MAOIs
What neurotransmitters are in increased circulation when you give MAOIs?
Dopamine, serotonin, NE
What type of anesthetic is ketamine?
Dissociative
Chronic ETOH use does what to your anesthetic requirements? What about acute ETOH?
Increases them for chronic, reduces them for acute.
What is the treatment of choice in someone in suspected opioid OD?
Narcan
True or false: Patients on amphetamine should stop taking them before surgery
False. They will likely have a depleted catecholamine store if they are chronically on amphetamines but it is worse for them to have the med DC'd.
I say.. individual on MAOIs chugging red wine and eating aged cheeses and meats (you know, a normal Saturday night) you say....
HTN CRISIS!!!
What is the only FDA approved ketamine treatment for depression?
Intranasal spray (esketamine)
What is cross tolerance?
Use of one drug makes it difficult to achieve expected results with other drugs
How many days did AJC say it takes for people to become addicted to opioids?
What are concerns for patients who regularly use cocaine?
Catecholamine depletion, prone to cardiac ischemia and dysrhythmias, increased anesthetic requirements for those acutely intoxicated, avoid sympathomimetics, thrombocytopenia (avoid regional)
If a patient is in HTN crisis which medication should we give intraop?
Esmolol
What is the goal of the elicited grand mal seizure in ECT treatment?
Seizure has to be at least 25 seconds in length
**STARRED ITEM
What is Wernicke-Korsakoff syndrome?
Loss of neurons in the cerebellum with associated loss of memory and gait disturbances
What's a potential weird SE of someone on ecstasy?
Spontaneous PTX
What are some anesthesia considerations in regards to someone on disulfiram?
Decreases anesthetic requirements, hepatoxicity potential, increased sedation, potentiates benzos, need direct acting vasopressors, avoid regional D/T polyneuropathy seen in ETOH, avoid ETOH containing solutions
Why specifically do we avoid co-administration with St. John's Wort?
It will precipitate serotonin syndrome because it ALSO prevents reuptake of dopamine, serotonin and NE
**STARRED ITEM
Immediately following the electrical stimulation in ECT treatment what should the CRNA be aware of?
10-15 seconds of PARASYMPATHETIC response; hypotension, bradycardia. Followed by SYMPATHETIC stimulation for several minutes; hypertension, tachycardia
**STARRED ITEM
What site of action is shared by ETOH, barbiturates and benzos? What is risk associated with this?
Inhibit GABA; hyper polarization of neurons. Can cause cross tolerance and cross dependence
What are amphetamine withdrawal S/S?
Multimodal tx with NON-opioids for pain, avoid opioid agonist-antagonist which could lead to withdrawal, post-operative pain can be exaggerated and difficult to manage, weigh options in regards regional anesthesia
What are the reversible MAOIs? Irreversible?
Irreversible= Isocarboxiazid, phenelzine, traylcypromine. Reversible= Selegiline
What is the induction dose of methohexital used for ECT treatments?
0.5-1mg/kg
When do you see withdrawal symptoms? When do you start to see DTs?
Withdrawal= 6-8h after last drink, pronounced at 24-36h and is considered the window for mortality. DTs= 2-4 days after withdrawal requires aggressive treatment (benzos q5 minutes)
How do diagnosis substance abuse/dependence?
3+ S/S persisting for at least one month or occurring repeatedly
What property does LSD have that actually may be helpful from an anesthetic prospective?
Huge analgesic properties