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Priniclpes Of Anesthesia > Psych/ECT exam 4 > Flashcards

Psych/ECT exam 4 Flashcards

1
Q

SSRI MOA

A

block re-uptake of serotonin at presynaptic memrbraines

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2
Q

Most common antidepressant

A

SSRI

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3
Q

SSRI anesthesia consideration

A

Discontinuation syndrome - continue SSRIs through peri-operative period

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4
Q

SSRI discontinuation syndrome s’sx

A

N/V
abdominal pain + diarrhea
Sleep disturbance
irritability and mood swings

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5
Q

TCA MOA

A
  1. inhibit synaptic reuptake of NE and serotonin
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6
Q

TCA anesthesia considerations - first 4-6 weeks of treatment

A
  1. Increased neurotransmitter availability = increased anesthesia requirements
  2. Increased catecholamines can cause exaggerated response to INDIRECT vasopressors (i.e. ephedrine) - use phenylephrine for hypotension
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7
Q

TCA anesthesia considerations all the time

A

Increase risk of anticholinergic syndrome (post - op delirium)

especially considering when using anticholinergics such as robinol

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8
Q

Serotonin syndrome: what is it, cause and main features

A

overstimulation of 5HT receptors

Common cause: 2 or more sertonergic drugs

main features: clonus, hyperreflexia, delerium

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9
Q

Serotonin syndrom treatemtn

A
  1. stop drug and supportive care
  2. cryohetadine
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10
Q

MAOI MOA

A

Inhibit metabolic breakdown of NE and serotonin (liver)

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11
Q

MAOI anesthesia considertaions

A
  1. Indirect hypertension
  2. May increase MAC
  3. avoid abrupt changes in SNS activity (i.e. not deep enough or too deep)
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12
Q

With MAOI, avoid

A
  1. merperidene (know triggering agent)
  2. Indirect - acting sympathomimetic (ephederine)
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13
Q

Pre-operative lithium levels should be

A

Less than 2mEq/L

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14
Q

Sodium and lithium

A

Sodium depletion reduces renal excretion of lithium

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15
Q

Lithium and neuromuscular blockade

A

Lithium prolongs NM blockade

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16
Q

Lithium and anesthesia

A

Lithium decreases anesthetic requirements

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17
Q

Anorexia anesthesia consideration

A

cardiomyopathy and hypokalemia

need EKG and maybe ECHO

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18
Q

Schizophrenia MAO

A

domaine dysfunction - treat with dopamine blockers

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19
Q

Antipsychotics act on

A

dopamine receptors

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20
Q

Neuroleptic Malignant syndrome differential diagnosis

A

shortly after neuroleptic medication

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21
Q

Main inhibitory neurotransmitter in the brain

A

GABA

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22
Q

Alcohol MOA

A

reduces excitatory neurotransmitters (asptarate, glutamate)

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23
Q

Aspatrate and glutamate act through

A

NMDA receptors (and non)

24
Q

How does alcohol affect brain function?

A

disrupts balance between inhibitory and excitatory neurotransmitters

25
Q

Long term ETOH exposure compensation

A

Brain attempts to tilt balance back toward equilibrium = tolerance

26
Q

ETOH withdrawal occurs from

A

excitation of neurotransmitter system from compensation

27
Q

Acute ETOH risk

A

aspiration of gastric contents because laryngeal reflex is blunted

28
Q

Acute intox ETOH anesthetic effeects

A
  1. exaggerated responses to anesthetic agents
  2. Decreased requirements
  3. additive depressant effect
29
Q

Long term ETOH mechanism

A

change in receptor level of protein composition of receptor –>decreased in GABA-A function –>decreased sensitivity to neurotransmission

30
Q

Chronic ETOH electrolyte imblanace

A

Hypomagnesia

31
Q

delirium tremens begins

A

2 -4 days after cessation of drinking

32
Q

Delirium tremens is characterized by

A

tremor
agitation
fever
tachycardia
confusion
delusions
hallucinations

33
Q

Anesthesia role in medically-assisted withdrawal

A

-high dose benzos to counteract sympathetic response
-sympatholytics
-control airway for safe sedation

34
Q

VTA (what it stands for and association)

A

Ventral tegmental area

associated with the reward pathway

35
Q

VTA neurons contain ____ which is released____

A

dopamine, which is released in the nucleus accumbens

pathway is activated by rewarding stimulus

36
Q

Illicit drugs anesthetic considerations

A

all cause NE reuptake blockade

=central and peripheral effects of increased endogenous NE

37
Q

Smoked drugs and MAC

A

Acute - decrease MAC
Chronic - increase MAC

38
Q

Cocaine MOA

A

Blocks reuptake of endogenous catecholamines presynaptically

= increase BP, HR, Temp

39
Q

Cocaine use: caution with

A

beta blockade - can lead to unopposed alpha 1 mediated coronary and peripheral vasoconstriction/spasm

40
Q

Cocaine HTN treatment:

A

alpha blockade (phentolamine) and NTG or vasodilator (nitropursside)

41
Q

Cocaine EKG/cardiac risk

A

prolonged QT interval and torsades

42
Q

Cocaine: avoid

A
  1. ketamine
  2. pancuronium

potentiates CV toxicity of cocaine

43
Q

Cocaine acute intoxication MAC

A

Increases MAC - they are revved up with lots of catecholamines so you need a lot more

44
Q

Meth anesthesia considerations

A

similar to cocaine

45
Q

Affinity of hemoglobin for CO is

A

200 x greater tahn oxygen

so CO binds first

46
Q

ECT anesthesia goals

A
  1. provide neuromuscular blockade to prevent fractures and muscle injury
  2. produce unconsciousness
47
Q

ECT seizure lasts

A

minimum 25 seconds to ensure adequate antidepressant efficacy

48
Q

ECT seizure parasympathetic CV response:

A
  1. transient bradycardia
  2. occasional asystole (hypotension, bradydysrthythmia)
49
Q

ECT seizure sympathetic CV respsonse:

A

during clonic phase
1. prominent HTN
2. tachycardia

50
Q

ECT seizure responses (7)

A
  1. Increased CBF
  2. Raised ICP
  3. Cardia dysrhythmias
  4. Myocardial ischemia, infarction
  5. neurologic vascular events
  6. increased IOP
  7. Increased intragastric pressure
51
Q

ECT side effect on memory

A

short term memory loss

52
Q

Most common long term effect associated with ECT

A

memory impairment

53
Q

ECT risks and SE (5)

A
  1. myalgia
  2. HA
  3. Emergence agitation
  4. staus epilepticus
  5. sudden death
54
Q

Absolute ECT contraindications (6)

A
  1. pheochromocytoma
  2. recent MI 4-6 weeks
  3. Recent CVA (3 month)
  4. recent intracranial surgery (3 mnths)
  5. Intracranial mass lesion
  6. Unstable cervical spine
55
Q

ECT gold standard induction agent

A

Methohexital 0.5.- 1 mg/kg

56
Q

Ketamine and ECT

A

Ketamine prolongs seizure duration (proconvulsant)

but also has negative effects

57
Q

Conditions that prolong seizure duration in ECT

A

Hyerventilation/hypocapnia

Priniclpes Of Anesthesia (19 decks)

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