Brain 5

Question 1

In patients with seizure disorders, these three drugs increase EEG activity and can be used to help determine the location of seizure foci during cortical mapping

Answer 1

methohexital, etomidate, alfentanil

Question 2

There are several case reports of _________-induced seizures and ___________. Although it is a first-line agent for the control of acute seizure activity.

Answer 2

propofol-induced seizures and opisthotonos (rigid posture with an arched back)

Question 3

_________ metabolism yields ______________, a proconvulsant.

Answer 3

Atracurium metabolism yield laudanosine
(cisatricurium produces laudanosine in a much smaller amount)

Question 4

__________ is a metabolite of __________ and is capable of producing seizure activity.

Answer 4

Normeperidine is a metabolite of meperidine

Question 5

Define status epilepticus.

Answer 5

seizure activity that lasts >30 min or 2 grand mal seizures without regaining consciousness in-between

Question 6

Acute treatment of status epilepticus is

Answer 6

phenobarbital, thiopental, phenytoin, benzos, propofol, and even GA

Question 7

Patients with status epilepticus can experience

Answer 7

respiratory arrest–> hypoxia
due to increased oxygen consumption d/t increased brain activity and muscle contraction

Question 8

______ seizures are more common in children

Answer 8

Akinetic

Question 9

Akinetic seizures result in

Answer 9

a temporary LOC and postural tone

Question 10

The concern with akinetic seizures is

Answer 10

can result in a fall–> head injury

Question 11

An absence seizure is

Answer 11

temporary loss of awareness (but remains awake)
more common in children

Question 12

Define a focal cortical seizure.

Answer 12

localized to a particular cortical region
-can be motor or sensory
-usually no LOC

Question 13

What is a grand mal seizure?

Answer 13

characterized by generalized tonic-conic activity
can result in respiratory arrest–> hypoxia

Question 14

What is a tonic phase?

Answer 14

whole body rigidity

Question 15

What is a clonic phase?

Answer 15

repetitive jerking motons

Question 16

Surgical tx. for grand mal seizures includes

Answer 16

vagal nerve stimulator or resection of foci

Question 17

Acute treatment for grand mal seizures includes

Answer 17

propofol, diazepam, and thiopental

Question 18

Which drug is excreted unchanged by the kidneys?
a. phenytoin
b. gabapentin
c. carbamazepine
d. valproic acid

Answer 18

B. gabapentin
it’s elimination is dependent on renal function

Question 19

Phenytoin ________ hepatic enzymes which contributes to _________ to nondepolarizing neuromuscular blockers

Answer 19

induces; resistance to

Question 20

Extravasation or arterial injection of phenytoin can cause. _________ avoids this risk

Answer 20

significant tissue injury; Fosphenytoin

Question 21

Valproic acid _________hepatic enzymes.

Answer 21

Inhibits

Question 22

Valproic acid can cause

Answer 22

hepatotoxicity and thrombocytopenia (risk of surgical bleeding)

Question 23

Carbamazepine ____________ hepatic enzymes.

Answer 23

induces

Question 24

Carbamazepine can cause

Answer 24

aplastic anemia, thrombocytopenia, liver dysfunction, and hyponatremia

Question 25

Gabapentinoids (gabapentin & pregabalin) _______ hepatic enzymes

Answer 25

do not induce; UNDERGO renal excretion instead

Question 26

Gabapentinoids can cause

Answer 26

postoperative respiratory depression especially when combined with opioids

Question 27

Gabapentinoids are useful for

Answer 27

neuropathic pain syndromes (diabetic neuropathy, postherpetic neuralgia, and complex regional pain syndrome)

Question 28

The mechanism of action of phenytoin is

Answer 28

blocks voltage-gated Na+ channels- membrane stabilizer

Question 29

What operation of kinetics does phenytoin follow?

Answer 29

zero order kinetics

Question 30

The therapeutic level of phenytoin is

Answer 30

10-20 mcg/mL

Question 31

Side effects of phenytoin include

Answer 31

dysrhythmias/hypotension (if IV rate >50 mg/min) gingival hyperplasia aplastic anemia Stevens-Johnson syndrome birth defects cerebellar-vestibular dysfunction (nystagmus, ataxia)

Question 32

The mechanism of action of valproic acid is

Answer 32

blocks voltage-gated Na+ channels- membrane stabilizer

Question 33

The mechanism of action of carbamazepine is

Answer 33

blocks voltage-gated Na+ channels- membrane stabilizer

Question 34

The mechanism of action of gabapentinoids is

Answer 34

inhibition of alpha 2-delta subunit of voltage-gated calcium channels in the CNS--> decreased excitatory neurotransmitter release

Question 35

The most common side effects gabapentinoids include

Answer 35

dizziness somnolence

Question 36

Abrupt withdrawal of gabapentinoids can produce

Answer 36

seizures if the patient has a history of seizures (taper for at least 1 week)

Question 37

The duration of action of which drug will be prolonged in the patient treated with donepezil for Alzheimer's disease? a. rocuronium b. vecuronium c. succinylcholine d. cisatricurium

Answer 37

c. succinylcholine

Question 38

Alzheimer's disease is a

Answer 38

chronic degenerative condition of the CNS

Question 39

Alzheimer's disease is the most common cause of ________ in patients 65 years and older

Answer 39

dementia

Question 40

Signs and symptoms of Alzheimer's disease include

Answer 40

memory loss, apraxia, aphasia, and agnosia

Question 41

The pathophysiology of Alzheimer's disease includes the development of

Answer 41

diffuse beta-amyloid rich plaques and neurofibrillary tangles in the brain

Question 42

The treatment for Alzheimer's is

Answer 42

palliative and aims to restore the concentration of Ach, this is accomplished with cholinesterase inhibitors

Question 43

Examples of cholinesterase inhibitors include

Answer 43

tacrine, donepezil, rivastigmine, and galantamine

Question 44

Cholinesterase inhibitors increase the duration of action of ___________, although the clinical significance of this is debatable.

Answer 44

Succinylcholine

Question 45

Patients with Alzheimer's disease are often

Answer 45

confused, scared, and uncooperative, thus making them poor candidates for MAC or regional anesthesia with or without sedation

Question 46

Consequences of plaque formation include

Answer 46

dysfunction synaptic transmission (most common in Ach neurons) apoptosis (programmed cell death)

Question 47

Describe the anesthetic management for patients with Alzheimer's.

Answer 47

use shorter-acting drugs with general anesthesia to allow for patient to return to baseline cognition as soon as possible preoperative sedation can worsen confusion so should be avoided if an anticholinergic is required, glycopyrrolate is the best option since it does not cross the BBB cholinesterase drugs increase PNS tone so s/sx of parasympathetic excess can develop (bradycardia, syncope, n/v)

Question 48

Some of the ______________ increase beta-amyloid production

Answer 48

halogenated anesthetics (halothane & isoflurane)

Question 49

Some studies suggest that ________________________ & ____________________ increase the rate of apoptosis in the brains of the very young and the very old

Answer 49

NMDA receptor antagonists and GABA agonists