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Starred Summer 2015 > ECT > Flashcards

ECT Flashcards

1
Q

ECT disproportionately increases ____ and ____ in anterior cingulate cortex, the generator of ____

A

metabolism and blood flow

Theta rhythms

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2
Q

____ receptors in postsynaptic neurons sensitized by repeated ECT

A

5Ht3 and 5HT1a

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3
Q

ECT also increases release of ___ and _____ from locus coeruleus and substantia nigra

A

noradrenaline and dopamine

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4
Q

Indications of ECT

A

Medication-resistant severe depression (especially with delusions/suicidal ideations), acute mania or catatonia not compliant with meds, acute psychosis with schizophrenia,

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5
Q

Contraindications to ECT

A

Respiratory infection, MI/CVA within 6 months, uncontrolled BP/HR/arrhythmias/CHF/unstable angina, anticoagulant therapy >3, intracranial HTN, glaucoma and retinal detachment

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6
Q

TCAs interact with ECT by…

A

anticholinergic effects = exaggerated CV response

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7
Q

MAOIs interact with ECT by…

A

exaggerated response - indirect sympathomimetic, fatal with demerol, prolonged succ (>3 months minimal CV response,

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8
Q

SSRI interact with ECT by …

A

NONE!

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9
Q

Lithium interact with ECT by…

A

potentiates barbs and succ, possible acute organic brain syndrome, should be stopped 36-48 hours before treatment, fatal with demerol

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10
Q

BP responses with ECT

A

Tachycardia and hypertension more common, may pretreat with glyco or atropine if at risk for brady

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11
Q

AFib and ECT?

A

HR should be about 70, anticoagulated to INR 2-3

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12
Q

Induction agent and succ should be based on ___ body weight

A

ideal

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13
Q

Bite block should be inserted after disappearance of ____ and removed immediately after relief of ____

A

fasciculation, masseter spasm

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14
Q

Airway pressure should not exceed ____ cm of water

A

20

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15
Q

Drug of choice for ECT

A

Methohexital, fast wake up with minimal effects but does suppress the seizure threshold

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16
Q

What medications to use to lower seizure threshold

A

Etomidate, ketamine, opioids, flumazenil *have to use when on benzos

17
Q

NMBA of choice for ECT

A

Succinycholine

18
Q

Why NMBA for ECT?

A

Prevent fracture, dislocation and myalgia- larger doses for patients at risk

19
Q

Adverse effects of ECT

A

Retrograde amnesia most common, anterograde amnesia, agitation (use propofol), HA (ketorolac or propofol), muscle aches, nausea, fatigue, delirium, status epilepticus

20
Q

Anesthesia is required for ECT to …

A

guarantee unawareness, muscle relaxation & control CV responses

21
Q

The treatment effectiveness is dependent on achieving adequate EEG seizures of ____ seconds

A

25

Starred Summer 2015 (12 decks)

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