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Anesthesia Pharm II > Psyc ppt (Part 2) > Flashcards

Psyc ppt (Part 2) Flashcards

1
Q

What is the pathological finding of Parkinson’s?

A

Degeneration of the neurons

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2
Q

The degeneration of Neurons originate where in the Brain

A

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

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3
Q

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

A

Levodopa and Carbidopa

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4
Q

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

A

L-aromatic amino acid decorboxylase

Dopamine

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5
Q

Does dopamine cross the BBB?

A

NO

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6
Q

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

A

precursors

Dopamine

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7
Q

Does Carbidopa cross the BBB?

A

NO

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8
Q

Carbidopa is classified as a ________ ________ ?

A

decarboxylase inhibitor

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9
Q

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

A

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

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10
Q

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

A

rigidity and bradykinesia late improvement is the tremors

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11
Q

Levodopa/Carbidopa side effects

A

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

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12
Q

Long term therapy Side Effects

A

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

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13
Q

Levodopa/Carbidopa contraindications

A 
MAO Inhibitors
narrow angle glaucoma
cardiac arrythmias
recent MI
Phenothiazines, butrophenones and reserpine can cause extrapryamidal symptoms
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14
Q

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

A

Enhancing endogenous dopamine

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15
Q

Interacts with TCA’s causing

A

Fever agitation deilerium and coma

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16
Q

Belladonna Alkaloids

A

Used in mild cases

combats tremors and dystonia

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17
Q

Antihistamines like benadryl

A

Can be used to control minor tremors in the elderly

18
Q

What % of people respond favorably to Dopamine agonists

A

only 20-30%

19
Q

Names of Dopamine agonists

A

Bromocriptine (parlodel), Pergolide (permax)

20
Q

Dopamine agonists side effects are

A

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

21
Q

Anesthetic Implications

A
  • 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
22
Q

Anesthetic Implications

A
  • 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
23
Q

Anesthetic Implications

A
  • 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
24
Q

Anticonvulsants _______ the Seizure threshold

A

Raise

25
Q

Only ____ % of Pts become SZ free on meds

A

40%

26
Q

______% of Pts get no benefit from currently avalilable meds

A

20%

27
Q

Anticonvulsants MOA

A

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

28
Q

Anticonvulsants Classes

A

I-IV based on MOA

29
Q

Type I

A

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

  • Phenytoin
  • Carbamazepine
30
Q

Type II

A

Multiple actions: enhances GABA inhibition reduces T calcium currents, possibly blocks SRF

  • Valproic Acid
  • Benzos
  • Phenobarbital
31
Q

Type III

A

Blocks T calcium currents only

-Trimethadione

32
Q

Type IV

A

only enhances GABA inhibition

-Gabapentin

33
Q

Na+ Channel blocking agents such as

A

Dilantin used for general tonic clonic and partial SZ

34
Q

Dilantin adverse effects

A

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

35
Q

Carbamazepine (Tegretol)

A

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

36
Q

Barbiturated

A

Increases GABA inhibition

main SE sedation and disturbance in cognitive function

37
Q

Valproic Acid

A

Blocks Na+ channels and increases GABA in the brain

SE hepatotoxic and Fetal neural tube defects

38
Q

Benzos

A

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

39
Q

Phenytoin

A

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

40
Q

Anesthetic Implications

A

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

Anesthesia Pharm II (19 decks)

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