AP Exam 4 Part III Flashcards
what is toxic psychosis
exposure to toxins –> delirium
emergence delirium of circulatory and respiratory origin
- hypoxemia 2. hypercarbia 3. hypotension
functional psychosis type delirium
brief reaction of paranoid and other changes not caused by an organic abnormality
what medications are correlated with increased incidence of postoperative delirium
- anticholinergics 2. antihistamines 3. benzos
emergence delirium occurs with greater incidence among whom?
combat veterans
______________ & _____________ are the most frequently occuring neurologic phenomena in older adults
postoperative delirium (POD); POCD
what is the predominant risk factor for POD and POCD ?
age 65 +
_______________ is characterized as a disruption of perception, thinking, memory, psychomotor behavior, sleep wake cycle, consciousness, and attention
postoperative delirium
POD has been found to increase the risk of ____________, ____________, and/or ________________
perioperative mortality; institutionalization; dementia
risk factors for POD
- renal insufficiency & metabolic derrangements 2. poorly controlled pain 3. polypharmacy 4. functional impairment 5. urinary retention + urinary catheter
management of postoperative delirium must r/o ______________ FIRST
hypoxemia
tx of POD
- r/o hypoxemia first 2. treat potential causes
what is the most common cause of delayed awakening
prolonged action of anesthetic medications
possible causes of delayed awakening
- prolonged action of anesthetic agents 2. metabolic causes (hypo/hyperglycemia, electrolyte disturbances, & Hothyroidism) 3. neuro injury (RARE): (CVA, IC hemorrhage, ICP, extreme hyper/hypotension, and/or emboli)
mild s/sx of serotonin syndrome
- mydriasis 2. diaphoresis 3. myoclonus 4. tachycardia 5. anxiety 6. restlessness
severe s/sx of serotonin syndrome
- fever 2. mental status change 3. muscle rigidity 4. multiple organ failure
serotonin syndrome is caused by concurrent administration of serotonergic medications: ______________ & _______________
antidepressants; chronic pain meds
what is the most important measure in evaluating pain in the PACU
self report (from the patient)
physiological indicators of pain in the PACU
vital signs
behavioral indicatiors of pain in the PACU
crying and agitation
somatic nociceptive pain is most commonly defined in the terms of what four processes?
- transduction 2. transmission 3. perception 4. modulation
transduction (nociceptive pain)
transformation of a noxious stimulus into an action potential
transmission (nociceptive pain)
the process by which an action potential is conducted from the periphery to the CNS
perception (nociceptive pain)
occurs once the signal is recognized by various areas of the brain (amygdala, somatosensory areas of cortex, hypothalamus, anterior cingulate cortex)
modulation (nociceptive pain)
altering neural afferent activity along the pain pathway (suppresses or enhances pain signals)
________________ are pain receptors which are free nerve endings, and can be stimulated chemically, mechanically, or thermally
nociceptors
where are nociceptors located
skin, bone, joints, viscera
afferent neurons, for transduction, are categorized based on
morphology (diameter, myelination, conduction, and velocity)
_______________ are large myelinated afferent neurons that elicit fast sharp pain
A delta fibers
what stimulates A-delta fibers
mechanical and thermal noxious stimuli
what types of fibers are responsible for the reflex withdrawal mechanism
A-delta
A beta fibers are stimulated by what noxious stimuli?
touch, pressure, proprioception
______________ are small, non-myelinated fibers that elicit slow, dull, poorly localized pain
C -fibers
what noxious stimuli can transduce C fibers?
mechanical, thermal, and chemical
C fibers are aka ______________ fibers
polymodal
when afferent neurons are stimulated due to peripheral tissue stimuli, what inflammatory mediators and NT are released?
- glutamate** 2. substance P** 3. bradykinin 4. histamine 5. serotonin 6. prostaglandins 7. cytokines 8. calcitonin Gene related peptides
what are the different pathways that carry noxious stimuli from periphery to the brain (i.e. transmission)
- spinothalamic tract 2. spinomesencephalic tract 3. spinoreticular tract 4. spinolimbic tract
spinothalamic tract aka _______________
anterolateral system
spinothalamic tract carries pain signals from the the _______________ & ___________ to the CNS
trunk; lower extremities
transmission through spinothalamic tract occurs via primary afferent first order neurons: ____________ & ____________
A delta; C fibers
in the spinothalamic tract, if the first order neuron is carried via A-delta fibers, it synapses with 2nd order neuron at laminae _______ & _________
I; V
in the spinothalamic tract if first order neuron is C -fiber it synapses with second order neuron at laminae ___________
II
suppression pain modulation occurs through ?
local inhibitory interneurons in the brainstem and descending efferent pathways
suppression of pain occurs through what receptors and neutotransmitters
- endogenous opioids (enkaphalins/dynorphin) 2. GABA** 3. norepi 4. serotonin 5. Ach 6. glycine
what is multimodal analgesia
- use of agents with different MOA –> synergistic or adaptive effects 2. captures effectiveness of individual agents at optimal dosages to maxmize efficacy and minimize s/e
what is preventative analgesia?
to suppress central sensitization, analgesia should be maintained throughout the perioperative period
preventative analgesia was previously known as?
pre-emptive analgesia
medications that can be used as preventative and multimodal analgesia
- opioids 2. non-opoids (NSAIDs, tylenol) 3. NMDA antagonists (ketamine) 4. Alpha-2 agonists (precedex and clonidine) 5. L.A. 6. magnesium infusion 7. anticonvulsants/membrane stablizers (Gabapentin) 8. glucocorticoids
CV consequences of pain
- increased HR 2. increased BP 3. increased myocardial work
pulmonary consequences of pain
- decreased VC 2. decreased TV 3. decreased TLC
