Neuro Flashcards
How do antiepileptics impact NMBA drug dosing?
Will need an increased dose
When a partial seizure progresses to a general seizure, it’s called:
a Jacksonian march
What is the tonic phase of a seizure?
What is the clonic phase?
Tonic: full body rigidity
Clonic: repetitive jerking motions
Status Epilepticus is defined as:
Seizure lasting more than 30 minutes
OR
2 grand mal seizures with no regained consciousness in between
What are the signs of a seizure under general anesthesia?
Tachycardia, increased EtCO2, hypertension
Which IV anesthetic commonly causes myoclonus, but NOT EEG spikes in patients without epilepsy?
Etomidate
Which IV anesthetic should absolutely be avoided in patients with a seizure disorder?
Ketamine
If cortical mapping is being performed, what are the optimal IV anesthetics to use?
Methohexital, etomidate, and alfentanil all increase EEG activity and can be used to help identify focal areas
Which opioid should not be given to patients with seizure disorders?
Meperidine
Its metabolite, normeperidine, is a proconvulsant
Which NMBA is a proconvulsant?
Atracurium (really only an issue with long term infusions)
How do local anesthetics impact the seizure threshold?
All of them reduce the seizure threshold if given in doses associated with CNS toxicity, but not if executed correctly
Which anticonvulsant demonstrates zero order kinetics?
Phenytoin
Which anticonvulsant is hepatotoxic?
Valproic Acid
Extravasation of which anticonvulsant causes purple glove syndrome?
Phenytoin (less risk with phosphenytoin)
Which anticonvulsants cause resistance to NMBAs?
Phenytoin
Carbamazepine
Which anticonvulsant is completely dependent on the kidney for elimination?
Gabapentin
It’s excreted unchanged by the kidney, with no hepatic metabolism whatsoever
What is the MOA of phenytoin?
Voltage gated Sodium Channel Blocker
What is the MOA of valproic Acid?
Voltage gated Sodium Channel Blocker
What is the MOA of carbamazepine?
Voltage gated Sodium Channel Blocker
What is the MOA of gabapentin?
inhibits voltage gated Ca channels in the CNS
Inhibition of pseudocholinesterases in the plasma results in an increased duration of action for which drugs?
Succinylcholine
Mivacurium
Ester-type LAs
What is the goal of pharmcological treatment of Alzheimer’s?
Increase Ach levels
Which neurotransmitter is pathologically low in Alzheimer’s?
Why?
Acetylcholine
Plaque formation results in dysfunctional synaptic transmission
How do the drugs given for Alzheimer’s impact the ANS?
They increase parasympathetic tone, and may cause bradycardia, syncope and N/V
Which anticholinergic should be given to Alzheimer’s patients?
Glycopyrrolate
It doesn’t cross the BBB
Which volatile anesthetic increases beta amyloid production?
Isoflurane
Should not be used in Alzheimers
How do anesthetics impact apoptosis?
GABA agonists and NMDA antagonists all increase the rate of apoptosis in the brains of the very old and very young
which anesthetics are ideal in Alzheimers patients?
Short acting
What is the pathophysiology of Parkinsons?
There’s decreased dopamine production in the substantia nigra →
Unchecked Ach production in the substantia nigra →
Increased GABA activity in the thalamus
The treatment aims for Parkinsons are decreasing ____ and increasing _____
decreasing Ach
Increasing Dopamine
What is levodopa?
Prodrug of dopamine
What is carbidopa?
Drug that inhibits metabolism of levodopa in the bloodstream, allowing more drug to reach the brain
What is the role of Selegiline in Parkinson’s?
MAO-B Inhibitor
Increases dopamine levels by inhibiting breakdown
What’s the difference between MAOIs and MAO-Bs?
MAOIs inhibit both MAO-A (which metabolizes NE, serotonin, tyramine, and dopamine) and MAO-B (which just inhibits dopamine)
MAO-B inhibitors are selective
Which drugs are contraindicated in Parkinson’s?
Antidopaminergics (haldol, droperidol, reglan)
Promethazine
Should diphenhydramine be used in patients with Parkinson’s?
Yes! It’s a great option for sedation and reduction of tremors because it has anticholinergic properties
What should be given to hypotensive patients with Parkinson’s?
Fluid and direct acting vasopressors, like phenylephrine
Which NMBA should be used in Parkinson’s?
Any of them are fine
Which opioid should NOT be used in patients with Parkinson’s?
Alfentanil
It can cause acute dystonic reaction
What is the #1 thing you should be vigilant of with a post op Parkinson’s patient?
Ventilatory Failure
There is one time Levodopa should be held preop:
If they’re undergoing deep brain stimulation
In those instances you actually want their symptoms to be worse to make it easier to locate the optimal lead placement
