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Anesthesia Pharm > Neuro > Flashcards

Neuro Flashcards

1
Q

How do antiepileptics impact NMBA drug dosing?

A

Will need an increased dose

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2
Q

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

A

a Jacksonian march

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3
Q

What is the tonic phase of a seizure?

What is the clonic phase?

A

Tonic: full body rigidity

Clonic: repetitive jerking motions

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4
Q

Status Epilepticus is defined as:

A

Seizure lasting more than 30 minutes

OR

2 grand mal seizures with no regained consciousness in between

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5
Q

What are the signs of a seizure under general anesthesia?

A

Tachycardia, increased EtCO2, hypertension

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6
Q

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

A

Etomidate

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7
Q

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

A

Ketamine

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8
Q

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

A

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

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9
Q

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

A

Meperidine

Its metabolite, normeperidine, is a proconvulsant

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10
Q

Which NMBA is a proconvulsant?

A

Atracurium (really only an issue with long term infusions)

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11
Q

How do local anesthetics impact the seizure threshold?

A

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

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12
Q

Which anticonvulsant demonstrates zero order kinetics?

A

Phenytoin

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13
Q

Which anticonvulsant is hepatotoxic?

A

Valproic Acid

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14
Q

Extravasation of which anticonvulsant causes purple glove syndrome?

A

Phenytoin (less risk with phosphenytoin)

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15
Q

Which anticonvulsants cause resistance to NMBAs?

A

Phenytoin

Carbamazepine

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16
Q

Which anticonvulsant is completely dependent on the kidney for elimination?

A

Gabapentin

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

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17
Q

What is the MOA of phenytoin?

A

Voltage gated Sodium Channel Blocker

18
Q

What is the MOA of valproic Acid?

A

Voltage gated Sodium Channel Blocker

19
Q

What is the MOA of carbamazepine?

A

Voltage gated Sodium Channel Blocker

20
Q

What is the MOA of gabapentin?

A

inhibits voltage gated Ca channels in the CNS

21
Q

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

A

Succinylcholine

Mivacurium

Ester-type LAs

22
Q

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

A

Increase Ach levels

23
Q

Which neurotransmitter is pathologically low in Alzheimer’s?

Why?

A

Acetylcholine

Plaque formation results in dysfunctional synaptic transmission

24
Q

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

A

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

25
Q

Which anticholinergic should be given to Alzheimer’s patients?

A

Glycopyrrolate

It doesn’t cross the BBB

26
Q

Which volatile anesthetic increases beta amyloid production?

A

Isoflurane

Should not be used in Alzheimers

27
Q

How do anesthetics impact apoptosis?

A

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

28
Q

which anesthetics are ideal in Alzheimers patients?

A

Short acting

29
Q

What is the pathophysiology of Parkinsons?

A

There’s decreased dopamine production in the substantia nigra →

Unchecked Ach production in the substantia nigra →

Increased GABA activity in the thalamus

30
Q

The treatment aims for Parkinsons are decreasing ____ and increasing _____

A

decreasing Ach

Increasing Dopamine

31
Q

What is levodopa?

A

Prodrug of dopamine

32
Q

What is carbidopa?

A

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

33
Q

What is the role of Selegiline in Parkinson’s?

A

MAO-B Inhibitor

Increases dopamine levels by inhibiting breakdown

34
Q

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

A

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

MAO-B inhibitors are selective

35
Q

Which drugs are contraindicated in Parkinson’s?

A

Antidopaminergics (haldol, droperidol, reglan)

Promethazine

36
Q

Should diphenhydramine be used in patients with Parkinson’s?

A

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

37
Q

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

A

Fluid and direct acting vasopressors, like phenylephrine

38
Q

Which NMBA should be used in Parkinson’s?

A

Any of them are fine

39
Q

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

A

Alfentanil

It can cause acute dystonic reaction

40
Q

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

A

Ventilatory Failure

41
Q

There is one time Levodopa should be held preop:

A

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

Anesthesia Pharm (12 decks)

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