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Anes. Pharm. Me > Subarachnoid Hemmorhage Dr. B > Flashcards

Subarachnoid Hemmorhage Dr. B Flashcards

2
Q

where do cerebral aneurysms usually occur?

A

most are anterior near bifurcation of vessels

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3
Q

Subarachnoid Hemmorhage

What are symptoms of cerebral aneurysm?

A

“worst headache of their life”

syncopal episode

nausea/vomiting

neck pain

photophobia

focal deficits

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4
Q

Subarachnoid Hemmorhage

Should you defer to Vancomycin because of a mild or distant reaction?

A

Rash reactions do not prevent use of cephalosporins perioperatively deferment is not recommended at 1/10 test dose is reasonable for documentation but be aware it will not always give an immediate reation

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5
Q

Subarachnoid Hemmorhage

What products are used to formulate propofol? what was it originally formulated with?

A

Originally formulated with Creamophor- a surfactant associated with severe anaphylactic reactionPropofol is currently formulated with egg lecithin and soybean oil.

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6
Q

Subarachnoid Hemmorhage

Why is there a rather small chance of egg allergy with propofol?

A

The egg in propofol is phoshatide extrated from the yolk to reduce allergenicity. most egg allergic people react to albumin. Propofol allergy is often attributed to diisopropyl sided chain or phenol group

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7
Q

Subarachnoid Hemmorhage

What is the purpose of taking 81mg aspirin q day?

A

vascular anticoagulation. Inhibits platelet aggregation and provides a cardio-protective effect

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8
Q

Subarachnoid Hemmorhage

What kind of drug is Valsartan?

A

Blood pressure control

Angiotensin II receptor antagonists

a member of the Renin-agiotensin system inhibitors

These are same class but different mechanism as ACE inhibitors

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9
Q

Subarachnoid Hemmorhage

Should AM dose of ACE inhibitor be taken prior to surgery?

A

not if HTN is well controlled

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10
Q

Subarachnoid Hemmorhage

What is Lorcet (Lortab, vicodin)

A

Pain medication consisting of Hydrocodone, a modified morphine (5-10mg) combined with Acetominiphen

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11
Q

Subarachnoid Hemmorhage

Waht is the class, use and example of dose for napoxen?

A

NSAID used for pain/inflammation

dose is 250mg q 4day or 500mg q 2day

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12
Q

Subarachnoid Hemmorhage

What is Novolin-

A

REcombinant engineered human insulin used to treat diabetes. supplined as 100units/ml

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13
Q

Subarachnoid Hemmorhage

Waht is metformin and how does it work?

A

Biguanide class hypoglycemic drug.it works to decrease glucose levels.decreases hepatic glucose productionincreses insulin action on muscle and fatIs used primarily in Type II diabetes

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14
Q

Subarachnoid Hemmorhage

What are containdications for metformin?

A

renal impairmenthistory of lactic acidosishepatic diseasecardiac failure

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15
Q

Subarachnoid Hemmorhage

What type of drug is Nimodipine? how is it used?

A

Calcium channel blocker used for angina, cardiac dysrythmias. often combined with other medications for treatment of patients with heart disease and HTN

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16
Q

Subarachnoid Hemmorhage

What are the effects fo calcium channel blockers?

A

Decrease systemic BP

Increase coronary blood flow

delaying of A-V conduction

decrease HR

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17
Q

Subarachnoid Hemmorhage

What is simvastatin (Zocor) used for?

A

treatment of dyslipidemia

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18
Q

Subarachnoid Hemmorhage

what are the indications for nimodipine?

A

for use in patients for improvement of neurological outcome where deficits secondary to vasospasm after cerebral aneurysm ruptureAlso indicated for vasospasm after cerebral aneurysm coiling

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19
Q

Subarachnoid Hemmorhage

What is the indication for vicodin?

A

moderate to moderately severe pain

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20
Q

Subarachnoid Hemmorhage

what are warning for vicodin?

A

REspiratory depressionincreased ICP

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21
Q

Subarachnoid Hemmorhage

how can vicodin lead to increased ICP?

A

CO2 building up for hypoventilation is a vasodilator which will increase ICP

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22
Q

Subarachnoid Hemmorhage

What is colace (docusate sodium)?

A

anionic surfactant which lowers the surface tension of stool, allowing easier defacation

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23
Q

Subarachnoid Hemmorhage

What is pepcid (famotidine) used for and how does it work?

A

Used to treate GERD and gastric and duodenal ulcersIt is an Histamine H2 receptor blockerInhibits gastric acid production70% reduction in acid secretionMost effective on basal acid secretion which is responsible for nocturnal acid secretion

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24
Q

Subarachnoid Hemmorhage

what are other drugs in pepsids class?

A

tagamet (cimetidine), Zantac (Ranitidine), Axid (Nizatidine)

25
Q

Subarachnoid Hemmorhage

Surgical mortality rates in the diabetic population is __ times higher than the non-diabetic population when end organ dysfunction extists.

A

5

26
Q

Subarachnoid Hemmorhage

What is the pathophysiology of diabetes mellitus?

A

Pancreatic Beta cells either do not produce insulin or not enough

27
Q

Subarachnoid Hemmorhage

This DM is an autoimmune disease that affects young nonobese patients.

A

Type I

28
Q

Subarachnoid Hemmorhage

DM with low or nonmeasurable insulin levels

A

Type I

29
Q

Subarachnoid Hemmorhage

90% (18 million) of all diabetics are this type,

A

Type II

30
Q

Subarachnoid Hemmorhage

This type of DM is susceptible to keto acidosis

A

Type I

31
Q

Subarachnoid Hemmorhage

How is type II diabetes diagnosed?

A

Fasting blood glucose > 125 mg/dlNormal plasma insulin levels or elevated but low for glucose level, A1c levesl, urine ketones

32
Q

Subarachnoid Hemmorhage

how do sulfonylureas and Repaglinide treat DM?

A

Stimulate insulin release

33
Q

Subarachnoid Hemmorhage

How does metformin treat DM?

A

Decreases hepatic glucose production and by increasing nsulin action in muscle and fat mass

34
Q

Subarachnoid Hemmorhage

What are concerns with DM and surgical wounds?

A

Wound healing-Granulocytic function and collagen synthesis are suppressed with glucose levels above 200 mg/dlWound infection–prevelance fo vacular and renal disease in diabetics contributes to higher rate of infection

35
Q

Subarachnoid Hemmorhage

What are the goals of Perioperative management of a DM patient?

A

Prevent ketoacidosis (hyperglycemia)

36
Q

Subarachnoid Hemmorhage

Diabetics should be the ___ case of the day

A

first

37
Q

Subarachnoid Hemmorhage

What is the greatest concern with diabetics. how is it treated?

A

Hypoglycemiaglucose <50mg/dl must be treated with 50% dextrose, starting with a 15ml bolus

38
Q

Subarachnoid Hemmorhage

What should be done before insulin infusion is started?

A

first 50 ml discardedSeparate IV started for insulin and glucose infusions

39
Q

Subarachnoid Hemmorhage

What are starting rates for insulin and D5W/.45NS with 20 meq of KCl?

A

Insulin at 1 units/hr and D5W at 100 cc/hr

40
Q

Subarachnoid Hemmorhage

When should glucose be checked in DM pt receiving infulsion?

A

every 1-2hours before surgery, every hour during

41
Q

Subarachnoid Hemmorhage

how is an insulin infusion titrated?

A

Aim for blood glucose 100-200 mg/dL by adjusting insulin infusion rate in 0.5 unit/hr

42
Q

Subarachnoid Hemmorhage

how is glucose checked intraoperatively?

A

Accucheck, arterial or venous

43
Q

Subarachnoid Hemmorhage

What are causes of asthma?

A

inhaled allergens-dust, animal dander, industrial pollutantsstressAirway instrumentationREcurrent pulmonary infections

44
Q

Subarachnoid Hemmorhage

What is the physiologic response of asthma?

A

Mast cell release fo Histamine

45
Q

Subarachnoid Hemmorhage

What is the pathology of Asthma?

A

Bronchoconstriction or SpasmAiway infllamation

46
Q

Subarachnoid Hemmorhage

What size aerosols make it to the alveolar level?

A

0.5um

47
Q

Subarachnoid Hemmorhage

What is the advantage of a nebulizer for use in the pediatric patient?

A

Does not require hand-breathing coordination like an MDI does

48
Q

Subarachnoid Hemmorhage

What is the onset and duration of short acting beta-2 agonists?

A

onset-1-5 minutes

duration 2-6 hours

49
Q

Subarachnoid Hemmorhage

can long acting Beta 2 agonists be used for perioperative prophylaxis?

A

NO, also not to treat an acute attack

50
Q

Subarachnoid Hemmorhage

What is the onset and duration of Long acting beta 2 agonists? Give 2 examples.

A

Onset > 20 minutesduration 12 hoursexamples: salmeterol, formoterol

51
Q

Subarachnoid Hemmorhage

how do steroids work to treat asthma?

A

Not categorized as bronchodilators, but do have that effect by decreasing mucosal edema and preventing the release of bronchoconstricting substances

52
Q

Subarachnoid Hemmorhage

How can steroids be administered for asthma?

A

Oral or aerosolized

53
Q

Subarachnoid Hemmorhage

How do accolate or singulair treat asthma

A

leukotriene receptor antagonistleukotriens 1000x more potent brochoconstrictors than histamine

54
Q

Subarachnoid Hemmorhage

How does Xolair treat asthma?

A

Anti-IgE therapyREcombinant humanized monoclonal antibody targeting IgE receptors on mast cells, thus preventing bronchoconstriction

55
Q

Subarachnoid Hemmorhage

How does theophylline treat Asthma?

A

theophylline is a methylxanthine that acts as a phosphodiesterase inhibitor–prevents the breakdown of cAMP

56
Q

Subarachnoid Hemmorhage

What are anesthetic considerations for cerebral aneurism coiling?

A
  1. Immobility–general anesthesia with neuromusclular blockade2. Hemodynamic stability–Direct arterial monitoring is needed to maintain cerebral perfusiona nd prevent aneurysm rupture3. Anticoagulation-heparin4. Rapid emergence for neurologic assessment
57
Q

Subarachnoid Hemmorhage

What are possible complications of aneurysm coiling?

A
  1. Aneurysm rupture with hemorrhage2. Thromboembolism3. Vasospasm

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