Neuro System Week #1 Flashcards
Types of local anesthesia
Topical anesthesia
Regional: Bier block Field blocking Nerve blocking Epidural Anesthesia Spinal Anesthesia
Parasympathetic
Increase secretion
Decreased heart rate & force of contraction
Increase intestinal motility
Constricts bronchi
No effect on peripheral blood vessels
Stimulates erection
Increases stomach motility & gastric acid secretion
Constricts pupil
Contracts bladder body & relaxes bladder sphincter
Sympathetic
Increases heart rate & force of contraction. (Decreases in parasympathetic)
Little/no effect on secretion (Increased in paras)
Dilates pupil (Constrict in paras)
Decreases stomach motility & gastric acid secretion. (Increase in paras)
Constricts peripheral blood vessels (Increase in paras)
Dilates bronchi. (constrict in paras)
Relaxes bladder body & constricts bladder sphincter (Contract in paras)
Stimulates ejaculation. (Stimulates erection)
Decreases intestinal mobility (Increased in paras)
When only a small area needs anesthesia OR client cannot tolerate anesthesia
Use: Local Anesthesia
Topical anesthesia
Application of a local anesthesia on the skin or mucus membrane
Topical, local anesthesia use for =>
Burns
Suturing wounds
Minor surgery
Dental procedures
Hemorrhoids
Bier Block Anesthesia
Injecting local anesthetic into upper of lower extremity
Field block anesthesia
Subcutaneous injection of local anesthetic around the margin of the surgical or procedure site
(Given to supply anesthetic to a specific area like hand or arm)
Nerve block anesthesia
Blocking a group of nerves called = plexus or ganglion, to a specific area
Spinal anesthesia
Injection of anesthetic into the cerebrospinal fluid = in the lumbar spine
Epidural anesthesia
Injection of local anesthetic into epidural space
General anesthesia has to balance in =>
Nerve blocked
Pt out of sleep
Pain is controlled
Amides = Ladocaine *
MoA = block nerve conduction by blocking the influx of sodium through sodium channels
Use = local anesthesia, topical (burns / sutures), mucus membrane, regional (IV), nerve block, epidural & spinal
AE: CNS depression = respiratory depression
LAST = Local Anesthetic Systemic Toxicity => large dose & accidental intravascular injection
Extreme SNC depression, restlessness, irritability, tremors, confusion, seizure activity, cardio excitement life threatening Arrhythmias
Intervention = monitor VS, hypotension = 1- lower HOB, if not 2 - epinephrine, pt report dizziness, paresthesia
Amides: Ladocaine Toxicity SAMS
S = slurrred or Difficult Speech
Paresthesias, numbness of lips / tongue
A = Altered Cardio System
Drowsiness/ dizziness/ hypotension, dysrhythmias = Bradycardia, Heart block
M = Muscle Twitching = tremors (الارتعاش)
S = Seizures
Confusion & respiratory depression
Inhaling Agents = isoflurane *
MoA= produces Amnesia (فقدان الذاكرة), musicale relaxation, hypnosis (التنويم المغناطيسي), blocks pain
AE = cardio & respiratory Depression, airway irritation, spasms (تشنجات), vomiting, Rare= immune mediated hepatotoxicity
General/ Barbiturate/ Intravenous Anesthesia
methohexital sodium
MoA= CNS Depression by amplifying the inhibitory neurotransmitter GABA
Use = hypnosis (تنويم مغناطيسي) & adjunct anesthesia
AE = Respiratory depression & decrease HR & BP
Intervention = monitor respiratory status, Inject Slowly, monitor VS before & during procedure
Contraindications = allergic to barbiturates
Precaution = hepatic/renal disease
General Anesthesia/ Benzodiazepines (flumazenil =antagonist)
midazolam *
MoA = inhibits the effects of (GABA), Hypnotic producing = sleep & sedation
AE = Amnesia (memory loss since before injection), cardia / respiratory arrest
Intervention= give slowly (wait 2min before 2 dose), prep resuscitation equip, monitor VS
TERATOGENIC (pregnancy risk)
General Anesthesia/ Benzodiazepines (flumazenil =antagonist)
fentanyl **
MoA = like opioid, CNS depression
Use = supplement anesthesia,
AE = sedation & nausea, Respiratory & Cardiac depression , sedation
Intervention = monitor level of consciousness, nausea, VS, resuscitation equip handy
& Naloxone = reverse agent
Contraindications = substance abuse
General Anesthetic
diprivan (Propofol)
AE= Nausea, cough, itching, burning around site, confusion/ agitation, anxiety, muscle pain or discolored urine
Report = weak breathing, fast/ slow HR, seizures
Neuromuscular Blocking Agent
vecuronium (Norcuron)
MoA = suspend nerve impulse at neuromuscular junction = cause muscle paralysis
AE = anaphylaxis (حساسية مفرطة) & erythema
AE = sedation, nausea, respiratory/ circulatory depression
Prep resuscitation equip
Risk for substance abuse
Seizure
Seizure = initiated by synchronous high frequency discharge from a group of hyper excitable neurons called focus
May be single event
May be chronic, recurrent pattern = called epilepsy
Convulsion
Convulsion= tonic=clonic type of seizure characterized by spasmodic contractions of involuntary muscles
Focus =
Focus = seizure
Focus = a group of hyper excitable neurons
Focus may result from =
Congenital defects
Hypoxia at birth
Head trauma
Brain infection
Stoke
Cancer
Genetic disorder
Seizure classification
Partial (Focal)= simple partial & complex partial
Generalized = Tonic-Clonic Absence (petit Mal) Atonic Myoclonic (muscle Twitching) Febrile (اهتياج)
Partial seizure
1) partial seizure = simple & complex
2)begin in a specific area of brain
3) caused by brain lesion, brain injury, trauma, stroke, tumor
4) symptoms can be simple & sensory effect
OR more complex & abnormal movements & bizarre behavior
5) Movements = automatic repetitive inappropriate to situation
partial seizure = simple & complex consciousness?
Simple = consciousness is Not impaired
Complex = Level of consciousness is decreased
Partial Seizure Movements
1) Automatic
2) Repetitive
3) Inappropriate to the situation
*Chewing, swallowing
*Adverse movements
Generalized
*Bilateral
*Symmetric
*No discernible point of origin in the brain
*Most common = Tonic-Clonic (major motor seizure & w/ aura)
Generalized =tonic & clonic
*Tonic-clonic
Tonic= sustained muscle contraction (انقباض الجسم)
Clonic= rapid rhythmic & symmetric jerking (اهتزاز مع انبساط الجسم)
Generalized = absence seizure
Absence = alteration in consciousness that lasts only a few seconds
Generalized = Myoclonic seizure
Contraction of muscle or group of muscles
Generalized = Akinetic
Akinetic = absence of movement
Seizure classification = status epilepticus (حالة صرعية)
Tonic & clonic
Last for minutes
*hypotension Hypoxia Cardiac dysrhythmias
*causes: stopping AEDs, brain trauma/tumors Systemic/CNS infection alcohol withdrawal/drug overdose
Anti-epileptic Drugs Effects
Effects:
*suppress discharge of neurons within a seizure focus
*suppress propagation of seizure activity from the focus to other areas of brain
Anti-epileptic Drugs MOA
Suppress of sodium influx
Suppress of calcium influx
Antagonism of glutamate
Potentiation of GABA
Antiepileptic
Phenytoin = inhibit sodium channels
Phenobarbital = inhibit the conduction of impulses= depress CNS & cerebral cortex & cerebellar funct
Carbamazepine = suppress high frequency neuro discharge & around seizure foci
Valproic acid = increase GABA effects = decrease electrical activity
Ethosuximide = suppress neurons in thalamus (responsible for generating absence seizure)
Gabapentin & Pregabalin
gaba = use for neuro pain
Name 3 Anti-epileptic Drugs = caution ⚠️ & use
High Voltage ⚡️⚡️⚡️
Use = management of tonic- clonic & partial seizure activity
Drugs= phenytoin. = selective inhibitor of sodium channels
carbamazepine = suppress high frequency neuro discharge
Valproic acid = block sodium & it’s channels to prevent neuron firing
Anti-epileptic Drugs = watch for ⚠️ ? What cause treatment failure?
High Voltage ⚡️⚡️⚡️
What for ⚠️ = Dilantin: gingival hyperplasia, bradycardia, rash
Tegretol: visual problems, leukemia, anemia, thrombocytopenia
Valproic acid: GI upset, hepatotoxicity, pancreatitis
Noncompliance = responsible for treatment failure
Phenytoin Warning ⚠️⚠️
Do NOT give to pregnant women (birth defects)
Do NOT abruptly withdraw (will trigger seizure)
Phenytoin MOA, USE, CONSIDERATION, INTERACTIONS
MOA = inhibition of sodium channels
Use = tonic-clonic seizure & partial seizure
AE = gingival hyperplasia, Steven Johnson syndrome
CONSIDERATION = therapeutic level = 10 - 20 mcl/mL & patient education, teratogenic, withdrawal trigger seizure
INTERACTIONS = warfarin, oral contraceptives/ 📉increase affect w/ diazapam, alcohol, Valproic acid
Barbiturates = *phenobarbital = MOA, USE, CONSIDERATION, INTERACTIONS
MOA = inhibit conduction of impulses
USE = sedative & antiepileptic = p & gen tonic clonic seizures
AE = CNA depression, sedation, drowsiness, congestive impairment
= children = irritability & hyperactivity
CONSIDERATION = teratogenic & withdrawal
Carbamazepine => MOA, USE, CONSIDERATION, INTERACTIONS
MOA => suppress high frequency
Use => epilepsy, bipolar disorder, trigeminal neuralgia
A/E => neurological effects = nystagmus & ataxia
BBW=> DECREASE ⬇️ blood cell production ( aplastic anemia & agranulocytosis)
=> Teratogenic = birth defects
Derma=> Rash & photosensitivity reactions & SJS (Steven Johnson syndrome)
Ethosuximide => USE MOA & A/E
Use => drug choice for absence seizure
MOA = suppress neurons in thalamus
A/E => hematologic effects = anemia, leukopenia. & anorexia or weight loss
Gabapintin & pregablin USE?
Used for neuro pain
Causes of drug therapy failure? *5
Non compliance, inadequate drug dose
Incorrect diagnosis or med for seizure type
Too frequent changes or premature withdrawal
Drug overdose, use of alcohol or recreational drugs
Severe electrolyte imbalance
Management of generalized convulsive status epilepticus?
- cont series of tonic clonic 20 to 30 min
Goals = maintain ventilation & correct hypoglycemia
Terminate seizure = benzodiazepine lorazepam = first line management
= diazepam if lorazepam isn’t available
Long term suppression = phenytoin (oin)
