Periop Cards
Select which procedure(s) are classified as high-risk
Open aortic surgery
Head and neck surgery
Carotid endarterectomy
Peripheral vascular surgeries
Endoscopic procedures
Open aortic surgery
Peripheral vascular surgeries
Head and neck surgery (intermediate)
Carotid endarterectomy (intermediate)
Endoscopic procedures (low)
How do Anticholinergics help with Parkinson's symptoms?
blunts the excitatory effects of acetylcholine (helps to correct the imbalance between dopamine and Ach)
What is carbidopa, and why is it given with levodopa?
It is a peripheral decarboxylase inhibitor, allowing more of levodopa to be effective since it's not being broken down as much
anticholinergics have a _____ effect with levodopa
A. additive
B. synergistic
C. competative
D. negative
B. synergistic
HOWEVER high doses lead to slowed gastric emptying, which decreases the absorption of levodopa
Which part of the brain is most involved in Parkinson's disease?
Substantia nigra pars compacta in the basal ganglia
Which three beta antagonists do not decrease mortality in the perioperative period?
Acebutolol
Penbutolol
Pindolol
All increase intrinsic sympathomimetic activity
Dopaminergic
Antiviral
MAOIs
Anticholinergics
COMT inhibitors
what are the top three side effects of Levodopa?
Nausea and vomiting (from stimulation at the CTZ)
orthostatic hypotension
involuntary movement
What drug/vitamin decreases the levels of levodopa via increased activity of dopa decarboxylase?
Vitamin B6 aka Pyridoxine
where does rigidity first manifest in PD?
neck muscles
What is the goal resting heart rate during the perioperative period
65-80 beats per minute
What airway challenges do you anticipate when placing a deep brain stimulator?
limited access to airway d/t head frame
possible need for fiberoptic bronchoscope for LMA placement
Why is synthetic dopamine agonist a treatment for Parkinson's, but endogenous dopamine is not?
Synthetic dopamine agonists can cross the BBB
Which RSI prophylactic med would you avoid in a Parkinson's patient and why?
Metoclopramide d/t its antagonism of dopamine
What are the two main goals of Parkinson's treatment (regarding neurotransmitters)
Increase dopamine in the basal ganglia
decrease the neuronal effects of Ach
Which patient(s) would warrant perioperative Beta blockade?
A. A type 2 diabetic who takes routine insulin
B. A patient recently diagnosed with CAD
C. A patient who received a positive stress test
D. A patient undergoing a high risk surgery
All of the above
what pharmacokinetics cause levodopa to be dosed so frequently?
95% metabolized in first-pass through liver
elimination 1/2 time is 1-3 hours (short)
therapeutic effects wear off around 6 hours
why is levodopa given instead of dopamine?
It can cross the BBB, and dopamine cannot. It will eventually turn into dopamine
True or False: Levodopa should be help the day of surgery
False (unless you're placing a deep brain stimulator)
all of the following are manifestations of PD EXCEPT:
akinesia
aphasia
rigidity
bradykinesia
aphasia
What are some reasons that beta blockers can be helpful in the perioperative period?
- decreased myocardial O2 consumption and demand
- attenuation of effects of endogenous catecholamines
- increased coronary blood flow (d/t increased diastolic time)
This one's just a free space. You're doing great :)
Almost break!
Match the drug name with its class
A. Tolcapone
B. Benztropine
C. Amantadine
D. Selegiline
1. Antiviral
2. COMT inhibitor
3. MAOI
4. Anticholinergic
A. Tolcapone - 2. COMT inhibitor
B. Benztropine - 4. Anticholinergic
C. Amantadine - 1. Antiviral
D. Selegiline - 3. MAOI
Which anesthetic medications should be avoided when placing a deep brain stimulator for a Parkinson's patient?
Propofol and Midazolam
- they can affect GABA and alter the microelectrode recordings --> use opioids and precedex instead
Patients with PD treated with chronic levodopa most commonly develop:
abnormal involuntary movements