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Justin Lyle Cards > AP Exam 4 Part III > Flashcards

AP Exam 4 Part III Flashcards

1
Q

what is toxic psychosis

A

exposure to toxins –> delirium

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2
Q

emergence delirium of circulatory and respiratory origin

A
  1. hypoxemia 2. hypercarbia 3. hypotension
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3
Q

functional psychosis type delirium

A

brief reaction of paranoid and other changes not caused by an organic abnormality

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4
Q

what medications are correlated with increased incidence of postoperative delirium

A
  1. anticholinergics 2. antihistamines 3. benzos
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5
Q

emergence delirium occurs with greater incidence among whom?

A

combat veterans

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6
Q

______________ & _____________ are the most frequently occuring neurologic phenomena in older adults

A

postoperative delirium (POD); POCD

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7
Q

what is the predominant risk factor for POD and POCD ?

A

age 65 +

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8
Q

_______________ is characterized as a disruption of perception, thinking, memory, psychomotor behavior, sleep wake cycle, consciousness, and attention

A

postoperative delirium

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9
Q

POD has been found to increase the risk of ____________, ____________, and/or ________________

A

perioperative mortality; institutionalization; dementia

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10
Q

risk factors for POD

A
  1. renal insufficiency & metabolic derrangements 2. poorly controlled pain 3. polypharmacy 4. functional impairment 5. urinary retention + urinary catheter
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11
Q

management of postoperative delirium must r/o ______________ FIRST

A

hypoxemia

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12
Q

tx of POD

A
  1. r/o hypoxemia first 2. treat potential causes
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13
Q

what is the most common cause of delayed awakening

A

prolonged action of anesthetic medications

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14
Q

possible causes of delayed awakening

A
  1. 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)
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15
Q

mild s/sx of serotonin syndrome

A
  1. mydriasis 2. diaphoresis 3. myoclonus 4. tachycardia 5. anxiety 6. restlessness
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16
Q

severe s/sx of serotonin syndrome

A
  1. fever 2. mental status change 3. muscle rigidity 4. multiple organ failure
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17
Q

serotonin syndrome is caused by concurrent administration of serotonergic medications: ______________ & _______________

A

antidepressants; chronic pain meds

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18
Q

what is the most important measure in evaluating pain in the PACU

A

self report (from the patient)

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19
Q

physiological indicators of pain in the PACU

A

vital signs

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20
Q

behavioral indicatiors of pain in the PACU

A

crying and agitation

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21
Q

somatic nociceptive pain is most commonly defined in the terms of what four processes?

A
  1. transduction 2. transmission 3. perception 4. modulation
22
Q

transduction (nociceptive pain)

A

transformation of a noxious stimulus into an action potential

23
Q

transmission (nociceptive pain)

A

the process by which an action potential is conducted from the periphery to the CNS

24
Q

perception (nociceptive pain)

A

occurs once the signal is recognized by various areas of the brain (amygdala, somatosensory areas of cortex, hypothalamus, anterior cingulate cortex)

25
Q

modulation (nociceptive pain)

A

altering neural afferent activity along the pain pathway (suppresses or enhances pain signals)

26
Q

________________ are pain receptors which are free nerve endings, and can be stimulated chemically, mechanically, or thermally

A

nociceptors

27
Q

where are nociceptors located

A

skin, bone, joints, viscera

28
Q

afferent neurons, for transduction, are categorized based on

A

morphology (diameter, myelination, conduction, and velocity)

29
Q

_______________ are large myelinated afferent neurons that elicit fast sharp pain

A

A delta fibers

30
Q

what stimulates A-delta fibers

A

mechanical and thermal noxious stimuli

31
Q

what types of fibers are responsible for the reflex withdrawal mechanism

A

A-delta

32
Q

A beta fibers are stimulated by what noxious stimuli?

A

touch, pressure, proprioception

33
Q

______________ are small, non-myelinated fibers that elicit slow, dull, poorly localized pain

A

C -fibers

34
Q

what noxious stimuli can transduce C fibers?

A

mechanical, thermal, and chemical

35
Q

C fibers are aka ______________ fibers

A

polymodal

36
Q

when afferent neurons are stimulated due to peripheral tissue stimuli, what inflammatory mediators and NT are released?

A
  1. glutamate** 2. substance P** 3. bradykinin 4. histamine 5. serotonin 6. prostaglandins 7. cytokines 8. calcitonin Gene related peptides
37
Q

what are the different pathways that carry noxious stimuli from periphery to the brain (i.e. transmission)

A
  1. spinothalamic tract 2. spinomesencephalic tract 3. spinoreticular tract 4. spinolimbic tract
38
Q

spinothalamic tract aka _______________

A

anterolateral system

39
Q

spinothalamic tract carries pain signals from the the _______________ & ___________ to the CNS

A

trunk; lower extremities

40
Q

transmission through spinothalamic tract occurs via primary afferent first order neurons: ____________ & ____________

A

A delta; C fibers

41
Q

in the spinothalamic tract, if the first order neuron is carried via A-delta fibers, it synapses with 2nd order neuron at laminae _______ & _________

A

I; V

42
Q

in the spinothalamic tract if first order neuron is C -fiber it synapses with second order neuron at laminae ___________

A

II

43
Q

suppression pain modulation occurs through ?

A

local inhibitory interneurons in the brainstem and descending efferent pathways

44
Q

suppression of pain occurs through what receptors and neutotransmitters

A
  1. endogenous opioids (enkaphalins/dynorphin) 2. GABA** 3. norepi 4. serotonin 5. Ach 6. glycine
45
Q

what is multimodal analgesia

A
  1. 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
46
Q

what is preventative analgesia?

A

to suppress central sensitization, analgesia should be maintained throughout the perioperative period

47
Q

preventative analgesia was previously known as?

A

pre-emptive analgesia

48
Q

medications that can be used as preventative and multimodal analgesia

A
  1. 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
49
Q

CV consequences of pain

A
  1. increased HR 2. increased BP 3. increased myocardial work
50
Q

pulmonary consequences of pain

A
  1. decreased VC 2. decreased TV 3. decreased TLC

Justin Lyle Cards (27 decks)

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