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Neuro II > Exam III > Flashcards

Exam III Flashcards

(111 cards)

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1
Q

local anesthetics act by blocking what kind of channel on nerves

A

voltage gated sodium

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2
Q

which local anesthetic has unique sympathomimetic vasoconstrictive properties

A

cocaine

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3
Q

which family of local anesthetic is widely distributed after IV bolus administration

A

amides

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4
Q

which family of local anesthetic is not widely distributed because of their short plasma half life

A

ester

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5
Q

where are amide anesthetics metabolized? (lidocaine, bupivacaine)

A

liver

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6
Q

tetracaine, pubivacaine, and ropivacaine are all more ___ than lidocaine and thus have more potency and longer duration of action

A

lipophilic

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7
Q

what will happen if we inject epinephrine containing solutions into tissue supplied by an end artery (such as fingers, nose, penis)

A

gangrene

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8
Q

if were gonna need a large local anesthetic dose, we can give __ prophylactically to increase the seizure threshold

A

benzodiazepine (like diazepam)

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9
Q

cocaine inhibits ___ reuptake leading to vasoconstriction (local ischemia), HTN, and arrhythmia

A

NE

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10
Q

most cardiotoxic local anesthetic

A

bupivacaine

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11
Q

topical anesthetic that is used for hemorrhoids, premature ejaculation, and as lubricant for NG tubes and endoscopes and catheters

A

benzocaine

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12
Q

general anesthesia normally involves the use of ___ as premedication and then you add ___ for deep levels of sedation

A

midazolam, propofol

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13
Q

concious sedation (like at the dentist) give you the ability to respond to verbal commands and involve benzodiazepine + opioid because we have what antidotes

A

flumazenil and naloxone

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14
Q

the blood: gas partition coefficient for inhaled anesthetics is essentially telling us the ___ of the drug in blood

A

solubility

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15
Q

low blood solubility equates with ___ onset of action

A

quick

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16
Q

inhaled anesthetic with the lowest blood: gas partition coefficient is ___ and it has rapid onset and recovery

A

NO

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17
Q

inhaled anesthetic with the highest blood: gas partition coefficient is ___ and it has medium rate onset and recovery

A

halothane

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18
Q

General. Anesthetic MOA

A

Excite Cl or K channels, Block ACh or EAA or seratonin channels

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19
Q

minimal alveolar concentration required to prevent a response in surgical incision is greater than 100 for a drug- what does this mean

A

if patient breathed air 100% this drug it would still not be enough for sedation

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20
Q

which general anesthetic causes bradycardia

A

halothane

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21
Q

which general anesthetic causes tachycardia

A

desflurane , isoflurane

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22
Q

succinylcholine plus inhaled volatile anesthetic may cause malignant hyperthermia and we need to give patient what

A

dantrolene

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23
Q

most common parenteral anesthetic in USA

A

propofol

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24
Q

propofol MOA

A

GABAa agonist

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25
lots of vasodilation makes this IV anesthetic the biggest BP lowering drug we give
propofol
26
water soluble prodrug of proposal (onset and recovery are prolonged-- also can cause perineal pain and paresthesia)
fospropofol
27
hypnotic with no analgesic effect (GABA agonist, rapid LOC)
etomidate
28
with very little cardio and respiratory depression, this is useful if patient is impaired in either of those systems
etomidate
29
major side effect of etomidate
inhibit 11 beta hydroxylase (adrenocortical suppression)
30
MOA is NMDA receptor antagonist (anesthetic, causes lacrimation and salivation and patients eyes remain open)
ketamine
31
the only IV anesthetic to produce profound analgesia, stimulate sympathetics bronchodilate and minimally depress respiration
ketamine
32
short term sedative that resembles sleep by activating alpha 2 adrenergic receptor (hypnosis)
dexmedetomidine
33
opioid agonists used to supplement anasthesia
fentanyl, sufentanil, morphine
34
propofol replaced what old GABAa agonist
barbituates
35
GABAa agonist that increases receptor sensitivity to GABA-- retrograde amnesia causing drugs
benzodiazepine (diazepam, lorazepam, MIDAZOLAM)
36
which anesthetics are also anticonvulsant
benzodiazepine
37
pupil dilation is caused by alpha 1 activation and inhibited by
parasympathetics
38
activation of which receptor increases production of aqueous humor
beta
39
activation of which receptor decreases production of aqueous humor
alphaa 2
40
whats the role of muscarinic receptors in aqueous humor pressure
muscarinic stimulation contracts mm to improve outflow
41
whats an ideal intraocular pressure for glaucoma patient
21 mm Hg
42
first line glaucoma drugs
prostaglandin analogue(-prosts), beta blocker (timolol), brimonidine (alpha2 agonist)
43
second line therapy for glaucoma
pilocarpine, apraclonidine, topical carbonic anhydrase inh
44
last ditch glaucoma txs
carbachol, cholinesterase inh
45
this precursor to dopamine is used as first line to treat parkinsons
levadopa
46
this is coadministered with levadopa to treat parkinsons
carbidopa
47
this drug is a decarboxylase inhibitor that does not cross BBB
carbidopa
48
on - off (alternating akinesia and dyskinesia) phenomenon can occur within the first few years of carbidopa-levodopa therapy and then we must prescribe what
apomorphine (subQ)
49
dopamine agonists that can supplement levadopa at end of dose or during on off phenomenon
bromocriptine, pramipexole (RLS), ropinerole (RLS)
50
MAO - B inhibitor that slows DA breakdown to prolong antiparkinson effects of levodopa
selegiline (rasagiline is the irreversible inhibitor but it can lead to hypertensive crisis)
51
DA agonist that stimulates D2Rs in caudate putamen, injected subQ, relief of off periods
apomorphine
52
antiviral used in parkinsons tx for unknown mechanism
amantadine
53
anticholinergic drugs like benztropine that cross the BBB may help with tremor / rigidity but don't affect what
bradykinesia
54
tremor txs
metoprolol, propranolol, primidone (low dose), topirimate, alprazolam, botox
55
drugs impair DA transmission and alleviate chorea in HD patients
reserpine, tetrabenazine (VMAT inh)
56
tx for tics most often includes what
clonidine, guanfacine
57
tx for als (inh glutamate release blocking NMDA postsynaptically also and inhibits voltage gated Na channels
riluzole
58
tx for wilson disease
low copper diet, penicillamine (chelating agent), potassium disulfide (reduce absorption of copper)
59
which WBC is found in subarachnoid space during acute pyogenic meningitis
neutrophils
60
most common agent of acute pyogenic meningitis in neonates
strep B, e coli
61
most common agent of acute pyogenic meningitis in infants
h flu
62
most common agent of acute pyogenic meningitis in young adults
neisseria meningitidis
63
most common agent of acute pyogenic meningitis in elderly
strep pneumo, listeria mono
64
raised intracranial pressure, CSF has low glucose, high protein, and many neutrophils
acute pyogenic meningitis
65
empiric treatment for acute pyogenic meningitis in neonates
cefotaxime or ceftriaxone (3rd gen cephalosporins) and vancomycin
66
empiric treatment for acute pyogenic meningitis in elderly
cefotaxime or ceftriaxone (3rd gen cephalosporins) and vancomycin (plus ampicillin if over 50)
67
empiric treatment for acute pyogenic meningitis in young adults
cefotaxime or ceftriaxone (3rd gen cephalosporins) and vancomycin
68
empiric treatment for acute pyogenic meningitis in infants
Hib vaccine, cefotaxime or ceftriaxone (3rd gen cephalosporins)
69
tx for acute pyogenic meningitis in an immunocompromised pt
vanco + ampicillin + cefepime or meropenem
70
tx for acute pyogenic meningitis in pt with beta lactam allergy
vanco + moxifloxacin
71
tx for acute pyogenic meningitis in pt with beta lactam allergy who is >50
vanco + moxifloxacin + bactrim
72
which antibiotic used to treat meningitis or MRSA can cause red man syndrome (non immune release of histamine leads to rash and itchy skin)
vanco
73
what causes aseptic meningitis
enterovirus (coxsackievirus, echovirus)
74
most common bugs to cause brain abscess
viridans strep, staph aureus
75
antibiotic given to those with brain abscess
penecillin g + metronidazole
76
which bug causes brain abscess following sinus or ear infection and what do you treat with
enterobacteriaceae, ceftriaxone
77
an infection of the skull bones or air sinuses that spreads to subdural space causing fever and progressive worsening headache
subdural empyema
78
how to tx sub dual empyema
surgery to evacuate, cefotaxime, vacomycin, metronidazole, meropenem
79
what are common causes of viral meningoencephalitis (a parenchymal brain infection)
measles (SSPE-cognitive decline, spacitty, seizures) or poliomyelitis (gastroenteritis then anterior horn symptoms of paralysis can effect diaphragm-death)
80
most common fungal agent for meningoencephalitis (appear as soap bubbles on brain section, can cause hydrocephalus)
cryptococcal neoformans
81
tx for cryptococcal meningitis
amphotericin B + flucytosine and then fluconazole
82
adverse rxn to amphotericin B in fungal meningitis patients
renal toxicity, acute febrile reaction, anemia, phlebitis
83
full mu receptor agonists
fentanyl (more potent) and morphine
84
partial mu receptor agonists
bupreneorphine
85
naloxone is a mu receptor antagonist when would you use it
after opioid overdose
86
how do opioids lead to acidosis
respiratory suppression --> retain CO2 in lungs --> rise in H+ in blood
87
what are two guaranteed side effects of opioid therapy
constipation, miosis
88
people who have super fast metabolism of opioids likely have two copies of which allele
CYP2D6
89
what is a non opioid (non habit forming) cough reliever
DM (dextromthophan)
90
which opioid acts at all three types of receptor
buprenorphine (detox/withdrawal along with naloxone)
91
where is the lesion and what is it called? R eye cannot adduct and L eye has nystagmus on lateral gaze
R MLF, INO
92
where is the lesion and what is it called? paralysis of L lower face mm
R CBT, supranuclear facial palsy
93
where is the lesion and what is it called? no L lateral gaze, hemiplegia on R side of body, L bells palsy
millard gubler, 6, 7, CST
94
what is it called? alternating abducens hemiplegia plus dorsal extension into VII, MLF, or ML
foville
95
lesion involving alternating hemianalgesia, 9, 10, and nucleus ambiguus: what is it called?
wallenberg syndrome (PICA)
96
lesion of 7, 8, 5, SL, and cerebellum leading to ataxia: what is it called?
CPA: cerebellopontine angle syndrome
97
lesion involving 3, ML, red nucleus: and what is it called?
benedikt's syndrome
98
lesion involving superior colliculus leading to no upward gaze: what is it called?
parinaud
99
what can cause parinaud syndrome (no upward gaze)
pineal tumor or varix of great v of galen (suppressing superior colliculus)
100
whats it called when you have a brain lesion leading to lots of pain, wacky emotions, auditory loss, homonomys hemianopia, and hemiparesis
thalamic syndrome
101
whats it called when we have alternating oculomotor hemiplegia with lesions in CST and SN
weber syndrome
102
whats the only efferent from cerebellar cortex
purkinje cell axons
103
bilateral destruction of mammillary bodies and dorsomedial thalamic nucleus: impaired rent memory leads to confabulation
korsakoff syndrome (chronic alcoholic=wernicke enephalopathy)
104
midline involvement of upper portion of pyramidal decussation that results in upper extremity paralysis
bells crutiate paralysis
105
if patient has ataxia and a normal Romberg's test it suggests what
cerebellar ataxia
106
lesions of the cerebellum cause ipsalateral deficits such as
ataxia, dysmetria, dysdiadochokineasia, intention tremor, robotic movement, slurred speech, hypotonia/hyporeflexia
107
word for: attention deficit, orientation disturbed, stimuli misinterpreted
confusion
108
word for: disoriented, stimuli misinterpreted, visual hallucination
delerium
109
word for: mental blunting, increase sleep, aroused by mild vocal stimuli
obtunded
110
word for: aroused only to pain and only rudimentary awareness
stupor
111
word for: unarousable, unresponsive, unaware
coma

Neuro II (3 decks)

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