Brain 6 Flashcards

(40 cards)

1
Q

Which factors contribute to the pathophysiology of Parkinson’s disease?
a. decreased dopamine in the basal ganglia
b. increased glutamate in the substantia nigra
c. decreased acetylcholine in basal ganglia
d. increased GABA in the thalamus

A

A. decreased dopamine in the basal ganglia
D. increased GABA in the thalamus

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2
Q

Parkinson’s disease is a

A

chronic neurodegenerative disorder of the basal ganglia

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3
Q

With Parkinson’s disease there is an imbalance between

A

dopamine (not enough) and acetylcholine (too much)

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4
Q

When given together ___ & ___ increase the concentration of dopamine in the basal ganglia

A

cabidopa & levodopa

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5
Q

Patients with Parkinson’s disease are at risk for

A

autonomic instability, orthostatic hypotension, dysrhythmias, and aspiration

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6
Q

_________ may be used to treat acute exacerbation of Parkinsonian symptoms

A

Anticholinergics

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7
Q

_____________________ can be used to treat the s/sx. of Parkinson’s disease.

A

A deep brain stimulator can be implanted

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8
Q

Procedure-related considerations for the insertion of a deep brain stimulator include

A

lack of airway access during the procedure and risk of venous air embolism

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9
Q

____________________ may exacerbate extrapyramidal s/sx and are contraindicated

A

Antidopaminergic drugs & phenothiazines

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10
Q

An example of a phenothiazine is

A

promethazine

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11
Q

Examples of antidopaminergic drugs include

A

metoclopramide
butyrophenones (haloperidol & droperidol)

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12
Q

Diagnosis of Parkinson’s disease requires 2 of the 4 cardinal signs:

A
  1. resting “pill-rolling” tremor
  2. skeletal muscle rigidity
  3. postural instability -loss of balance with an altered gait
  4. bradykinesia- very slow movement and reflexes
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13
Q

Risk factors for the development of Parkinson’s disease include

A

old age- greatest risk factor
exposure to manganese in welders as well as herbicides, pesticides, and possibly genetics

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14
Q

Levodopa is a precursor to

A

dopamine

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15
Q

Carbidopa is a

A

decarboxylase inhibitor

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16
Q

By preventing levodopa metabolism in the blood, more

A

levodopa can enter the CNS

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17
Q

In the circulation, levodopa is metabolized to

A

dopamine and DA in the blood does not penetrate the CNS

18
Q

Cardiovascular effects of levodopa and carbidopa include

A

increased inotropy, tachycardia and orthostatic hypotension

19
Q

Other side effects of levodopa & carbidopa include

A

dyskinesia, nausea and vomiting

20
Q

Selegiline is a

A

MAO-B inhibitor

21
Q

MAO-inhibitors restore

A

dopamine concentration by reducing dopamine metabolism in the CNS

22
Q

Unlike non-selective MAOIs, selegiline does not increase the risk of

A

tyramine-induced hypertensive crisis

23
Q

Other treatments for Parkinson’s disease include

A

dopamine agonists
anticholinergics
amantadine
hormonal replacement
catechol-o-methyltransferase inhibitors

24
Q

Patients with Parkinson’s disease are at risk for

A

autonomic instability, orthostatic hypotension, dysrhythmias and aspiration

25
___________ has anticholinergic properties and is useful for sedation and reduction of tremors
diphenhydramine
26
Hypotension with patients with Parkinson's should be treated with
intravascular volume expansion and direct acting agents such as phenylephrine
27
_______________ can cause an acute dystonic reaction due to the interruption of central dopaminergic neurotransmission.
Alfentanil
28
________ is controversial to give due to its effects on the SNS
Ketamine
29
It is important to monitor for __________ postoperatively for Parkinson's patients.
postoperative ventilatory failure
30
Can you give neuromuscular blockers to Parkinson's patients?
yes, no contraindications
31
Levodopa has a half-life of
6-2 hours; it must be given the morning of surgery to prevent worsening of symptoms such as rigidity which can impact ventilation
32
For longer surgeries for Parkinson's patients,
levodopa should be administered via an orogastric tube
33
With deep brain stimulation surgery, seizures can be treated with
small dose of propofol, barbiturate or benzodiazepine
34
To minimize the risk of intracranial hemorrhage for deep brain stimulation surgery, SBP should not exceed
140 mmHg
35
The sitting position increases the risk of
VAE; a precordial doppler aids in diagnosis
36
If deep brain stimulation is planned, it may be helpful to withhold
levodopa; it causes symptoms to worsen which facilitates optimal electrode placement
37
Deep brain stimulation requires a ________
burr hole to insert electrodes into the subthalamic nucleus, globuc pallidus, and ventralis intermedius; this is done under stereotactic guidance
38
With deep brain stimulation, the patient's head is placed in a
rigid frame. this can complicate airway management so avoid oversedation and respiratory depression
39
To determine optimal electrode placement, the patient must be
awake but can be lightly sedated with opioids or dexmedetomidine
40
Because of the crucial role of GABA in the thalamus,
GABA agonists such as propofol or benzodiazepines are avoided as they can interfere with electrophysiologic brain monitoring