Anti Epileptics
Neuro Disorders/Parkinson's
Drugs Used In Headace
Local Anesthetics
Local Anesthetic Leftovers
General Anesthesia
IV Therapy
100

Phenytoin Side Effects

ataxia, nystagmus, hirsutism, gingival hyperplasia, coarsening of facial features

100

Drugs That Increase dopamine function

levodopa, tolcapone, entacapone, selegiline, rasagiline

100

Triptan MOA

5HT 1B and 5HT 1D serotonin receptor agonism (selective), vasoconstriction (1B), modulate neurotransmitter release, inhibit trigeminal nerve activation

100

local anesthetic MOA

sodium channel blockade
100

Injection sites from highest to lowest vascularity

Intercostal > caudal (sacral hiatus) > brachial plexus > sciatic nerve

100

5 cardinal effects of general anesthesia

unconsciousness, analgesia, amnesia, skeletal muscle relaxation, loss of autonomic reflexes

100

body fluid compartments and % body water

intracellular - 40%, extracellular - 20%

200

Drug of Choice for Absence Seizures

Ethosuximide

200

drug that inhibits DOPA decarboxylase, preventing LDOPA -> Dopamine conversion in tissues 

Carbidopa

200

triptan ADE

bitter taste, flushing, paresthesia, ANGINA, vasospasm

200

amide metabolism

liver amidase

200

Adjunct to prevent systemic effects

inject epinepherine - causes vasoconstriction, less distribution of anesthetic, less side effects, prolongs local anesthesia

200

what single drug can achieve all 5 cardinal effects?

None!  Requires combination of drugs, inhaled and intravenous (balanced anesthesia)

200

Subdivisions of extracellular fluid and % body water

interstitial - 15%, plasma - 5%

300

Valproate Side Effects

elevated liver enzymes, tremor, thrombocytopenia, pancreatitis, alopecia, weight gain, neural tube defects

300

Toxic Effects of Levodopa

arrhythmia, dyskinesia, "on-off" effects, psychosis, hypotension, vomiting

300

triptan contraindications

CAD, CVD, uncontrolled HTN

300

amide t1/2

1.5 - 2 hours, longer with liver disease

300

extra effect of epinepherine in spinal injection

direct analgesia via postsynaptic alpha 2 receptors in spinal cord

300

dissociative general anesthetic

ketamine

300

fluid loss routes and typical volume

urine - 800-1500mL, stool - 250mL, insensible - 600-900

400

SV2A Binding Seizure Meds

Levetiracetam, brivaracetam

400

Tolcapone and Entacapone MOA

COMT inhibitors, COMT breaks down L-dopa

400

acute cluster headache mgmt

100% O2, subQ sumatriptan, nasal/oral zolmitriptan, lidocaine, subQ octreotide (somatostatin), dihydroergotamine (nasal/parenteral)

400

Amide drugs

lidocaine, bupivacaine, Mepivacain, Etidocaine, Prilocaine

400

another alpha 2 agonist used as adjuvant anesthetic in spinal anestesia

clonidine

400

ketamine CNS effects

increased cerebral blood flow; distorted visual, tactile, and auditory sensitivity; hallucinations, vivid dreams, out of body feeling (K - ketamine, "K"ick start my heart!)

400

required fluid intake for afebrile 70kg man

35mL/kg ~ 2.5 liters

500
Carbamazepine Side Effects

granulocyte suppression, aplastic anemia, SIADH, diplopia, ataxia, spina bifida

500

dopamine receptor agonists

bromocriptine, pergolide, pramipexole, ropinirole

500

cluster headache prophylaxis

verapamil, lithium, topiramate, galacanezumab, melatonin, prednisone

500

why not bupivicaine?

cardiac toxicity

500

where is epinephrine injection contraindicated?

end arteries (fingers, toes, nose, ear)

500

ketamine autonomic effects

increased heart rate, blood pressure, and cardiac output; bronchodilation

500

required fluid intake for body weight <70kg

1st 10kg - 100mL/kg, 2nd 10kg - 50mL/kg, for weight above 20kg - 20mL/kg

600

Anti Seizure Med Known For Stevens Johnson Syndrome

Lamotrigine

600

drugs that increase dopamine release

amantadine

600

Ergot alkaloids

ergotamine, ergonovine, ergometrine
600

Bupivicaine alternatives

levobupivicaine - less affinity for cardiac sodium channels

ropivacaine - less cardiac affinity, but less effective

600

signs and symptoms of local anesthetic CNS toxicity

oral/tongue numbness, metallic taste, nystagmus, muscle twitching, seizures, depression, loss of consciousness

600

cardiac output(CO) and solubility affect on anesthesia activity

high solubility = less anesthesia (anesthesia active when its undissolved), high CO = less anesthesia (fast blood flow ~ less time for gas absoprtion)

600

Examples of Colloids

albumin, blood products, plasma protein fraction

700

Anti Seizure Drug Known For General Anesthetic Effects, Used In Status Epilepticus

Phenobarbitol

700

MAO-B inhibitors

selegiline, rasagiline

700
semisynthetic ergot

dihydroergotamine

700

ester drugs

cocaine, procaine, tetracaine, benzocaine

700
treatment/prophylaxis of local anesthetic CNS toxicity

benzos(diazepam, lorazepam, treat and prevent), oxygen, propofol, succinylcholine

700

Minimum Alveolar Concentration of Anesthetic:  Drug A - 10, Drug B - 20, which drug is more potent?

Drug A (less drug needed for anesthesia effect)

700

indications for colloids

intravascular fluid deficit, hypoalbuminemia, protein loss, combine with crystalloids when large volume replacement needed

800

Felbamate Side Effects

hepatitis, aplastic anemia

800

on-off phenomenon

unpredictable, sudden shifts of medication working and not working, occurs with levodopa

800

synthetic ergot derivatives

bromocriptine, pergolide, LSD, methysergide

800

ester metabolism

butyrylcholinesterase (pseudocholinesterase) in tissue and blood

800

precautions with pre-medicating to prevent CNS side effects

benzos don't prevent cardiac toxicity, benzos and propofol may delay recognition of cardiac effects

800
Halothane CNS effects

reduced vagal/parasympathetic tone [per AI : )], bronchodilation, reduced uterine and intestinal contractions

800

examples of crystalloids

normal saline, dextrose in water, lactated ringer solution

900

Anti Seizure Medication That Follows Zero Order Kinetics

Phenytoin

900

Drugs that decrease acetylcholine action

benztropine, trihexyphenidyl, diphenhydramine, biperiden, orphenadrine, procyclidine

900

Ergot MOA 

bind 5HT-1B and 5HT-1D serotonin receptors

900

ester t1/2

< 1 minute

900

dangerous local anesthetic in pregnancy and why

bupivacaine - no paracervical block due to possible uterine artery constriction, no epidural in pregnancy due to engorged epidural veins in pregnant women, potential for cardiac effects if penetrated [per AI : ) ]

900

Halothane ADEs

liver failure, arrhythmia (reduced vagal tone), hypotension, malignant hyperthermia

900

indications for crystalloids

hemorrhagic shock, septic shock, burns

1000

Anti Seizure Med That Causes Autoinduction of its Own Metabolism

Carbamazepine

1000

cholinergic hypothesis

deficiency of acetylcholine is critical in the genesis of Alzheimer's

1000

Ergot peripheral ADEs

leg weakness, muscle pain, numbness/tingling of the fingers

1000

This allows local anesthetics to cross the cell membrane

lipophilic aromatic portion

1000

local anesthetic that causes hypertension

cocaine - prevents reuptake of norepinephrine, dopamine, serotonin

1000

uncontrolled muscle contraction due to excessive calcium outflow

malignant hyperthermia

1000

isotonic fluids

normal saline (0.9%), PlasmaLyte, stereofundin

1100

sole indication for felbamate

refractory seizures that respond poorly to other meds

1100

what drug is the basis for the cholinergic hypothesis and why?

atropine - acetylcholine antagonist, it can induce a confusional state similar to that seen in Alzheimer's

1100

other Ergot ADEs

angina like symptoms, excessive vasoconstriction (non selective serotonin agonist), fibrosis

1100
local anesthetics more effective in a basic or acidic environment?  Why?

Basic.  They are unionized in a base.  Here they stay lipophilic and able to cross the cell membrane.

1100

toxic extracellular sodium channel blockers

tetrodotoxin - puffer fish, saxitoxin - algae

1100

meds that trigger uncontrolled calcium release

volatile anesthetics (halothane, isoflurane, sevoflurane, methoxyflurane, ether), also succinylcholine 

1100

hypotonic fluids and complications

lactated ringer (LR), D5W, cellular swelling, tissue edema, increased intracranial pressure

1200

other drugs for absence seizures besides ethosuximide

clonazepam, valproic acid

1200

acetylcholinesterase inhibitors only

Donepezil (Aricept), Galantamine (Razadyne)

1200

Ergot contraindications

pregnancy, PVD, CAD, HTN, impaired renal or hepatic function, don't take w/i 24 hours of triptans

1200
Adjunct medication to help local anesthetic in an acidic environment

Sodium Bicarbonate (NaHCO3)

1200

types of local anesthesia

surface, infiltration (subcutaneous), conduction block (nerve trunk), spinal (subarachnoid space or L2-3/L3-4), epidural

1200

treatment for uncontrolled calcium release and MOA

Dantrolene - blocks ryanodine receptors on sarcoplasmic reticulum, stopping Ca2+ outflow

1200

hypertonic fluids and complications

1.4%NaHCO3, hypertonic saline, cellular shrinking, hypernatremia

1300

drug for atonic seizures

clonazepam

1300

dual acetylcholinesterase and butyrylcholinesterase inhibitors

Rivastigmine (Exelon), Tacrine (Cognex)

1300

tension headache prophylaxis

amitriptyline

1300

when do local anesthetics block sodium channels

in the inactivated state

1300

advantages of spinal anesthesia

safety, no loss of consciousness

1300

ADEs of volatile anesthetics

desflurane - airway irritation, sevflurane - nephrotoxic, isoflurane - respiratory depression, enflurane - seizures

1300

MAXI drip chamber drop(gtt) volume

10 drops(gtt)/mL

1400

features of fetal hydantoin syndrome

caused by phenytoin, upturned nose, mild midfacial hypoplasia, long upper lip with thin vermillion border

1400

common ADEs of Alzheimer's drugs

GI distress, muscle cramping, abnormal dreams

1400

Triptan metabolism

MAO-A enzyme, triptan's contraindicated in patients taking MAO inhibitors (within 2 weeks)

1400

why does Na channel blockade prevent a nerve impulse?

stops cell membrane depolarization, thus stops action potential

1400

disadvantages of spinal anesthesia

hypotension, nausea, vomitting, headache, neuro damage, septic meningitis

1400

ADEs of fentanyl

respiratory depression, chest wall stiffness

1400

MICRO drip chamber drip (gtt) volume

60 drops (gtt)/mL

1500
treatment of infantile spasms

corticotropin, prednisone, Vigabatrin is 3rd line

1500

Huntington's Disease medications

fluoxetine, haloperidol, clozapine, quetapine, carbamazepine; w/ seizures - clonazepam, valproic acid; large chorea - tetrabenazine

1500

MORE Triptan contraindications

recent exposure to ergot alkaloids, taking 5-HT receptor agonists

1500

what happens to local anesthetics injected into highly vascular tissue?

high systemic concentration, adverse side effects

1500

prilocaine and benzocaine side effect and how to treat

methemoglobinemia due to iron oxidation in hemoglobin, treat with ascorbic acid or methylene blue
1500

depolarizing skeletal muscle relaxant

succinylcholine

1500

Tonicity of D5W solution

isotonic at first, cells consume glucose in the fluid and it becomes hypotonic, can cause cerebral edema

M
e
n
u