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Brandon’s AFN Health Assessment > test 3 part 8 > Flashcards

test 3 part 8 Flashcards

1
Q

what are some causes of reversible dementiaq

A

medications
alcohol
metabolic d/o
depression
CNS neoplasms

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2
Q

treatment options for dementia

A

cholinesterase inhibitors
NMDA antagonist: memantine
MAOIs
SSRIs
vitamin E and ginko biloba

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3
Q

if a pt with dementia is being treated with a cholinesterase inhibitor; what do you need be aware of from an anesthesia standpoint

A

cholinesterase inhibitors may prolong succinylcholine

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4
Q

what drugs are affiliated with increased development of postop delirium ?

A

benzodiazepines
antihistamines
anticholinergics

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5
Q

risk factors of postop delirium

A
  1. renal insuff/metabolic derangements
  2. poorly controlled pain
  3. polypharmacy (psychoactive drugs)
  4. functional impairment
  5. urinary retention and prescence of urinary catheter
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6
Q

anesthesia implications of dementia

A
  1. determine level of cognitive dysfunction
  2. increased risk of aspiration
  3. increased risk for Postop delirium
  4. multimodal pain management
  5. caution with use of benzos, antihistamines, and anticholinergics
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7
Q

parkinsons disease is a neurodegenerative d/o of the CNS d/t __________________________

A

loss of dopamine containing neurons from the pars compacta of the substantia nigra with lewy bodies

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8
Q

loss of dopamine in parkinsons dz causes what

A
  1. unopposed acetylcholine action: bradykinesia, rigidity, tremor, postural instability
  2. autonomic dysfunction : orthostatic hypotn, poor tem control, urinary retention, salivation, delayed gastric emptying
  3. high incidence of dysphagia
  4. dementia
  5. depression
  6. immobility and falls
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9
Q

what is the most frequently reported cause of death reported in a pt with parkinsons

A

pneumonia

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10
Q

there is no cure for parkinsons, however some meds/tx are given for symptom relief and quality of life, what are they?

A
  1. dopamine prodrug: levodopa/carbidopa
  2. dopamine agonists
  3. selective MAOIs and anticholinergics
  4. surgery: Deep brain stimulator
  5. rehab
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11
Q

what is the current mainstay of surgical tx in a patient with parkinsons?

A

deep brain stimulator

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12
Q

when would a dopamine agonist be the first line drug of choice in a patient with parkinsons?

A

if they are < 55 y/o

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13
Q

____________ is a dopamine precursor that is used in the intial tx of parkinsons

A

levodopa

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14
Q

__________________ inhibits the activity of the decarboxylating enzyme that is present with parkinsons

A

carbidopa

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15
Q

T/F: effectiveness of levodopa decreases as the dz progresses

A

true

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16
Q

if patient presents for 1pm surgery with parkinsons and they state they took their levodopa at 8 am, you know this drug has a half life of ____________, thus you could have issues with ___________________ intraop

A

6-12; ventilation (due to med wearing off and msucle rigidity ensuing)

17
Q

if pt is on levodopa you may want to place ________________ due to autonomic instability and 6-12 hour half life of drug

A

invasive hemodynamic monitoring

18
Q

pt with parkinsons presents for surgery; you know from there hx they have a deep brain stimulator. Wht should be done peroperatively?

A

it should be shut off because cautery can damage

19
Q

which cautery is preferred if pt has deep brain stimulator

A

bipolar

20
Q

if you have to use a unipolar cautery in a pt with deep brain stimulator, even though it is turned off what other protective actions should be taken?

A

unipolar cautery should be set to lowest possible setting on low voltage mode with grounding pad as far away as possible from the components of the stimulator

21
Q

deep brain stimulators can be damaged from _______________ and _________ thus should be turned off prior to

A

electrocaudery; MRI

22
Q

preanesthesia considerations with parkinsons

A
  1. assess and document severity of disease
  2. do they have pulmonary compromise/dysphagia?
  3. parkinsons meds should be continued DOS
  4. avoid prolonged fasting and dehydration
23
Q

if pt is on dopamine agonist for parkinsons, you know they can increase the risk of ?

A
  1. neuroleptic malignant syndrome
  2. fever
  3. altered mental status
  4. muscle rigidity
  5. autonomic dysfunction
24
Q

what are the most common type of intracranial tumors?

A

metastatic

25
Q

clinical features of intracranial tumors

A
  1. increased ICP
  2. cerebral edema (vasogenic or cytotoxic)
  3. autonomic dysfunction
  4. cushings triad
26
Q

if pt has an intracranial tumor; you know they may be prescribed dexmethasone for what?

A

reduce vasogenic edema

27
Q

anesthesia considerations with intracranial tumor

A
  1. hx of presenting sx and previous therapies
  2. baseline ECG, CBC, BMP, and T&C
  3. review team goals (monitoring, post op expectations, Abx and antiepileptic selections)
28
Q

_______________ results in subarachnoid hemorrhage where pt c/o the worst headache of their life

A

rupture aneurysm

29
Q

aneurysms have an increased risk of rupture during __________________, most commonly in the _______________ perior

A

pregnancy ; post-partum

30
Q

______________ = abnormal weak vessels connecting the high pressure arterial system to low pressure venous system

A

AVM

31
Q

what is the most common causes of intracranial hemorrhage in young patients

A

AVM

32
Q

tx of avm

A

embolization, sterotactic radiosurgery

33
Q

anesthesia considerations with aneuyrsm / AVM

A
  1. doc hx, phsyical exam, Sx and deficits
  2. blood pressure and heart rate control are critical
  3. know that: cardene, steroids, mannitol, and antiepileptics are used to manage sx (thus check labs accordingly)
34
Q

what dzs are cerebral aneurysms associated with?

A
  1. polycystic kidney dz
  2. ehlers-danlos
  3. marfan
  4. coarctation of the aorta
  5. pheochromocytoma
35
Q

what is the most common electrolyte d/o in SAH? and what is it caused from?

A

hyponatremia; cerebral salt wasting or SIADH

36
Q

what drugs induce SLE

A

ACE-I
hydralazine
procanamide
methyldopa
isoniazid

37
Q

What 5 drugs lower the seizure threshold

A

ketamine
etomidate
methohexitol
meperidine
atracurine

Brandon’s AFN Health Assessment (17 decks)

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