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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
Q

When was the National Halothane Study?

A

1959-1962

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26
Q

What is the MAC of Halothane?

A

0.75%, very potent

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27
Q

What is the Blood:Gas for Halothane?

A

2.3, slow

28
Q

How is halothane stored?

A

amber bottles to protect from UV light, preserved with thymol to slow decomposition but STICKY

29
Q

What are some properties of Halothane?

A

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
Q

What are Halothane’s effects on the body?

A

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
Q

What is halothane hepatitis type 1?

A

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
Q

What is halothane hepatitis type II?

A

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
Q

When is halothane a good agent to use?

A

mask inductions, patients with asthma or other bronchospasms, tetralogy of fallot (decreases contractility and maintains SVR, peds.

34
Q

When was methoxyflurane (penthrane) synthesized and used?

A

1958; used 1960-1974

35
Q

Describe some properties of methoxyflurane.

A

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
Q

What is the MAC of penthrane (methoxyflurane)?

A

MAC 0.16%, most potent inhalation agent.

37
Q

What is the blood:gas of penthrane?

A

10-14, high! takes a long time to reach the brain, soluble in delivery system/hoses.

38
Q

Pros of methoxyflurane:

A

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
Q

Cons of methoxyflurane:

A

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
Q

True/false: penthrane can be self-administered.

A

True, historically used in penthrane inhalers for obstetrics, penthrox inhaler/green whistle for skiing accidents/traumas.

41
Q

When was enthrane (enflurane) synthesized?

A

1963

42
Q

What are some properties of ethrane?

A

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
Q

What is the MAC of ethrane?

A

MAC 1.68, between iso/sevo

44
Q

What is the blood:gas solubility of ethrane?

A

1.8, lower solubility, a little faster but not as fast as des/sevo.

45
Q

What is the vapor pressure of ethrane?

A

172 mmHg, similar to sevo.

46
Q

Pros of Enthrane?

A

Rapid induction compared to others available at the time, non-irritating, low PONV, hemodynamic stability maintained, no myocardial sensitization to catecholamines, bronchodilation.

47
Q

Cons of Enthrane?

A

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
Q

How do you avoid ethrane shakes?

A

keep CO2 normal and keep lower dose of ethrane

49
Q

When was cyclopropane synthesized?

A

1882, anesthetic value discovered 1930.

50
Q

What is the MAC of cyclopropane?

A

MAC 9.2%, low potency.

51
Q

What are some characteristics of cyclopropane?

A

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
Q

Pros of cyclopropane?

A

non-irritating, CV stability–no depressant effects, BP stability maintained, cardiac output increased, no hepatic effects/

53
Q

What is the blood:gas solubility of cyclopropane?

A

0.55, lower solubility, fast induction/rapid recovery, no delirium

54
Q

Cons of cyclopropane?

A

powerful respiratory depressant and bronchoconstrictor, sensitizes myocardium to catecholamines–arrhythmias, emetic, explosive!

55
Q

When was Xenon discovered?

A

1898, narcotic properties discovered 1946, 1950 used on 2 patients–uneventful.

56
Q

True/False: xenon cannot be manufactured.

A

True, xenon cannot be manufactured, it must be extracted from air–limits quantities, EXPENSIVE

57
Q

What is the MAC of Xenon?

A

MAC 71%, VERY WEAK, used like N2O

58
Q

What is the blood:gas coefficient of xenon?

A

0.11, very low, VERY QUICK

59
Q

What are some properties of xenon?

A

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
Q

Pros of Xenon:

A

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
Q

How does Xenon compare to N2O?

A

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
Q

Cons of Xenon:

A

increased cerebral blood flow by 28-31%, increased pulm resistance, dense, 5x heavier than air, slight increase in PONV, COST AND AVAILABILITY.

63
Q

Compare costs of iso, sevo, des.

A

Des most expensive 59c/mL, then sevo 30c/mL, iso cheapest at 13c/mL

64
Q

What types and % makes up US greenhouse gas emissions?

A

CO2 81%, Methane 10%, N2O 6%, Fluorinated gases 3%.

65
Q

Order the gases worst for environment to best in terms of GWP.

A

Des, iso, N2O, sevo

66
Q

What gas lasts longest in the atmosphere?

A

N2O (114 years), then des (14), iso (3.2), and sevo (1.1)

Pharmacology Exam I (11 decks)

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