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Neuro 2 > Anesthetic Pharmacology 2 > Flashcards

Anesthetic Pharmacology 2 Flashcards

1
Q

Pharmacokinetics of inahlation

A

Absoprtion phase - uptake
Metabolic - biotransformation
Excretion - elmination

NO and xenon are true gases but all others are vapors of volatile liquids

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2
Q

Volatile anesthetics

A

Exist in liquid form in ambient pressure and temp

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3
Q

Vapor pressure

A

If system is in closed container, will equilibrate between liquid and gas phases

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4
Q

Boiling point

A

Point at which VP exceeds atmospheric temp

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5
Q

How is anesthetic effect acheieved

A

Deliver a specific PP of agent to the brain

All phases are minimal relative to rate at which delivered or removed from the lungs

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6
Q

INhaled anesthetics transferred

A

From lungs to blood to brain…all pressures will equilibrate

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7
Q

Anesthetic inhalation…how do we control

A

Plasma and tissues havbe low capacity to absorb the inhaled relative to amount we can deliver to lungs…allows use ot rapidly change concentration in BS and brain

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8
Q

Anesthetic uptake

A

Rate of rise of partial pressure of the inhalational agfent at the alveolus (Fa/Fi) correlates best with onset

Blood gas sloubility best used to describe the speed of onset

Low blood gas solubility causes a fadster rise in Fa/Fi and induces faster anesthesia

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9
Q

Low, medium and high solubility

A

Low - desflurane, sevoflurane

Med - isoflurane

High - halothane

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10
Q

If you want to increase speed of induction

A

CHoose low solubility agent
Increase inspired ocncentration
Increase minute ventilation (hyperventilation)

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11
Q

How to induce a child

A

Mix sevoflurane and N2)
Turn dials to maximum
Crying baby helps speed up

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12
Q

Anesthesia termination

A

Biotransformation plays little role in termination of anesthesia

Halothane is major exception and up to 20% is biotransforemd in liver

Effects are primarily terminated by excretion (nearly exclusively throug hthe lungs)

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13
Q

Wakeup occurs when

A

PP of volatile agents drops below MAC(awake)

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14
Q

Depot

A

Amount of anesthetic abosrbed in fat once the vaporizer has been turned off and inspired concentration drops

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15
Q

Speedy wake up

A

Choose low blood/gas solubility agent
Low fat solubility
Increase minute ventilation

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16
Q

MAC

A

Minimuum alveolar concentation
Analogous to ED50 for an IV drug

Alveolar conetration at one atmosphere that prevents movement in response to a surgical stimulus in 50% of patients

17
Q

MAC is a measure of

A

Potnecy

Halothane 
Isoflurane
Sevoflurane
Desflurane
N2O
18
Q

MAC aware
MAC awake
MACBAR

A

.4XMAC
.25XAMC
1.5XMAC

19
Q

Most anesthesiologists use

A

1.3-1.4 MAC (MAC95%)

MAC values are additivie

20
Q

Increase MAC

A

NT levels (cocaine, MAOI, meth, ephdrine, lveodopa)
Hyperthermia
Chronic EtOH abuse
Hypernatremia

21
Q

Factors that decrease MAC

A 
Age
EtOH intoxication
Hypothermiaa/thyrodism/tnesion/oxia
Pregnancy
Opiodis
22
Q

N2O

A

Very low potency
MAC greater than atmospheric pressure
Very rapid

Could cause megaloblastic anemia
Methionine synthase inhibition
Reduced homocysteine production

23
Q

N2O rapidly discojntinued

A

iffusion hypoxia

Rapid elmination reduces amount of oxygen in alveolus
Desaturation during awakening

24
Q

Desflurane

A

Fluorinated mehtyl ethyl ether
Very low B/G solubility (rapid onset)
Very low fat solubility (rapid elimination)
Very high VP (specialy designed vaporizer)

25
Q

Desflurane side effects

A

Small of immune-mediated hepatotoxicity

Some tachycardia and hypertension

26
Q

Sevoflurane

A

Methyl isopropyl ether
Low blood/gas solubility (fast onset)
Sweet smelling (good for mask induction)

27
Q

Sevoflurane biotransformation and side effect

A

Release of inorganic fluoride ions and compound A which may lead to kidney injury

Also with heat generating reaction in certain situations

28
Q

Isoflurane

A

High potency
Intermediate blood gas solubility
Stable for long periods of time
Smells bad

29
Q

Halothane

A

Not avbailbale in US

30
Q

Malignant hyperthermia

A

Severe and sustained muscular contractions

Auto dom

Avoid triggering agents

Tx with dantrolene and aggressive ocoling

Neuro 2 (26 decks)

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