and may be displaced by an agonist. Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a strong affinity for the receptor protein, usually via

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Flashcard 1678121766156

Question
Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a strong affinity for the receptor protein, usually via [...] bonds, and cannot be displaced by the agonist
Answer
covalent


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the same receptor protein (e.g., atropine, esmolol) are competitive and may be displaced by an agonist. Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a strong affinity for the receptor protein, usually via <span>covalent bonds, and cannot be displaced by the agonist<span><body><html>

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Flashcard 1678123863308

Question
Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a [stong/weak] affinity for the receptor protein, usually via covalent bonds, and cannot be displaced by the agonist
Answer
strong


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agonists that possess the property of weak affinity for the same receptor protein (e.g., atropine, esmolol) are competitive and may be displaced by an agonist. Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a <span>strong affinity for the receptor protein, usually via covalent bonds, and cannot be displaced by the agonist<span><body><html>

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Flashcard 1678125698316

Question
While Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a strong affinity for the receptor protein, they can NOT be [attracted/displaced] by the agonist
Answer
displaced


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(e.g., atropine, esmolol) are competitive and may be displaced by an agonist. Noncompetitive antagonists, such as phenoxybenzamine and aspirin, have a strong affinity for the receptor protein, usually via covalent bonds, and cannot be <span>displaced by the agonist<span><body><html>

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Flashcard 1678127533324

Question
Antagonists cause a [leftward/rightward] shift in the drug dose-response curve.
Answer
rightward


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New receptor protein must be synthe- sized if agonist receptor complexing is to occur. As with ago- nist drugs, not all receptors are bound by antagonists. Antagonists cause a rightward shift in the drug dose-response curve. The extent of rightward shift reflects the number of available receptors occu- pied by the antagonist drug (Figure 5-9). Comparison of the ED 50 i

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Flashcard 1678130416908

Question
The extent of rightward shift reflects the number of available receptors occu- pied by the [...] drug
Answer
antagonist


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is to occur. As with ago- nist drugs, not all receptors are bound by antagonists. Antagonists cause a rightward shift in the drug dose-response curve. The extent of rightward shift reflects the number of available receptors occu- pied by the <span>antagonist drug (Figure 5-9). Comparison of the ED 50 in Figure 5-9 shows a reduced affinity of the agonist for its receptor when the antagonist is present.<span><body><html>

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Flashcard 1678132251916

Question
With drug- receptor-response triad, when a drug combines with its receptor, a [...] change occurs in the receptor protein itself.
Answer
conformational


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With drug- receptor-response triad, when a drug combines with its receptor, a conformational change occurs in the receptor protein itself. No tissue response can occur without the structural shift. Evidence does suggest that events within the biosphere after drug associa- tion

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Flashcard 1678134086924

Question
True/False: Tissue response can occur without the structural shift.
Answer
False: No Tissue response can occur without the structural shift.


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With drug- receptor-response triad, when a drug combines with its receptor, a conformational change occurs in the receptor protein itself. No tissue response can occur without the structural shift. Evidence does suggest that events within the biosphere after drug associa- tion with the receptor are the principal regulatory variables of the response onset-offset time course<

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Flashcard 1678136446220

Question
Constitutively active receptors can exist and are shifted toward the [...] state, even though no agonist or ligand is present. Receptors for benzodiazepines, cannabinoids, and serotonin are examples.
Answer
activated


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Constitutively active receptors can exist and are shifted toward the activated state, even though no agonist or ligand is present. Receptors for benzodiazepines, cannabinoids, and serotonin are examples. Agonists shift the equilibrium toward activation. Antagonist

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Flashcard 1678138281228

Question
Receptors for benzodiazepines, cannabinoids, and serotonin are
Answer
active receptors that exist and are shifted toward the activated state, even though no agonist or ligand is present


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Constitutively active receptors can exist and are shifted toward the activated state, even though no agonist or ligand is present. Receptors for benzodiazepines, cannabinoids, and serotonin are examples. Agonists shift the equilibrium toward activation. Antagonists freeze the equilibrium, and inverse ago- nists sh

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Flashcard 1678140116236

Question
Agonists shift the equilibrium toward [...].
Answer
activation


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>Constitutively active receptors can exist and are shifted toward the activated state, even though no agonist or ligand is present. Receptors for benzodiazepines, cannabinoids, and serotonin are examples. Agonists shift the equilibrium toward <span>activation. Antagonists freeze the equilibrium, and inverse ago- nists shift the equilibrium toward inactivation. The two-state model<span><body><html>

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Flashcard 1678141951244

Question
Antagonists [...] the equilibrium, and inverse agonists shift the equilibrium toward inactivation.
Answer
freeze


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eceptors can exist and are shifted toward the activated state, even though no agonist or ligand is present. Receptors for benzodiazepines, cannabinoids, and serotonin are examples. Agonists shift the equilibrium toward activation. Antagonists <span>freeze the equilibrium, and inverse ago- nists shift the equilibrium toward inactivation. The two-state model<span><body><html>

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Flashcard 1678143786252

Question
Antagonists freeze the equilibrium, and inverse [...] shift the equilibrium toward inactivation.
Answer
ago- nists


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oward the activated state, even though no agonist or ligand is present. Receptors for benzodiazepines, cannabinoids, and serotonin are examples. Agonists shift the equilibrium toward activation. Antagonists freeze the equilibrium, and inverse <span>ago- nists shift the equilibrium toward inactivation. The two-state model<span><body><html>

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Flashcard 1678146407692

Question
agonist-antagonist drugs have [...] affinity and intrinsic activity, but often only a fraction of the potency of the pure agonist
Answer
recep- tor protein


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agonist-antagonist drugs have recep- tor protein affinity and intrinsic activity, but often only a fraction of the potency of the pure agonist

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Flashcard 1678147456268

Question
agonist-antagonist drugs have recep- tor protein affinity and [...] activity, but often only a fraction of the potency of the pure agonist
Answer
intrinsic


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agonist-antagonist drugs have recep- tor protein affinity and intrinsic activity, but often only a fraction of the potency of the pure agonist

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Flashcard 1678148504844

Question
agonist-antagonist drugs have recep- tor protein affinity and intrinsic activity, but often only a [...] of the potency of the pure agonist
Answer
fraction


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agonist-antagonist drugs have recep- tor protein affinity and intrinsic activity, but often only a fraction of the potency of the pure agonist

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Flashcard 1678149553420

Question
Chronic administration of an antagonist results in [...]- regulation as the number and sensitivity of the receptors increase as a response to chronic blockade.
Answer
up


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Chronic administration of an antagonist results in up- regulation as the number and sensitivity of the receptors increase as a response to chronic blockade.

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Flashcard 1678150601996

Question
Chronic administration of an antagonist results in up- regulation as the number and sensitivity of the receptors increase as a response to chronic [...].
Answer
blockade


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Chronic administration of an antagonist results in up- regulation as the number and sensitivity of the receptors increase as a response to chronic blockade.

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Flashcard 1678151650572

Question
With up-regulation, the patient develops [...], requiring higher doses of the antagonist to counteract the increasing receptor number
Answer
tol- erance


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With up-regulation, the patient develops tol- erance, requiring higher doses of the antagonist to counteract the increasing receptor number

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Flashcard 1678152699148

Question
With up-regulation, the patient develops tol- erance, requiring higher doses of the antagonist to counteract the increasing [...] number
Answer
receptor


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With up-regulation, the patient develops tol- erance, requiring higher doses of the antagonist to counteract the increasing receptor number

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Flashcard 1678153747724

Tags
#5 #jrs #nagelhount
Question

[...] is the combined effect of two drugs is greater than the algebraic sum of their individual effects. 1 + 1 = 3
Answer
Synergism


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Addition The combined effect of two drugs acting via the same mechanism is equal to that expected by simple addition of their individual actions. 1 + 1 = 2 Synergism The combined effect of two drugs is greater than the algebraic sum of their individual effects. 1 + 1 = 3 Potentiation The enhancement of the action of one drug by a second drug th

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Flashcard 1678156369164

Question
The enhancement of the action of one drug by a second drug that has no detectable action of its own. 1 + 0 = 3
Answer
Potentiation


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the same mechanism is equal to that expected by simple addition of their individual actions. 1 + 1 = 2 Synergism The combined effect of two drugs is greater than the algebraic sum of their individual effects. 1 + 1 = 3 Potentiation <span>The enhancement of the action of one drug by a second drug that has no detectable action of its own. 1 + 0 = 3 Antagonism The action of one drug opposes the action of another. 1 + 1 = 0<span><body><html>

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Flashcard 1678157417740

Question
Antagonism is
Answer
The action of one drug opposes the action of another. 1 + 1 = 0


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sm The combined effect of two drugs is greater than the algebraic sum of their individual effects. 1 + 1 = 3 Potentiation The enhancement of the action of one drug by a second drug that has no detectable action of its own. 1 + 0 = 3 <span>Antagonism The action of one drug opposes the action of another. 1 + 1 = 0<span><body><html>

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Flashcard 1678159252748

Question
[...] is the combined effect of two drugs acting via the same mechanism is equal to that expected by simple addition of their individual actions. 1 + 1 = 2

Answer
Addition


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Addition The combined effect of two drugs acting via the same mechanism is equal to that expected by simple addition of their individual actions. 1 + 1 = 2 Synergism The combined effect of

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Flashcard 1678161087756

Question
A drug [...] is an alteration in the therapeutic action of a drug by concurrent administration of other drugs or exogenous substances.
Answer
interaction


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A drug interaction is an alteration in the therapeutic action of a drug by concurrent administration of other drugs or exogenous substances.

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Flashcard 1678162136332

Question
A drug interaction is an alteration in the therapeutic action of a drug by [...] of other drugs or exogenous substances.
Answer
concurrent administration


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A drug interaction is an alteration in the therapeutic action of a drug by concurrent administration of other drugs or exogenous substances.

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Flashcard 1678163184908

Question
A drug interaction is an alteration in the [...] action of a drug by concurrent administration of other drugs or exogenous substances.
Answer
therapeutic


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A drug interaction is an alteration in the therapeutic action of a drug by concurrent administration of other drugs or exogenous substances.

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Flashcard 1678164233484

Question
The drug receptor [...] site is the primary regulator of onset-offset drug response
Answer
sub- unit


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The drug receptor sub- unit site is the primary regulator of onset-offset drug response

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Flashcard 1678165282060

Question
More and more evidence suggests that individual genetic variation in receptor proteins accounts for [...] variation within seem- ingly normal populations.
In clinical anesthesia, the range of patient responses to a given drug dose reflects this variation
Answer
drug-response


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More and more evidence suggests that individual genetic variation in receptor proteins accounts for drug-response variation within seem- ingly normal populations. In clinical anesthesia, the range of patient responses to a given drug dose reflects this variation

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Flashcard 1678167117068

Question
The age-related decline in anesthetic drug dose needed to achieve a desired anesthetic end-point is related to a change in both [...] and pharmacokinetics
Answer
pharmacodynamics


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The age-related decline in anesthetic drug dose needed to achieve a desired anesthetic end-point is related to a change in both pharmacodynamics and pharmacokinetics

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Flashcard 1678168165644

Question
The age-related decline in anesthetic drug dose needed to achieve a desired anesthetic end-point is related to a change in both pharmacodynamics and [...]
Answer
pharmacokinetics


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The age-related decline in anesthetic drug dose needed to achieve a desired anesthetic end-point is related to a change in both pharmacodynamics and pharmacokinetics

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Flashcard 1678169214220

Question
Physiologic antagonism, another form of antagonism, involves [...] agonist drugs that bind to different receptors.
Answer
two


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Physiologic antagonism, another form of antagonism, involves two agonist drugs that bind to different receptors. At the physiological antagonism, drugs bind to specific unrelated receptor proteins, initiate a protein conformational shift, and el

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Flashcard 1678171049228

Question
Physiologic antagonism, another form of antagonism, involves two agonist drugs that bind to [...] receptors.
Answer
different


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Physiologic antagonism, another form of antagonism, involves two agonist drugs that bind to different receptors. At the physiological antagonism, drugs bind to specific unrelated receptor proteins, initiate a protein conformational shift, and elicit individual tissue responses. The

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Flashcard 1678172884236

Question
At the physiological antagonism, drugs bind to specific [unrelated/related] receptor proteins, initiate a protein conformational shift, and elicit individual tissue responses. The responses, however, generate opposing forces such as are observed with isoproterenol-induced vasodilation and norepinephrine- induced vasoconstriction.
Answer
unrelated


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Physiologic antagonism, another form of antagonism, involves two agonist drugs that bind to different receptors. At the physiological antagonism, drugs bind to specific unrelated receptor proteins, initiate a protein conformational shift, and elicit individual tissue responses. The responses, however, generate opposing forces such as are observed with isoprotere

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Flashcard 1678174719244

Question
At the physiological antagonism, drugs bind to specific unrelated receptor proteins and then what??
Answer
initiate a protein conformational shift,


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Physiologic antagonism, another form of antagonism, involves two agonist drugs that bind to different receptors. At the physiological antagonism, drugs bind to specific unrelated receptor proteins, initiate a protein conformational shift, and elicit individual tissue responses. The responses, however, generate opposing forces such as are observed with isoproterenol-induced vasodi

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Flashcard 1678176554252

Question
At the physiological antagonism, what is the next line of action when drugs bind to specific unrelated receptor proteins, and initiate a protein conformational shift?
Answer
elicit individual tissue responses


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Physiologic antagonism, another form of antagonism, involves two agonist drugs that bind to different receptors. At the physiological antagonism, drugs bind to specific unrelated receptor proteins, initiate a protein conformational shift, and elicit individual tissue responses. The responses, however, generate opposing forces such as are observed with isoproterenol-induced vasodilation and norepinephrine- induced vasoco

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Flashcard 1678178389260

Question
At the physiological antagonism, the responses generate [...] forces such as are observed with isoproterenol-induced vasodilation and norepinephrine- induced vasoconstriction.
Answer
opposing


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rugs that bind to different receptors. At the physiological antagonism, drugs bind to specific unrelated receptor proteins, initiate a protein conformational shift, and elicit individual tissue responses. The responses, however, generate <span>opposing forces such as are observed with isoproterenol-induced vasodilation and norepinephrine- induced vasoconstriction.<span><body><html>

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Flashcard 1678180224268

Question
The anesthetist uses pharmacologic intervention to elicit a desired patient response. The site of the intervention is the known as [...],
Answer
bio- sphere or protein drug receptor


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The anesthetist uses pharmacologic intervention to elicit a desired patient response. The site of the intervention is the bio- sphere, or the protein drug receptor, which is the primary regulator of the therapeutic response. Observed variation in patient drug response reflects the functionality of the biospher

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Flashcard 1678182845708

Question
Observed variation in patient drug response reflects the functionality of the biosphere and [...], as well as physiologic variability

Note: The site of the intervention is the bio- sphere, or the protein drug receptor, which is the primary regulator of the therapeutic response.
Answer
genetics


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se. The site of the intervention is the bio- sphere, or the protein drug receptor, which is the primary regulator of the therapeutic response. Observed variation in patient drug response reflects the functionality of the biosphere and <span>genetics, as well as physiologic variability<span><body><html>

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Flashcard 1678184680716

Question
For competitive antagonism, the agonist and antagonist have affinity for the [...] receptor protein;
Answer
same


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For competitive antagonism, the agonist and antagonist have affinity for the same receptor protein;

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Flashcard 1678185729292

Question
The mean, median, and mode typically describe the [...] relationship of a “normally distributed” population.
Answer
dose- response


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The mean, median, and mode typically describe the dose- response relationship of a “normally distributed” population.

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Flashcard 1678186777868

Question
The SD, SEM, and median effective dose provide a description of a [...] response to a drug. Such descriptors provide only an approximate dosage; the anesthetist must adjust this dosage for each patient to achieve the desired physiologic response
Answer
population’s


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The SD, SEM, and median effective dose provide a description of a population’s response to a drug. Such descriptors provide only an approximate dosage; the anesthetist must adjust this dosage for each patient to achieve the desired physiologic response</

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Flashcard 1678187826444

Question
The SD, SEM, and median effective dose provide a description of a population’s response to a drug. Such descriptors provide only an approximate dosage; the anesthetist must adjust this dosage for each patient to achieve the desired [...] response
Answer
physiologic


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an>The SD, SEM, and median effective dose provide a description of a population’s response to a drug. Such descriptors provide only an approximate dosage; the anesthetist must adjust this dosage for each patient to achieve the desired <span>physiologic response<span><body><html>

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Flashcard 1678188875020

Question
[...] antagonism occurs when a drug’s action is blocked and no receptor activity is involved. For example, protamine is a positively charged protein that forms an ionic bond with heparin, thus rendering it inactive. Sugammadex, mentioned previously, is another example
Answer
Chemical


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Chemical antagonism occurs when a drug’s action is blocked and no receptor activity is involved. For example, protamine is a positively charged protein that forms an ionic bond with he

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Flashcard 1678189923596

Question
In Chemical antagonism, For example, protamine is a [...] charged protein that forms an ionic bond with heparin, thus rendering it inactive. Sugammadex, mentioned previously, is another example

Chemical antagonism occurs when a drug’s action is blocked and no receptor activity is involved.
Answer
positively


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Chemical antagonism occurs when a drug’s action is blocked and no receptor activity is involved. For example, protamine is a positively charged protein that forms an ionic bond with heparin, thus rendering it inactive. Sugammadex, mentioned previously, is another example

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Flashcard 1678192545036

Question
Chemical antagonism occurs when a drug’s action is blocked and no receptor activity is involved. For example, protamine is a positively charged protein that forms an [...] bond with heparin, thus rendering it inactive. Sugammadex, mentioned previously, is another example
Answer
ionic


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Chemical antagonism occurs when a drug’s action is blocked and no receptor activity is involved. For example, protamine is a positively charged protein that forms an ionic bond with heparin, thus rendering it inactive. Sugammadex, mentioned previously, is another example

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Flashcard 1678193593612

Question
Each drug-receptor interaction at the protein receptor elicits a fractional tissue response, and the [...] of the fractional responses provides the observed response.
Answer
sum


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span>Viewed at the molecular level, the observed response to a drug represents countless individual drug responses at the biosphere. Each drug-receptor interaction at the protein receptor elicits a fractional tissue response, and the sum of the fractional responses provides the observed response.<span><body><html>

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Flashcard 1678195428620

Question
This conformational shift causes a central space or [...] to open, allowing specific ions to enter or leave the cell or a G protein to be activated
Answer
channel


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In accor- dance with the law of mass action, when free drug binds to a recep- tor, a conformational shift occurs in the receptor protein. This shift causes a central space or channel to open, allowing specific ions to enter or leave the cell or a G protein to be activated, resulting in a biochemical cascade yielding pharmacologic effects. The resultant tissue res

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Flashcard 1678196477196

Question
In accor- dance with the law of mass action, when free drug binds to a recep- tor, a [...] shift occurs in the receptor protein.
Answer
conformational


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In accor- dance with the law of mass action, when free drug binds to a recep- tor, a conformational shift occurs in the receptor protein. This shift causes a central space or channel to open, allowing specific ions to enter or leave the cell or a G protein to be activated, resulting

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Flashcard 1678200147212

Question
[...] drugs also bind to the receptor but lack the ability to initiate the required protein conformational shift.
Answer
Antagonist


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Antagonist drugs also bind to the receptor but lack the ability to initiate the required protein conformational shift. The sum of fractional tissue responses elicited when an antagonist is prese

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Flashcard 1678201982220

Question
Continued stimulation of cells with agonists generally results in a state of desensitization, also referred to as
Answer
refractoriness or down-regulation


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Continued stimulation of cells with agonists generally results in a state of desensitization, also referred to as refractoriness or down-regulation, such that the effect that follows continued or sub- sequent exposure to the same concentration of drug is diminished.

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Flashcard 1678203030796

Question
Molecular pharmacology is
Answer
identifying site-specific and age- related causes for the observed variation in patient drug response.


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Molecular pharmacology is identifying site-specific and age- related causes for the observed variation in patient drug response.

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Flashcard 1678204865804

Question
attenuated response to the repeated use of β-adrenergic agonists as bronchodilators for the treatment of asthma is an example of what regulation?
Answer
refractoriness or down-regulation


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refractoriness or down-regulation is very important in therapeutic situations; an example is attenuated response to the repeated use of β-adrenergic agonists as bronchodilators for the treatment of asthma

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#redes #tcp-ip
Características Básicas. Los servicios que TCP proporciona para la comunicación entre aplicaciones, pueden caracterizarse en los cuatro puntos siguientes: - Cuando dos aplicaciones transfieren grandes cantidades de datos, podemos pensar en esos datos como secuencias de octetos. El módulo TCP del nodo destino entrega las secuencias de octetos que recibe a la capa superior, tal y como la capa superior del nodo origen se la entregó a TCP. - Circuito virtual: TCP proporciona un servicio de comunicación orientado a la conexión. De esta forma TCP suministra un servicio fiable de transporte de datos de extremo a extremo. Entre otros servicios, TCP proporciona el establecimiento de la conexión, la transferencia de información y la desconexión. - Buffers de datos. Las aplicaciones transfieren sus datos en forma de cadenas de octetos al módulo TCP. Este agrupa o divide las cadenas de octetos recibidas en función del tamaño del paquete que puede transmitir. Para hacer más eficiente la transmisión y reducir el tráfico en la red, es necesario que el módulo TCP disponga de buffers donde acumular la información. Obviamente estos buffers pueden retrasar la transmisión de determinada información. Cuando es necesario realizar la transmisión inmediata de algunos datos, puede solicitarse a TCP que transmita dicha información (push), aún cuando su tamaño sea menor que el que proporciona mayor rendimiento. - Conexión full-duplex: |TCP/IP permite que las conexiones establecidas entre dos nodos sean concurrentes o simultáneas en ambos sentidos. Las aplicaciones ven este servicio como dos canales de transmisión (uno de entrada y otro de salida), sin interacción aparente.

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#redes #tcp-ip
Código: Especifica el propósito y el contenido del segmento. Los seis bits de este campo tienen el siguiente significado cuando su valor es 1: • URG: Puntero datos urgentes válido. • ACK: Número de confirmación válido. • PSH: Solicitud de push. • RST: Reinicialización de la conexión. • SYN: Sincronización de números de secuencia. • FIN : El emisor ha enviado todos los datos.

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His adversary, al-Farazdaq, also used obscenity as a lampooning tool. He is crying on the dungheaps of the abandoned campsites, while his mother, on the tips of the slaves' penises, is going up and down.

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They brought l:fiqqa, 31 having stuffed her perineum, while a hireling, saddler of beasts, was singing to make the she-ass go. She stopped to scold me but I said to her, 'On your knees, 185 l:fiqqa, you and your collected works (i.e. lampoons on me) will be underneath!' And I bared my prick to her. She cowered, just as a she-ass in heat cowers. She found someone with a hard-on, who had changed into easy clothes; and someone who does scandalous things will change into easy clothes. And I left your mother, Jarir, as if she were, kneeling, for the people a well-trodden road. The penis-knobs of the infatuated ones on her arse

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were like travellers coming to the wells of (the villages of) al-Nibaj and Thaytal. I::Iiqqa, I have never heard about a man with two testicles who got pregnant, except al-Maragha's son (i.e. Jarir). He drank the sperm and in his belly there grew an uncircumcised woman whose clitoris is itching at the end.

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#ccmc #jrs #positioning
Positioning allows the best exposure of surgical site and the least compromise in both physiological functions and mechanical stresses in joints and other body parts

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A Lawyer focused on nerve injuries

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Flashcard 1678761659660

Question
A Lawyer focused on [skeletal/nerve] injuries
Answer
nerve


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A Lawyer focused on nerve injuries

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#1 #ccmc #jrs #positioning
Potential for corneal abrasion is always present when mask ventilating patients.

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Aortocaval Syndrome • Pressure of baby and uterus decreases blood return hence hypotension

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Aortocaval Syndrome • Pressure of baby and uterus decreases blood return hence hypotension • Put a wedge under mom’s right hip

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#1 #ccmc #jrs #positioning
Aortocaval Syndrome starts at 18-24 weeks

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Keep hanging badges away from the patients face when hand ventilating

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Treatment of Corneal Abrasions • Patch • Topical Numbing • Topical Antibiotics • Fluorscein Eye Stain/Wood Lamp • Sew there eyes shut • Optho Consult

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#1 #ccmc #jrs #positioning
Sunderland Classification system divides nerve injuries into five categories

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#1 #ccmc #jrs #positioning
First-degree injury is A reversible local conduction block at the site of the injury. This injury does not require surgical intervention and usually will recover within a matter hours to a few weeks

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#1 #ccmc #jrs #positioning
A second-degree injury is a loss of continuity of the axons or electrical wires within the nerve. If 2nd degree is confirmed through pre-operative nerve testing, surgical intervention is usually not required

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Third-degree injury: There is damage to the axons and their supporting structures within the nerve. In this case, recovery is variable.

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Third-degree injury: There is damage to the axons and their supporting structures within the nerve. In this case, recovery is variable. Intra-operative nerve conduction studies are often able to help predict outcome and need for simple cleaning of the nerve (neurolysis) or a more extensive repair with grafting.

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Fourth-degree injury: In this case, there is damage to the axons and the surrounding tissues sufficient to create scarring that prevents nerve regeneration. Intra-operative electrical testing confirms that no electrical energy can be passed along the neural pathways in this injured nerve. Surgical intervention with nerve grafting is necessary to repair the damage.

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Fifth-degree injury: These injuries are usually found in laceration or severe stretch injuries. The nerve is divided into two. The only way to repair a fifth-degree injury is through surgery.

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What causes nerve injuries ? •Laceration •Focal contusion (Gunshot wounds) •Stretch/traction injury, Position related •Compression, possible position related •Hypotension •Misapplication of devices

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• Drug injection injury • Electrical injury • Crnas • Prolonged flexion at elbow • Diabetes • Vitamin deficiencies • Alcoholism • Cancer • Hereditary Neuropathy

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ngenital anomalies • Types of surgery, i.e. cardiac sternotomy • Prolonged Lithotomy, greater than 4 hours, i.e. Robotic • Body habitus • Obese • Body ‘folds’ • Increased pressure under folds • Non-obese • Lack of padding

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Types of Nerve Injuries I. Pressure II. Friction III. Shearing forces

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Pressure, friction, and shearing forces account for most problems and injuries due to faulty positioning of the surgical patient

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Pressure • A mechanical force, can lead to obstruction of blood vessels, compression of nerves and soft tissue leads to inhibition of blood flow

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Pressure • Tissues covering bony prominences are usually thin and easily damaged by pressure leading to tissue hypoxia

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Pressure and rubbing are two external forces responsible for most injuries to bony prominences

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Pathophysiology of Pressure •

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When the patient is turned there is a hyperemic reaction: Vasodilation Release of blood elements into interstitial space Edema

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Pathology of Pressure • End capillary pressure averages 32 mmHg

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• This is the currently accepted external threshold pressure • Beyond this pressure small vessels collapse and thrombose • Occluded blood flow and oxygen deprivation occurs • Toxic metabolites then accumulate which leads to increased capillary permeability, edema, cell death, and pressure sore formation

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Friction Injury to skin occurs when skin moves across coarse surfaces such as linen on the operating room table, transport litter, towels, or bath blankets used in positioning the patient.

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Friction leads to: Abrasion, tearing, and inflammation

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Operating room devices lead to injury: Safety belt Masks, straps Excessive rubbing on the skin by instruments

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Friction is most commonly associated with superficial injuries manifesting as Blisters and abrasions

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Shearing occurs when the skin remains stationary and the underlying tissue shifts

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Shearing Forces In the operating room, shearing injuries can occur when an anesthetized patient is repositioned or when a body part is moved without repositioning the patients entire body

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Sliding or dragging a patient or limb, without supporting all body parts leads to shearing

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Transection • A cross section along a long axis. • Division by cutting across

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New Role As CRNA •Guardian Angel

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More Concerns and Considerations

• Patent airway • Optimal surgical exposure • Adequate respiratory excursion and air exchange • Adequate circulation • No excessive pressure to superficial nerves • Eyes protected from abrasions, pressure, fluids • Extremities supported • Head adequately supported • Minimal muscle strain or hyperextension • Anectine Myalgia’s or Nondepolarizer

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The key issue in surgical patient positioning is prevention of injury

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Planning and intervening ensures correct patient positioning

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A first step is recognition of risk related events to vulnerable patient populations

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You should be checking a patients position at least every 15 minutes, arms fall off bed, heads fall off pillow

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Safety strap? Two needed for obese patient's

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Pt too heavy for bed, each bed has a limit, some beds won’t move if pt is too heavy, find out the bed’s tolerance

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Recommendations for Positioning of the Brachial Plexus •Limit arm abduction to 90 degrees or less •Axillary role placed for lateral position to minimize compression of humeral head into axilla •In prone position with arms above head, maintain abduction and anterior flexion of the arm to 90 degrees or less

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After ulnar, brachial plexus is 2nd most common injury

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Two fixation points, vertebrae, fascia of axilla

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Two moveable points, clavicle and humeru

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Nerve stretch from head turn opposite and arm abducted more than 90 degrees

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Ulnar Neuropathy Anatomical Considerations Tubercle of the coronoid process is 1.5 times larger in men and boys Males are also more likely to have a thicker cubital tunnel retinaculum Females have a much thicker layer of subcutaneous fat between the skin and the ulnar nerve at the cubital tunnel and medial aspect of the coronoid process

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Ulnar Nerve Damage Manifestations: ◦ Inability to abduct or oppose the fifth finger, diminish sensation over both surfaces of the fourth and fifth finger with resultant atrophy ◦ Claw Hand

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A Simple, Quick, and Easy Test an Axillary Block To quickly assess the block, perform the “push-pull-pinch-pinch” test. This test can be done in less than a minute. It can identify “missed” nerves allowing time to formulate an alternative plan of anesthesia (i.e. supplementation or general anesthesia).

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Ask the patient to extend or “push” their forearm against light resistance. This tests the radial nerve.

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Ask the patient to flex or “pull” the arm towards the nose against light resistance. This will test th e musculocutaneous nerve

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A Simple, Quick, and Easy Test an Axillary Block To quickly assess the block, perform the “push-pull-pinch-pinch” test. This test can be done in less than a minute. It can identify “missed” nerves allowing time to formulate an alternative plan of anesthesia (i.e. supplementation or general anesthesia). Ask the patient to extend or “push” their forearm against light resistance. This tests the radial nerve. Ask the patient to flex or “pull” the arm towards the nose against light resistance. This will test th e musculocutaneous nerve.

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Pinch the hypothenar aspect of the hand (i.e. small finger). This will test the ulnar nerve.

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Pinch the thenar aspect of the hand (i.e. on the palmar surface of the hand). This will test the median nerve.

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Radial Nerve Damage ◦ Manifested by: ◦ Wrist drop ◦ Inability to extend the metocarpals ◦ Weakness of abduction of the thumb

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Ulnar Nerve Injury Etiology ◦ Complex Most common peripheral nerve injury ◦ 0.5% incidence in general population ◦ 35% incidence in cardiac surgical patient ◦ Why: ◦ Runs very superficial at the elbow ◦ Little tissue or fat to protect the nerve from external compression

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Postural hypotension: Frequent complication of supine or head elevated position Treatment of choice includes: Fluids Vasopressors Avoid head up position until patient is CV stable

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Prolonged compression of the hair follicles can occur causes ischemic changes to the blood vessels. Hypothermia and hypotension enhance the process Hair regrowth is usually complete within twelve weeks Generally occurs between the 3 rd and 28 th postoperative day Permanent hair loss can occur

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Pressure Alopecia First week: Swelling Edema Crusting Ulceration

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Permanent hair loss can occur Occipito-parietal pain and tenderness within 24 hours postop

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Anti-Alopecia Recommendations • Reposition head every 30 minutes reduced the incidence of alopecia from 14% to 1% in a prospective study in cardiac surgical patients. • Remember that when you lift the head forward, your ETT is pushed forward and if the patient is light, they will gag, it can also change the position of your LMA, always consider listening with your stethoscope after a position change

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Contoured Supine Position Commonly referred to as the ‘lawn chair’ position offers the patient an anatomically feasible position because of reduced lumbar sacral strain

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So you have a nerve injury, now what? •Neurological consult •Nerve conduction and electromyographic studies •Nerve injuries sometimes take 18-21 days to manifest •Testing promptly can indicate whether the injury is old or new, acute or chronic •Recovery is slow •Deficits may be irreversible

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Early neurology consultation EMG Determine level of lesion Sensory deficits are usually transient If longer than 5 days, refer to neurology for follow up No reliable treatment for peripheral nerve injury except supportive care Physical therapy is useful to prevent: Muscle atrophy Joint contractures Surgical decompression is used only when neuroma formation hampers recovery

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Gather what you think you'll need, you get points for being independent and thoughtful • Blankets • Tape • Foam • Head pillow, Gummy pillow • Arm boards • Blue or green towels. • Prep for tape

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• Arms straps • Axillary roll • Eye lube • Skin prep • Special arm holders • Pillows to elevate legs • To name but a few • No one remembers everything, write stuff down, have a flight plan

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Initial Assessment •Comorbidities, diabetes, neuropathy, stroke, arthritis •Previous nerve injuries, stroke, trauma, surgery •Previous surgeries, wounds, chest tubes, vac dressings •ROM limitations/Any broken bones or dislocations

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• Steroid skin/Super thin and friable • Anti coagulated, you can get a hematoma from just lying there • Labs, are they on Tpn, how is their nutrition • What nerve groups do I have to be worried about with the positioning •Pacemaker/AICD/, can I go prone? How long will the surgery be? •Accessed or nonaccessed Chemotherapy port •Old with no subcutaneous fat, skin tear waiting to happen

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How would you attempt to decrease Peak • pressures during mechanical ventilation in the • paralyzed anesthetized patient? • Hint: deepen anesthetic, muscle relaxation, • decrease Vt and increase Rate, change I:E ratio • from 1:2 to 1:1.5. • Consider Pressure Control ventilation due to its • decelerating waveform

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The supine or dorsal recumbent position should place the patients cervical, thoracic and lumbar vertebrae in a straight line. horizontal

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Even More Supine Influence of gravity is minimal Intravascular pressures from head to foot vary little from mean pressures at the level of the heart

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Cardiovascular Changes from Standing to Supine • Changing from the erect to the supine position: • Venous pooled lower extremity blood is returned to the heart • Increase in preload stimulates atrial stretch receptors

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More Cardiovascular Stuff • Myocardial contractility increases to disperse venous blood • CO and BP transiently increase • Baroreceptors respond to increased BP, decrease sympathetic output and heart rate slows and vasodilation occurs

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More Cardiovascular Stuff • Numbers to remember • 0.5 – 1.0 liters of blood can pool in the lower extremities in the upright position • Cardiac output is reduced by 20% in the upright position • SPU and discharge considerations • Translation, are they tanked enough to leave

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Supine Respiratory Concerns • Abdominal viscera gravitates towards the dorsal body wall and moves the dorsal parts of the diaphragm cephalad • Decreases FRC by approximately 0.5 liters

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Complications of Supine Position ▪Pressure alopecia ▪Backache (paraspinal musculature and the normal lordotic curve are lost under anesthesia) ▪Pressure ulcers at bony prominences due to ischemia (heels, sacrum) ▪Ulnar nerve injury ▪Brachial plexus injury (stretch, abduction >90 0 )

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Soft Tissue and Skeletal Injuries Back Pain Frequently occurs secondary to anesthesia and surgical positioning 20% of the patient population Etiology: Relaxation of the paraspinous muscles Flattening of the lumbar lordosis Application of tension to posterior ligament/muscles Prevention: Lumbar support Lithotomy: Bring 2 legs together simultaneously

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Supine Arm Positioning Classic teaching: Palm up or supination is preferred over palms down or pronation: Relieves pressure on the ulnar nerve as it passes through the humeral notch at the elbow Pressure on the brachial artery is also decreased in this position

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Lithotomy Patient supine with arms on the abdomen or abducted on armboards. Both legs are flexed at the hip and knee and simultaneously elevated to expose the perineum

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Cardiopulmonary Changes with Lithotomy • CV: • Increases the central blood volume • Autotransfusion from elevating the legs above the trunk. • Leg volume estimated 100 – 250 ml per leg • Hypovolemia may not be recognized in a patient in the lithotomy position • Respiratory: • FRC is not significantly changed • Lithotomy with Trendelenburg does further reduce FRC • Raising the legs causes a slight decrease in TV and an 18% decrease in vital capacity

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Cardiopulmonary Changes with Lithotomy • Severe hypotension can occur if volume replacement has been inadequate or compensatory mechanisms are abolished by general or regional anesthesia • Bring legs midline from stirrups or leg holders and place on bed simultaneously • ANESTHESIA IMPLICATION • Always check blood pressure after legs are down and BEFORE moving patient to PACU or SPU

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Lithotomy Complications • Flexion of hips > 90 degrees • Kinks or compresses the femoral neurovascular structures under the tight inguinal ligament with subsequent arterial or venous occlusion and nerve palsy • Raising one leg at a time can lead to hip dislocation and back pain postoperatively • Extreme flexion of the knee • Obstructs the popliteal vein and impedes venous outflow from the extremity • Duration • Lower extremity neuropathy • Limit duration of lithotomy to < 2 hours

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Exaggerated Lithotomy • Combines the worst features of lithotomy and trendelenburg into one position • Head down tilt adds the weight of the abdominal viscera and that produced by the flexed thighs • Net effect: • A greater ventilation perfusion mismatch

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Lithotomy Position Boots Boot stirrups evenly distribute the load between the heels and the calves. Molded foot pieces decrease the risk of compartment syndrome

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Lithotomy Position Vulnerable Body Sites • Popliteal space • Peroneal nerve • Lateral aspect of the leg • Legs • Knees • Feet and hips

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Ischemia, edema and the possibility of rhabdomyolysis occurs from the increased pressure in the fascial compartment

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Injury to the common peroneal nerve. This is the MOST COMMOM nerve injury to the lower extremities accounting for 78% of all lower extremity motor neuropathies caused by compression of the nerve between the lateral head of the fibula and “candy cane” bar stirrups

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Duration of surgery greater than 2 hours is a predictor of increased incidence of lower extremity neuropathy

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Reverse Trendelenburg Tilt Test
• The cardiovascular response to head up tilt of 75 degrees for three minutes can be a useful indicator of the magnitude of acute blood loss • If sustained tilt causes an increase in HR of more than 25 bpm, but does not produce hypotension or syncope: • The blood volume deficit is 9 - 14 mL/kg • If syncope occurs on tilting: • The deficit is likely to be as much as 20 mL/kg

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Reverse Trendelenburg Cardiovascular Changes When the lower extremities are lower than the level of the heart, blood pools in the distensible dependent vessels, causing a reduction in effect of circulating blood volume, cardiac output, and systemic perfusion

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Trendeleburg Cardiovascular Changes • Pressure in the cerebral veins increases in proportion to the gradient upward to the heart • Some c/o pounding headache • Contraindicated in the presence of intracranial pathology • Baroreceptors activated • Results in rapid vasodilation, reduced CO, and decreased organ perfusion

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AUTONOMIC FUNCTION • Aortic arch and carotid sinus house barorecetors that are part of the bodies homeostatic mechanism to maintain blood pressure within a narrow range. Increased firing of the receptors when stretched from an increase in blood pressure is part of a negative feed back loop. • The increased firing from the baroreceptors enhances the parasympathetic nervous system lowering blood pressure and slowing the heart rate

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Bottom Line, anesthesia ablates or reduces the bodies ability (feedback systems to respond to hemodynamic changes, we are now the part of the external feedback loop for hemodynamic control.

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Trendelenburg Respiratory Changes • Trendelenburg shifts the weight of the visceral mass onto the diaphragm • Result = impeded caudad excursions, prevention of lung base expansion • Movement of the mediastinum toward the head moves the carina closer to the ETT • Can result in preferential ventilation of one lung • Tube can move into the right main bronchus

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Trendelenburg Position Complications • Swelling • Face • Larynx • Conjunctiva • Increase incidence of postoperative upper airway complications • Leak Test for Extubation, suction before you deflate cuff

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Lowering the head will increase the pressure in the • cerebral veins which may lead to vascular head ache, congestion of nasal mucosa and conjunctiva in
• healthy individuals. This may lead to edema in the
• larynx as well. The sclera is the window to the
• vocal cords

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Normal excursion of the diaphragm in head down position is impeded and increase the work of breathing

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In the paralyzed mechanically ventilated patient, higher peak pressures will be required for adequate ventilation

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• Head lowering in patients with intra-cranial lesions will exacerbate the condition raising CPP and ICP
• Maintenance of CPP reduces mortality in severe head injury.

CPP should be maintained above 70-80mmHg
• Systemic hypotension is associated with poor prognosis

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Solution to swelling • Return them to supine and place them in high fowlers • If they can hemodynamically tolerate it and if the procedure will allow the post surgical position • Reverse Trendelenburg in a pince if you can’t bend them

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Sitting Position • The weight of the body becomes unequally distributed over certain areas • Flexion of the thighs and some elevation tends to prevent untoward changes in blood pressure: • TEDS or inflation stockings

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Sitting position • Rarely if ever see true sitting • Torso at 90 degrees • Modification of Sitting Position • Lounging or beach chair position • Torso at 45 degrees

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• CV: • CO decreases as the patient is elevated • Venous pooling • Intrathoracic blood volume decreases 300 – 500 ml • Intracranial perfusion • Hypotension is NOT tolerated because MAP decreases 2mm Hg for each inch the head is above the level of the heart

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Pulmonary: • Caudal shifting of the abdominal contents causes less interference with diaphragmatic movement. • Allows for greater expansion of the dependent lung regions

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Beachchair Considerations • Developed in 1980’s for arthroscopic shoulder surgery • 30 – 90 o above horizontal plane • Upright ‘beachchair’ position • Decreases in • CVP • MAP • CO • PaO2 • Increase in • Total peripheral resistance

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