NMSP Flashcards
In order to explain the use of sedatives in a patient with ANXIETY, list and describe BENZODIAZEPINES and their associated mechanism of action.
Common agents are diazepam, lorazepam, and midazolam.
MOA: act on GABA-A receptor to increase receptor sensitivity to GABA (agonist) and enhance inhibitory neurotransmission
These can help with anxiety, and are used in the perioperative period since they also produce anterograde amnesia (good for stuff like colonoscopies where patient is in conscious sedation)
can terminate actions w/ antagonist (flumazenil)
In order to explain IATROGENIC ACUTE ONSET FEVER, identify the drugs that contribute to the rising body temperature due to MALIGNANT HYPERTHERMIA.
Malignant hyperthermia includes rapid onset tachycardia, HTN, severe muscle rigidity, rhabdomyolysis, hyperthermia, hyperkalemia, and acidosis
Drugs involved (Inhaled volatile anesthetics):
- nitrous oxide, desflurane, sevoflurane, isoflurane, enflurane, and halothane.
Succinylcholine
In order to explain nausea and vomiting due to acute hepatitis, describe the signs and symptoms of HALOTHANE-INDUCED HEPATITIS.
Halothane may cause hepatitis with or without previous exposure.
Signs/Sx: anorexia, nausea, myalgias, arthralgias, rash, eosinophilia, hepatomegaly, and jaundice.
Typically w/in 2 days to 3 weeks after exposure.
In order to explain adverse effects due intravenous anesthetics, identify the drug that causes a DISSOCIATIVE ANESTHETIC STATE characterized by catatonia, amnesia, and analgesia without loss of consciousness.
KETAMINE is a NMDA receptor antagonist known for the dissociative anesthetic state (catatonia, amnesia, and analgesia) it causes.
In order to treat a skin lesion due to trauma, identify the local anesthetic(s) that may be applied topically during wound cleaning.
Benzocaine & dibucaine are the two used topically
***we see more reactions to ester type local anesthetics, which have only one “i” in their name, in the -caine suffix. Amide types have two “i”s.
Describe and explain the relationship between blood: gas partition coefficient and time to anesthesia onset.
Low blood gas partition coefficient = lower solubility in blood = faster arterial saturation/partial pressure = faster onset of action
High blood gas partition coefficient = higher solubility in blood = takes longer to reach arterial saturation/partial pressure = slower onset of action
Define minimum alveolar concentration (MAC).
The MAC is the minimum concentration of an inhaled anesthetic (exp as percentage) at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision or remain asleep to noxious stimuli in 50% of patients.
MAC is inversely related to potency!
In order to induce CNS depression (e.g., deep sedation) necessary for balanced anesthesia, you should be able to explain the MOA of inhaled and intravenous anesthetics.
Inhaled anesthetics MOA is mostly unknown. Fundamentally, they work within the central nervous system by augmenting signals to chloride channels (GABA) and potassium channels while depressing neurotransmission pathways.
Intravenous anesthetics have varying MOA:
Propofol/fospropofol: GABA-A Receptor Agonist, potentiates the Cl- current
Etomidate- enhances the actions of GABA on GABA-A Receptors
Ketamine: NMDA receptor antagonist
Dexmedetomidine: a2 adrenergic agonist that produces hypnosis presumably from stimulation of a2 receptors in the locus ceruleus and analgesic effects at the level of the spinal cord
In order to treat weakness due to neuromuscular blockade as a result of DRUG-INDUCED PARALYSIS, describe the drug(s) used to RESTORE NORMAL SKELETAL MUSCLE FUNCTION.
To reverse drug-induced paralysis, you must use an AChE INHIBITOR.
Neostigmine (commonly used)
Some others include: pyridostigmine, physostigmine, rivastigmine, ambenonium, donepezil, echothophate, edrophonium, galatamine, and tacrine.
In order to treat weakness due to neuromuscular blockade as a result of drug-induced paralysis, identify the drug(s) used to MINIMIZE ADVERSE EFFECTS that result from reversal of pharmacological paralysis.
ANTICHOLINERGIC AGENTS (atropine and glycopyrrolate) co-admin with AChE INHIBITORto minimize adverse cholinergic effects (bradycardia, bronchoconstriction, salivation, nausea, and vomiting) at mAChRs.
In order to treat peripheral weakness with sensory changes due to exposure to organophosphates, identify the drug that will RELIEVE SKELETAL MUSCLE FASCICULATIONS AND PARALYSIS.
Organophosphates (often in insecticides) include: echothiophate, parathion, malathion, sarin, and soman.
In this case, you would use the drug PRALIDOXIME, a CHOLINESTERASE REGENERATOR that acts peripherally upon BOTH NAChRs and MAChRs.
In order to treat peripheral weakness due to MYASTHENIA GRAVIS, you should be able to recognize symptoms of decreased acetylcholine signaling at the neuromuscular junction, select a drug mechanism for appropriate treatment, and explain anticipated adverse effects.
Sx of decreased ACh signaling at NMJ: weak arms/legs/hands/fingers/neck, ptosis, diplopia,
If in myasthenic crisis: severe SOB –> need a ventilator. EDROPHONIUM can help with a myasthenic crisis but won’t help if the ventilator issues are from a cholinergic crisis (excess AChE inhibitor use).
Appropriate Tx for MG:
AChE Inh: PYRIDOSTIGMINE, NEOSTIGMINE, AMEBONIUM
Explain anticipated adverse Fx:
“DUMBBELSS”- cholinergic effects
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of msk, Lacrimation, Salivation, Sweating
In order to treat movement disorder due to MS, you should be able to select an appropriate pharmacologic therapy and describe anticipated adverse effects.
non-centrally acting spasmolytic (dantrolene): muscle weakness, sedation, and occassionally hepatitis
- all cause immunosuppression
Azathioprine: No adverse fx listed
Dalgampridine: No adverse fx listed
Glucocorticoids: weight gain, feeling hungry, water retention, mood swings, blurred vision, muscle weakness
Cyclophosphamide: No adverse fx listed
Glatiramer acetate: anxiety, bleeding, injection site issues, chest pain, cough, hoarseness, excessive muscle tone, fast or irregular hearts rate, fever or chills
Interferons beta-1a or beta-1b: swelling at site, flu like symptoms, chills, fever, nausea, vomiting, or diarrhea
Mitoxantrone: nausea, vomiting, diarrhea, constipation, heartburn, loss of appetite, sore on mouth and tongue, or runny or stuffed nose
Natalizumab: HA, D, back pain, cough, and abn liver enzymes
In order to explain the anticipated adverse effects of drugs used to treat muscle spasticity,
you should be able to list and describe adverse effects of carisoprodol and cyclobenzaprine.
Carisoprodol; dizziness + drowsiness; CNS depressant
Cyclobenzaprine: drowsiness, dizziness, and xerostomia; reduces tonic somatic motor activity by influencing both alpha and gamma motor neurons; may cause significant sedation, confusion and transient visual hallucinations.
