Week 8 Neuro/Psych Flashcards
1
Q
What is the first drug given for an initial seizure intraoperatively?
A
Benzodiazepine
2
Q
After seizure has stopped, what drug is most commonly given after a Benzodiazepine?
A
Keppra 1000-3000mg
3
Q
What drug classes are included in neurologically active medications?
A
analgesics, antiepileptics, anti psychotics, anesthetics, and stimulants
4
Q
What ion channels are involved in seiures?
A
Na, Ca, K
5
Q
What causes seizures?
A
- abnormal ion channels
- excitatory neurotransmitters
- loss of inhibitory neurons
- imbalances of extracellular Ca and K
- abnormal synchronization
6
Q
How do antiepileptic drugs work?
A
- by decreasing excitability (altering electrical activity or GABA in a synapse)
OR - enhancing the inhibition of neurotransmitters
7
Q
What are the indications for tegretol?
A
seizures, trigeminal and glossopharyngeal neuralgia
8
Q
Anesthesia considerations for tegratol:
A
hepatic inducer (increased need of NMB and other anesthetics)
Plasma protein bound
9
Q
What are side effects of tegretol?
A
sedation, vertigo, diplopia, hyponatremia, and suppression of WBCs
10
Q
What are indications for gabapentin?
A
Chronic pain, diabetic neuropathy, seizures, anxity/depression
11
Q
What is the MOA for gabapentin?
A
inhibits voltage gated CA channels in CNS
12
Q
Side effects of gabapentin:
A
sedation, ataxia, vertigo, gi disturbances
13
Q
What is the dosage for gabapentin?
A
10-60mg/kg daily
14
Q
T/F gabapentin should be discontinued a week prior to surgery
A
False, should be continued until preoperative setting
15
Q
If gabapentin cession in indicated, how should this occur?
A
1 week taper
16
Q
What is the MOA of Lamictal?
A
stabilizes sodium and calcium channels, encouraging the release of neurotransmitters
17
Q
What are the indications of lamictal?
A
seizures and Lennox-Gataut syndrome
18
Q
Side effects of lamictal:
A
HA, n/v, dizzziness, diplopia, ataxia, tremors, SJS
19
Q
Should lamictal be discontinued prior to surgery?
A
no, can increase seizure activity
20
Q
What is the most common anticonvulsant medication?
A
Keppra
21
Q
What is the MOA of Keppra?
A
Binds to calcium channels to decrease release of NTs
22
Q
What are indications for Keppra?
A
epilepsy, seizures, neurosurgery- brain tumor removals
23
Q
When are barbiturates not indicated as treatment of seizures?
A
nonconvulsive generalized seizures
24
Q
What is the MOA of phenobarbital?
A
increases GABA and inhibits glutamate, prolongs cl channel opening
25
Is phenobarbital a hepatic inducer?
yes
26
What are side effects of phenobarbital?
sedation, irritability, excitability, megablastic anemia, nystagmus, ataxia
27
Why should phenobarbital not be used with halothane?
it can cause halothane necrotizing hepatitis
28
Why is phenobarbital not used in children?
it can increase the risk of acetaminophen toxicity
29
What are the indications of phenytoin?
Partial and generalized seizures
30
What is the MOA of phenytoin?
regulated neuronal excitability by regulating Na and Ca channels, stabilizes cell membranes
31
Which AEDs cause the need for higher doses of anesthetic drugs?
Tegretol, Phenytoin
32
Does phenytoin undergo first order or zero order kinetics?
first at <10mcg/mL
zero at >10mcg/mL
33
What are side effects of phenytoin?
nystagmus, ataxia, diplopia, vertigo, neuropathy, hyperglycemia, gi irritability
34
What are some examples of benzodiazapines?
midazolam, clonazepam, diazepam, lorazepam, clobazapam
35
What are benzodiazepines used for?
anxiolytic, sedation, muscular relaxant, anticonvulsant effects, also decreases n/v
36
What receptor do benzos activate?
a subset of GABA, inhibits neuronal firing
37
What is the first line agent for myoclonic seizures?
benzodiazepines
38
What benzodiazepine is most frequently used?
Midazolam
39
What AED causes upregulation of acetylcholine receptors and what does that cause?
Phenytoin, effects NDMB and DMB: can cause release of high levels of potassium or greater response to succs
40
What is the dose for midazolam?
2.5-5mg/IV (up to 15mg for status epilepticus)
41
How long must a seizure occur to be considered status epilepticus?
greater than 5 minutes
42
How should status epilepticus be managed?
upper airway management, O2
IV access, benzo, AED drug
43
Do ketamine and propofol increase or decrease the risk of seizure?
increase, can actually mimic seizure like phenomenon
44
What are the effects of benzos and barbs on AEDs?
interactive, decreasing metabolism
45
What are the effects of inhaled anesthetics on seizures threshold?
decreases threshold
46
How does ethanol affect volatile agents?
volatiles must compete with the same GABA receptors as ethanol, competitive inhibition
47
What surgeries sometimes use cocaine?
ENTs
48
What type of patients are frequently under the influence of illegal substances?
trauma
49
Serotonin: head, red, fed
Head: satisfaction, sociality, migraine, decreased anxiety, impulsivity, sex
Red: inhibits platelets and bleeding
Fed: Gi motility, naused
50
How long do SSRIs take to work?
4-6 weeks
*If stopped causes brain zap*
51
What SSRI has the longest 1/2 life?
prozac/fluoxetine
52
MOA of Sertraline
SSRI, squirtraline (diarrhea, take w/ food),
53
What SSRI is recommended for pregnant women?
sertraline
54
What is unique about paroxetine?
very rapidly absorbed
55
High doses of citalopram can cause:
prolonged QTc
56
What drug treats OCD?
fluvoxamine
57
What are the three drugs that increase serotonin and norepi?
venlafaxine, mirtazapine, and duloxetine
58
What is a side effect with venlafaxine that is not seen with SSRIs?
Hypertension
59
other than depression, what else does duloxetine treat?
chronic pain conditions
60
What is a preferred side effect of mirtazapine?
increase in appetite
61
What drug class does bupropion belong to?
Dopamine norepinephrine reuptake inhibitor
62
What is bupropion commonly used for?
stop smoking
63
What is a major side effect of bupropion?
lowers seizure threshold
64
What drug class is trazodone?
serotonin antagonist and reuptake inhibitor
65
What is trazodone for?
sleep
66
What is the medical emergency associated with trazodone?
long lasting erection
67
What is the oldest class of antidepressants?
Tricyclic antidepressants
68
Whats the MOA of TCA's?
Everything!!! +se, +ne, -ACh, -HIS, -Na, -Ca
69
What are the cardiac symptoms that occur with TCA's?
Wide QRS complex
70
What is the treatment for TCA overdose?
Bicarbonate
71
What is the gold standard treatment for OCD?
Clomipramine
72
What are other indications for TCAs apart from depression?
pain
73
What do MAOIs work on?
SE, DA, NE
74
What occurs when an individual on an MAOI eats aged wines and cheeses (tyrosines)?
hypertensive crisis
75
Which MAOI is good for treating Parkinson's?
Selegiline
76
What are the two major categories of antipsychotics?
First generations (typicals) and second generations (atypical)
77
_____ generation antipsychotics normally have _____ side effects while _____ generations normally have _____ side effects
first, neurological; second, metabolic
78
What is the DOPAMINE mnemonic?
Drive
psychOsis
Parkinsonism
Attention
Motor
Inhibition of prolactin
Narcotics
Extrapyramidal
79
What are the three extrapyramidal side effects?
Muscle: acute dystonia (4hr)
Rustle: akathisia (4 days)
Hustle: akinesia (4 weeks)
80
What is given to treat acute muscular dystonia from antipsychotics?
Benadryl 50mg
81
Pill rolling is an example of:
Akinesia
82
What is the most concerning side effect of antipsychotics?
Tardive Dyskinesia (can be irreversible if goes on too long)
83
What drug increases the risk of gynecomastia in men?
Risperidone
84
What is Neuroleptic Malignant Syndrome and the S/S associated with it?
Occurs with recent antipsychotic use: can mimic MH
S/S: confusion
agitation
hyperthermia
muscular rigidity
seizures
85
What are the S/S of NMS?
confusion
agitation
hyperthermia
muscular rigidity
seizures
86
What medication is used to treat NMS?
Dantrolene
87
What is the gold standard route of antipsychotic administration and why?
IV, 100% bioavailability
88
What should be trialed and failed prior to a depot injection?
PO dosage
89
What side effect occurs with chlorpromazine?
corneal deposits
90
What is the most popular first generation antipsychotic?
haloperidol
91
What is a major side effect of clozapine?
agranulocytosis
92
What does clozapine treat?
schizophrenia
93
What drug is the first line treatment for schizophrenia?
olanzapine
94
What antipsychotic causes the most significant metabolic side effects?
olanzapine
95
Which second gen antipsychotic causes QT prolongation?
ziprasidone
(and citalopram)
96
T/F aripriprazole is good for treating acute psychotic episodes:
False
97
in addition to mood stabilizers, what other drug class should be used in an acute manic event?
Antipsychotics
98
What is the oldest mood stabilizer?
Lithium
99
Why is lithium not frequently used?
narrow therapeutic index (1.0-1.2)
100
What antipsychotic can cause Diabetes incipitus?
lithium
101
what three drugs cause fatal hepatic necrosis?
halothane
valproic acid
acetaminophen
102
What anticonvulsants are also used as mood stabilizers?
valproic acid, carbamazepine, lamotrigine
103
What is a popular side effects of topiramate?
weight loss
104
What are the two main classes of anxiolytics?
benzos and barbs
105
What is the MOA of benzodiazapines?
increases frequency of opening on GABA channels
106
What is the MOA of barbiturates?
increases duration of opening of GABA channels
107
What benzodiazepine is used to assist one in falling asleep?
temazepam
108
What are two over the counter medications that assist with getting to sleep?
doxylamine, diphenhydramine
109
What is a side effect of zolpidem?
forgetfulness and sleepwalking
110
What anesthetic drug is most notorious for causing seizures?
Ketamine
111
What drug increases requirement of non-depolarizing paralytic doses?
keppra, levetiracetam
112
What is an indication for methadone?
withdrawal period is much more tolerable
113
What is the MOA of buprenorphine?
partial mu agonist
114
What is the MOA of butorphanol?
partial mu agonist
115
What SSRI is frequently used to treat pain syndromes?
duloxetine
116
117
When should a seizure be treated?
Pediatric: second seizure
Adult: unremitting generalized convulsions lasting greater than 5 minutes (can be focal or myoclonic)
118
What volatile gas is pro-convulsive?
sevoflurane
119
T/F propofol is pro-convulsant
False, it can cause seizure like twitching/excitatory event but it is not a seizure
120
What are some seizure inducing medications used in anesthesia?
ketamine, etomidate, methohexital, sevo, NO, merperidine
121
T/F Neuromuscular blockades do stop seizures
False, they stop the appearance of the seizure but not the actual neurological seizure
122
What is the gold standard medication to treat a seizure and why?
Lorazepam 4mg Q3-5min - long half life 0.1mg/kg
123
What do we frequently give for seizures that is NOT the gold standard?
Midazolam 2-15mg (10mg)
124
What is second line therapy for seizures?
levetiracetam (keppra) 1000-3000mg
phenytoin
valproic acid
125
What is the difference between adults and children for seizure management?
First seizure in the pediatric population would not be treated with an AED
126
What is the dose of diazepam when used for seizure management?
0.15mg/kg up to 10mg
127
What occurs with chronic use of keppra?
increased dose requirement for neuromuscular blockade
128
What class of neuro drugs does not cause withdrawal symptoms if stopped before surgery? When should they be d/ced prior to surgery?
mood stabilizers, 24H prior to surgery
129
When before surgery should MAOIs be stopped?
2 weeks (irreversible) - 1 day (reversible)
130
Should TCAs be discontinued prior to surgery?
yes
131
Taking a SNRI such as venlafaxine _____ the effects of drugs such as codeine and tramadol
decreases bioavailability
132
What are the two neuro syndromes that can look like MH?
Serotonin syndrome and neurological malignant syndrome
133
What drugs should not be given to an individual taking MAOIs or TCAs?
no ephedrine or ketamine
only low doses of direct acting sympathomimetics to prevent a hypertensive crisis event
134
What are some anesthesia considerations for patients on antipsychotics?
post op confusion
hypotension
impaired temp regulation
135
What are some anesthetic considerations for patients taking lithium?
should stop 24H prior, prolongs muscle relaxants, reduces GA requirement, no NSAIDs
136
What are major anesthesia considerations of Cannabis ?
Coronary artery spasm with CAD, increased airway reactivity
137
What drugs should not be given to individuals who use cannabis?
ketamine, atropine, epinephrine
138
What order kinetics with alcohol associated with?
zero order kinetics- high risk of toxicity
139
What are the effects of acute and chronic alcohol use on anesthesia requirements?
acute caused inhibition which decreases the need of medications
chronic causes induction which increases the amount of medication needed
140
What are the effects of cocaine and amphetamines on anesthetic requirement?
decreases it
141
What drugs should be avoided in patients taking cocaine or amphetamines?
ketamine, ephedrine, and catecholamines
142
What is the one thing that isnt present in patients with SS and NMS?
no CO2 changes
143
