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Pharm Fall 2019 > Ex2IA2 > Flashcards

Ex2IA2 Flashcards

1
Q

Characteristics of Isoflurane

A

Halogenated methyl ethyl ether
Clear, nonflammable at room temp
Pungent, ethereal odor
Intermediate solubility, high potency

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2
Q

Isoflurane has a ______ onset and recovery from anesthesia

A

Rapid

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3
Q

T/F isoflurane contains thymol

A

False

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4
Q

Intermediates of isoflurane

A

Acyl halide - hepatic necrosis

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5
Q

Sevoflurane characteristics

A

Fully fluorinated - methyl isopropyl ether
Nonpungent, minimal odor
Least degree of airway irritation

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6
Q

Preferred agent for inhalation induction

A

Sevoflurane

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7
Q

Sevoflurane has a _____ induction/emergence

A

Rapid

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8
Q

Sevoflurane metabolism

A

3-5% undergoes biodegradation

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9
Q

Sevoflurane metabolites

A

Inorganic fluoride (nephrotoxic)
Hexafluoroisopropanol (ulcerations to mucus membrane/skin)
No acyl halide metabolites (liver toxicity)

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10
Q

Least likely to form CO on exposure to CO2 absorbants

A

Sevo

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11
Q

Formed in presence of CO2 absorbents (Sevo)

A

Compound A (renal proximal tubular injury)

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12
Q

Which agent has flow rate requirements?

A

Sevo

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13
Q

Flow rate requirements for Sevo

A

During 1st 2 MAC hours: flow must equal or > 1L/min

After 2 MAC hours: flows must be 2L/min

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14
Q

Risk of low flows

A

High temperature of absorbant assoc. with canister explosions (esp 100% O2/N20 on ped pts Monday morning)

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15
Q

Fluorination results in

A

Increased vapor pressure
Enhances molecular stability
Decreases potency

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16
Q

Which agents are fully fluorinated?

A

Sevo, Des

Only 2 Hydrogens

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17
Q

Desflurane characteristics

A

Fluorinated methyl ethyl ether

Very pungent/irritating to lungs

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18
Q

Which agent is not preferred for inhalation induction

A

Desflurane

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19
Q

How does desflurane differ from iso

A

Substitution of F for Cl

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20
Q

Agent that produces most CO

A

Desflurane

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21
Q

Des metabolism

A

Minimal serum/urinary trifluoroacetate concentrations

Hepatic necrosis rare but possible

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22
Q

Desflurane potency

A

1/5 of Iso

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23
Q

Unique aspect of desflurane

A

High vapor pressure (boil at room temp)

Requires special vaporizer to regulate concentration

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24
Q

Sudden initiation of high concentrations of ______ may cause _______

A

Des
Tachycardia/coughing
**fentanyl 1.5-3mcg/kg can attenuate

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25
Q

What permits rapid onset/prompt awakening in ______

A

Solubility/potency

Desflurane

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26
Q

How is Nitrous administered during general anesthesia

A

Admin in combo with opioids/VAs

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27
Q

Characteristics of N2O

A

LMW, inorganic
Sweet smelling/odorless
Non-flammable, low potency, poorly soluble; supports combustion

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28
Q

N2O metabolism

A

Minimal - via gut reductive processes

29
Q

Which IA produces analgesia

A

N2O

30
Q

AEs of N2O

A

Skeletal muscle rigidity
PONV
Expansion of gas filled spaces
Inactivation of VitB12

31
Q

PTX volume can double in _____ with _____% N2O

A

10 minutes

75%

32
Q

Magnitude of volume expansion from N2O is influenced by

A

Partial pressure of N2O
Blood flow to gas filled spaces
Duration of administration

33
Q

Which operations should you avoid N2O in?

A

Bowel obstruction
Tympanic rupture
Intraocular (retinal artery/vision loss)

34
Q

Effect on CNS - CBF, CMRO2

A

Increased CBF (VAs > N2O)
Decreased CMRO2
N2O increases CMRO2

35
Q

How is increased ICP offset?

A

Hyperventilation paCO2 < 30 torr

36
Q

Desflurane 0.5 MAC results in _____ ICP

A

No effect on ICP until >1.1 MAC

37
Q

EEG at < 0.4 MAC

A

Increases in voltage/frequency produced

38
Q

EEG 0.4 MAC

A

Amnesia occurs

CMRO2 begins to decrease

39
Q

EEG 1 MAC

A

Decreased frequency

Max voltage achieved

40
Q

ISO produces _____ at ____ MAC and _____ at 2 MAC

A

Burst suppression at 1.5 MAC

Isoelectric EEG at 2 MAC

41
Q

Which IA has anticonvulsant properties?

A

ISO

42
Q

N2O < 0.75 MAC can produce

A

Clonus/opisthotonus

43
Q

N2O effect on evoked potentials

A

Decreases amplitude

44
Q

What may effect anesthetic requirement

A

Surgical stimulation may increase requirement

45
Q 
Effect of IAs on CVS: 
direct myocardial \_\_\_\_\_\_
\_\_\_\_\_\_\_ of sympathetic outflow
Peripheral autonomic ganglion \_\_\_\_\_\_\_ 
\_\_\_\_\_\_ Carotid sinus reflex activity
\_\_\_\_\_\_\_ cAMP
\_\_\_\_\_\_\_\_ catecholamine release
\_\_\_\_\_\_\_\_ calcium influx via slow channels
A

direct myocardial ___depression___
____inhibition___ of sympathetic outflow
Peripheral autonomic ganglion ___blockade____
___attenuated___ Carotid sinus reflex activity
____decreased___ cAMP
___ decreased_____ catecholamine release
____ decreased____ calcium influx via slow channels

46
Q

Effect of IAs on CSF

A

Iso improves rate of absorption

47
Q

Nitrous effect on CVS

A

Mild sympathomimetic stimulation - masks the cardiac depressant effects

  • mydriasis
  • increased body temp
  • increased catecholamine release
  • increased RAP
  • diaphoresis
  • vasoconstriction
48
Q

How would IAs effect patients with HTN/anxiety?

A

Larger decrease in MAP

49
Q

IA effect on MAP

A

Dose-dependent decrease

Offset during surgical stimulation

50
Q

How do IAs effect MAP?

A

Primarily via reductions in SVR

51
Q

N2O effect on MAP

A

Increase or no effect

52
Q

IAs effect on HR

A

ISO/Sevo/Des increase HR

  • elderly less likely
  • Sevo at >1.5MAC
53
Q

IA effect on HR

A

Des produces significant increases in HR if concentration increased suddenly
*attenuated by prior small dose of opioid
N2O depresses carotid sinus - may dampen HR response to hypotension

54
Q

IA effect on CO

A

N/A only Sevo @ 1.5-2 MAC decreases

55
Q

VA effect on SV

A

Decrease by 15-30%

56
Q

Effect of N2O on CO

A

Modestly increased CO

  • d/t sympathomimetic effect
  • cardiac depression offset by sympathomimetic effect
57
Q

IA effect on RAP

A

Increase
(Sevo does NOT)
N2O - d/t increased PVR (don’t use in pHTN)

58
Q

IAs effect on SVR

A

Decrease
N2O does not change - may produce constriction of cutaneous vessels (increased body temp)
Iso - Beta agonist; heat loss

59
Q

IAs effect on PulmVR

A

Little or no effect

N2O - increases (R—>L shunting may jeopardize oxygenation in pts with congenital heart defects)

60
Q

Effect on HPV

A

Inhibited at greater than 1 MAC

61
Q

Effect on dysrhthmias

A

Iso slows SA discharge - prolongs ventricular conduction times

62
Q

Effect on rhythm

A

Prolong QTc

63
Q

Which IA is acceptable for ablative procedures?

A

Sevo

64
Q

Which IA should not be used in ablative studies?

A

Iso - increases the refractory period of accessory pathways/slows AV conduction

65
Q

Effect on Coronary blood flow

A

All produce coronary dilation

*Iso preferentially dilates small resistance vessels more than larger conductance vessels

66
Q

Anesthetic preconditioning

A

Brief exposure to VAs confers cardioprotection

Brief periods of myocardial ischemia prior to a longer period of ischemia provides protection

67
Q

Abrupt increases in Iso/Des can result in?

A

Increase sympathetic/RAA activity
Cause transient increase in SBP/HR/coughing
**doses from 0.55-1.66 MAC
*des>iso

68
Q

Factors that effect transfer of IA from arterial blood to brain

A

Brain-blood partition coefficient
CBF
A-vD difference

Pharm Fall 2019 (33 decks)

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