Neuro: first aid 2015 pg 495-502

Question 1

A 42-year-old man involved in an automobile accident sustains multiple fractures of the right leg and arm and is suffering from severe pain. In the emergency department, his wife reports that her husband is a recovering heroin addict who has been enrolled in a methadone program for 3 months and is also taking phenelzine for depression. The most appropriate drug to alleviate the patient’s severe pain is

A. butorphanol.
B. meperidine.
C. morphine.
D. nalbuphine.
E. pentazocine.

Answer 1

A

methadone program —> withdrawal program so don’t give opioid agonist

so Butorphanol is Kagonist and u partial agonist!

Question 2

butorphanol overdose–> easily reversible with naloxone?

Answer 2

nope

Question 3

Tramadol
what is it?
and fatal side effect

Answer 3

tram it all work on everything
Serotonin syndrome!!
also decreases seizures threshold

Question 4

Absence seizure treatment

Answer 4

Ethosuxmide

Question 5

List Ca2+ blockers for antiseizures

Answer 5

EcG
Ethosuxmide
Calcium
Gabapentin

Question 6

Increase in GABA

Answer 6

Topiramate and phenobarbital

Question 7

where do you use Gabapentin other than seizures

Answer 7

peripheral neuropathy and postherpatic neuralgia

Question 8

Migraine prophylaxis?

Answer 8

BACT

Topiramate!

Question 9

drug that cause stevens-johnson syndrome

Answer 9

lamotrigine

Question 10

antiepileptic causing SIADH

Answer 10

carbamazepine

Question 11

bipolar

1. manic phase
2. depressed phase

Answer 11

1. manic: carbamezepine

2. lamotrigine

Question 12

status epilepticus DOC

Answer 12

phenytoin

Question 13

tonic-clonic DOC

Answer 13

valporic

Question 14

p450 inducer

Answer 14

carbamazepine

Question 15

patient with tonic clonic and absence seizures

Answer 15

valporic

Question 16

gingival hyperplasia

Answer 16

phenytoin

Question 17

baby with cleft palate, cardiac

defects, phalanx/fingernail hypoplasia

Answer 17

fetal phenytoin syndrome

Question 18

eclampsia 1st line and what’s the other drug

Answer 18

MgSO4

BDZ

Question 19

hepatotoxic, neural tube defects

Answer 19

phenytoin

Question 20

kidney stones

Answer 20

topiramate

Question 21

list 2 GABA channels that works by Cl- influx

Answer 21

A and B
A is in brain
B is in retina

Question 22

what’s GABAb? MOA?

Answer 22

in brain too. it’s ta Gprotein so Gi
K+ efflux
decreased in Ca2+ influx
Net effect: hyperpolarize

Question 23

whats contraindicated in porphyria?

Answer 23

barbs

Question 24

low potency think what?

Answer 24

high MAC = low solubility in lipid

Question 25

high potency --> lipid or blood solubility

Answer 25

potency--> think lipid! want high solubility in lipid for high potency

Question 26

rapid induction think lipid or blood? (low or high)

Answer 26

blood, low blood

Question 27

rapid induction means what recovery times?

Answer 27

fast

Question 28

rapid induction, want B/G ratio to be?

Answer 28

low--> increased free fraction

Question 29

list properties of N2O in term of 1. induction 2. potency

Answer 29

1. induction: rapid --> low blood solu | 2. potency: low lipid solu --> low potency

Question 30

halothane SE

Answer 30

hepatotoxic

Question 31

Methyoxyflurane SE

Answer 31

nephrotoxic

Question 32

proconvulsant

Answer 32

enflurane

Question 33

treatment for 1. malignant hyperthermia 2. Neuroepileptic syndrome 3. serotonin syndrome 4. extrapyramidal systems SE of antipyschotics

Answer 33

1. dantrolene (fever+severe muscle contractions) (SSRI+inhaled anesthetics except N2O) 2. dantrolene and D2 agonists (bromocriptine) (myoglobinuria + ridigity) 3. cyproheptadine (myoclonus + diarrhea) 4. beztropine or diphenhydramine

Question 34

inhaled anethestics cause increased cerebral blood flow but this one cause decreased cerebral blood flow. its IV anesthetics. what is it?

Answer 34

barbituates (thiopental)

Question 35

for endoscopy, what anesthetics?

Answer 35

midazolam

Question 36

Chronic alcoholic came in for endoscopy. He seemed to make up stories. He is given midazolam. He is B1 deficient too. after surgery, what will happen to his memory?

Answer 36

Korsakoff syndrome: Ante> retro midazolam: Retro so he's gone gone gone

Question 37

This IV anesthetics is used in older patients with bradycardia (or heart problem), and it is used when you the patient to be conscious but you just want to induce muscle catatonia?

Answer 37

ketamine

Question 38

what is ketamine?

Answer 38

arylcyclohexylamines ACHA

Question 39

this IV anesthetic is often used for outpatient quick and easy procedures like botox. K-pop stars favorites

Answer 39

propofol

Question 40

bad thing about propofol is there is pain at injection site, what would you use instead?

Answer 40

fospropofol

Question 41

local anesthetics most effective in what type of neurons?

Answer 41

activated Na+ --> rapidly firing neurons