Lecture 8 review Flashcards
Scale of level of consciousness from most to least
Alert Lethargic Obtunded Stupor Coma
What kind of drug is diazepam (Valium)?
Long acting benzodiazepine. Onset: po 0.5-2 h; Half-life 100 h
What kind of drug is lorazepam (Ativan)?
Intermediate acting benzodiazepines. Onset: po 2-4 h, sl 1 h, IV 5-10 min; Half-life 10-20 hours
What kind of drug is midazolam (IM/ IV only)?
Short acting Benzodiazepines. Onset: IV 1.5-5 min; Half-life 1-4 hours
What kind of drug is Flumazenil (Anexate)?
Benzodiazepine reversal drug
What kind of drug is phenobarbital?
Barbiturate. Very narrow therapeutic index.
What kind of drug is zopiclone (Immovane)?
A miscellaneous CNS depressant
Flat affect (blunted affect)
Lack of emotional response, no expression
Depression
Sad, gloomy, dejected
Depersonalization
Loss of identity, feeling estranged, feels disconnected from everything
Elation
Joy and optimism, overconfidence
Euphoria
Cheerfulness and optimism that is inappropriate to the situation
Anxiety
Worried, uneasy, and apprehensive, but without specific cause
Fear
Worried, apprehensive
Irritability
Annoyed, easily provided, impatient
Rage
Furious, loss of control
Ambivalence
Opposing emotions. Not sure what they’re feeling
Labile
Rapid shift of emotions
Inappropriate affect
Mismatch of affect with behaviour/ speech
What is delirium?
- An acute confusional state.
- Consciousness clouded
- Dulled cognition
- impaired alertness
- inattentive
- incoherent
- poor memory
- agitated
- hallucinations
Causes of delirium
- underlying medical condition
- alcohol/ substances
- medications
- environment
Physiological conditions that affect LOC
- low blood glycose
- low oxygen
Appropriate painful stimuli to central
- trapezius squeeze
- supraorbital pressure
- mandibular pressure
- sternal rub
Decorticate posture
This is a type of flexed posturing and can indicate damage to the cerebral hemispheres.
There will be adduction and flexion of arms and hands will be closed shut (flexed). The legs will be rotated internally and feet plantar flexed.
Remember the letters COR in the word decorticate for the word “core”. The patient will bring their ARMS to the core of the body (middle).
Decerebrate posture
This is a type of extended posturing and can indicate damage to the brain stem. This is the worst type of posturing between the two.
There will be adduction and extension of the arms and pronation of the hands and fingers will be flexed along with extended legs and plantar flexion of the feet.
Look at all the E’s in this word. There are a lot of them, so remember the word EXTENDED. The arms are going to be extended rather than flexed.
Safest adjuvant medication
benzo-like
Less safe adjacent medication
barbiturates
What is GABA?
A neurotransmitter with inhibitory effect on CNS
How do benzos and barbiturates work with GABA?
They bind to GABA receptor, opening the chloride channel, inhibiting the neuron from firing. Inhibitory effects of GABA are enhanced
The inhibitory effects of GABA
- anxiety is reduced
- wakefulness is reduced
- memory and awareness is affected
- neuro-excitability is reduced
Benzodiazepines compared to barbiturates
Benzodiazepines only potentiates GABA. Barbiturates enhances GABA and mimics GABA
Barbiturates drug effects
- notorious enzyme inducers
- accumulation with liver impairment and in the elderly
- reduced REM sleep
- additive effect with alcohol and other CNS depressants
- overdose frequently leads to respiratory depression and subsequent respiratory arrest
- overdose produces CNS depression
