Exam 2 RA Cannabis Resp Psych Flashcards
1
Q
Length of time of tidal breathing to achieve an EtCO2 of 100%
A
4-5min
2
Q
4 non-overlapping lung volumes:
A
1) inspiratory reserve volume (IRV)
2) tidal volume (Vt)
3) expiratory reserve volume (ERV)
4) residual volume (RV)
3
Q
IRV=
A
inspiratory reserve volume = 3000mL
4
Q
Vt=
A
tidal volume = 500mL
(dead space = about 150mL of that)
5
Q
ERV=
A
expiratory reserve volume = 1100mL
6
Q
RV=
A
residual volume = 1200mL
7
Q
4 overlapping lung capacities:
A
1) inspiratory capacity (IC)
2) functional reserve capacity (FRC)
3) vital capacity (VC)
4) total lung capacity (TLC)
8
Q
IC=
A
inspiratory capacity = IRV + Vt = 3500mL
9
Q
FRC=
A
functional reserve capacity = ERV + RV = 1800mL
10
Q
VC=
A
vital capacity = IRV + Vt + ERV = 4600mL
11
Q
TLC=
A
total lung capacity = 5800mL
12
Q
What two lung volumes can we actually quantify in real time?
A
- Vt
- dead space
13
Q
How do you calculate dead space without drawing an ABG?
A
- look at EtCO2
- allow one full exhalation
- look at EtCO2
- calculate difference
- the % difference in EtCO2 multiplied by Vt = dead space
14
Q
What structures lie within the conducting zone?
A
- trachea
- bronchi
- bronchioles
- terminal bronchioles
15
Q
What structures lie within the respiratory zone?
A
- respiratory bronchioles
- alveolar ducts
- alveolar sacs
16
Q
What occurs in the conducting zone?
A
movement of air
17
Q
What occurs in the respiratory zone?
A
gas exchange
18
Q
Describe the relationship between velocity of air movement and cross sectional area
A
inversely related
- as CSA increases, the forward velocity of air decreases
- decreased flow allows for diffusion of gas/deposition of pollutants
19
Q
Air flow is turbulent in which airway structures?
A
upper airways:
- trachea
- lobar bronchi
- segmental bronchi
20
Q
Air flow is laminar in which airway structures?
A
lower airways:
- conducting bronchioles
- terminal bronchioles
21
Q
Ohms Law:
A
flow = change in pressure / resistance
22
Q
Increasing Vt or RR has what effect on peak airway pressure?
A
increasing flow (Vt or RR) will increase the pressure gradient/peak airway pressure
23
Q
Define peak airway pressure:
A
pressure in the airway with air flow = indicator of dynamic compliance of the lungs
24
Q
Define plateau pressure:
A
pressure in the airway with no air flow = indicator of static compliance of the lungs
25
What effect does decreasing the tube radius have on resistance?
For laminar flow: magnified increase in resistance
26
Where is the highest resistance to flow in the respiratory system? Why?
trachea/bronchi:
- most turbulent (highest Re)
- lowest CSA
- transition from cartilage to smooth muscle
27
Plateau pressure correlates with which lung capacity?
FRC
28
Plateau pressure is associated with a (low/high) flow rate, (low/high) CSA, and (laminar/turbulent) flow
- low flow rate
- high CSA
- laminar flow
29
Where is the lowest resistance to flow in the respiratory system? Why?
lower airways:
- laminar flow
- higher CSA
- smooth muscle to mucosae
30
You can control the radius of the upper airways by _____
You can control the radius of the lower airways by _____
upper: ETT size
lower: medications (Albuterol)
31
How do minute ventilation and alveolar ventilation differ?
MV = what you set on the ventilator = Vt x RR
VA = accounts for deadspace = (Vt-Vd) x RR
32
Normal amount of dead space:
2mL/kg or 150mL
33
Applying a mask to a patient (increases/decreases) dead space
increase (up to 300mL); "apparatus dead space"
34
Utilizing an ETT (increases/decreases) dead space
decreases (less anatomic dead space)
35
Insertion of a tracheostomy (increases/decreases) dead space
decreases (bypasses oral dead space)
36
Administration of glyco or atropine (increases/decreases) dead space
increases (more anatomic dead space d/t anticholinergic smooth muscle dilation in the conducting zone)
37
Dead space (increases/decreases) with age
increases
38
If a patient's VCO2 increases, what must also increase proportionally?
alveolar ventilation
39
Phase I of a capnograph indicates
anatomic dead space
40
Phase 2 of a capnograph indicates
mixture of dead space and alveoli
41
Phase 3 of a capnograph indicates
gas exchange/effective alveolar ventilation
42
Phase 4 of a capnograph indicates
inspiration (drops off)
43
Which lung volume experiences the greatest change when a patient lays supine?
ERV decreases significantly --> decreases FRC
44
Apneic time for normal patient and for a supine/anesthetized/paralyzed patient
2 minutes for normal
3.5 minutes for supine/anesthetized/paralyzed
45
How does FRC change with induction?
-1L laying supine
-0.5L under anesthesia
46
Volume calculation for FRC
FRC = 34mL/kg
47
For a 40 y/o patient laying flat, how are FRC and CC related?
FRC=CC
48
Define closing capacity
the volume of gas within the lungs at the point at which airways closure begins; CV + RV
49
Equation/definition for compliance
compliance = volume / pressure
= the volume that can be achieved in the lungs per unit pressure change
(ability of the lungs to expand)
50
Equation/definition for elastance
elastance = pressure / volume
= the pressure change required to elicit a unit volume change
(measure of the resistance of lungs to expansion)
51
Describe the elastance and compliance of alveoli in geriatric/COPD patients
- increased compliance
- decreased elastance
52
Describe the elastance and compliance of the chest wall in geriatric/COPD patients
- decreased compliance
- increased elastance
53
Describe the elastance and compliance of alveoli in neonates/OB/pulmonary fibrosis patients
- decreased compliance
- increased elastance
54
Describe the elastance and compliance of the chest wall in neonates/OB/pulmonary fibrosis patients
- increased compliance
- decreased elastance
55
A pressure-volume loop is a graphical representation of what?
compliance versus elastance
- slope of the loop = static compliance / no air flow
- loop itself = dynamic compliance / inspiration & expiration
56
A pressure-volume loop that is laying down is indicative of what?
decrease in static compliance
57
A decrease in compliance is related to the (airway/alveoli)
alveoli
58
An increase in resistance is related to the (airway/alveoli)
airway
59
Definition of extrathoracic resistance
FEF is decreased
FIF is increased
FEF/FIF = 0.3
60
Definition of intrathoracic resistance
FEF is increased
FIF is decreased
FEF/FIF = 2.2
61
Source of extrathoracic resistance
pressures inside of trachea
62
Example of variable extrathoracic resistance
OSA
exhalation is OK, inhalation collapse of airway
63
Example of fixed extrathoracic resistance
epiglotitis
64
Source of intrathoracic resistance
pressures outside of trachea/bronchial tree
65
Example of variable intrathoracic resistance
tracheal malacia (usually is stented)
inhalation is OK; airway collapses on exhalation
66
Example of fixed intrathoracic resistance
tumor or mass or constriction (more dangerous)
67
Why are the volume-flow loops inverted on the ventilator
the vent measures inhalation as negative flow (out of the bag) away from the vent and exhalation as positive flow (fills the bag) back toward it
68
Gold standard for PFTs and assessing for disease
FEV1 = forced expiratory volume in 1 second
69
Define DLCO and when it is relevant
measurement of ability to transport CO2
- a decrease is reflective of emphysema
- 30% is when it is relevant
70
FEV1 is indicative of ____
DLCO is indicative of _____
- FEV1 = bronchitis
- DLCO = emphysema
71
PFT measurements indicative of obstructive lung disease
- FVC increased
- RV increased
- FEF ratios decreased
- FEV1/FVC <75%
- DLCO 30% (emphysema)
72
PFT measurements indicative of restrictive lung disease
- FVC decreased
- RV decreased
- FEV1/FVC >85%
73
What is the equation of motion of the respiratory system?
Paw = (volume x elastance) + (resistance x flow)
74
In VCV, what is set on the ventilator?
- volume
- flow
75
In VCV, what does Paw/Ppeak reflect?
the respiratory system
76
In VCV, a change in Paw/Ppeak indicates a change in _____
compliance and/or resistance
77
In PCV, what is set on the ventilator?
Paw/Ppeak
78
In PCV, what does Paw/Ppeak reflect?
settings on the ventilator
79
In PCV, changes in compliance and/or resistance will change _____
Vt and flow
80
What must you be conscious of when your ventilator is set to PCV?
- Pmax is set to 40 and is "High Priority", but you have set your Paw so you don't really care
- Vt and MV alarms are "Low Priority" and will not alert you to changes in the patient unless you are watching for them
81
PCV pressure waveform on the vent appears:
squared - it has a set pressure to achieve
82
VCV pressure waveform on the vent appears:
variable - the pressure reached with each breath changes but the delivered Vt is the same
83
PCV volume waveform on the vent appears:
triangular and variable - the volume achieved changes based on when Ppeak is met
84
VCV volume waveform on the vent appears:
triangular but consistent - the volume gradually increases but each delivered breath is the same
85
PCV flow waveform on the vent appears:
triangular and variable
86
VCV flow waveform on the vent appears:
squared - a set flow is delivered per breath and is not affected by effort, resistance, etc
87
In PCV-VG, what determines the Paw/Ppeak?
- you set the volume
- ventilator sets the Paw based on compliance
- adjusts Pinsp based on compliance to achieve set volume
88
What parameters do you set in SIMV modes?
- Vt
- RR
- PEEP
- Pressure support
89
What parameters can be adjusted in "more settings" in SIMV?
- flow trigger
- Tinsp (I:E ratio)
- Tpause
- Trigger window %
- End of breath % of peak flow
- Rise rate
90
If you have a RR=10 and I:E of 1:2, what is your Tinsp and Texp?
- Tinsp = 2 sec (20s / 10)
- Texp = 4 sec (40s / 10)
91
What must you do to the Tinsp in synchronous modes if you increase your RR? Why?
adjust your Tinsp (under more settings) to achieve the I:E ratio you want - if you don't, you risk breath-stacking the patient
92
In SIMV, what does a negative deflection in your pressure scalar indicate?
patient-initiated breath
(also should turn blue)
93
What effect does increasing your trigger window % have?
increases the window in the expiratory phase so the vent is more likely to sense a patient-initiated breath and synchronize with both mandatory and initiated breaths
94
What is the risk of adjusting the flow trigger?
it may falsely indicate that the patient is breathing enough and is ready for extubation
95
Define End of Breath % of Peak Flow
- stock setting = 30%
- the lower you go, the longer the vent will support a patient-initiated breath
- no real reason to change it
96
Define Rise Rate
- rate of breath delivery on a supported breath
- range of 1-10
- higher rise rate = faster breath delivery = sharper flow scalar
97
To get a measurement for plateau pressure, what mode must you be in?
VCV
98
How you find your plateau pressure in VCV?
reduce your RR and increase your Tpause (60%)
99
In VCV, your Paw increases, but your Pplat stays the same. What does this mean?
increase in airway resistance with NO change in compliance
*bronchospasm, mucous plug..*
100
In VCV, your Paw and Pplat both increase. What does this mean?
decrease in lung compliance
*insufflation, Trendelenberg, high BMI, pneumothorax...*
101
The difference between PIP and Pplat indicates ____
resistance to flow
typically want it <10
102
In PCV, what happens to the inspiratory limb of the flow curve when there is an increase in resistance?
taller and skinnier
103
In PCV, what happens to the expiratory limb of the flow curve when there is an increase in resistance? Air trapping? Squiggly?
- increased resistance = decreased flow
- air trapping = doesn't return to baseline
- squiggly = obstruction/secretions
104
On room air, what is the pressure of O2 in your lungs?
~100
105
On 100% FiO2, what is the pressure of O2 in your lungs?
663
106
What is the alveolar oxygen equation?
PAO2 = FiO2 (Pb-PH2O) - (PaCO2 / R)
107
When calculating FRC you should use (IBW/TBW)
IBW
108
When calculating total O2 needs, you should use (IBW/TBW)
TBW
109
A PaO2 of 40 correlates with a SpO2 of ___
70
110
A PaO2 of 50 correlates with a SpO2 of____
80
111
A PaO2 of 60 correlates with a SpO2 of ___
90
112
A PaO2 of 80 correlates with a SpO2 of ____
94
113
SpO2 is calculated based on ____
SaO2 is calculated based on ____
SpO2 - light absorption
SaO2 - ABG analyzer, corrected for PaO2, temp, pH, HCO3-
114
A leftward shift on the O2 dissociation curve indicates...
an increase in affinity of Hgb for O2
115
A rightward shift on the O2 dissociation curve indicates...
a decrease in the affinity of Hgb for O2
116
4 factors that cause a leftward shift in the O2 dissociation curve:
decreased
- temp
- CO2
- 2,3 DPG
- alkalosis
(fetal Hgb)
117
4 factors that cause a rightward shift in the O2 dissociation curve:
increased
- temp
- CO2
- 2,3 DPG
- acidosis
(adult Hgb)
118
Factors that can make your SpO2 inaccurate:
- motion
- low perfusion (systolic <80)
- SpO2 < 70%
- CO poisoning - falsely elevated
- MetHgb - approaches 85% as it ^
- NOT anemia unless significantly hypoxic
119
Equation for O2 carrying capacity (CaO2)
CaO2 = (SaO2 x Hgb x 1.34) + (0.003 x PaO2)
120
Define the P:F ratio
PaO2:FiO2 ratio
- Mild = 200-300
- Moderate = 100-200
- Severe < 100
121
5 principle causes of hypoxia:
1) hypoxic mixture
2) hypoventilation
3) V/Q mismatch
4) shunt
5) diffusion impairment
*the last 3 cause a A-a gradient*
122
Equation for delivered O2
DO2 = CO x CaO2
123
Compare hypoxia to hypoxemia:
- hypoxia means your SpO2 is low (but your CaO2 may be OK)
- hypoxemia means your DO2 is low (d/t tissue deprivation, organ dysfxn)
124
A shark fin appearance in the EtCO2 waveform indicates:
bronchoconstriction
125
CO2 is transported in 3 main forms:
1) 7% dissolved in plasma
2) 23% carried by Hgb as carbaminohemoglobin
3) 70% as HCO3
126
What equation describes dead space?
Enghoff's equation
127
Define shunt
perfusion of unventilated areas / gas exchange cannot occur
- the part of the CO that returns to the L side of the heart without being ventilated
Va/Q = 0
128
Define dead space
ventilation without perfusion
infinite Va/Q
129
Vt should be based on (IBW/TBW)
IBW
(reduces lung injury)
130
The majority of atelectasis occurs during which part of anesthesia?
within 5-10 minutes of induction
131
What does the literature indicate is the most effective way to combat atelectasis?
- FiO2 <0.6
- VCM (+40cmH2O x 15sec)
- PEEP (+10cmH2O)
132
Define driving pressure
- real time pressure the alveoli are experiencing
= Pplat - PEEP
*ideally <15*
133
If you increase PEEP and perform VCM, and your driving pressure increases, what does this indicate?
lungs are overdistended
134
If you increase PEEP and perform VCM, and your driving pressure decreases, what does this indicate?
lungs are recruitable
135
If you increase PEEP and perform VCM, and your driving pressure is unchanged, what does this indicate?
you are in the linear portion of the compliance curve
136
What was the tipping point for PEEP in the literature?
7
137
2 most common causes of anesthesia related atelectasis
1) PEEP @ 5 (too low)
2) FiO2 >80% (too high)
138
The source of rheumatoid arthritis is...
autoimmune
139
Rheumatology accounts for what % of causes of disability in the US?
27% - making it #1
140
3 potential causes of RA
1) genetics (50% risk)
2) hormonal influence
3) viral insult
141
RA diagnosis typically occurs at what age?
40-50 years old
<40 3:1 female:male
>40 1:1 female:male
142
Describe the pathogenesis of RA
- injury to synovial endothelial cells (they are rich in Helper T cells that orchestrate cell mediated response)
- cytokines released (tumor necrosis factor & interleukin-1)
- necrosis of cartilage
- joint narrowing
143
4 stages of RA
1) synovitis
2) pannus (fibrous tissue)
3) fibrous ankylosis
4) bony ankylosis
144
Effect of RA on mortality
- 50% increased risk of premature death
- 3-10 year reduction in lifespan
145
RA joint symptoms
- most commonly affects wrist/hand/knees/feet
- morning stiffness
- symmetrical swelling
- possible C-spine involvement (esp. atlanto-axial subluxation)
146
Body systems that RA can affect:
- renal
- hepatic
- skin/eyes
- lymphadenopathy
- neuromuscular
- hematological
147
RA pulmonary effects
- effusions
- HTN
- nodules
- restrictive lung dz
- resp myopathy
- interstitial fibrosis
148
RA cardiovascular effects
- pericarditis
- myocarditis
- valvular dysfxn
- vasculitis
- conduction abnormalities
- restrictive cardiomyopathy
- accelerated coronary atherosclerosis
149
Why are the CV risks associated with RA a significant contributor to mortality?
- plaques more vulnerable to rupture
- increased arterial stiffness
- pro-thrombotic state
- insulin resistance
150
3 cardiac conditions that RA patients are at an increased risk for:
- silent MI (6x)
- sudden cardiac death (2x)
- heart failure (2x)
*rheumatoid cachexia also increases CV mortality*
151
Define systemic lupus erythematosus
multi-system, chronic inflammatory disease characterized by antinuclear antibody production
152
2 important groups that SLE affects most often:
- young women (15-44)
- women of color (2-3x)
153
Proposed SLE theories:
- genetics
- drug-induced
- viral (Epstein Barr)
- hormones
154
Which 2 associated conditions indicate a worse prognosis for patients with SLE?
- nephritis
- HTN
155
SLE exacerbation during pregnancy has implications for...
poor fetal outcome
156
Common factors associated with SLE:
- **presence of antinuclear antibodies**
- rash (butterfly)
- photosensitivity
- oral ulcers
- arthritis
- serositis
- renal disorders
- hematologic disorders
- immunologic disorders
- muscle aches
- Raynaud's
157
SLE cardiac effects
- pericarditis
- myocarditis
- CHF
- MI
- valve problems
- conduction problems
158
SLE pulmonary effects
- lupus pneumonia
- restrictive dz
- alveolar hemorrhage
- pulmonary HTN
159
SLE musculoskeletal effects
- non-erosive, symmetrical arthritis (90% of patients)
- osteoporosis
- atlanto-occipital subluxation
- avascular necrosis (femoral)
- tendonitis
160
SLE GI effects
- acute abd pain
- oral ulcers
- esophageal s/s
- PUD (2* NSAIDS, steroid use)
161
SLE hematologic effects
- lymphoma
- thromboembolism
- increased r/f infection
- thrombocytopenia
- anemia
162
SLE renal effects
- glomerular nephritis with proteinuria
- hematuria
- reduced GFR
- oliguric renal failure
163
SLE laryngeal effects
- mild inflammation
- vocal cord paralysis
- subglottic stenosis
- laryngeal edema
- complete obstruction
164
SLE neurologic effects
- cognitive dysfxn (30% of pts)
- psychological changes (50% of pts)
- HA
- seizures (7-20% of pts)
165
SLE skin effects
- butterfly macular rash (50%, worse with sun)
- discoid lesions (scalp, face, upper trunk)
- alopecia
166
What is the 2nd most common autoimmune rheumatic disease?
Sjogren's syndrome
167
Disease that Sjogren's syndrome is commonly misdiagnosed:
- fibromyalgia
- MS
- SLE
- RA
168
Sjogren's syndrome more commonly affects (men/women)
women (9/10)
169
How is Sjogren's syndrome diagnosed?
- labs (ANA, rheumatoid factor, SS-A and SS-B markers, erythrocyte sed rate, IGs)
- ophthalmologic tests
- dental tests (measure saliva fxn)
170
SS signs/symptoms
- DRYNESS (salivary, eye, lacrimal)
- non-erosive arthritis
- fever
- fatigue
171
SS other affected body systems
- lymphadenopathy *high r/f lymphoma*
- enlarged parotid glands d/t lack of drainage
- peripheral neuropathy
- lung involvement
172
2 primary aims of rheumatologic management
1) symptom relief
2) reduction of immune response (prevent joint, organ, CV damage)
173
Rheumatologic dz symptoms are commonly managed with what drug classes?
- NSAIDs
- COX-2 inhibitors
- corticosteroids (flares)
- opioids
174
Drugs used to reduce immune response in rheumatologic dz:
- Disease modifying anti-rheumatic drugs (DMARDs)
- TNF inhibitors
- human monoclonal antibody
- Janus Kinase inhibitors
175
MOA of DMARDs
- reduce flare frequency
- prevent erosions/long-term disability
176
Examples of DMARDs
- Methotrexate
- Sulfasalazine
- Lefunomide
- Hydroxycholoroquine (Plaquenil)
177
Methotrexate effects:
- immunosuppression
- interstitial lung dz/pulmonary tox
- hepatotox
- synergistic action with nitrous oxide?
178
Drugs used for management of SLE:
- Azathioprine (hepatotox)
- Cyclophosphamide (cardiotox)
- Mycophenolate
179
Splenectomy may help manage which rheumatologic disease?
SLE (d/t source of the antiplatelet antibodies)
180
Why are exogenous corticosteroids used in treatment of rheumatologic diseases?
stops the feedback loop with the HPA axis that results in the release of corticotropin releasing hormone
181
Normal cortisol secretion in the absence of stress
10-20mg/day
182
Cortisol secretion in the presence of stress:
150mg/day
183
Cortisol regulates:
- metabolism
- CV fxn
- growth
- immunity
184
Cortisone replacement for minor surgery
- normal corticosteroid dose
- 25mg hydrocortisone day of procedure
- no taper
185
Cortisone replacement for moderate surgery
- normal corticosteroid dose
- 50-75mg hydrocortisone day of procedure
- taper over 1-2 days
186
Cortisone replacement for major surgery
- normal corticosteroid dose
- 100-150mg hydrocortisone day of procedure
- taper over 1-2 days
187
What chronic steroid use patients do not need steroid supplementation?
- daily prednisone 5mg or less
- topical steroids only
188
Dose equivalencies of Hydrocortisone - Dexamethasone - Methylprednisolone
Hydrocortisone 25mg
Dexamethasone 1mg
Methylprednisolone 5mg
189
Important thing to remember for patients with SLE and regional anesthesia
may have clotting issues and struggle with resumption of anticoagulation
190
Special anesthetic considerations for SS patients
- no Scopolamine
- lube eyes
- monitor for QT prolongation
191
THC acts on which receptors
CB1 and CB2 (partial agonist)
192
CBD acts on which receptors
CB2 (allosteric modulator at CB2>CB1)
193
CB1 receptors are located:
CNS and PNS
- nociception
- anxiolysis
- memory
- cognition
- emotion
- movement
- NO respiration
194
CB2 receptors are located:
- peripheral lymphoid and hematopoeietic cells
- immunomodulatory function
195
Rank the Delta strains of THC in order of strength
Delta 10 < Delta 8 < Delta 9
196
Compare Delta 8 to Delta 9 side effects
Delta 9
- anxiety/tachycardia
- red eyes/dry mouth
- STM loss
- delayed rxn times
- coordination problems
- vomiting @ high doses
Delta 8
- pts with autoimmune disorders report redness/swelling of joints
- thermoregulation
197
Delta 10 has a SE profile most similar to..
Delta 8
198
List the Deltas and their receptors
Delta 9 - CB1
Delta 8 - CB1 and CB2
Delta 10 - CB1 and CB2
199
CBD has effects on...
- adenosine
- serotonergic
- glycine
- nuclear PPARs
- transient receptor potential channels
- opioid
- NDMA
- GABA
200
Cannabis is metabolized through which pathway?
CYP450 (2C9, 3A4, 2B6)
201
Drug interactions with THC
- increased effects of Clobazam, Warfarin, Hexobarbital
- decreased effects of Theophylline
- increased sedation with benzos, opioids, volatiles
202
Effects of cannabis use on airway
- hyperreactivity/bronchospasm
- edema
- obstruction
- *chronic cough*
- bronchitis
- emphysema
**more irritating d/t burns at higher T**
203
THC effect on sympathetic/parasympathetic nervous systems
- stimulates SNS
- inhibits PNS
204
Cannabis CV risks
- endothelial dysfxn
- platelet dysfxn
- arrhythmias
205
THC effects on CV
- increased HR
- increased myocardial O2 demand
- increased BP
206
CBD effects on CV
- reduced HR
- vasodilation
- hypotension
207
5 major anesthesia considerations for pts using THC/CBD
- airway
- CV/cerebrolvascular issues d/t endothelial/PLT dysfxn
- delayed gastric emptying
- drug interactions
- increased analgesic/volatile requirements
208
Some studies demonstrated an increased r/f ___ in cannabis users
MI
r/t PLT/endothelial dysfxn
209
Acute s/s of cannabis intoxication
- anxiety
- paranoia
- psychosis
210
Cannabis CV risks
- endothelial dysfxn
- platelet dysfxn
- arrhythmias
211
3 classes of drugs used to treat depression:
- TCAs
- MAOIs
- SSRIs
212
MOA of TCAs
- block reuptake of serotonin and NE
- competitive antagonist at muscarinic ACh receptors
213
SE of TCAs
- anticholinergic (dry/red/blind/EPS)
- antihistamine
- conduction abnormalities (depresses cardiac impulses, prolonging intervals)
214
TCA with most SE
Amitriptyline
215
TCA OD looks like:
- CNS depression
- sz
- hypoventilation
- coma
- anticholinergic s/s
216
Treatment for TCA OD/anticholinergic toxicity
Physostigmine - reversible AChE inhibitor that crosses the BBB
217
Patients on TCAs need (direct/indirect) acting agonists to treat low HR/BP
direct (Phenylephrine, then NE if that doesn't work)
indirect can lead to HTN crisis
218
Chronic administration of TCAs has what effect on the SNS?
- downregulation of B-adrenergic receptors
- decreased amount of NT
- reduced sensitivity to that receptor
219
MAO of SSRIs
- increase serotonin by inhibiting reuptake
- also inhibit reuptake of NE
220
SE of SSRIs
- insomnia
- agitation
- HA
- sexual dysfxn
- withdrawal symptoms if abruptly stopped
221
Which SSRI is a CYP450 inhibitor?
Prozac (most potent inhibitor)
222
Describe the effect of SSRIs on PLT activity
- anti-PLT activity
- block reuptake of serotonin in PLT
- serotonin helps with aggregation
*relevant for pregnant women on SSRIs*
223
MOA of MAOIs
- inhibit the enzyme monoamine oxidase to elevate serotonin, NE, and DA levels
224
SE of MAOIs
- orthostatic hypotension
- sedation
- blurred vision
- peripheral neuropathy
- agitation/tremor/sz
225
Patients taking MAOIs should avoid what foods?
- aged cheese
- smoked fish
- cured meats
- some beers
(tyramine)
226
SE if a patient on MAOIs eats forbidden foods
- HTN
- hyperpyrexia
- increased cerebrovascular resistance
227
Drug to be avoided in pts taking MAOIs:
Demerol
- serotonin syndrome
- hyperthermia
- sz
- coma
- death
228
Muscle relaxant to avoid with MAOIs
Pancuronium
229
Risks associated with a spinal/epidural in pt on MAOI
hypotension
