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Pharmacology Exam I > Hx and rarely used anesthetics > Flashcards

Hx and rarely used anesthetics Flashcards

1
Q

How did they do anesthetics 3000-2500 BC?

A

compression nerve bundles

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2
Q

What old anesthetics did they use in India?

A

hemp smoke

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3
Q

What did they use for anesthesia in China?

A

acupuncture

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4
Q

What did they use for anesthesia in the middle ages/renaissance?

A

mixture of herbs boiled into a sponge, placed in water and vapors inhaled; parallel lines of ice with incision between them, compression with large clamp device to put pressure on a nerve, alcohol.

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5
Q

What did Humphry Davy research in 1800?

A

Nitrous oxide and ether

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6
Q

In January 1842 who anesthetized a patient with ether?

A

William Clark

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7
Q

In March 1842 who used ether for removal of tumors from the back of a patient’s neck?

A

Crawford Long

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8
Q

In 1844 who observed N2O abolishes pain?

A

Horace Wells

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9
Q

What was the “turning point” on October 16, 1846?

A

William Morton used ether for removal of jaw tumor at Mass Gen and surgeon remarked “gentleman this is no humbug.”

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10
Q

What happened December 16, 1846?

A

news arrived in London of either use and first ether anesthetic delivered in UK 3 days later.

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11
Q

Who invented the vaporizer? when?

A

John Snow; 1847

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12
Q

What was the first vaporizer made of?

A

coiled copper

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13
Q

What’s the MAC of ether?

A

1.92, used 1840s-1950s

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14
Q

What were the positives of ether?

A

excellent analgesic, reliable signs of anesthetic depth, relatively safe/non-toxic, CO and ABP maintained, respiratory stimulant and bronchodilator, muscle relaxation

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15
Q

What were the negatives of ether?

A

airway irritant, increased secretions, potential for laryngospasm, strong emetic properties, muscle relaxation, depresses temp regulating center, EXTREMELY FLAMMABLE and EXPLOSIVE.

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16
Q

Who introduced chloroform in 1847?

A

James Simpson

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17
Q

Who invented a vaporizer for chloroform?

A

John Snow

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18
Q

What are the characteristics of diethyl ether?

A

R-O-R, lipid soluble, low boiling point, flammable, slow induction/emergence

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19
Q

What is halogenation?

A

a chemical reaction that incorporates a halogen atom into a molecule. (fluoride, chloride, bromium, iodine)

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20
Q

Pros of halogens?

A

very stable, increased bond strength, non-flammable, less toxic, lower solubility/better kinetic characteristics; fluorination is more stable than chlorination.

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21
Q

How many fluorinated compounds synthesized from 1959-1980?

A

Over 700

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22
Q

What is compound 347?

A

Enflurane (Ethrane)

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23
Q

What is compound 469?

A

Isoflurane (Forane)

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24
Q

What is the halothane timeline? Synthesized/US use?

A

1951 Synthesized, 1956 England, 1958 US and first death from acute yellow atrophy.

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25
When was the National Halothane Study?
1959-1962
26
What is the MAC of Halothane?
0.75%, very potent
27
What is the Blood:Gas for Halothane?
2.3, slow
28
How is halothane stored?
amber bottles to protect from UV light, preserved with thymol to slow decomposition but STICKY
29
What are some properties of Halothane?
slow induction/emergence, large Vd, moderate solubility in blood, poor analgesic, 12-20% metabolized (a lot!), excreted by kidneys,(trifluoriacetic acid and chloride and bromide ions formed), non-pungent, non-irritating to resp mucosa
30
What are Halothane's effects on the body?
strongest myocardial depressant, coronary artery vasodilator, enhances myocardial sensitivity to catecholamine induced arrhythmias--increased risk for vtach and vfib, potent bronchodilator, chemoreceptor trigger zone depressant-low PONV.
31
What is halothane hepatitis type 1?
mild, from biotransformation, genetic factors, reduced liver oxygenation, S&S: within first hours of exposure, transient elevation in liver enzymes, jaundice, no hepatocellular disease.
32
What is halothane hepatitis type II?
similar to allergic reaction/immune response. Results from antibodies: binds to hepatocytes causing immune response and massive centrilobular necrosis. S&S: high fever day 3-14, rash, eosinophilia, elevated bili, jaundice 1-2 days after fever, GI upset, N&V, increased liver enzymes, encephalopathy, mortality 50%, 80% with encephalopathy
33
When is halothane a good agent to use?
mask inductions, patients with asthma or other bronchospasms, tetralogy of fallot (decreases contractility and maintains SVR, peds.
34
When was methoxyflurane (penthrane) synthesized and used?
1958; used 1960-1974
35
Describe some properties of methoxyflurane.
stable, compatible with other agents, nonflammable below 4% and below 75 degrees C, oxidizes when exposed to heat/light/air/moisture, easy to use--delivered by any type of vaporizer.
36
What is the MAC of penthrane (methoxyflurane)?
MAC 0.16%, most potent inhalation agent.
37
What is the blood:gas of penthrane?
10-14, high! takes a long time to reach the brain, soluble in delivery system/hoses.
38
Pros of methoxyflurane:
mild hemodynamic effects at low concentrations, profound muscle relaxant at deep plane, doesn't sensitize myocardium to catecholamines, powerful analgesic properties at well below full anesthetic doses.
39
Cons of methoxyflurane:
up to 50% metabolism and production to free fluoride ions and dichloroacetic acid, associated with vasopressin-resistant, high-output renal failure, hepatotoxicity, powerful respiratory depressant, pungent.
40
True/false: penthrane can be self-administered.
True, historically used in penthrane inhalers for obstetrics, penthrox inhaler/green whistle for skiing accidents/traumas.
41
When was enthrane (enflurane) synthesized?
1963
42
What are some properties of ethrane?
non-flammable, colorless, non-irritating, very stable, can be used in any vaporizer, no impurities, structurally similar to methoxyflurane, physiochemically closer to halothane, still used in developing countries.
43
What is the MAC of ethrane?
MAC 1.68, between iso/sevo
44
What is the blood:gas solubility of ethrane?
1.8, lower solubility, a little faster but not as fast as des/sevo.
45
What is the vapor pressure of ethrane?
172 mmHg, similar to sevo.
46
Pros of Enthrane?
Rapid induction compared to others available at the time, non-irritating, low PONV, hemodynamic stability maintained, no myocardial sensitization to catecholamines, bronchodilation.
47
Cons of Enthrane?
produces free fluoride ions, can hit kidneys, "ethrane shakes," increases secretion of CSF and resistance to CSF outflow, during deep anesthesia and PCO2 <30 high-voltage/high-frequency EEG changes progress to spike-and-wave that looks like tonic-clonic seizures.
48
How do you avoid ethrane shakes?
keep CO2 normal and keep lower dose of ethrane
49
When was cyclopropane synthesized?
1882, anesthetic value discovered 1930.
50
What is the MAC of cyclopropane?
MAC 9.2%, low potency.
51
What are some characteristics of cyclopropane?
colorless, potent gas with sweet smell, used in kids until 1980s, stored in orange cylinders as pressurized liquid, explosive at concentrations of 5-10%, can cause dysrhythmias,
52
Pros of cyclopropane?
non-irritating, CV stability--no depressant effects, BP stability maintained, cardiac output increased, no hepatic effects/
53
What is the blood:gas solubility of cyclopropane?
0.55, lower solubility, fast induction/rapid recovery, no delirium
54
Cons of cyclopropane?
powerful respiratory depressant and bronchoconstrictor, sensitizes myocardium to catecholamines--arrhythmias, emetic, explosive!
55
When was Xenon discovered?
1898, narcotic properties discovered 1946, 1950 used on 2 patients--uneventful.
56
True/False: xenon cannot be manufactured.
True, xenon cannot be manufactured, it must be extracted from air--limits quantities, EXPENSIVE
57
What is the MAC of Xenon?
MAC 71%, VERY WEAK, used like N2O
58
What is the blood:gas coefficient of xenon?
0.11, very low, VERY QUICK
59
What are some properties of xenon?
similar effects as ketamine and N2O, inhibits NDMA, extremely insoluble in blood and other tissues--rapid induction/emergence, sufficient to produce surgical anesthesia when admin with 30% O2.
60
Pros of Xenon:
good analgesic, little/no CV depression, maintains cerebral autoregulation, minimal side effects, doesn't affect pulm function, no hepatic or renal toxicity, not metabolized in human body, not a trigger for MH, very stable hemodynamic profile, possible neuroprotection
61
How does Xenon compare to N2O?
xenon anesthetic effect is 1.5 times higher, lower b:g coefficient (0.11 to 0.47) so more rapid induction/emergence, greater circulatory stability, lower analgesic consumption, less diffusion into air filled spaces, no diffusion hypoxia
62
Cons of Xenon:
increased cerebral blood flow by 28-31%, increased pulm resistance, dense, 5x heavier than air, slight increase in PONV, COST AND AVAILABILITY.
63
Compare costs of iso, sevo, des.
Des most expensive 59c/mL, then sevo 30c/mL, iso cheapest at 13c/mL
64
What types and % makes up US greenhouse gas emissions?
CO2 81%, Methane 10%, N2O 6%, Fluorinated gases 3%.
65
Order the gases worst for environment to best in terms of GWP.
Des, iso, N2O, sevo
66
What gas lasts longest in the atmosphere?
N2O (114 years), then des (14), iso (3.2), and sevo (1.1)

Pharmacology Exam I (11 decks)

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