CLASS 4 - GENERAL SURVEY, LOC, SEDATIVE-HYPNOTICS, + PHARMACODYNAMICS Flashcards
How would you observe cognition in terms of a patient’s physical appearance?
Age, gender, LOC, skin colour, facial features
How would you observe cognition in terms of a patient’s body structure?
Stature, nutrition, symmetry, posture, position, body build, contour
How would you observe cognition in terms of a patient’s behaviour?
facial expresson, mood + affect, speech, dress, personal hygiene
How would you observe cognition in terms of a patient’s mobility?
gait, range of motion
What is a flat (blunted) affect?
lack of emotional response, no expression
what is depersonalization?
loss of identity, feeling estranged
What are some potential causes of delirium?
underlying medical condition such as infection or pain
alcohol / substances / medications
environment (ICU, psychosis)
What are 2 physiological conditions that affect LOC?
Hypoglycemia, low oxygenation
What does it mean if a patient is lethargic?
Somnolent, inattentive to voice
What does it mean if a patient is obtunded?
difficult to awaken, marginal cooperation, incoherent
what does it mean if a patient is stupor?
semi-coma, withdraws to pain, maons / mumbles, spontaneously unconscious
What is the glasgow coma scale?
what are the 3 responses it assesses?
scoring system used to describe the level of consciousness in a person following a traumatic brain injury.
eye opening response (4), verbal response (5), and motor response (6)
Which score ranges on the Glasgow Coma Scale indicate:
Minor brain injury?
Moderate brain injury?
Severe brain injury?
minor: 13-15
moderate: 9-12
severe: 3-8
Describe the section of the glasgow coma scale used to assess the eye opening response.
highest score is 4
4: eyes open simultaneously
3: eyes open to verbal command
2: eyes open to pain
1: do not open
Describe the section of the glasgow coma scale used to assess the verbal response.
highest score is 5
5: oriented
4: confused but able to answer questions
3: inapproriate responses, words discernible
2: incomprehensible sounds or speech
1: no response
Describe the section of the glasgow coma scale used to assess the motor response.
highest score is 6
6: obeys commands for mvmt
5: purposeful mvmt to painful stimulus
4: withdraws from pain
3: abnormal (spastic) flexion, decorticate posture
2: extensor (rigid) response, decerebrate posture
1: no motor response
What is decerebrate posture?
results from damage to the upper brain stem.
The arms are adducted and extended w the wrists prinated and fingers flexed/ Lefs are stiffly extended, w plantar flexion of the feet (score of 2 on GCS).
What is decorticate posture?
results from damage to one or both corticospinal tracts. Arms are adducted and flexed w the wrists and fingers flexed on the chest. Legs are stiffly extended and internally rotated w plantar flexion of the feet (score of 3 on GCS)
Why is the PO route preferred of benzodiazepines instead of IV?
IV doses may have profound BP drop or respiratory depression
what is drug half-life?
the amt of time required for the amt of drug in the body to decrease by 50%.
do drugs w short half-lives leave the body quickly or slowly?
quickly
do drugs w long half-lives leave the body quickly or slowly?
slowly
what is CYP450?
CYP450 is the main enzyme system in the liver responsible for drug metbolism.
If drug A is metabolized by a CYP450 enzyme and drug B induces that enzyme, what effect will this have on drug A?
This will cause drug A to break down faster and therefore reduce the effect of drug A.
If drug A is metabolized by a CYP450 enzyme and drug C inhibits that enzyme, what effect will this have on drug A?
Drug A will be broken down more slowly and therefore its effects will be enhanced.
how do enzyme inducers change the effects of benzodiazepines
how do enzyme inhibitors change the effect of benzodiazepines?
Enzyme inducers: reduced effect of Benzo by speeding breakdown
Enzyme inhibitors: increased effect of Benzo by delaying breakdown
what are the 4 types of receptors in the body?
Ligand-gated ion channels
G protein-coupled receptors
Enzyme-linked receptors
Intracellular receptors
Where does drug metabolism most often take place?
In the liver
what is first pass metabolism?
Drugs given orally may be metabolized in the liver before they reach systemic circulation.
What is the relationship between first pass mechanism and administering a drug intravenously?
sometimes first pass mechanism is so dramatic that it necessitates gving a drug intravenously as giving it orally would lead to significantly less active drug in the systemic circulation
What is the difference between central and peripheral painful stimuli when assessing a patient’s neurological response?
Central painful stimuli: evaluates brain function
Peripheral painful stimuli: evaluates spinal cord
Give examples of a central painful stimulus
squeezing trapezius muscle
applying supraorbital or submandibular pressure
sternum rub
which central painful stimulus should be avoided if possible?
sternum rub
give an example of a peripheral painful stimulus
applying pressure on the nail plate w a pencil
how long should a stimulus be applied to assess a patient’s response?
at least 15 seconds but no longer than 30.
