test 3 part 8 Flashcards
what are some causes of reversible dementiaq
medications
alcohol
metabolic d/o
depression
CNS neoplasms
treatment options for dementia
cholinesterase inhibitors
NMDA antagonist: memantine
MAOIs
SSRIs
vitamin E and ginko biloba
if a pt with dementia is being treated with a cholinesterase inhibitor; what do you need be aware of from an anesthesia standpoint
cholinesterase inhibitors may prolong succinylcholine
what drugs are affiliated with increased development of postop delirium ?
benzodiazepines
antihistamines
anticholinergics
risk factors of postop delirium
- renal insuff/metabolic derangements
- poorly controlled pain
- polypharmacy (psychoactive drugs)
- functional impairment
- urinary retention and prescence of urinary catheter
anesthesia implications of dementia
- determine level of cognitive dysfunction
- increased risk of aspiration
- increased risk for Postop delirium
- multimodal pain management
- caution with use of benzos, antihistamines, and anticholinergics
parkinsons disease is a neurodegenerative d/o of the CNS d/t __________________________
loss of dopamine containing neurons from the pars compacta of the substantia nigra with lewy bodies
loss of dopamine in parkinsons dz causes what
- unopposed acetylcholine action: bradykinesia, rigidity, tremor, postural instability
- autonomic dysfunction : orthostatic hypotn, poor tem control, urinary retention, salivation, delayed gastric emptying
- high incidence of dysphagia
- dementia
- depression
- immobility and falls
what is the most frequently reported cause of death reported in a pt with parkinsons
pneumonia
there is no cure for parkinsons, however some meds/tx are given for symptom relief and quality of life, what are they?
- dopamine prodrug: levodopa/carbidopa
- dopamine agonists
- selective MAOIs and anticholinergics
- surgery: Deep brain stimulator
- rehab
what is the current mainstay of surgical tx in a patient with parkinsons?
deep brain stimulator
when would a dopamine agonist be the first line drug of choice in a patient with parkinsons?
if they are < 55 y/o
____________ is a dopamine precursor that is used in the intial tx of parkinsons
levodopa
__________________ inhibits the activity of the decarboxylating enzyme that is present with parkinsons
carbidopa
T/F: effectiveness of levodopa decreases as the dz progresses
true
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
6-12; ventilation (due to med wearing off and msucle rigidity ensuing)
if pt is on levodopa you may want to place ________________ due to autonomic instability and 6-12 hour half life of drug
invasive hemodynamic monitoring
pt with parkinsons presents for surgery; you know from there hx they have a deep brain stimulator. Wht should be done peroperatively?
it should be shut off because cautery can damage
which cautery is preferred if pt has deep brain stimulator
bipolar
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?
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
deep brain stimulators can be damaged from _______________ and _________ thus should be turned off prior to
electrocaudery; MRI
preanesthesia considerations with parkinsons
- assess and document severity of disease
- do they have pulmonary compromise/dysphagia?
- parkinsons meds should be continued DOS
- avoid prolonged fasting and dehydration
if pt is on dopamine agonist for parkinsons, you know they can increase the risk of ?
- neuroleptic malignant syndrome
- fever
- altered mental status
- muscle rigidity
- autonomic dysfunction
what are the most common type of intracranial tumors?
metastatic
clinical features of intracranial tumors
- increased ICP
- cerebral edema (vasogenic or cytotoxic)
- autonomic dysfunction
- cushings triad
if pt has an intracranial tumor; you know they may be prescribed dexmethasone for what?
reduce vasogenic edema
anesthesia considerations with intracranial tumor
- hx of presenting sx and previous therapies
- baseline ECG, CBC, BMP, and T&C
- review team goals (monitoring, post op expectations, Abx and antiepileptic selections)
_______________ results in subarachnoid hemorrhage where pt c/o the worst headache of their life
rupture aneurysm
aneurysms have an increased risk of rupture during __________________, most commonly in the _______________ perior
pregnancy ; post-partum
______________ = abnormal weak vessels connecting the high pressure arterial system to low pressure venous system
AVM
what is the most common causes of intracranial hemorrhage in young patients
AVM
tx of avm
embolization, sterotactic radiosurgery
anesthesia considerations with aneuyrsm / AVM
- doc hx, phsyical exam, Sx and deficits
- blood pressure and heart rate control are critical
- know that: cardene, steroids, mannitol, and antiepileptics are used to manage sx (thus check labs accordingly)
what dzs are cerebral aneurysms associated with?
- polycystic kidney dz
- ehlers-danlos
- marfan
- coarctation of the aorta
- pheochromocytoma
what is the most common electrolyte d/o in SAH? and what is it caused from?
hyponatremia; cerebral salt wasting or SIADH
what drugs induce SLE
ACE-I
hydralazine
procanamide
methyldopa
isoniazid
What 5 drugs lower the seizure threshold
ketamine
etomidate
methohexitol
meperidine
atracurine
