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Pharmacology > Des > Flashcards

Des Flashcards

1
Q

Most insoluble volatile anesthetic

A

Desflurane

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2
Q

1 determinant of speed of recovery and onset of anesthetic

A

BGPC

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3
Q

Low BGPC =

A

More insoluble

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4
Q

Lower solubility in blood and tissues accomplished by

A

Halogenation with fluorine

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5
Q

Change in iso to des

A

Chlorine replaced by fluorine on alpha ethyl carbon

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6
Q

The most electronegative element

A

Fluorine

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7
Q

What changes boiling point, vapor pressure and stability of volatile anesthetic

A

Fluoridation

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8
Q

Isoflurane broken down by soda lime at what temp

A

60 degrees celcius

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9
Q

Is desflurane broken down by soda lime at 40-60 degrees Celsius

A

No

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10
Q

Which broken down further by soda lime (sevo, des, iso)

A

Sevoflurane

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11
Q

Resistance to degredation results in ability to use

A

Low flows

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12
Q

Lowest flow can go on des

A

Lowest metabolic oxygen requirements for pt

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13
Q

Desflurane is _______ as potent as isoflurane

A

1/5

MAC of 6% in comparison to 1.17%

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14
Q

Desflurane vapor pressure

A

669

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15
Q

High vapor pressure of desflurane requires

A

Use of a special vaporizer

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16
Q

BGPC of des

A

0.42

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17
Q

Most rapid elimination of volatile anesthetic

A

Desflurane

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18
Q

Which volatile has less shivering and delirium

A

Desflurane

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19
Q

8 carbons on desflurane…how many fluoridated?

A

6

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20
Q

If replace last hydrogen’s with Florine’s you get

A

Immobilizers

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21
Q

Best patient population to use desflurane

A

Bariatric surgery bc better able to maintain airway after case

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22
Q

Differences between concentration of anesthetic delivered from vaporizer and concentration in alveoli- __________ the difference the greater the control

A

Smaller

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23
Q

Vaporizer setting better indicates ______________ with desflurane as opposed to iso or sevo

A

Alveolar concentration

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24
Q

Larger the difference in vaporizer setting and alveolar concentration reflects

A

Higher BGPC

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25
Q

Insolubility advantages (3)

A
  1. Rapid induction
  2. Precise control of anesthetic
  3. Prompt recovery independent of length of anesthesia
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26
Q

If go up on vaporizer with desflurane too rapidly results in

A

Airway irritation and HTN, tachycardia

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27
Q

Can you do an inhaled induction with desflurane?

A

No

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28
Q

Disadvantages of desflurane (4)

A
  • airway irritation
  • SNS stimulation
  • CO production
  • new vaporizer technology
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29
Q

Regardless of tissue type, which volatile anesthetic has lowest tissue:blood partition coefficient

A

Desflurane

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30
Q

More insoluble the anesthetic, over time the more ________

A

Rapid equilibration of

FA/FI at 1

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31
Q

Desflurane and mental function

A

No impairment

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32
Q

Desflurane and retrograde amnesia

A

Does not produce

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33
Q

Desflurane effect on

  • CMRO2
  • cerebral activity
  • cerebral blood flow
A
  • decreased CMRO2
  • decreased cerebral activity
  • increased cerebral blood flow
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34
Q

Desflurane electrical silence around what MAC

A

1.5-2 MAC

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35
Q

At what MAC has Desflurane maximally reduced CMRO2?

A

2 MAC- bc electrical silence on EEG

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36
Q

Desflurane and evoked potential monitoring

A

0.5MAC don’t exceed 1

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37
Q

Desflurane increase in CBF last up to

A

4 hours

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38
Q

Desflurane < CMRO2 less than ________ but comparable to ______

A

Less than Isoflurane but comparable to Sevoflurane

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39
Q

Desflurane and ICP

A

Increases especially with space occupying lesions

40
Q

How to decrease elevation in ICP with des

A

Hyperventilate to ETCO2 on 30

41
Q

Dose required to increase ICP with des lies bw

A

0.8-1.1 MAC

42
Q

Circulatory effects of des most closely resemble

A

Iso

43
Q

Desflurane changes on - BP

  • HR
  • SVR
A

Decreased BP
Increased HR
Decreased SVR

44
Q

Biggest effect of des to decrease BP found where

A

Skeletal muscular vascular bed vasodilation

45
Q

To decrease magnitude of BP drop with des

A

Substitute nitrous for equal MAC portion of des

46
Q

Increase HR with desflurane blunted by

A

Opioids and beta blockers

47
Q

HR increase with des seen less in

A

Elderly

48
Q

Desflurane and dysrhythmia

A

Does not cause dysrhythmia

49
Q

Desflurane, isoflurane, and sevoflurane decrease LV SV by _______

  • effect dissipates within how long of des anethesia
A

15-30%

  • 5 hours
50
Q

Decrease in SV is offset by

A

Increase in HR

51
Q

Desflurane and RAP

A

Raises sim to iso and sevo

52
Q

Desflurane and PVR

A

Does not alter

53
Q

What inhaled anesthetic does increase PVR

A

Nitrous

54
Q

Abrupt increase in Desflurane cause transient increase in HR and BP r/t

A

SNS and RAA activity increased

55
Q

Site mediating increase in HR and BP with des

  • abated by what
A

Upper airway
Lungs

-fentanyl and beta blockers

56
Q

HR and SNS responses less than _____ MAC

A

1

57
Q

HR increase with desflurane not dependent on

A

Rate of increase or desflurane concentration

58
Q

Desflurane and myocardium

A

Myocardial depressant effects

59
Q

Des and coronary steal

A

Redistributes blood from ischemic to non-ischemic areas

60
Q

Apnea with desflurane

A

1.5-2 MAC

61
Q

Net effect on MC and PaCO2

A

Decreased MV

Increased PACO2

62
Q

Desflurane increases PaCO2 more with what pt

A

Pt with lung disease

63
Q

Overall breathing pattern of pt spontaneously breathing Desflurane

A

increased RR decreased TV

64
Q

Increase in PaCO2 with desflurane begins to decrease

A

After 5 hours of spontaneously breathing des

65
Q

Best way to balance elevated CO2 with desflurane

A

Mechanical ventilation

66
Q

Is assistive ventilation effective to decrease PACO2 with pt spontaneously breathing des

A

No. Do not assist, control ventilation

67
Q

Desflurane and bronchoconstriction

A

May induce bronchoconstriction in smokers

68
Q

Is des pungent

A

Yes

69
Q

Volatile agent easiest to spontaneously breath with

A

Sevolfurane

70
Q

In children des associated with

A

Oxyhemoglobin desaturation

71
Q

Desflurane and LFT’s

A

Transient increase in LFTs following Desflurane administration

72
Q

Desflurane and liver

A

Post op liver dysfunction

-worse with hepatocyte hypoxemia, preexisting liver disease

73
Q

Desflurane is metabolized by ___________ to _____

A

Cytochrome P-450 to form acetylated liver protein adduct

Results in antibody-antigen ____

74
Q

Desflurane and renal fx

A

Dose dependent decrease in

  • renal blood flow
  • GFR
  • UOP

Rt < SVR

75
Q

To counterbalance des effect on kidneys

A

Pre-op hydration

76
Q

Desflurane and NMB

A

Dose dependent enhancement of NMBs

77
Q

Desflurane and OB

A

Dose dependent decrease in uterine smooth muscle contractility and uterine blood flow

78
Q

OB changes with des are modest at ______ MAC and significant at _______ MAC

A

0.5 MAC

Significant at 1 MAC

79
Q

Desflurane and total body oxygen requirements

A

Reduced

80
Q

Organ with largest O2 requirement decrease with desflurane

A

Heart

81
Q

How does des decrease total body O2 requirements

A
  • metabolic depressant effect

- decreased functional needs

82
Q

Greater metabolism of desflurane seen with

A

Increased MACs

83
Q

______ of desflurane undergoes metabolism

A

0.02%

84
Q

Results of Desflurane metabolism

A
  • inorganic fluorides
  • trifluroacetic acid
  • CO2
  • water
85
Q

CO production of volatile anesthetic comparison

A

Desflurane > Isoflurane > Sevoflurane

86
Q

Metabolism order of magnitude of volatile anesthetic

A

Sevoflurane > Isoflurane > Desflurane

87
Q

Completely dry soda lime produces more CO than absorbent with _________

A

1.4% water content

88
Q

Soda lime containing > _______ water generates no CO

A

4.8%

89
Q

Standard soda lime contains what percent water

A

15% water

90
Q

Baralyme with _________ water produces high CO concentrations

A

<1.6%

91
Q

Baralyme containing >_______water produces no CO

A

9.7%

92
Q

Which absorbent produces more carbon monoxide

A

Baralyme more than soda lime

93
Q

Temperature effect on CO production

A

Increased temp increases CO production

94
Q

More carbon monoxide produced from _______ concentrations

A

Higher concentrations

95
Q

Carbon monoxide generation can be avoided by (3)

A
  • soda lime with > 4.8% water
  • Baralyme with > 9.7% water
  • FGF < 2-3 L/min to ensure absorbent doesn’t dry out
96
Q

Desflurane MAC

A

6%

Pharmacology (6 decks)

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