Antipsychotics, antiepileptics & PD

Question 1

SSRIs and bleeding

Answer 1

increase bleeding by inhibiting uptake by platelets

Question 2

the triad of serotonin syndrome characteristics

Answer 2

1. autonomic instability
   (hyperthermia, tachy, sweating)
2. neuromuscular hyperactivity
   (tremor, clonus, rigid)
3. Mental Status change
   (agitation, confusion, halluc)

Question 3

drugs implicated in serotonin syndrome

Answer 3

meperidine
fentanyl
tramadol

SSRI
atypical antipsychotics (clozapine)

reglan
zofran

dextromethorphan

in anesthesia:
used TIVA
morphine
scopolamine
decadron

Question 4

most important sign in Hunter’s Serotonin Toxicity

Answer 4

clonus (ocular, inducible, spontaneous)

Question 5

treatment of serotonin syn

Answer 5

usually remove offending agent

first line: cyproheptadine (max 32mg)

Question 6

what effects does TCA cause?

Answer 6

anticholinergic

Question 7

Anesthesia Implications for TCA

Answer 7

baseline EKG
increases MAC (need more)
use neo instead of ephedrine (why?)

Question 8

MAOIs (STIP)

Answer 8

selegiline
tranylcypromine
isocarboxazid
phenelzine

Question 9

serotonin drugs and MAOIs should not be used within how long of each other

Answer 9

2 weeks

Question 10

meperidine and MAOI SE

Answer 10

hypotension and depression of ventilation

Continue MAOI and plan to avoid meperidine and ephedrine

Question 11

lithium and MAC

Answer 11

decreases MAC

lithium prolongs the activity of NMBDs and blocks release of epi/NE from the brain stem,

Question 12

antipsychotics and anesthesia

Answer 12

avoid hypotension
baseline EKG

Question 13

Antiepileptic drugs effect on p450 enzymes and dose requirements

Answer 13

Increase P450 enzymes
&
Patients have increased dose requirements:
thiopental, propofol, midazolam, opioids, and ND-NMBD

Question 14

MOA of antiepileptics (2 ways)

Answer 14

1 decrease neuronal activity (electrolytes)
2 enhance inhibition of neurotransmission (GABA)

Question 15

MOA benzos in antiepileptics

Answer 15

increase GABA

Question 16

MOA of barbiturates in antiepileptics

Answer 16

BarbiTURates: increase the DURation of ion channel openings

Question 17

most serious SE of valproate

Answer 17

hepatotoxicity (children usually)

Question 18

Phenytoin follows what order kinetics:

Answer 18

zero order >10mcg/mL

Question 19

most common manifestation of Phenytoin toxicity

Answer 19

gingival hyperplasia

Question 20

phenytoin

Answer 20

zero order kinetics
p450 inducer
gingival hyperplasia
fetal hydantoin syndrome

Question 22

carbamazepine uses

Answer 22

glossopharyngeal neuralgia
trigeminal neuralgia

Chew carbs with your cheeks

Question 23

SE carbamazepine anticonvulsant

Answer 23

sedation, vertigo, diplopia, nausea, vomitting

Question 24

lamotrigine (lamictal)

Answer 24

Seizures and bipolar disorder

“Thats LAMOtriGine”
Steven Johnson syndrome

Stabilities NA channel, aspartate, and GLUTAMATE

Question 25

KEPPRA typical dose

Answer 25

1 g IV

Question 26

Mainstay for status epilepticus and local anesthetic induces seizures

Answer 26

DIAZEPAM
0.1mg/kg Q10m until it stops or max dose of 30 mg

Question 27

metabolite of levodopa

Answer 27

homovanillic acid

Question 28

SE levodopa in anesthesia

Answer 28

exaggerated respiratory movements
gasping patterns and dyskinesia of respiratory muscles

Watching during extubation

Question 29

treatment serotonin syndrome

Answer 29

Cyproheptadine 12mg PO w/ 2mg q2h until symptoms resolve (max 32mg)

Question 30

MOA difference between barbs and benzos

Answer 30

Benzo: increased frequency of GABA-mediated ion channel openings

Barbiturates: increase the duration of ion channel openings

frequency vs. duration