Describe the pharmacology of * insulin preparations *oral hypoglycaemic *corticosteroid drugs.
Intravenous dexamethasone has a slow onset of action. TRUE/FALSE
Prednisone and dexamethasone are synthetic corticosteroids with predominantly mineralocorticoid effects. TRUE/FALSE
The anti-inflammatory response of corticosteroids is a mineralocorticoid effect. TRUE/FALSE
Mineralocorticoid effects of synthetic corticosteroids are less than the natural hormones. TRUE/FALSE
Dexamethasone lacks mineralocorticoid effects. TRUE/FALSE
Stress: A state of mental or emotional strain or tension resulting from adverse or demanding circumstances.
Is it a bad thing?
I recently attended a management course that concentrated on resilience in the workplace. Learning how to identify stress in your life and identify it in others is at the crux of this course. The above slide was put up and my mind immediately travelled to performance in the primary examinations. Examinations are stressful, but is this a bad thing?
The above graph looks different for everyone but displays some important points. The yellow section is where people perform best. It is called the “optimum stress” area and is where you want to be when you sit the vivas. You are tense yet motivated, your senses are heightened and you are prepared for the challenge ahead.
At the Olympics, what separates good athletes from extraordinary athletes is often their ability to perform in high stress situations. Most of the athletes are very similar in their fitness and physique, and it comes down to performance on the day. Two people with very similar skills and training can perform drastically different when faced with high-pressure situations.
Everyone has warning signs about when they are moving into the overload category, and when fatigue is becoming exhaustion. In this overload area, we tend to do less of our normal, healthy coping mechanisms (e.g. exercise) and our performance starts to decline. This overload of stress has been linked to impaired performance in military and in civilian populations.
Resilience: The capacity to recover quickly from difficulties; toughness.
The good news is that you can get better at identifying and managing the stress you inevitably feel when facing difficult and uncertain situations. Identification and management of stress, and building of resilience, is possible. The trick is to manage your stress and keep it within optimal levels in order to perform on the day. If you don’t have the tools in place to keep your stress in check, you’ll under perform on the day of the exam.
The key thing to understanding this is that you are indeed facing uncertainty—the outcome of your future has not been decided. It’s up to you to develop the beliefs and mental toughness that will get you through the next few weeks, and perform well on the day of the viva.
With the exam rapidly approaching, I thought this would be a good time to address the 8 minute reading time. This is a time where you can read the questions and start planning your attack. You cannot write anything during this time, but you can have an internalised plan.
Easy things first…There are 15 questions to read during this time, read them well. There will be some repeat questions. Do not spend your 8 minutes thinking about the repeat questions. There may be questions that you think are repeats if you don’t read them properly so read them well! There will be other new questions. Some of these will be hard and one or two of them may seem impossible during the first read. Use your reading time to think about these new questions.
The things to ask yourself during this time are things such as “what are the key words in this question?” “WHY are the examiners asking me this question?” “WHAT about this topic is important?”. Vomiting an answer onto the page, without a plan or structure, does not fill the examiner with a feeling that you understand the topic. Whereas, if you have a structure to the question then the important points will hopefully follow. The better answers are often shorter than many of the other answers as they are efficient, and demonstrate that the candidate knows the topic well enough to know what is important.
When answering new questions, remember that this is an exam to enter anaesthetic training (more or less). Placing a whole bunch of random facts onto the paper will get you a few marks, but it won’t score you high marks. Stay calm, think about the question and have trust in yourself and the work you have done. Use the eight minutes to your advantage and think “structure, structure, structure (and handwriting!)”.
Good luck and stay strong!
Describe methods to reverse the effect of warfarin
Describe the pharmacology of warfarin and other anticoagulant drugs
The metabolic clearance of warfarin is inhibited by amiodarone. TRUE/FALSE
Third generation cephalosporins reduce the anticoagulant effect of warfarin. TRUE/FALSE
Intravenous vitamin K should return the prothrombin time to a normal range within 1 hour. TRUE/FALSE
Skin necrosis is a side effect of warfarin therapy. TRUE/FALSE
Warfarin can be reversed with recombinant factor VIIa TRUE/FALSE
Describe the pharmacology of warfarin and other anticoagulant drugs
Warfarin has a mild effect on platelet function. TRUE/FALSE
Peak concentration of warfarin occurs at 36 hours. TRUE/FALSE.
Despite its low protein binding, warfarin has a long elimination half time after oral administration. TRUE/FALSE
Warfarin crosses the placenta and is found in significant levels in breast milk. TRUE/FALSE
The elimination half time of warfarin may be prolonged by volatile anaesthetic agents. TRUE/FALSE
Describe the physiological changes and their implications for anaesthesia that occur during pregnancy, labour and delivery, in particular the respiratory, cardiovascular, haematological and gastrointestinal changes.
There is delayed gastric emptying for 12 weeks gestation. TRUE/FALSE/CONTROVERSIAL
During pregnancy, liver blood flow remains unaltered. TRUE/FALSE
The lower oesophageal sphincter becomes incompetent in pregnancy solely due to the loss in the angle of the gastro-oesophageal angle. TRUE/FALSE
Epidural analgesia using local anaesthetics and no opioids can reduce gastric emptying. TRUE/FALSE
Gastrin from the foetus may slow gastric emptying TRUE/FALSE
Describe the alteration to drug response due to hepatic disease.
Metabolic clearance is usually constant and independent of dose. TRUE/FALSE
For drugs with an extraction ratio of nearly 0, a change in liver blood flow produces a nearly proportional change in clearance. TRUE/FALSE
Alfentanil is an example of a drug whose hepatic metabolism is capacity-limited. TRUE/FALSE
In cirrhosis, hepatic drug clearance is usually reduced. TRUE/FALSE
CYP3A4 is responsible for nearly half of all drug metabolism. TRUE/FALSE. Hint…this is the enzyme system affected by grapefruit juice (and interestingly, propofol).
One of the body’s most under-rated sphincters…
- Physiology of swallowing
- Factors preventing reflux of gastric contents into the oesophagus
- Control of gastric motility and emptying
- Composition of gastric fluid
- Physiology of nausea and vomiting
General anaesthesia reduces lower oesophageal sphincter tone. TRUE/FALSE
Cricoid pressure reduces lower oesophageal sphincter tone. TRUE/FALSE
Suxamethonium reduces lower oesophageal sphincter tone. TRUE/FALSE
The lower oesophageal sphincter is a physiological sphincter, primarily due to the oblique gastro-oesophageal angle. TRUE/FALSE
Relaxation of the lower oesophageal sphincter after swallowing is neurally mediated. TRUE/FALSE
SB_OB 1.9 and SB_OB 1.8
Describe the influence of pregnancy on the pharmacokinetics and pharmacodynamics of drugs commonly used in anaesthesia and analgesia
Describe the anatomy and physiology of pain in labour and childbirth
Paracetamol is a category A drug in pregnancy, but care should still be taken in patients with pre-eclampsia. TRUE/FALSE
The addition of lipid-soluble opioids to lumbar epidurals allows a reduction of local anaesthetic concentration. TRUE/FALSE
Visceral pain receptors located in the lower uterine segment and cervix extend to the spinal segments of S2-S4. TRUE/FALSE
Oxygen consumption increases by 40% during the first stage of labour. TRUE/FALSE
Entonox side effects include maternal sedation. TRUE/FALSE.