Neuro

Question 1

How do antiepileptics impact NMBA drug dosing?

Answer 1

Will need an increased dose

Question 2

When a partial seizure progresses to a general seizure, it’s called:

Answer 2

a Jacksonian march

Question 3

What is the tonic phase of a seizure?

What is the clonic phase?

Answer 3

Tonic: full body rigidity

Clonic: repetitive jerking motions

Question 4

Status Epilepticus is defined as:

Answer 4

Seizure lasting more than 30 minutes

OR

2 grand mal seizures with no regained consciousness in between

Question 5

What are the signs of a seizure under general anesthesia?

Answer 5

Tachycardia, increased EtCO2, hypertension

Question 6

Which IV anesthetic commonly causes myoclonus, but NOT EEG spikes in patients without epilepsy?

Answer 6

Etomidate

Question 7

Which IV anesthetic should absolutely be avoided in patients with a seizure disorder?

Answer 7

Ketamine

Question 8

If cortical mapping is being performed, what are the optimal IV anesthetics to use?

Answer 8

Methohexital, etomidate, and alfentanil all increase EEG activity and can be used to help identify focal areas

Question 9

Which opioid should not be given to patients with seizure disorders?

Answer 9

Meperidine

Its metabolite, normeperidine, is a proconvulsant

Question 10

Which NMBA is a proconvulsant?

Answer 10

Atracurium (really only an issue with long term infusions)

Question 11

How do local anesthetics impact the seizure threshold?

Answer 11

All of them reduce the seizure threshold if given in doses associated with CNS toxicity, but not if executed correctly

Question 12

Which anticonvulsant demonstrates zero order kinetics?

Answer 12

Phenytoin

Question 13

Which anticonvulsant is hepatotoxic?

Answer 13

Valproic Acid

Question 14

Extravasation of which anticonvulsant causes purple glove syndrome?

Answer 14

Phenytoin (less risk with phosphenytoin)

Question 15

Which anticonvulsants cause resistance to NMBAs?

Answer 15

Phenytoin

Carbamazepine

Question 16

Which anticonvulsant is completely dependent on the kidney for elimination?

Answer 16

Gabapentin

It’s excreted unchanged by the kidney, with no hepatic metabolism whatsoever

Question 17

What is the MOA of phenytoin?

Answer 17

Voltage gated Sodium Channel Blocker

Question 18

What is the MOA of valproic Acid?

Answer 18

Voltage gated Sodium Channel Blocker

Question 19

What is the MOA of carbamazepine?

Answer 19

Voltage gated Sodium Channel Blocker

Question 20

What is the MOA of gabapentin?

Answer 20

inhibits voltage gated Ca channels in the CNS

Question 21

Inhibition of pseudocholinesterases in the plasma results in an increased duration of action for which drugs?

Answer 21

Succinylcholine

Mivacurium

Ester-type LAs

Question 22

What is the goal of pharmcological treatment of Alzheimer’s?

Answer 22

Increase Ach levels

Question 23

Which neurotransmitter is pathologically low in Alzheimer’s?

Why?

Answer 23

Acetylcholine

Plaque formation results in dysfunctional synaptic transmission

Question 24

How do the drugs given for Alzheimer’s impact the ANS?

Answer 24

They increase parasympathetic tone, and may cause bradycardia, syncope and N/V

Question 25

Which anticholinergic should be given to Alzheimer's patients?

Answer 25

Glycopyrrolate It doesn't cross the BBB

Question 26

Which volatile anesthetic increases beta amyloid production?

Answer 26

Isoflurane Should not be used in Alzheimers

Question 27

How do anesthetics impact apoptosis?

Answer 27

GABA agonists and NMDA antagonists all increase the rate of apoptosis in the brains of the very old and very young

Question 28

which anesthetics are ideal in Alzheimers patients?

Answer 28

Short acting

Question 29

What is the pathophysiology of Parkinsons?

Answer 29

There's decreased dopamine production in the substantia nigra → Unchecked Ach production in the substantia nigra → Increased GABA activity in the thalamus

Question 30

The treatment aims for Parkinsons are decreasing ____ and increasing \_\_\_\_\_

Answer 30

decreasing Ach Increasing Dopamine

Question 31

What is levodopa?

Answer 31

Prodrug of dopamine

Question 32

What is carbidopa?

Answer 32

Drug that inhibits metabolism of levodopa in the bloodstream, allowing more drug to reach the brain

Question 33

What is the role of Selegiline in Parkinson's?

Answer 33

MAO-B Inhibitor Increases dopamine levels by inhibiting breakdown

Question 34

What's the difference between MAOIs and MAO-Bs?

Answer 34

MAOIs inhibit both MAO-A (which metabolizes NE, serotonin, tyramine, and dopamine) and MAO-B (which just inhibits dopamine) MAO-B inhibitors are selective

Question 35

Which drugs are contraindicated in Parkinson's?

Answer 35

Antidopaminergics (haldol, droperidol, reglan) Promethazine

Question 36

Should diphenhydramine be used in patients with Parkinson's?

Answer 36

Yes! It's a great option for sedation and reduction of tremors because it has anticholinergic properties

Question 37

What should be given to hypotensive patients with Parkinson's?

Answer 37

Fluid and direct acting vasopressors, like phenylephrine

Question 38

Which NMBA should be used in Parkinson's?

Answer 38

Any of them are fine

Question 39

Which opioid should NOT be used in patients with Parkinson's?

Answer 39

Alfentanil It can cause acute dystonic reaction

Question 40

What is the #1 thing you should be vigilant of with a post op Parkinson's patient?

Answer 40

Ventilatory Failure

Question 41

There is one time Levodopa should be held preop:

Answer 41

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