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Apex Review > Brain 5 > Flashcards

Brain 5 Flashcards

1
Q

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

A

methohexital, etomidate, alfentanil

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2
Q

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

A

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

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3
Q

_________ metabolism yields ______________, a proconvulsant.

A

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

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4
Q

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

A

Normeperidine is a metabolite of meperidine

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5
Q

Define status epilepticus.

A

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

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6
Q

Acute treatment of status epilepticus is

A

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

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7
Q

Patients with status epilepticus can experience

A

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

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8
Q

______ seizures are more common in children

A

Akinetic

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9
Q

Akinetic seizures result in

A

a temporary LOC and postural tone

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10
Q

The concern with akinetic seizures is

A

can result in a fall–> head injury

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11
Q

An absence seizure is

A

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

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12
Q

Define a focal cortical seizure.

A

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

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13
Q

What is a grand mal seizure?

A

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

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14
Q

What is a tonic phase?

A

whole body rigidity

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15
Q

What is a clonic phase?

A

repetitive jerking motons

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16
Q

Surgical tx. for grand mal seizures includes

A

vagal nerve stimulator or resection of foci

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17
Q

Acute treatment for grand mal seizures includes

A

propofol, diazepam, and thiopental

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18
Q

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

A

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

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19
Q

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

A

induces; resistance to

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20
Q

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

A

significant tissue injury; Fosphenytoin

21
Q

Valproic acid _________hepatic enzymes.

A

Inhibits

22
Q

Valproic acid can cause

A

hepatotoxicity and thrombocytopenia (risk of surgical bleeding)

23
Q

Carbamazepine ____________ hepatic enzymes.

A

induces

24
Q

Carbamazepine can cause

A

aplastic anemia, thrombocytopenia, liver dysfunction, and hyponatremia

25
Q

Gabapentinoids (gabapentin & pregabalin) _______ hepatic enzymes

A

do not induce; UNDERGO renal excretion instead

26
Q

Gabapentinoids can cause

A

postoperative respiratory depression especially when combined with opioids

27
Q

Gabapentinoids are useful for

A

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

28
Q

The mechanism of action of phenytoin is

A

blocks voltage-gated Na+ channels- membrane stabilizer

29
Q

What operation of kinetics does phenytoin follow?

A

zero order kinetics

30
Q

The therapeutic level of phenytoin is

A

10-20 mcg/mL

31
Q

Side effects of phenytoin include

A

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

32
Q

The mechanism of action of valproic acid is

A

blocks voltage-gated Na+ channels- membrane stabilizer

33
Q

The mechanism of action of carbamazepine is

A

blocks voltage-gated Na+ channels- membrane stabilizer

34
Q

The mechanism of action of gabapentinoids is

A

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

35
Q

The most common side effects gabapentinoids include

A

dizziness
somnolence

36
Q

Abrupt withdrawal of gabapentinoids can produce

A

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

37
Q

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

A

c. succinylcholine

38
Q

Alzheimer’s disease is a

A

chronic degenerative condition of the CNS

39
Q

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

A

dementia

40
Q

Signs and symptoms of Alzheimer’s disease include

A

memory loss, apraxia, aphasia, and agnosia

41
Q

The pathophysiology of Alzheimer’s disease includes the development of

A

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

42
Q

The treatment for Alzheimer’s is

A

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

43
Q

Examples of cholinesterase inhibitors include

A

tacrine, donepezil, rivastigmine, and galantamine

44
Q

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

A

Succinylcholine

45
Q

Patients with Alzheimer’s disease are often

A

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

46
Q

Consequences of plaque formation include

A

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

47
Q

Describe the anesthetic management for patients with Alzheimer’s.

A

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)

48
Q

Some of the ______________ increase beta-amyloid production

A

halogenated anesthetics (halothane & isoflurane)

49
Q

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

A

NMDA receptor antagonists and GABA agonists

Apex Review (224 decks)

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