Anesthetic Considerations with AD and PD drugs.

Question 1

The clearance of memantine (NMDA receptor antagonist for AD) can be reduced when what is increased?

Answer 1

Urinary pH.

Be careful with bicarbonate.

Question 2

Cholinesterase inhibitors (prevent breakdown of ACh in AD) can prolong which drug?

Answer 2

Succhs

Question 3

What side effects of anticholinergic drugs (PD) do we especially need to monitor for? What should we avoid?

Answer 3

HR

Avoid drugs that impact cholinergic tone (TCAs) or increase side effects (HR) if possible.

Question 4

Amantadine (Increases DA in synapse) needs to be evaluated for what kind of effect? What needs to be ruled our as a side effect?

Answer 4

Anti-cholinergic like side effects

CHF

Question 5

When a patient is on levodopa + decarboxylase inhibitors how often must they receive the combo? What could suddenly happen if they do not receive it? What kind of side effects?

Answer 5

Must receive q 6-12 hours.
Administer 20 minutes pre op and intra op NG tube to avoid sudden loss of effect and neuromuscular and respiratory failure.
We care about cardiac dysrhythmias, adrenergic stimulation, orthostatic HTN GI

Question 6

What side effects are we assessing for with synthetic dopamine agonists (pramipexole and ropinirole)?

Answer 6

CV
Hypotension
Pleuropulmonary fibrosis

Question 7

What meds are we avoiding with Selegine (MAO-b) which increases DA in synapse

Answer 7

Ephedrine, meperidine and vasoactive medications.

Pronounced effect with NM blockers, sedatives, diuretics.