Psyc ppt (Part 2)

Question 1

What is the pathological finding of Parkinson’s?

Answer 1

Degeneration of the neurons

Question 2

The degeneration of Neurons originate where in the Brain

Answer 2

The substantia nigra of the midbrain and terminate in the basal ganglia

Question 3

Name the 2 most reliable and effective drugs to treat Parkinson’s

Answer 3

Levodopa and Carbidopa

Question 4

Levadopa crosses the blood brain barrier and is converted by what enzyme ______into what?

Answer 4

L-aromatic amino acid decorboxylase

Dopamine

Question 5

Does dopamine cross the BBB?

Answer 5

NO

Question 6

Levadopa works for Parkinson’s disease because it is a ________ to _______ and is converted upon crossing the BBB

Answer 6

precursors

Dopamine

Question 7

Does Carbidopa cross the BBB?

Answer 7

NO

Question 8

Carbidopa is classified as a ________ ________ ?

Answer 8

decarboxylase inhibitor

Question 9

Carbidopa inhibits decarboxylase in the Liver, Kidneys and GI tract and prevents the breakdown of _________?

Answer 9

Levadopa (Carbidopa just prevents Levadopa from being broken down before it crosses the BBB)

Question 10

First symptoms to improve with the use of Levodopa/Carbidopa are?

Answer 10

rigidity and bradykinesia late improvement is the tremors

Question 11

Levodopa/Carbidopa side effects

Answer 11

NV and anorexia D/T activation of the chemoreactive trigger zone in the medulla oblangata
orthostatic hypotension
Cardiac arrythmias D/T Beta adrenergic dopamine stimulation

Question 12

Long term therapy Side Effects

Answer 12

Abnormal Choreiform movements of the limbs and hands, trunk and tongue.
serious mental disturbances such as psychotic episodes and a need for a 1 week drug holiday

Question 13

Levodopa/Carbidopa contraindications

Answer 13

MAO Inhibitors
narrow angle glaucoma
cardiac arrythmias
recent MI
Phenothiazines, butrophenones and reserpine can cause extrapryamidal symptoms

Question 14

Selegiline first line drug for parkinsons before moving to levodopa by?

Answer 14

Enhancing endogenous dopamine

Question 15

Interacts with TCA’s causing

Answer 15

Fever agitation deilerium and coma

Question 16

Belladonna Alkaloids

Answer 16

Used in mild cases

combats tremors and dystonia

Question 17

Antihistamines like benadryl

Answer 17

Can be used to control minor tremors in the elderly

Question 18

What % of people respond favorably to Dopamine agonists

Answer 18

only 20-30%

Question 19

Names of Dopamine agonists

Answer 19

Bromocriptine (parlodel), Pergolide (permax)

Question 20

Dopamine agonists side effects are

Answer 20

Anorexia and Nausea due to stimulation of the Chemotatic trigger Zone (CTZ)

Question 21

Anesthetic Implications

Answer 21

• Have Pt take meds preoperatively effects last 6-12 hrs
• Avoid Phenothiazines, butyrophenones, metoclopramide
• Muscle rigidity may impede mask ventilation
• Increased aspiration risk
• Intravascularly volume depleted

Question 22

Anesthetic Implications

Answer 22

• Normal response to muscle relaxants
• Increased risk of post op laryngospasm
• violent tremors on emergence
• No ephedrine in taking Deprenyl
• Ketamine can cause exaggerated sympathetic response
• Potential hyperkalemic response to Sucs

Question 23

Anesthetic Implications

Answer 23

• Skeletal muscle tremor may mimic VFIB on ECG
• May have diminished reserve due to poor exercise tolerance
• Muscle relaxants will relax even the most rigid of patients

Question 24

Anticonvulsants _______ the Seizure threshold

Answer 24

Raise

Question 25

Only ____ % of Pts become SZ free on meds

Answer 25

40%

Question 26

______% of Pts get no benefit from currently avalilable meds

Answer 26

20%

Question 27

Anticonvulsants MOA

Answer 27

Inhibition of neuronal Na+ channels in hyperexcitable cells Disinhibition may increase SZs Reduction in GABA increases SZs

Question 28

Anticonvulsants Classes

Answer 28

I-IV based on MOA

Question 29

Type I

Answer 29

Blocks sustained high frequency repetitive firing by enhancing Na+ channel inactivation - Phenytoin - Carbamazepine

Question 30

Type II

Answer 30

Multiple actions: enhances GABA inhibition reduces T calcium currents, possibly blocks SRF - Valproic Acid - Benzos - Phenobarbital

Question 31

Type III

Answer 31

Blocks T calcium currents only | -Trimethadione

Question 32

Type IV

Answer 32

only enhances GABA inhibition | -Gabapentin

Question 33

Na+ Channel blocking agents such as

Answer 33

Dilantin used for general tonic clonic and partial SZ

Question 34

Dilantin adverse effects

Answer 34

Overdose- nystagmus, ataxia, vertigo, diplopia Common- enlarged lips and nose, gingival hyperplasia idiosyncratic- dermatitis, hepatic necrosis

Question 35

Carbamazepine (Tegretol)

Answer 35

Used for tonic clonic and absent SZ common SE id drowsiness Increases metabolism in other anticonvulsants

Question 36

Barbiturated

Answer 36

Increases GABA inhibition | main SE sedation and disturbance in cognitive function

Question 37

Valproic Acid

Answer 37

Blocks Na+ channels and increases GABA in the brain | SE hepatotoxic and Fetal neural tube defects

Question 38

Benzos

Answer 38

interacts with GABA and causes sedation with a rapid development of tolerance

Question 39

Phenytoin

Answer 39

resistant to NDNMB causes decreased duration of muscle relaxants rate of administration is 25-50 mg / min to avoid hypotension Stevens-Johnson syndrome

Question 40

Anesthetic Implications

Answer 40

Induction w/ thiopental or propofol N2O/Narcotic techniques Avoid enflurane and methohexital opoid tolerance r/t enzyme activation by the anticonvulsants