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DNURS 836 Advanced Pharmacology for Anesthesia II > Neuropsychiatric Meds - Quiz 8 > Flashcards

Neuropsychiatric Meds - Quiz 8 Flashcards

1
Q

What should be done in the first 5 minutes of a seizure?

A

Rule out everything else

ABC’s

Check Blood Sugar & Labs

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2
Q

What should be done in the First Phase (5-20 min) of a Seizure?

A

Give any Benzo

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3
Q

What should be given in the Second Phase (20-40 min) of a Seizure?

A

Fosphenytoin

Valproic Acid

Keppra

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4
Q

What should be done in the Third Phase (40-60 min) of a Seizure?

A

Repeat any Second Line Therapy

or

Anesthetic Dose of Thiopental, Propofol, Versed, or Pentobarbital

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5
Q

How do Calcium Channel Blockers work as Anticonvulsants?

A

Blocks T-Type Ca Channels in Thalamus

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6
Q

What is a major consideration with using Carbamazepine & Oxacarbazepine?

A

Drug Interaction - CYP inducers that reduces their own affects along with Versed & Propofol

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7
Q

What electrolyte should be checked when using the -azepines?

A

Sodium Level - risk for Hyponatremia

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8
Q

What are common side effects of -azepines?

A

Dizziness

PONV

Sedation

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9
Q

Why was Oxcarbazepine created?

A

Prevent Auto-Induction of Carbamazepine

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10
Q

How does Oxcarbazepine compare to Carbamazepine?

A

Same Side Effects, but LESS Drug Interactions & Better tolerated

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11
Q

What is different about the Pharmacokinetics of Phenytoin?

A

Non-Linear

Need much smaller dose adjustments

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12
Q

Why was Fosphenytoin created?

A

Prodrug for IV Administration

Can be given Safer & Faster

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13
Q

What are the Side Effects of Phenytoin?

A

Gingival Hyperplasia

Nystagmus

Vitamin K Deficiency

Arrhythmias

Hypotension

Osteoporosis

Bleeding

Ataxia

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14
Q

What can Phenytoin cause in Pregnancy?

A

Cleft Palate & Lip

Slowed Growth

Mental Deficiency

Congenital Heart Disease

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15
Q

What is the Advantage & Disadvantage of using Lamotrigine?

A

Autoinducer, but very LOW drug interactions, except when given with Valproic Acid

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16
Q

What happens if Lamotrigine is given with Valproic Acid?

A

Steven-Johnson Syndrome

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17
Q

What is the main concern with Zonisamide?

A

Increased risk for Kidney Stones

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18
Q

What is the advantage of using Locosamide?

A

Less Side Effects, Drug Interactions, and No CYP effects

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19
Q

What is the ONLY indications for Clobazam (Onfi)

A

Seizures

HIGH RISK for Withdrawal

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20
Q

Which Benzo has the longest duration?

A

Diazepam & Clonazepam d/t High Lipophilicity

Higher Lipophilicity = Faster Onset

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21
Q

What is the biggest risk associated with Vigabatrin?

A

Permanent Vision Loss

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22
Q

What is the advantage of using Gabapentin?

A

Neuropathy Pain Control

Not Protein Bound

No Drug Interactions

Excreted Unchanged

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23
Q

What is the biggest concern with Gabapentin?

A

Post-Op Sedation

Severe Respiratory Distress when given with Opiates

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24
Q

What is Pregablin used for?

A

Neuropathy

Seizure

Anxiety

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25
Q

How does Pregablin compare to Gabapentin?

A

Similar, but risk for Ataxia

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26
Q

What pregnancy category risk does Valproic Acid have?

A

Category D - X

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27
Q

What are the main concerns related to Valproic Acid?

A

Thrombocytopenia

↑Ammonia

Liver Toxicity

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28
Q

Which Anti-Seizure meds are Glutamate Blockers?

A

Felbamate

Topiramate

Perampanel

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29
Q

How does Topiramate work?

A

Inhibits Sodium, AMPA, and Carbonic Anhydrase

&

Enchances GABA

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30
Q

What are the main concerns with using Topiramate?

A

Psychomotor Slowing

Depression

Agitation

Loss of Appetite

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31
Q

What is the Black Box warning for Perampanel?

A

Life-Threatening Behavioral Effects

Agression

Hostility

Homicidal

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32
Q

What are the main side effects of Perampanel?

A

Dizziness & Threats

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33
Q

How does Levetiracetam work?

A

Inhibits Calcium via SV2A Protein to reduce Hyperexcitability

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34
Q

What are the advantages with using Levetiracetam?

A

No Protein Binding

Short Half-Life

No Drug Interactions

35
Q

What are the side effects of Levetiracetam

A

General Anti-Seizure Side Effects

Accidental Injury

Convulsions

Cognitive Impairment

36
Q

How does Baclofen work?

A

Hyperpolarization to reduce Calcium, Glutamate, Motor Neuron Activity

↑Potassium Conduction

Blocks Substance P

37
Q

What happens when Baclofen is abruptly stopped?

A

Severe Withdrawal

Hallucinations

Agitation

Seizures

38
Q

How does Tizanidine work as a Skeletal Muscle Relaxant?

A

Alpha-2 Agonist w/ Anti-Cholinergic Effects

39
Q

How does Dantrolene work as a Skeletal Muscle Relaxant?

A

Blocks Ryanodine to reduce Calcium from Sarcoplasmic Reticulum

40
Q

What is the Black Box warning for using more than 800 mg/day of Dantrolene?

A

Diarrhea

&
Liver Toxicity

41
Q

What are the main concerns with using Skeletal Muscle Relaxants?

A

Oversedation

&

Withdrawal

42
Q

Which drugs are Sedative Hypnotics?

A

Z-Drugs

Ramelteon

Suvorexant

Melatonin

Valerian Root

43
Q

What are the Disadvantages of using Sedative Hypnotics?

A

No Restorative / REM Sleep

&

Sleep Eating, Fighting, and Walking

44
Q

Which meds are SSRIs?

A

Citalopram

Fluoxetine

Paroxetine

Sertraline

Escitalopram

Fluvoxamine

45
Q

Which meds are Tricyclic Antidepressants?

A

Amitriptyline

Clomipramine

Desipramine

Doxepin

Imipramine

Nortriptyline

46
Q

How do Tricyclic Antidepressants work?

A

Inhibits Serotonin & Norepi Reuptake

Anticholinergic

1A Antiarrhythmic

47
Q

What are the adverse effects of Tricyclic Antidepressants?

A

Anticholinergic Effects

&

QT Prolongation & Arrhythmias

48
Q

What should be done for a Tricyclic Antidepressant overdose?

A

Give Sodium Bicarb to treat Acidosis

49
Q

Most Serotonin Receptors are ________, while some are _______

A

Most Serotonin Receptors are G-Coupled, while some are 5-HT3 Antogonist

50
Q

Which Serotonin Receptors are Inhibitory?

51
Q

What are the concerns with SSRIs?

A

Hyponatremia

Thrombocytopenia

Suicidality

Arrhythmias

Serotonin Syndrome

N/V

Weight Fluctuations

52
Q

What do Neuroleptic Malignant Syndrome & Serotonin Syndrome have in common?

A

HTN

Tachycardia

Tachypnea

Hyperthermia

Diphoresis

Hypersalivation

Mental Problems

Increased Muscle Tone

53
Q

What are the differences between Neuroleptic Malignant Syndrome & Serotonin Syndrome?

A

NMS:
HYPO-reflexia w/ Normal Pupils & Bowel Sounds

SS:
HYPER-reflexia & Clonus w/ Dilated Pupils & Hyperactive Bowels

54
Q

What causes Neuroleptic Malignant Syndrome and when is its onset?

A

Dopamine Antagonism

Happens in 1-3 days

55
Q

What causes Serotonin Syndrome & when is its onset?

A

Serotonergic Agents

Occurs in < 12 hrs

56
Q

Which meds are Serotonin Norepi Reuptake Inhibitors (SNRIs)?

A

Duloxetine

Venlafaxine

Desvenlafaxine

Levomilnacipran

57
Q

What are the Adverse Effects of SNRIs?

A

Serotonin Syndrome

Liver Toxicity

HTN

Insomnia

Tremor

58
Q

What kind of med is Bupropion?

A

Dopamine and Norepi Reuptake Inhibitor (DNRI)

59
Q

Which meds are 5HT2A Antagonists?

A

Mirtazepine

&

-azodone

60
Q

What are the concerns with 5HT2A Antagonists?

A

Highly Sedating

Increased Appetite

Severe Liver Damage

61
Q

What is Nuedexta used for?

A

Treats Pseudobulbar Affect - Inappropriate Laughing/Crying

62
Q

How does Nuedexta work?

A

Uses Quinidine to Increase Dextromethorphan to inhibit NMDA receptors

63
Q

What are the concerns with using Nuedexta?

A

QT Prolongation

Lupus

Thrombocytopenia

Anemia

64
Q

What does Lithium do?

A

Stabilizes Mood by altering Sodium Transport since it looks like Sodium

65
Q

What can occur w/ Lithium Toxicity?

A

DI

Tremors

Arrhythmias

Hypothyroidism

Syncope

Weight Gain

66
Q

What is associated w/ the Mesolimbic Dopamine Pathway?

A

Schizophrenia

&

Psychosis

67
Q

What is associated w/ the Mesocortical Dopamine Pathway?

A

Depression

&

Mood Disorders

68
Q

What is associated w/ the NigrostriatalDopamine Pathway?

A

Extrapyrimidal Symptoms

&

Tardive Dyskinesia

69
Q

What is associated w/ the Tuberohypophyseal Dopamine Pathway?

A

↑Prolactin

70
Q

How do Antipsychotics work?

A

S2/D2 Blockade

Anticholinergic

Antihistamine

Alpha-2 Blockade

71
Q

What is the Black Box warning for Antipsychotics?

A

Dementia related Death

&

Agranulocytosis (Clozaril)

72
Q

Patients with Parkinsons have a deficiency in __________

A

Patients with Parkinsons have a deficiency in DOPAMINE

73
Q

Which meds are Dopamine Analogs?

A

Carbidopa/Levodopa/Entacapone

74
Q

How does Carbidopa/Levodopa/Entacapone work?

A

Carbidopa: False Dopamine

Levodopa: Dopamine Precursor

Entacapone: Blocks COMT

75
Q

What are the adverse effects of Dopamine Analogs?

A

Psychosis

Hallucinations

Hypotension

Syncope

GIB

76
Q

Which meds are Dopamine Agonists?

A

Pramipexole

Ropinirole

Rotigotine

Bromcriptine

Apomorphine

77
Q

Which Anticholinergics are used for Parkinsons?

A

Benztropine

&

Triheyxphenidyl

78
Q

Which MAOB Inhibitors are used for Parkinsons?

A

Rasaligine

&

Selegiline

79
Q

Which Alzheimer’s meds are Acetylcholinesterase Inhibitors?

A

Donepezil

Galantamine

Rivastigmine

80
Q

Which Alzheimer’s meds is a NMDA Antagonist?

81
Q

When can Post-Op Delirium & Cognitive Impairment occur?

A

Up to 1 Year Post-Op

82
Q

What is the best strategy to prevent Post-Op Delirium?

A

Avoid Opioids, Benzos, Hypnotics, etc..

83
Q

What was found in the 2018 STRIDE Trial regarding Post-Op Delirium?

A

Limiting Sedation Levels provide NO SIGNIFICANT benefit

84
Q

How should Post-Op Delirium be managed?

A

Use 1x LOW dose Antipsychotics ONLY IF patient is at risk for harming self or others

Benzos worsen Delirium

DNURS 836 Advanced Pharmacology for Anesthesia II (12 decks)

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