Lecture 3: Subarachnoid Hemorrhage Flashcards
Where do cerebral aneurysms normally occur? Why?
At or near bifurcation of the vessels d/t more vulnerable geometry
What is a syncopal episode?
Fainting
What are the components of propofol that can trigger allergies? (Do keep in mind that propofol was reformulated to reduce anaphylactic reaction.)
Egg lecithin + soybean oil
What part of propofol usually causes allergic reactions?
Diisopropyl group + phenol group
What is valsartan/diovan?
Antihypertensive medication; angiotensin II receptor blocker
Common name of acetylated salicyclic acid?
Aspirin
Hydrocodone dose?
5-10 mg q3-4 hours
Acetominophen is what class of drug? Dose?
NSAID; 10-15 mg/kg q4 hours
Naproxen: common name? Class? Dose?
Aleve; NSAID; 250 mg q4 day or 500 mg q2 day
What disease does novolin treat?
Dose?
Supplied?
Diabetes
6 units subcutaneously q12hr
Supplied 100 units/ml
Common name of glucophage? Class? What disease does glucophage treat?
Metformin
Biguanide
Diabetes
Nimotop’s generic name? Treats?
Nimodipine; Ca++ channel blocker that treats hypertension
Zocor’s generic name? Treats?
Simvastatin; treats high cholesterol
Colace treats what problem?
Colace is an anionic surfactant that decreases the surface tension of stool– a stool softener that treats constipation.
Mechanism of metformin?
Reduces glucose levels by decreasing hepatic glucose production and increasing insulin action in muscle and in fat
Mechanism of action of sulfonylureas:
Stimulate the insulin release from the Beta cells of the pancreas
Who shouldn’t take metformin?
Patients with a history of renal impairment, lactic acidosis, hepatic disease or cardiac failure
Which Ca++ channel blocker has the most widespread effect on all aspects of the heart?
Verapamil
Which Ca++ channel blocker has its main effect in slowing conduction of both SA and AV nodes?
Diltiazam
Which Ca++ channel blocker improves neurological outcomes in patients where deficits secondary to vasospasm are present after cerebral aneurysm rupture and is also recommended to prevent vasospasm after cerebral aneurysm coiling?
Nimodipine
Why do we prescribe aneurysm patients stool softeners after surgery?
We don’t want them to strain; that would increase ICP and cause aneurysm to burst.
What class of drug is pepcid? What does it inhibit?
Histamine H2 receptor blocker; inhibits gastric acid production
Pepcid results in what percentage drop in acid secretion?
70%
On what type of secretion is pepcid most effective?
Basal acid secretion, which is responsible for nocturnal acid secretion
Drug name of pepcid?
Famotidine
When end organ function exists, surgical mortality for diabetic patients is _____ times higher than normal patients.
5x higher
Which three patient groups demand perioperative tight control of blood sugar?
1) Pregnant patients
2) Patient undergoing cardiopulmonary bypass
3) Patient with global CNS ischemia
What is a common complications during surgery in patients with diabetes?
Cerebral CNS insult
Which type of diabetic patient is susceptible to ketoacidosis?
Type I diabetic
NIDDM is defined as a fasting blood glucose:
> 125 mg/dl
Which type of diabetic medication increases insulin binding to the insulin receptors on target tissue?
Sulfonylureas
What effect does high glucose levels have on wound healing?
Decreased granulocytic function + collagen synthesis
What is another word for ketoacidosis?
Hyperglycemia
What glucose level is considered hypoglycemic? How do you treat hypoglycemia?
< 50 mg/dl
Treat with 50% dextrose, starting with 15 ml bolus.
Under what circumstances would you have your patient on an IV insulin infusion during surgery?
If your patient is having a major surgery and has DM on insulin or DM poorly controlled w/ oral meds
Why do you discard the first 50 ml of insulin infusion?
Insulin sticks to plastic tubing, so we use the first 50 ml to coat the system to prevent that.
What is the physiological response during an asthma attack?
Mast cell release of histamine
What is the pathology of an asthma attack?
Bronchoconstriction and airway inflammation
In what way do B2 agonists treat asthma?
They activate muscarinic receptors in the lungs to cause bronchodilation by relaxing smooth muscle.
Particle sizes of aerosolized spray in:
Mouth and oropharynx
Conducting and low airways
Alveolar level
1) 10 micrometer in mouth and oropharynx
2) 1-10 micrometer in conducting and low airways
3) Alveolar level
What are the two types of aerosols?
1) Metered dose
2) Nebulizers
Onset and duration of short-acting B2-agonists?
Onset: 1-5 min
Duration: 2-6 hours
Onset and duration of long-acting B2-agonists?
Onset: > 20 minutes
Duration: 12 hours
What are the two long-acting B2-agonists?
1) Salmeterol
2) Formoterol
What steroid (glucocorticoid) is used to treat asthma?
Beclomethasone
By what means do steroids have a bronchodilating effect?
They decrease mucosa edema and prevent the release of bronchoconstricting substances
What are three possible complications of aneurysm coiling?
1) Aneurysm rupture
2) Thromboembolism
3) Vasospasm
