Lecture 3: Subarachnoid Hemorrhage

Question 1

Where do cerebral aneurysms normally occur? Why?

Answer 1

At or near bifurcation of the vessels d/t more vulnerable geometry

Question 2

What is a syncopal episode?

Answer 2

Fainting

Question 3

What are the components of propofol that can trigger allergies? (Do keep in mind that propofol was reformulated to reduce anaphylactic reaction.)

Answer 3

Egg lecithin + soybean oil

Question 4

What part of propofol usually causes allergic reactions?

Answer 4

Diisopropyl group + phenol group

Question 5

What is valsartan/diovan?

Answer 5

Antihypertensive medication; angiotensin II receptor blocker

Question 6

Common name of acetylated salicyclic acid?

Answer 6

Aspirin

Question 7

Hydrocodone dose?

Answer 7

5-10 mg q3-4 hours

Question 8

Acetominophen is what class of drug? Dose?

Answer 8

NSAID; 10-15 mg/kg q4 hours

Question 9

Naproxen: common name? Class? Dose?

Answer 9

Aleve; NSAID; 250 mg q4 day or 500 mg q2 day

Question 10

What disease does novolin treat?
Dose?
Supplied?

Answer 10

Diabetes
6 units subcutaneously q12hr
Supplied 100 units/ml

Question 11

Common name of glucophage? Class? What disease does glucophage treat?

Answer 11

Metformin
Biguanide
Diabetes

Question 12

Nimotop’s generic name? Treats?

Answer 12

Nimodipine; Ca++ channel blocker that treats hypertension

Question 13

Zocor’s generic name? Treats?

Answer 13

Simvastatin; treats high cholesterol

Question 14

Colace treats what problem?

Answer 14

Colace is an anionic surfactant that decreases the surface tension of stool– a stool softener that treats constipation.

Question 15

Mechanism of metformin?

Answer 15

Reduces glucose levels by decreasing hepatic glucose production and increasing insulin action in muscle and in fat

Question 16

Mechanism of action of sulfonylureas:

Answer 16

Stimulate the insulin release from the Beta cells of the pancreas

Question 17

Who shouldn’t take metformin?

Answer 17

Patients with a history of renal impairment, lactic acidosis, hepatic disease or cardiac failure

Question 18

Which Ca++ channel blocker has the most widespread effect on all aspects of the heart?

Answer 18

Verapamil

Question 19

Which Ca++ channel blocker has its main effect in slowing conduction of both SA and AV nodes?

Answer 19

Diltiazam

Question 20

Which Ca++ channel blocker improves neurological outcomes in patients where deficits secondary to vasospasm are present after cerebral aneurysm rupture and is also recommended to prevent vasospasm after cerebral aneurysm coiling?

Answer 20

Nimodipine

Question 21

Why do we prescribe aneurysm patients stool softeners after surgery?

Answer 21

We don’t want them to strain; that would increase ICP and cause aneurysm to burst.

Question 22

What class of drug is pepcid? What does it inhibit?

Answer 22

Histamine H2 receptor blocker; inhibits gastric acid production

Question 23

Pepcid results in what percentage drop in acid secretion?

Answer 23

70%

Question 24

On what type of secretion is pepcid most effective?

Answer 24

Basal acid secretion, which is responsible for nocturnal acid secretion

Question 25

Drug name of pepcid?

Answer 25

Famotidine

Question 26

When end organ function exists, surgical mortality for diabetic patients is _____ times higher than normal patients.

Answer 26

5x higher

Question 27

Which three patient groups demand perioperative tight control of blood sugar?

Answer 27

1) Pregnant patients 2) Patient undergoing cardiopulmonary bypass 3) Patient with global CNS ischemia

Question 28

What is a common complications during surgery in patients with diabetes?

Answer 28

Cerebral CNS insult

Question 29

Which type of diabetic patient is susceptible to ketoacidosis?

Answer 29

Type I diabetic

Question 30

NIDDM is defined as a fasting blood glucose:

Answer 30

>125 mg/dl

Question 31

Which type of diabetic medication increases insulin binding to the insulin receptors on target tissue?

Answer 31

Sulfonylureas

Question 32

What effect does high glucose levels have on wound healing?

Answer 32

Decreased granulocytic function + collagen synthesis

Question 33

What is another word for ketoacidosis?

Answer 33

Hyperglycemia

Question 34

What glucose level is considered hypoglycemic? How do you treat hypoglycemia?

Answer 34

< 50 mg/dl | Treat with 50% dextrose, starting with 15 ml bolus.

Question 35

Under what circumstances would you have your patient on an IV insulin infusion during surgery?

Answer 35

If your patient is having a major surgery and has DM on insulin or DM poorly controlled w/ oral meds

Question 36

Why do you discard the first 50 ml of insulin infusion?

Answer 36

Insulin sticks to plastic tubing, so we use the first 50 ml to coat the system to prevent that.

Question 37

What is the physiological response during an asthma attack?

Answer 37

Mast cell release of histamine

Question 38

What is the pathology of an asthma attack?

Answer 38

Bronchoconstriction and airway inflammation

Question 39

In what way do B2 agonists treat asthma?

Answer 39

They activate muscarinic receptors in the lungs to cause bronchodilation by relaxing smooth muscle.

Question 40

Particle sizes of aerosolized spray in: Mouth and oropharynx Conducting and low airways Alveolar level

Answer 40

1) 10 micrometer in mouth and oropharynx 2) 1-10 micrometer in conducting and low airways 3) Alveolar level

Question 41

What are the two types of aerosols?

Answer 41

1) Metered dose | 2) Nebulizers

Question 42

Onset and duration of short-acting B2-agonists?

Answer 42

Onset: 1-5 min Duration: 2-6 hours

Question 43

Onset and duration of long-acting B2-agonists?

Answer 43

Onset: > 20 minutes Duration: 12 hours

Question 44

What are the two long-acting B2-agonists?

Answer 44

1) Salmeterol | 2) Formoterol

Question 45

What steroid (glucocorticoid) is used to treat asthma?

Answer 45

Beclomethasone

Question 46

By what means do steroids have a bronchodilating effect?

Answer 46

They decrease mucosa edema and prevent the release of bronchoconstricting substances

Question 47

What are three possible complications of aneurysm coiling?

Answer 47

1) Aneurysm rupture 2) Thromboembolism 3) Vasospasm