CLASS 4 - GENERAL SURVEY, LOC, SEDATIVE-HYPNOTICS, + PHARMACODYNAMICS

Question 1

How would you observe cognition in terms of a patient’s physical appearance?

Answer 1

Age, gender, LOC, skin colour, facial features

Question 2

How would you observe cognition in terms of a patient’s body structure?

Answer 2

Stature, nutrition, symmetry, posture, position, body build, contour

Question 3

How would you observe cognition in terms of a patient’s behaviour?

Answer 3

facial expresson, mood + affect, speech, dress, personal hygiene

Question 4

How would you observe cognition in terms of a patient’s mobility?

Answer 4

gait, range of motion

Question 5

What is a flat (blunted) affect?

Answer 5

lack of emotional response, no expression

Question 6

what is depersonalization?

Answer 6

loss of identity, feeling estranged

Question 7

What are some potential causes of delirium?

Answer 7

underlying medical condition such as infection or pain
alcohol / substances / medications
environment (ICU, psychosis)

Question 8

What are 2 physiological conditions that affect LOC?

Answer 8

Hypoglycemia, low oxygenation

Question 9

What does it mean if a patient is lethargic?

Answer 9

Somnolent, inattentive to voice

Question 10

What does it mean if a patient is obtunded?

Answer 10

difficult to awaken, marginal cooperation, incoherent

Question 11

what does it mean if a patient is stupor?

Answer 11

semi-coma, withdraws to pain, maons / mumbles, spontaneously unconscious

Question 12

What is the glasgow coma scale?

what are the 3 responses it assesses?

Answer 12

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)

Question 13

Which score ranges on the Glasgow Coma Scale indicate:
Minor brain injury?
Moderate brain injury?
Severe brain injury?

Answer 13

minor: 13-15
moderate: 9-12
severe: 3-8

Question 14

Describe the section of the glasgow coma scale used to assess the eye opening response.

Answer 14

highest score is 4

4: eyes open simultaneously
3: eyes open to verbal command
2: eyes open to pain
1: do not open

Question 15

Describe the section of the glasgow coma scale used to assess the verbal response.

Answer 15

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

Question 16

Describe the section of the glasgow coma scale used to assess the motor response.

Answer 16

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

Question 17

What is decerebrate posture?

Answer 17

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).

Question 18

What is decorticate posture?

Answer 18

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)

Question 19

Why is the PO route preferred of benzodiazepines instead of IV?

Answer 19

IV doses may have profound BP drop or respiratory depression

Question 20

what is drug half-life?

Answer 20

the amt of time required for the amt of drug in the body to decrease by 50%.

Question 21

do drugs w short half-lives leave the body quickly or slowly?

Answer 21

quickly

Question 22

do drugs w long half-lives leave the body quickly or slowly?

Answer 22

slowly

Question 23

what is CYP450?

Answer 23

CYP450 is the main enzyme system in the liver responsible for drug metbolism.

Question 24

If drug A is metabolized by a CYP450 enzyme and drug B induces that enzyme, what effect will this have on drug A?

Answer 24

This will cause drug A to break down faster and therefore reduce the effect of drug A.

Question 25

If drug A is metabolized by a CYP450 enzyme and drug C inhibits that enzyme, what effect will this have on drug A?

Answer 25

Drug A will be broken down more slowly and therefore its effects will be enhanced.

Question 26

how do enzyme inducers change the effects of benzodiazepines

how do enzyme inhibitors change the effect of benzodiazepines?

Answer 26

Enzyme inducers: reduced effect of Benzo by speeding breakdown
Enzyme inhibitors: increased effect of Benzo by delaying breakdown

Question 27

what are the 4 types of receptors in the body?

Answer 27

Ligand-gated ion channels
G protein-coupled receptors
Enzyme-linked receptors
Intracellular receptors

Question 28

Where does drug metabolism most often take place?

Answer 28

In the liver

Question 29

what is first pass metabolism?

Answer 29

Drugs given orally may be metabolized in the liver before they reach systemic circulation.

Question 30

What is the relationship between first pass mechanism and administering a drug intravenously?

Answer 30

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

Question 31

What is the difference between central and peripheral painful stimuli when assessing a patient’s neurological response?

Answer 31

Central painful stimuli: evaluates brain function

Peripheral painful stimuli: evaluates spinal cord

Question 32

Give examples of a central painful stimulus

Answer 32

squeezing trapezius muscle
applying supraorbital or submandibular pressure
sternum rub

Question 33

which central painful stimulus should be avoided if possible?

Answer 33

sternum rub

Question 34

give an example of a peripheral painful stimulus

Answer 34

applying pressure on the nail plate w a pencil

Question 35

how long should a stimulus be applied to assess a patient’s response?

Answer 35

at least 15 seconds but no longer than 30.