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SRNAPharmacology II > Inhalation Agents > Flashcards

Inhalation Agents Flashcards

1
Q

Uptake

A

removal from the lungs

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2
Q

Increase in uptake

A

delay anesthetic action

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3
Q

Increase of Input of anesthetic

A

Help speed up anesthetic action and fall asleep

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4
Q

The more dissolved in the blood

A

the more time patient takes to fall asleep

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5
Q

Blood solubility

A

affects delivery.

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6
Q

Vehicle absorption and elimination

A

Lungs

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7
Q

Desflurane and N2O

A

minimal metabolism

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8
Q

Measurable

A

Inspired concentration

and expired concentration

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9
Q

At equillibration of FA/FI

A

any changes in the machine occurs quickly in the brain

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10
Q

N2O is the only gas

A

at room temperature

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11
Q

The larger breathing circuit

A

Hinders anesthetic, can work against wor

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12
Q

Fraction inspired

A

The gas then enters the inspiratory limb of the circuit to be inspired
by the patient

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13
Q

Fraction alveolar FA.

A

The inspired concentration is then taken into the lungs through spontaneous or controlled ventilation and transferred to the alveoli

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14
Q

VA are respiratory

A

Depressant

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15
Q

Too much anesthetics

A

breathing will decline, protecting mechanism of the patient

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16
Q

**2 effects of VA:

A

Myocardial depressant

Respiratory depressants

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17
Q

The more soluble in the BLOOD

A

the longer time to fall asleep

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18
Q

BLOOD GAS PARTITION of Des

A

1.4

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19
Q

BG partition of 0.5 (fills in quicker)

A

At equillibration, for every 2 molecules in alveolar gas, 1 moleculres will be in the blood

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20
Q

BG partition of 1.5 (fills in slower)

A

2 molecules in alveolar gas, 3 molecules in the blood.

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21
Q

Partial pressure determined by

A

Solubility in blood and solubility in the tissues.

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22
Q

Relationships

A

FD> FI > FA> pressure arterial > pressure brain> Pressure venous

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23
Q

Agents with a low blood to gas partition coefficient equilibrate_________ than do agents with a high blood to gas partition coefficient if other variable are held constant.

A

more rapidly

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24
Q

Mass spectometry

A

How much in and how much out

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25
Q

FA/FI has to be close to

A

1

26
Q

ISoflurane very

A

1.5

27
Q

Des, Nitrous, Sevo

A

fast onset and offset

28
Q

Each 1% of agent at normal atmospheric pressure represents 1% of

A

760 mm Hg or

7.6 mm Hg pressure

29
Q

A blood gas solubility of 1.0 indicates that at equilibrium a concentration of anesthetic in arterial blood of 1% would mean

A

that the concentration in the lung would be 1%

30
Q

If the blood to gas partition coefficient is 2.0, the concentration in the blood must

A

equal 2% to achieve a concentration in the lung of 1%.

31
Q

iF B/G partition is 0.5 , how many molecules would it take for 1 molecule in blood

A

4

32
Q

follows Formulae

• Uptake=

A

cardiac output (Q) X concentration gradient
(alveolar to venous partial pressure difference) X
blood to gas solubility (λ)

33
Q

Higher cardiac output in VA

A

slower induction time

34
Q

For induction though, higher CO

A

Faster induction time

35
Q

Alveolar-venous measure

A

Venous measure how much in the tissue

Alveolar

36
Q

Sevo, NITROUS , DESp

A

Poorly soluble
less uptake into blood
fall asleep faster

37
Q

Sevo, NITROUS , DESFlurane

A

Poorly soluble
less uptake into blood
fall asleep faster

38
Q

Increasing FD:

A

overpressuring
Increasing the concentration on the
vaporizer to supraphysiologic levels
(Caution is warranted)

39
Q

Increasing FGF

A

Increasing the fresh flow rates via

anesthesia machine

40
Q

Increasing alveolar ventilation

A

Increasing rate and/or tidal volume
(note tidal volume must not exceed
dead space)

41
Q

Concentrating effect

A

The administration of a gas in high
concentrations will increase its own
concentration and the rate of rise in
FA/FI

42
Q

Second gas effect

A

The administration of a gas in high
concentration will increase the rate
of rise of the FA/FI of companion
gas

43
Q

Risk of DELIVERING TOO MUCH ANESTHETIC

A

Hypotension

44
Q

Delivery high to low

A

FD >FI>FA>Pa>Pbr>Pv

45
Q

B/G partition less than 1

A

Faster sleep

46
Q

For example, isoflurane has a blood-gas partition coefficient of 1.4. This means that,

A

at equilibrium, the isoflurane concentration in the

blood would be 1.4 times the concentration in the gas (alveolar) phase

47
Q

The principle objective is to achieve

A

a constant and optimal brain partial pressure of the inhaled anesthetic

48
Q

The alveolar partial pressure (PA) of the inhaled anesthetic

mirrors

A

the brain partial pressure (Pbr)

49
Q

Transfer of inhaled anesthetic from machine to alveoli (anesthetic input) FIAC

A
  • Inspired partial pressure
  • Alveoli ventilation
  • Characteristics of breathing system
  • Functional residual capacity
50
Q

Ratio that determines delivry

A

Alveolar ventilation

Functional Residual Capacity

51
Q

Transfer of inhaled anesthetic from alveoli to arterial blood
•

A

**Blood gas partition coefficient
• Cardiac output
• Alveolar-to-venous partial pressure difference

52
Q

Transfer of inhaled anesthetic from arterial blood to brain (anesthetic loss)

A
  • Brain:blood partition coefficient
  • Cerebral blood flow
  • Arterial-to-venous pressure difference
53
Q

The PA and ultimately the Pbr of an inhaled

anesthetic are determined

A

by input (delivery) into alveoli MINUS (uptake) loss of the drug from alveoli into arterial blood.

54
Q

**Inhaled partial pressure (PI) is high during initial

administration to offset _____________.it is then decreased during maintenance to match the ____________

A

uptake from alveoli into arterial blood (similar to administering IV loading dose);
Decreased uptake as tissues accumulate anesthetic.

55
Q

Initial fraction of VA, More important for drugs that are MORE SOLUBLE (HIGHER PARTITION COEFFICIENT)

A

ISOFLURANE

56
Q

A high PI delivered from the anesthetic machine is required during_______• This will help__________
• With time, as uptake into the blood
decreases, the PI should be

A
  • initial administration to offset the impact of uptake.
  • accelerate induction of anesthesia.
  • decreased to match the decreased anesthetic uptake and therefore maintain a constant optimal Pbr.
57
Q

what is the second gas effect?

A

Ability of high volume uptake of one gas (first-gas) to accelerate the rate of increase on PA of a concurrently administered companion gas (second gas).

58
Q

Simultaneous administration of slower agent, such as halothane with a faster drug such as

A 
nitrous oxide (in high concentrations) can
speed the onset of the slower agent.
59
Q

Controlled ventilation of the lungs that results in

hyperventilation and decreased venous return will________

A

accelerates the rate of increase in PA by virtue
of increased input (increased VA) and decreased
uptake (decreased cardiac output).

60
Q

OIL: GA

A

Affect potency

61
Q

KNow B/G partition

A

Sevo des, nitrous, iso

62
Q

Opiates __________MAC

A

decrease

SRNAPharmacology II (32 decks)

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