Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1a. 675 - Coexisting Diseases > Week 5 - Brain Disorders > Flashcards

Week 5 - Brain Disorders Flashcards

1
Q

What are the two types of Alzheimer’s?

A

Early & Late Onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is considered Early onset Alzheimer’s and what is the primary causative factor?

A

< 60-65 years
* Genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is considered Late onset Alzheimer’s and what is the primary causative factor?

A

> 60-65 years
* Less Genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of Alzheimer’s?

4

A
  • ↑ in Amyloid beta rich plaques
  • Neurofibrillay Tangles in nerve cells
  • Hyperphosphorylated Tau protein
  • ↓ Ach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors for Alzheimer’s?

7

A
  • HTN
  • HLD
  • Cerebrovascular Disease
  • T2DM
  • Prior TBI
  • Female
  • Genetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the Apolipoprotein E risk for each gene expression?

A
  • e2: ↓ risk
  • e3: neither ↑/↓ risk
  • e4: High risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When might early onset alzheimer’s present?

A

< 65 years but as early as 30 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

1st sign of Alzheimers

A

Forgetfulness

uh oh…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Regarding racial disparities in the presentation of Alzheimer’s, which race has the most & least prevalence?

A
  • Most: Native/Alaskan American
  • Least: Asian/Pacific Islander
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mortality of Alzheimer’s?

A

4-8 years post-diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Primary pharmacological treatment class for Alzheimer’s?

A

Cholinesterase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Donepezil?

A

(Aricept)
* acetylcholinesterase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MoA of Donepezil?

3

A

Reversibly binds to acetylcholinesterase -> Inhibits Ach hydrolysis -> ↑ Ach @ synapses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What kind of effect is presented when combining Donepezil with Neo/physostigmine?

A

Synergistic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Should Donepezil be continued Day of Surgery?

A

Si

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe donepezil’s effects on NMB administration?

2

A
  • Antagonizes NDNMBs: ↑ doses required
  • Prolongs Succinylcholine by ↓ Ach metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Your Alzheimer pt is nearing the end of surgery and you’ve given them an aminosteroidal NMB, what reversal agent would you choose and why?

A

Sugammadex
* Neostigmine ineffective 2/2 preexisting cholinesterase inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drugs when given concomitantly with Donepezil pts ↑ the risk of Bradycardia?

A
  • Fentanyl
  • Propofol
  • Neostigmine (Synergistic)
  • Succinylcholine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anesthetic considerations for Alzheimer’s?

4

A
  • MAC/Regional Challenging
  • Use short acting sedatives/hypnotics
  • NMB drug interactions with Donepezil
  • Dexmedetomidine ↓ risk of delirium

The ppt says dementia instead of delirium but that seems wishful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

S/s and TX of Donepezil OD?

A
  • Confusion
  • Diaphoresis
  • Bradycardia
  • GI symptoms
  • Tx: Atropine 1-2mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Parkinson Disease is caused by:

A

↓ in Dopaminergic fibers in Basal Ganglia/Substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What neurotransmitter alteration occurs in Parkinson disease?

A

↓ in Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Risk factors for Parkinson’s disease

3

A
  • > 60 years
  • Being a Man
  • Exposure to herbicides/pesticides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Classic parkinsonian triad?

A
  • Skeletal Muscle Tremor
  • Rigidity
  • Akinesia
25
Q

Treatment goals of pharmacolgoical Parkinsonian therapy?

2

A
  • ↑ Dopamine in Basal Ganglia
  • ↓ Ach neuronal effects
26
Q

Drug(s) of choice in tx of Parkinson’s disease and their role?

A

Levodopa: dopamine precursor
Carbidopa: prevent levodopa side-effects

27
Q

Side-effects of Levodopa

4

A
  • Nausea
  • Dizziness
  • HA
  • somnolence
28
Q

Drug class & purpose of Selegiline?

A

MAO-B inhibitor
* ↓ dose of Levodopa/Carbidopa needed to control symptoms

29
Q

Which medications should be avoided when taking Selegiline, and why?

A
  • Meperidine
  • Methadone
  • Tramadol
    May cause Serotonin Syndrome
30
Q

Your parkinsonian patient is undergoing surgery, which medication would you continue and why?

A

Continue Levodopa
* Neuroleptic malignant syndrome may develop

31
Q

What opioids may be of concern in a Parkinson’s pt and why?

A
  • Fentanyl
  • Morphine

Cause muscle rigidity

32
Q

Which medications should be avoided in Parkinson’s?

4

A
  • Demerol + Selegiline
  • Dopamine antagonists: Metoclopramidem
  • Butyrophenones: Haloperidol
  • Phenothiazines: Chlorpromazine
33
Q

What drug is used to tx chorea in Huntington Disease?

A

Butyrophenones: Haloperidol

34
Q

What are “chorea”

A

Involuntary movements & Unsteady Gait

35
Q

Risk factors for Multiple Sclerosis?

6

A
  • 1st degree relative with MS
  • Female (3x ↑ risk)
  • EBV & Varicella zoster exposure
  • Autoimmune disorders (T1DM, IBD)
  • ↓ VitD
  • Smoking

IBD = inflammatory bowel disease

36
Q

What is the most common type of MS and what % of people are diagnosed with it?

A

Relapsing-remitting MS
* 85%

37
Q

What kind of MS has worsening disability/neurologic function as soon as symptoms appear without relapses/remissions, and what % are diagnosed with it?

A

Primary Progressive MS
* 15%

38
Q

What is dysesthesia in MS?

A

Known as MS hug: hugging sensation around torso

39
Q

What is the Lhermitte Sign?

4

A

Electric shock sensation
* Moves down back of head down spine
* Occurs after bending forward
* Radiates to arms/elgs

40
Q

What are some treatment options for MS?

2

A
  • Corticosteroids to ↓ nerve inflammation
  • Plasma pheresis
41
Q

Anesthesia considerations for MS?

4

A
  • Avoid hyperthermia (> 1°C may cause exacerbation)
  • ↓ LA dose (Lidocaine demyelinate neurons)
  • Avoid Succinylcholine (hyperkalemia)
  • General, Regional, & Epidural OK
42
Q

Why might spinal anesthesia be avoided in MS?

4

A
  • Cause exacerbation
  • HoTN
  • Bradycardia
  • Arrhythmias
43
Q

What is the postictal period?

2

A

Occurs after active portion of seizure
* Confusion period

44
Q

How long do most seizures last?

A

30 sec - 2 min

45
Q

When is a seizure considered status epilepticus and what does it become?

A

Seizure > 5 min
* Medical emergency

46
Q

How is epilepsy characterized?

A

2 or more seizures in sequence w/o regaining consciousness

47
Q

What are metabolic causes of Seizures?

A

Electrolytes

48
Q

What are some structural causes of seizures?

A

Tu-muh
Cancer

49
Q

What are some medicinal causes of Seizures

A
  • Drugs (uh duh)
  • ETOH
  • LAST
50
Q

What are some infectious causes of seizures?

A

Meningitis

51
Q

What are some other causes of seizures?

4 real ones, 1 really real one

A
  • Pre-eclampsia (then wouldn’t it become eclampsia?)
  • Febrile
  • MS
  • Concussion
  • Reading the 609A professors explanations
52
Q

What drugs and (some) doses may be given to manage seizures?

4

A
  • Midazolam (IDK dose I’m too lazy)
  • Propofol: 0.05mg/kg titrated
  • Phenytoin: 20mg/kg
  • Phenobarbital 20mg/kg
53
Q

What drugs are proconvulsants in low doses but anticonvulsants in high doses?

3

A
  • Etomidate
  • Methohexital
  • Propofol
54
Q

What anesthetic gases are proconvulsant vs. anticonvulsant?

4

A

Proconvulsant:
* Sevoflurane
* Hypocapnia

Anticonvulsant:
* Isoflurane
* Desflurane

55
Q

Timeline for Post-op delirium?

A

Start in PACU - up to 1 week/discharge

56
Q

Timeline for delayed neurocognitive recovery?

A

Last up to 30 days

57
Q

Timeline for post-op neurocognitive disorder?

A

30 days - 1 year

58
Q

Post-op risk factors for Postop Neurocognitive Disorder

7

A
  • Uncontrolled pain
  • Benzos
  • Opioids
  • Electrolyte abnormalities
  • Dehydration
  • Sleep deprivation
  • ICU admission

1a. 675 - Coexisting Diseases (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions