Neuro: first aid 2015 pg 495-502 Flashcards
A 42-year-old man involved in an automobile accident sustains multiple fractures of the right leg and arm and is suffering from severe pain. In the emergency department, his wife reports that her husband is a recovering heroin addict who has been enrolled in a methadone program for 3 months and is also taking phenelzine for depression. The most appropriate drug to alleviate the patient’s severe pain is
A. butorphanol. B. meperidine. C. morphine. D. nalbuphine. E. pentazocine.
A
methadone program —> withdrawal program so don’t give opioid agonist
so Butorphanol is Kagonist and u partial agonist!
butorphanol overdose–> easily reversible with naloxone?
nope
Tramadol
what is it?
and fatal side effect
tram it all work on everything
Serotonin syndrome!!
also decreases seizures threshold
Absence seizure treatment
Ethosuxmide
List Ca2+ blockers for antiseizures
EcG
Ethosuxmide
Calcium
Gabapentin
Increase in GABA
Topiramate and phenobarbital
where do you use Gabapentin other than seizures
peripheral neuropathy and postherpatic neuralgia
Migraine prophylaxis?
BACT
Topiramate!
drug that cause stevens-johnson syndrome
lamotrigine
antiepileptic causing SIADH
carbamazepine
bipolar
- manic phase
- depressed phase
- manic: carbamezepine
2. lamotrigine
status epilepticus DOC
phenytoin
tonic-clonic DOC
valporic
p450 inducer
carbamazepine
patient with tonic clonic and absence seizures
valporic
gingival hyperplasia
phenytoin
baby with cleft palate, cardiac
defects, phalanx/fingernail hypoplasia
fetal phenytoin syndrome
eclampsia 1st line and what’s the other drug
MgSO4
BDZ
hepatotoxic, neural tube defects
phenytoin
kidney stones
topiramate
list 2 GABA channels that works by Cl- influx
A and B
A is in brain
B is in retina
what’s GABAb? MOA?
in brain too. it’s ta Gprotein so Gi
K+ efflux
decreased in Ca2+ influx
Net effect: hyperpolarize
whats contraindicated in porphyria?
barbs
low potency think what?
high MAC = low solubility in lipid
high potency –> lipid or blood solubility
potency–> think lipid! want high solubility in lipid for high potency
rapid induction think lipid or blood? (low or high)
blood, low blood
rapid induction means what recovery times?
fast
rapid induction, want B/G ratio to be?
low–> increased free fraction
list properties of N2O in term of
- induction
- potency
- induction: rapid –> low blood solu
2. potency: low lipid solu –> low potency
halothane SE
hepatotoxic
Methyoxyflurane SE
nephrotoxic
proconvulsant
enflurane
treatment for
- malignant hyperthermia
- Neuroepileptic syndrome
- serotonin syndrome
- extrapyramidal systems SE of antipyschotics
- dantrolene (fever+severe muscle contractions) (SSRI+inhaled anesthetics except N2O)
- dantrolene and D2 agonists (bromocriptine) (myoglobinuria + ridigity)
- cyproheptadine (myoclonus + diarrhea)
- beztropine or diphenhydramine
inhaled anethestics cause increased cerebral blood flow but this one cause decreased cerebral blood flow. its IV anesthetics. what is it?
barbituates (thiopental)
for endoscopy, what anesthetics?
midazolam
Chronic alcoholic came in for endoscopy. He seemed to make up stories. He is given midazolam. He is B1 deficient too. after surgery, what will happen to his memory?
Korsakoff syndrome: Ante> retro
midazolam: Retro
so he’s gone gone gone
This IV anesthetics is used in older patients with bradycardia (or heart problem), and it is used when you the patient to be conscious but you just want to induce muscle catatonia?
ketamine
what is ketamine?
arylcyclohexylamines ACHA
this IV anesthetic is often used for outpatient quick and easy procedures like botox. K-pop stars favorites
propofol
bad thing about propofol is there is pain at injection site, what would you use instead?
fospropofol
local anesthetics most effective in what type of neurons?
activated Na+ –> rapidly firing neurons
