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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
Q

ECT induction drug

A

0.5-1 mg/kg methohexital

propofol

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26
Q

what should you give after ECT induction?

A

sux to decr muscle contractions from seizure

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27
Q

what should you use to treat tachycardia and HTN in ECT pts?

A

esmolol
NTG

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28
Q

ECT induction drugs options

A

methohexital
propofol
etomidate
ketamine

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29
Q

fastest onset ECT induction drug

A

methohexital

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30
Q

propofol induction pro

A

decr HTN

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31
Q

propofol induction con

A

shorter seizure activity

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32
Q

ketamine induction for ECT will have

A

prolonged receovery

33
Q

what is important to know about bipolar pts?

A

lithium level if treated with lithium

34
Q

lithium side effects

A

QT prolongation
non-specific ST segment and t-wave changes

35
Q

fluids for lithium pts

A

sodium containing to decrease lithium

36
Q

what drug to avoid in lithium pts?

A

thiazide diuretics will incr lithium

37
Q

pts on lithium may have _____ anesthetic requirement

A

decr

38
Q

neuroleptic malignant syndrome

A

dopamine blockade/depletion in basal ganglia and impaired thermoregulation

39
Q

NMS symptoms appear

A

gradually over 24-72 hrs

40
Q

NMS symtpoms

A

hyperpyrexia (fever)
muscle rigidity (sk)
rhabdo
autonomic hyperrreflexia
altered consciousness
acidosis
CK incr

41
Q

NMS treatment

A

stop antipsychotic drugs
supportive therapy
dantrolene
bromocriptine

42
Q

what should you do for pts going under anesthesia with a history of NMS?

A

monitor for MH

43
Q

incr CK is associated with what?

A

NMS

44
Q

anesthetic need: acute alchol

A

decr anesthetic need

45
Q

anesthetic need: chronic

A

incr anesthetic need

46
Q

how long before surgery should you stope oral naltrexone?

A

72 hrs

47
Q

how long before surgery should you stop naltrexone injections?

A

4 weeks

48
Q

pts who stop naltrexone will

A

be more sensitive to opioids due to incr receptor density

49
Q

pts who are on naltrexone will

A

be resistant to opioid

need higher opioid dosing

50
Q

disulfiram

A

inhibits aldehyde dehydrogenase in alcohol metabolism

51
Q

disulfiram SE

A

hTN

52
Q

how to treat disulfiram hTN

A

phenylephrine

53
Q

anesthetic need: acute cocaine

A

incr need

54
Q

anesthetic need: chronic cocaine

A

negligible effect

55
Q

duration of cocaine toxicity

A

2 hrs

56
Q

what happens after taking cocaine?

A

catecholamine deficient

57
Q

anesthetic need: acute opioids

A

decr anesthetic need

58
Q

anesthetic need: chronic opioids

A

incr anesthetic need

59
Q

should you continue or discontinue chronic opioids prior to surgery?

A

continue to have higher opioid receptor saturation

60
Q

should you cntinue or discontinue methadone or buprenorphine before surgyer?

A

continue
- need pain mgmt consult

61
Q

anesthetic need: acute amphetamines

A

incr anesthetic requirement

62
Q

acute amphetamine pts will have

A

tachycardia
HTN
hyperthermia

63
Q

anesthetic need: chronic amphetamines

A

decr anesthetic requirement

64
Q

chronic amphetamine users will be

A

catecholamine depleted
hTN

65
Q

vasopressor for chronic amphetamine users

A

direct acting
phenylephrine
NE

66
Q

should you contine or discontinue amphetamines prescibed for ADHD?

A

discontinue

67
Q

anesthetic need: acute cannabis

A

decr requirement

68
Q

cannabis toxicity lasts

A

2-3 hrs

69
Q

anesthetic need: chronic cannabis

A

higher propofol
incr analgesia

70
Q

chronic cannabis users will have

A

pulmonary issues similar to long-term smokers

71
Q

alcohol withdrawal S+S

A

tremors
pereptual disturbances
incr HR
HTN
N/V
confusion

72
Q

alcohol withdrawal is most prononuced

A

24-36 hrs post-intake

73
Q

delerium tremens is most pronounced

A

2-4 days post-intake

74
Q

delerium tremens mortality

A

10%

75
Q

delerium tremens

A

alcohol withdrawl + seizures

76
Q

delerium tremens treatment

A

alcohol
benzos

77
Q

which benzos for delerium tremens?

A

long-acting:
lorazepam
diazepam

78
Q

which HD meds for delerium tremens?

A

B blocker
a blocker

Fa: Coexisting 2 (6 decks)

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