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Fa: Coexisting 2 > 6. Psychiatric > Flashcards

6. Psychiatric Flashcards

1
Q

depression pathophysiology

A

monamine deficiency theory

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2
Q

monoamine deficiency theory

A

depletion of NTs in CNS:
- serotonin
- NE
- dopa

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3
Q

depression meds

A

MAOI
TCA
SSRI

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4
Q

MAOI mechanism

A

prevent breakdown of catecholamines and serotonin

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5
Q

MAOI risks

A

hypertensive crisis
serotonin syndrom

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6
Q

what drugs should you avoid with MAOIs?

A

meperidine
ketamine

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7
Q

which opioid is ok with MAOI?

A

fentanyl

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8
Q

can you give benzos with MAOI?

A

yes

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9
Q

pts on MAOI have ________ anesthetic requirements

A

increased

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10
Q

vasopressors for pts on MAOI

A

direct acting
(phenylephrine)

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11
Q

TCAs mech

A

inhibit synaptic reuptake of NE and serotonin

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12
Q

what other neurochemical systems do TCAs impact?

A

histamine
cholinergics

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13
Q

SSRIs mech

A

inhibit reuptake of serotonin from the neuronal synapse

Does not affect NE reuptake

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14
Q

serotonin syndrome symptoms

A

Shivering
Hyperreflexia + myoclonus
Incr Temp > 41c
Vital sign instability
Encephalopathy
Restlessness
Sweating

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15
Q

serotonin syndrome treatment

A

supportive measures
cyproheptadine

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16
Q

cyproheptadine class

A

serotonin antagonist

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17
Q

Electroconvulsion therapy seizure length

A

25-75s

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18
Q

ECT seizure type

A

grand mal seizure

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19
Q

min ECT seizure length

A

15s

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20
Q

ECT: phase 1

A

parasympathetic
- brady
- hTN

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21
Q

ECT: phase 2

A

sympathetic
- tachy
- HTN

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22
Q

incr CBF will ______ ICP

A

incr ICP

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23
Q

methods to determine seizure activity

A

electroencelphalogram
or
tournique to leg

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24
Q

pre-op med for ECT

A

0.2 mg glyco to control brady and decr secretions

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25
ECT induction drug
0.5-1 mg/kg methohexital propofol
26
what should you give after ECT induction?
sux to decr muscle contractions from seizure
27
what should you use to treat tachycardia and HTN in ECT pts?
esmolol NTG
28
ECT induction drugs options
methohexital propofol etomidate ketamine
29
fastest onset ECT induction drug
methohexital
30
propofol induction pro
decr HTN
31
propofol induction con
shorter seizure activity
32
ketamine induction for ECT will have
prolonged receovery
33
what is important to know about bipolar pts?
lithium level if treated with lithium
34
lithium side effects
QT prolongation non-specific ST segment and t-wave changes
35
fluids for lithium pts
sodium containing to decrease lithium
36
what drug to avoid in lithium pts?
thiazide diuretics will incr lithium
37
pts on lithium may have _____ anesthetic requirement
decr
38
neuroleptic malignant syndrome
dopamine blockade/depletion in basal ganglia and impaired thermoregulation
39
NMS symptoms appear
gradually over 24-72 hrs
40
NMS symtpoms
hyperpyrexia (fever) muscle rigidity (sk) rhabdo autonomic hyperrreflexia altered consciousness acidosis CK incr
41
NMS treatment
stop antipsychotic drugs supportive therapy dantrolene bromocriptine
42
what should you do for pts going under anesthesia with a history of NMS?
monitor for MH
43
incr CK is associated with what?
NMS
44
anesthetic need: acute alchol
decr anesthetic need
45
anesthetic need: chronic
incr anesthetic need
46
how long before surgery should you stope oral naltrexone?
72 hrs
47
how long before surgery should you stop naltrexone injections?
4 weeks
48
pts who stop naltrexone will
be more sensitive to opioids due to incr receptor density
49
pts who are on naltrexone will
be resistant to opioid need higher opioid dosing
50
disulfiram
inhibits aldehyde dehydrogenase in alcohol metabolism
51
disulfiram SE
hTN
52
how to treat disulfiram hTN
phenylephrine
53
anesthetic need: acute cocaine
incr need
54
anesthetic need: chronic cocaine
negligible effect
55
duration of cocaine toxicity
2 hrs
56
what happens after taking cocaine?
catecholamine deficient
57
anesthetic need: acute opioids
decr anesthetic need
58
anesthetic need: chronic opioids
incr anesthetic need
59
should you continue or discontinue chronic opioids prior to surgery?
continue to have higher opioid receptor saturation
60
should you cntinue or discontinue methadone or buprenorphine before surgyer?
continue - need pain mgmt consult
61
anesthetic need: acute amphetamines
incr anesthetic requirement
62
acute amphetamine pts will have
tachycardia HTN hyperthermia
63
anesthetic need: chronic amphetamines
decr anesthetic requirement
64
chronic amphetamine users will be
catecholamine depleted hTN
65
vasopressor for chronic amphetamine users
direct acting phenylephrine NE
66
should you contine or discontinue amphetamines prescibed for ADHD?
discontinue
67
anesthetic need: acute cannabis
decr requirement
68
cannabis toxicity lasts
2-3 hrs
69
anesthetic need: chronic cannabis
higher propofol incr analgesia
70
chronic cannabis users will have
pulmonary issues similar to long-term smokers
71
alcohol withdrawal S+S
tremors pereptual disturbances incr HR HTN N/V confusion
72
alcohol withdrawal is most prononuced
24-36 hrs post-intake
73
delerium tremens is most pronounced
2-4 days post-intake
74
delerium tremens mortality
10%
75
delerium tremens
alcohol withdrawl + seizures
76
delerium tremens treatment
alcohol benzos
77
which benzos for delerium tremens?
long-acting: lorazepam diazepam
78
which HD meds for delerium tremens?
B blocker a blocker

Fa: Coexisting 2 (7 decks)

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