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Advanced Pharm Exam 2 > Week 8 Neuro/Psych > Flashcards

Week 8 Neuro/Psych Flashcards

1
Q

What is the first drug given for an initial seizure intraoperatively?

A

Benzodiazepine

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2
Q

After seizure has stopped, what drug is most commonly given after a Benzodiazepine?

A

Keppra 1000-3000mg

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3
Q

What drug classes are included in neurologically active medications?

A

analgesics, antiepileptics, anti psychotics, anesthetics, and stimulants

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4
Q

What ion channels are involved in seiures?

A

Na, Ca, K

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5
Q

What causes seizures?

A
  1. abnormal ion channels
  2. excitatory neurotransmitters
  3. loss of inhibitory neurons
  4. imbalances of extracellular Ca and K
  5. abnormal synchronization
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6
Q

How do antiepileptic drugs work?

A
  1. by decreasing excitability (altering electrical activity or GABA in a synapse)
    OR
  2. enhancing the inhibition of neurotransmitters
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7
Q

What are the indications for tegretol?

A

seizures, trigeminal and glossopharyngeal neuralgia

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8
Q

Anesthesia considerations for tegratol:

A

hepatic inducer (increased need of NMB and other anesthetics)
Plasma protein bound

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9
Q

What are side effects of tegretol?

A

sedation, vertigo, diplopia, hyponatremia, and suppression of WBCs

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10
Q

What are indications for gabapentin?

A

Chronic pain, diabetic neuropathy, seizures, anxity/depression

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11
Q

What is the MOA for gabapentin?

A

inhibits voltage gated CA channels in CNS

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12
Q

Side effects of gabapentin:

A

sedation, ataxia, vertigo, gi disturbances

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13
Q

What is the dosage for gabapentin?

A

10-60mg/kg daily

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14
Q

T/F gabapentin should be discontinued a week prior to surgery

A

False, should be continued until preoperative setting

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15
Q

If gabapentin cession in indicated, how should this occur?

A

1 week taper

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16
Q

What is the MOA of Lamictal?

A

stabilizes sodium and calcium channels, encouraging the release of neurotransmitters

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17
Q

What are the indications of lamictal?

A

seizures and Lennox-Gataut syndrome

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18
Q

Side effects of lamictal:

A

HA, n/v, dizzziness, diplopia, ataxia, tremors, SJS

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19
Q

Should lamictal be discontinued prior to surgery?

A

no, can increase seizure activity

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20
Q

What is the most common anticonvulsant medication?

A

Keppra

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21
Q

What is the MOA of Keppra?

A

Binds to calcium channels to decrease release of NTs

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22
Q

What are indications for Keppra?

A

epilepsy, seizures, neurosurgery- brain tumor removals

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23
Q

When are barbiturates not indicated as treatment of seizures?

A

nonconvulsive generalized seizures

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24
Q

What is the MOA of phenobarbital?

A

increases GABA and inhibits glutamate, prolongs cl channel opening

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25
Q

Is phenobarbital a hepatic inducer?

A

yes

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26
Q

What are side effects of phenobarbital?

A

sedation, irritability, excitability, megablastic anemia, nystagmus, ataxia

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27
Q

Why should phenobarbital not be used with halothane?

A

it can cause halothane necrotizing hepatitis

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28
Q

Why is phenobarbital not used in children?

A

it can increase the risk of acetaminophen toxicity

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29
Q

What are the indications of phenytoin?

A

Partial and generalized seizures

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30
Q

What is the MOA of phenytoin?

A

regulated neuronal excitability by regulating Na and Ca channels, stabilizes cell membranes

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31
Q

Which AEDs cause the need for higher doses of anesthetic drugs?

A

Tegretol, Phenytoin

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32
Q

Does phenytoin undergo first order or zero order kinetics?

A

first at <10mcg/mL
zero at >10mcg/mL

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33
Q

What are side effects of phenytoin?

A

nystagmus, ataxia, diplopia, vertigo, neuropathy, hyperglycemia, gi irritability

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34
Q

What are some examples of benzodiazapines?

A

midazolam, clonazepam, diazepam, lorazepam, clobazapam

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35
Q

What are benzodiazepines used for?

A

anxiolytic, sedation, muscular relaxant, anticonvulsant effects, also decreases n/v

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36
Q

What receptor do benzos activate?

A

a subset of GABA, inhibits neuronal firing

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37
Q

What is the first line agent for myoclonic seizures?

A

benzodiazepines

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38
Q

What benzodiazepine is most frequently used?

A

Midazolam

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39
Q

What AED causes upregulation of acetylcholine receptors and what does that cause?

A

Phenytoin, effects NDMB and DMB: can cause release of high levels of potassium or greater response to succs

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40
Q

What is the dose for midazolam?

A

2.5-5mg/IV (up to 15mg for status epilepticus)

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41
Q

How long must a seizure occur to be considered status epilepticus?

A

greater than 5 minutes

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42
Q

How should status epilepticus be managed?

A

upper airway management, O2
IV access, benzo, AED drug

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43
Q

Do ketamine and propofol increase or decrease the risk of seizure?

A

increase, can actually mimic seizure like phenomenon

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44
Q

What are the effects of benzos and barbs on AEDs?

A

interactive, decreasing metabolism

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45
Q

What are the effects of inhaled anesthetics on seizures threshold?

A

decreases threshold

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46
Q

How does ethanol affect volatile agents?

A

volatiles must compete with the same GABA receptors as ethanol, competitive inhibition

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47
Q

What surgeries sometimes use cocaine?

A

ENTs

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48
Q

What type of patients are frequently under the influence of illegal substances?

A

trauma

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49
Q

Serotonin: head, red, fed

A

Head: satisfaction, sociality, migraine, decreased anxiety, impulsivity, sex
Red: inhibits platelets and bleeding
Fed: Gi motility, naused

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50
Q

How long do SSRIs take to work?

A

4-6 weeks
If stopped causes brain zap

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51
Q

What SSRI has the longest 1/2 life?

A

prozac/fluoxetine

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52
Q

MOA of Sertraline

A

SSRI, squirtraline (diarrhea, take w/ food),

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53
Q

What SSRI is recommended for pregnant women?

A

sertraline

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54
Q

What is unique about paroxetine?

A

very rapidly absorbed

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55
Q

High doses of citalopram can cause:

A

prolonged QTc

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56
Q

What drug treats OCD?

A

fluvoxamine

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57
Q

What are the three drugs that increase serotonin and norepi?

A

venlafaxine, mirtazapine, and duloxetine

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58
Q

What is a side effect with venlafaxine that is not seen with SSRIs?

A

Hypertension

59
Q

other than depression, what else does duloxetine treat?

A

chronic pain conditions

60
Q

What is a preferred side effect of mirtazapine?

A

increase in appetite

61
Q

What drug class does bupropion belong to?

A

Dopamine norepinephrine reuptake inhibitor

62
Q

What is bupropion commonly used for?

A

stop smoking

63
Q

What is a major side effect of bupropion?

A

lowers seizure threshold

64
Q

What drug class is trazodone?

A

serotonin antagonist and reuptake inhibitor

65
Q

What is trazodone for?

A

sleep

66
Q

What is the medical emergency associated with trazodone?

A

long lasting erection

67
Q

What is the oldest class of antidepressants?

A

Tricyclic antidepressants

68
Q

Whats the MOA of TCA’s?

A

Everything!!! +se, +ne, -ACh, -HIS, -Na, -Ca

69
Q

What are the cardiac symptoms that occur with TCA’s?

A

Wide QRS complex

70
Q

What is the treatment for TCA overdose?

A

Bicarbonate

71
Q

What is the gold standard treatment for OCD?

A

Clomipramine

72
Q

What are other indications for TCAs apart from depression?

A

pain

73
Q

What do MAOIs work on?

A

SE, DA, NE

74
Q

What occurs when an individual on an MAOI eats aged wines and cheeses (tyrosines)?

A

hypertensive crisis

75
Q

Which MAOI is good for treating Parkinson’s?

A

Selegiline

76
Q

What are the two major categories of antipsychotics?

A

First generations (typicals) and second generations (atypical)

77
Q

_____ generation antipsychotics normally have _____ side effects while _____ generations normally have _____ side effects

A

first, neurological; second, metabolic

78
Q

What is the DOPAMINE mnemonic?

A

Drive
psychOsis
Parkinsonism
Attention
Motor
Inhibition of prolactin
Narcotics
Extrapyramidal

79
Q

What are the three extrapyramidal side effects?

A

Muscle: acute dystonia (4hr)
Rustle: akathisia (4 days)
Hustle: akinesia (4 weeks)

80
Q

What is given to treat acute muscular dystonia from antipsychotics?

A

Benadryl 50mg

81
Q

Pill rolling is an example of:

A

Akinesia

82
Q

What is the most concerning side effect of antipsychotics?

A

Tardive Dyskinesia (can be irreversible if goes on too long)

83
Q

What drug increases the risk of gynecomastia in men?

A

Risperidone

84
Q

What is Neuroleptic Malignant Syndrome and the S/S associated with it?

A

Occurs with recent antipsychotic use: can mimic MH
S/S: confusion
agitation
hyperthermia
muscular rigidity
seizures

85
Q

What are the S/S of NMS?

A

confusion
agitation
hyperthermia
muscular rigidity
seizures

86
Q

What medication is used to treat NMS?

A

Dantrolene

87
Q

What is the gold standard route of antipsychotic administration and why?

A

IV, 100% bioavailability

88
Q

What should be trialed and failed prior to a depot injection?

A

PO dosage

89
Q

What side effect occurs with chlorpromazine?

A

corneal deposits

90
Q

What is the most popular first generation antipsychotic?

A

haloperidol

91
Q

What is a major side effect of clozapine?

A

agranulocytosis

92
Q

What does clozapine treat?

A

schizophrenia

93
Q

What drug is the first line treatment for schizophrenia?

A

olanzapine

94
Q

What antipsychotic causes the most significant metabolic side effects?

A

olanzapine

95
Q

Which second gen antipsychotic causes QT prolongation?

A

ziprasidone
(and citalopram)

96
Q

T/F aripriprazole is good for treating acute psychotic episodes:

A

False

97
Q

in addition to mood stabilizers, what other drug class should be used in an acute manic event?

A

Antipsychotics

98
Q

What is the oldest mood stabilizer?

A

Lithium

99
Q

Why is lithium not frequently used?

A

narrow therapeutic index (1.0-1.2)

100
Q

What antipsychotic can cause Diabetes incipitus?

A

lithium

101
Q

what three drugs cause fatal hepatic necrosis?

A

halothane
valproic acid
acetaminophen

102
Q

What anticonvulsants are also used as mood stabilizers?

A

valproic acid, carbamazepine, lamotrigine

103
Q

What is a popular side effects of topiramate?

A

weight loss

104
Q

What are the two main classes of anxiolytics?

A

benzos and barbs

105
Q

What is the MOA of benzodiazapines?

A

increases frequency of opening on GABA channels

106
Q

What is the MOA of barbiturates?

A

increases duration of opening of GABA channels

107
Q

What benzodiazepine is used to assist one in falling asleep?

A

temazepam

108
Q

What are two over the counter medications that assist with getting to sleep?

A

doxylamine, diphenhydramine

109
Q

What is a side effect of zolpidem?

A

forgetfulness and sleepwalking

110
Q

What anesthetic drug is most notorious for causing seizures?

A

Ketamine

111
Q

What drug increases requirement of non-depolarizing paralytic doses?

A

keppra, levetiracetam

112
Q

What is an indication for methadone?

A

withdrawal period is much more tolerable

113
Q

What is the MOA of buprenorphine?

A

partial mu agonist

114
Q

What is the MOA of butorphanol?

A

partial mu agonist

115
Q

What SSRI is frequently used to treat pain syndromes?

A

duloxetine

116
Q
A
117
Q

When should a seizure be treated?

A

Pediatric: second seizure
Adult: unremitting generalized convulsions lasting greater than 5 minutes (can be focal or myoclonic)

118
Q

What volatile gas is pro-convulsive?

A

sevoflurane

119
Q

T/F propofol is pro-convulsant

A

False, it can cause seizure like twitching/excitatory event but it is not a seizure

120
Q

What are some seizure inducing medications used in anesthesia?

A

ketamine, etomidate, methohexital, sevo, NO, merperidine

121
Q

T/F Neuromuscular blockades do stop seizures

A

False, they stop the appearance of the seizure but not the actual neurological seizure

122
Q

What is the gold standard medication to treat a seizure and why?

A

Lorazepam 4mg Q3-5min - long half life 0.1mg/kg

123
Q

What do we frequently give for seizures that is NOT the gold standard?

A

Midazolam 2-15mg (10mg)

124
Q

What is second line therapy for seizures?

A

levetiracetam (keppra) 1000-3000mg
phenytoin
valproic acid

125
Q

What is the difference between adults and children for seizure management?

A

First seizure in the pediatric population would not be treated with an AED

126
Q

What is the dose of diazepam when used for seizure management?

A

0.15mg/kg up to 10mg

127
Q

What occurs with chronic use of keppra?

A

increased dose requirement for neuromuscular blockade

128
Q

What class of neuro drugs does not cause withdrawal symptoms if stopped before surgery? When should they be d/ced prior to surgery?

A

mood stabilizers, 24H prior to surgery

129
Q

When before surgery should MAOIs be stopped?

A

2 weeks (irreversible) - 1 day (reversible)

130
Q

Should TCAs be discontinued prior to surgery?

A

yes

131
Q

Taking a SNRI such as venlafaxine _____ the effects of drugs such as codeine and tramadol

A

decreases bioavailability

132
Q

What are the two neuro syndromes that can look like MH?

A

Serotonin syndrome and neurological malignant syndrome

133
Q

What drugs should not be given to an individual taking MAOIs or TCAs?

A

no ephedrine or ketamine
only low doses of direct acting sympathomimetics to prevent a hypertensive crisis event

134
Q

What are some anesthesia considerations for patients on antipsychotics?

A

post op confusion
hypotension
impaired temp regulation

135
Q

What are some anesthetic considerations for patients taking lithium?

A

should stop 24H prior, prolongs muscle relaxants, reduces GA requirement, no NSAIDs

136
Q

What are major anesthesia considerations of Cannabis ?

A

Coronary artery spasm with CAD, increased airway reactivity

137
Q

What drugs should not be given to individuals who use cannabis?

A

ketamine, atropine, epinephrine

138
Q

What order kinetics with alcohol associated with?

A

zero order kinetics- high risk of toxicity

139
Q

What are the effects of acute and chronic alcohol use on anesthesia requirements?

A

acute caused inhibition which decreases the need of medications
chronic causes induction which increases the amount of medication needed

140
Q

What are the effects of cocaine and amphetamines on anesthetic requirement?

A

decreases it

141
Q

What drugs should be avoided in patients taking cocaine or amphetamines?

A

ketamine, ephedrine, and catecholamines

142
Q

What is the one thing that isnt present in patients with SS and NMS?

A

no CO2 changes

143
Q
A

Advanced Pharm Exam 2 (3 decks)

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