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Pharm 3 (me) > Neuroaneesthesia > Flashcards

Neuroaneesthesia Flashcards

1
Q

What 6 things are used to lower ICP?

A 
Mannitol 
Hypertonic saline (3%)
Furosemide 
Corticosteroids 
Barbiturates 
Propofol
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2
Q

How do IV hyperosmotic drugs work?

A

Produce transient increase in osmolality of plasma; draws water from tissues into plasma and eliminated renally

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3
Q

What are the 2 secondary effects of IV hyperosmotic drugs?

A

Diuretics and reduction

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4
Q

3 adverse effects of mannitol?

A

Hyper osmolality, hyponatremia, hypokalemia

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5
Q

How fast does mannitol work?

A

Rapidly

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6
Q

Dose of mannitol?

A

.25g-.5g/kg

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7
Q

Goal serum osmolality for mannitol?

A

300-315 mOsm/L

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8
Q

What serium should you stop mannitol?

A

320

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9
Q

When can you get a rebound increase in ICP with mannitol?

A

Larger initial dose

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10
Q

What 3 cautions are taken with mannitol?

A

Intact BBB
LV dysfunction/poor cardiac reserve/HF
Aneurysms/arteriovenous malformations/intracranial hemorrhage

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11
Q

How should hypertonic saline be administered?

A

Central venous catheter

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12
Q

Target serum Na and serum osmolarity?

A

Na: 145-155
Osm: <320

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13
Q

Is hypertonic saline a higher risk than mannitol?

A

YES

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14
Q

How is the efficacy of furosemide compared to mannitol and hypertonic saline?

A

Significantly less

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15
Q

When is furosemide useful?

A

Increased IV volume; pulmonary edema

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16
Q

Is furosemide used to aid tolerance of mannitol or hypertonic solution?

A

YES

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17
Q

When are corticosteroids effective?

A

Lowering ICP caused by localized vasogenic edema (brain tumor or craniotomy)

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18
Q

When using corticosteroids, what should be monitored and why?

A

Blood glucose because may cause hyperglycemia needing insulin

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19
Q

Barbiturates in what kind of doses an lower ICP after acute head injury?

A

High doses

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20
Q

When should propofol be taken in caution?

A

Peds

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21
Q

When should propofol be avoided?

A

High anion-gap metabolic acidosis

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22
Q

Should you continue therapies for cerebral edema or increased ICP for preop management?

A

YES

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23
Q

Why should you use sedative and opioids sparingly?

A

Can leads to not breathing=hypoventilation=hypercarbia=increase ICP

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24
Q

2 things needed for induction of anesthesia for brain tumor?

A

Propofol (or barbiturate)

Non depolarizing muscle relaxant

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25
Q

You should use NMB to prevent straining, bucking, movement except when?

A

Neuro physiological monitoring needed

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26
Q

What kind of solution should be avoided for cranial tumor surgery?

A

Dextrose

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27
Q

What 4 things can be given to attenuate skull pinning?

A

Opioid (fent or remi)
Propofol
Esmolol
Lidocaine

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28
Q

When should you give opioid and esmolol before pinning?

A

1 min

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29
Q

Does brain tissue have pain receptors?

A

NO

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30
Q

Which drug activates seizure foci for induction?

A

Methohexital

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31
Q

What 2 drugs do you want to avoid for induction?

A

Etomidate and ketamine

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32
Q

3 NMB, non-histamine release agents used for induction for craniotomy

A

Roc, vec, cisatracurium

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33
Q

If ICP is a concern for craniotomy, what should be added when using sux for rapid sequence induction?

A

Defasciculating dose of non depolarizing agents

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34
Q

Which maintenance is preferred if ICP is elevated for craniotomy?

A

IV technique (propofol, opioids, dexmedetomidine)

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35
Q

Which opioid should be avoided due to histamine release?

A

Morphine

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36
Q

Should you keep pt paralyzed while skull pins are in place?

A

Yes

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37
Q

TOF peripheral nerve stimulator to guide depth, deep for skull pins?

A

1-2 twitches

38
Q

CPP equation?

A

MAP - ICP (CVP)

39
Q

Goal CPP?

A

65-80 mmHg

40
Q

Normal ICP?

A

5-10 mmHg

41
Q

Normal MAP?

A

75-90 mmHg

42
Q

For craniotomy, if hypovolemia and hypotensive what kind of colloid should be used and should be avoided?

A

Used: albumin
Avoid: starch

43
Q

BG target range for craniotomy?

A

110-150, and treat >180

44
Q

When should you gibe antiemetic for craniotomy?

A

1 hr prior to emergence (zofran)

45
Q

Should you give long acting opioids for emergence of craniotomy, like hydromorphone?

A

NO

46
Q

BP control for emergence of craniotomy?

A

SBP <160 but avoid hypotension

47
Q

Emergence BP meds for craniotomy (3)?

A

Labetalol
Esmolol
Nicardipine

48
Q

Does esmolol need continuous infusion otherwise rebound HTN?

A

YES

49
Q

Hypotensive management due to neurogenic shock for organ retrieval (3):

A
  1. Fluid resuscitation without causing hypervolemia
  2. Avoid vasoconstrictors
  3. Inotrope preferred (dobutamine, dopamine, then epi at low dose)
50
Q

Organ retrieval DM leads to hypovolemia, how to do you treat? (2)

A

Hypotonic solution

Inotropic support with vasopressin

51
Q

For acute ischemic stroke, antiHTN only necessary when?

A

BP > 220/120 (labetalol or infusion of esmolol and clevidipine)

52
Q

Transient alteration of behavior due to disordered, synchronous, and rhythmic firing of populations of brain neurons (provoked or unprovoked)

A

Seizure

53
Q

Disorder of brain function with periodic and unpredictable occurrence of seizures

A

Epilepsy

54
Q

3 drugs for seizures:

A

Antiepileptic drugs (AEDs)
Anti seizure drugs
Anticonvulsants

55
Q

One area of brain seizure:

A

Focal seizure

56
Q

Both hemispheres seizure of brain:

A

Generalized seizure

57
Q

Antiseizure general mechanisms of ions:

A

Modulation of Na, K, Ca channels

  • prolonged of inactivated state of voltage gated Na channels
  • positive modulation of K channels
  • inhibition of Ca channels
58
Q

Anti seizure general mechanism of GABA:

A

Enhancement of GABA transmission through actions on GABA receptors, modulation of GABA metabolism, inhibition of GABA reuptake

59
Q

How do most antiseizure drugs metabolize?

A

Hepatic metabolism before undergoing renal elimination

60
Q

Which drugs are exception of live metabolism and rely only on renal elimination?

A

Gabapentin

Levetiracetam

61
Q

Do gabapentin and levetiracetam have other drug interactions?

A

NO

62
Q

CYP enzyme induction agents for antiseizure?

A

Phenytoin, carbamazepine, phenobarbital

63
Q

Do phenytoin, carbamazepine, and phenobarbital alter rate of metabolism of other drugs?

A

YES

64
Q

Pts receiving chronic treatment with certain anticonvulsants are relatively resistant to what due to accelerated clearance of these drugs?

A

Non depolarizing NMBs

65
Q

Which 2 drugs shorten duration of action of NMB?

A

Carbamazepine and phenytoin

66
Q

Do you continue antiseizure meds periop?

A

YES

67
Q

What are 3 parenteral agents of antiseizure meds?

A

Levetiracetam, phenytoin and fosphenytoin

68
Q

If new seizure, need to determine cause and not assume anesthetic adverse effect; what could be the cause?

A

LA

69
Q

What can have both proconvulsant and anticonvulsant effects?

A

Methohexital and etomidate can activate epileptic foci

70
Q

What can cause epileptiform EEG activity in pts without epilepsy, but can also suppress such activity (5)

A 
Alfentanil 
Ketamine 
Enflurane 
Iso 
Sevo
71
Q

This of large doses or pts with renal insufficiency an cause seizures?

A

Meperidine

72
Q

Proconvulsant metabolite of atracurium and cisatracurium:

A

Laudanosine

73
Q

This metabolite derangements can cause periop seizures?

A

Hyponatremia, hypocalcemia, sepsis, hypoglycemia

74
Q

4 commonly used drugs for acute seizure management:

A

Fosphenytoin
Levetiracetam
Valproate acid
Propofol

75
Q

What acute seizure drug is a parent drug and rarely used due to hypotension, asystole, widened QRS and prolonged QT, arrhythmia, and CANNOT be given IM

A

Phenytoin

76
Q

Acute seizure management drug that is water soluble prodrug for IV or IM and doses expressed as phenytoin equivalents?

A

Fosphenytoin

77
Q

After how long is it less likely to spontaneously terminate?

A

5min

78
Q

What is more likely to cause neuronal damage and is continuous or intermittent for more than 5 min without recovery or consciousness?

A

Status epilepticus

79
Q

What should be considered for status epilepticus?

A

Intubation

80
Q

1 and 2 drugs for managing status epilepticus:

A

1: benzodiazepine
2: antiseizure drug

81
Q

First and second choice of benzodiazepines?

A

1: diazepam
2: lorazepam

82
Q

Which is short lived anti seizure action but need to add anticonvulsant?

A

Benzodiazepines

83
Q

Which benzodiazepines is longer antiseizure duration of action?

A

Lorazepam

84
Q

Which sedation is used to avoid epileptiform activity?m (3)

A
  1. Thiopental
  2. Opioids
  3. Benzodiazepines
85
Q

Which anesthesia maintenance is used to avoid epileptiform activity? (4)

A

ISO, des, sevo, propofol

86
Q

For pts under GA and muscle relaxation, how do you know one manifests and what do you do?

A
  • abrupt changes in HR and BP

- add or increase doses of propofol, barbiturate, benzodiazepines

87
Q

Agents that suppress epileptic activity (4)

A

Benzodiazepines
Volatile agents
Barbiturates
Propofol

88
Q

Agents to use during electrocorticography to isolate epileptic foci (5)

A 
Opioids 
Nitrous oxide 
Droperidol 
Diphenhydramine 
Dexmedetomidine
89
Q

Agents to enhance epileptiform activity (3)

A

High dose short acting opioids
Methohexital
Etomidate

90
Q

4 complications of seizures:

A

Musculoskeletal injury
Hypoventilation
Hypoxemia
Aspiration

91
Q

Drugs that may be epileptogenic (3)

A
  1. Ketamine, enflurane, etomidate
  2. Methohexital (paradoxical small doses)
  3. Metabolites - meperidine, atracurium

Pharm 3 (me) (7 decks)

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