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RUSVM Pharmacology I > Inhalation Anesthetics > Flashcards

Inhalation Anesthetics Flashcards

1
Q

Inhalation Anesthetics Pros

A

Control of the airway Control ventilation Control drug uptake & elimination

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2
Q

Inhalation anesthetics Cons

A

Specialized *expensive* equipment Equipment failure

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3
Q

Inhalation anesthetics Dosage

A

Concentration (volume%) of inspired gas Partial Pressure

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4
Q

Partial Pressure conversion 4% Halothane

A

4% Halothane = 0.04 F1 hal = 4 kPa

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5
Q

Partial Pressure conversions kPa, atm, bar, mmHg, psi, cm water

A

101 kPa 1 atm 1 bar 760 mmHg 15 psi 1000 cm water

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6
Q

Inhalation anesthetics Uptake

A

Taken up by lungs

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7
Q

Inhalation anesthetics Elimination

A

Excreted mostly unchanged by lungs Alveolar concentration ~ brain concentration

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8
Q

Inhalation anesthetics Saturated vapor pressure

A

Ability of anesthetic to evaporate Match druge with proper vaporizer, varies greatly

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9
Q

Inhalation anesthetics Rubber & plastic solubility

A

Concern with older agents -Soluble into tubes

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10
Q

Inhalation anesthetics Blood/Brain coefficient

A

Concern with older agents

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11
Q

Inhalation anesthetics Blood/Gas coefficient

A

Solubility Influences rate of uptake/distribution Speed of induction, recovery, change of anesthetic level

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12
Q

Inhalation anesthetics Physical factors Solubility

A

Completely insoluble = not into brain Relatively insoluble = fast induction & recovery Soluble anesthetics = longer induction & recovery

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13
Q

Inhalation anesthetics Soluble anesthetics

A

Longer induction, recovery Large Vd = more drug to be absorbed More potent drugs

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14
Q

Inhalation anesthetics Physiologic factors

A

Ventilation Cardiac output

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15
Q

Inhalation anesthetics Ventilation

A

No breathing = no drug uptake -Induction drug –> apnea –> IPPV –> Large drug quantities -Lung disease (thickening of blood/gas barrier)

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16
Q

Inhalation anesthetics Cardiac output

A

No heartbeat = no systemic drug uptake Shock –> decreased CO Excitement –> increased CO

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17
Q

Inhalation anesthetics Distribution

A

All are fat-soluble Penetrate most tissues Fat reservoirs Cross placenta

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18
Q

Inhalation anesthetics MAC

A

Minimal alveolar concentration -Anesthetic at steady state which will prevent purposeful movement in response to supramaximal noxious stimulus in 50% of individuals (similar to ED 50) -Varies across species

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19
Q

Inhalation anesthetics MAC for maintenance

A

~1.3 for maintenance -Animal’s state of excitement/pain -Premedication

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20
Q

Table of MAC for species

A

Graph Below

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21
Q

Inhalation anesthetics Pharmacologic effects overview

A

General anesthesia Some muscle relaxation (not with NO) No analgesia Respiratory depression Cardiovascular depression

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22
Q

Inhalation anesthetics Pharm effects on CNS

A

Depression (anesthesia) Amnesia (Supraspinal site) Immobility / no response to noxious stimuli (spinal site) Predisposed to seizure activity (enflurane & sevoflurane) Vasodilation

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23
Q

What two drugs have a predisposiiton to seizure activity?

A

Enflurane & sevoflurane)

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24
Q

Inhalation anesthetics Describe vasodilation effects

A

Increased cerebral blood flow –> intracranial pressure

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25
Q

Inhalation anesthetics Pharm effects on Respiratory

A

Dose-dependent depression (incr PaCO2) Bronchodilation Airway irritation

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26
Q

Inhalation anesthetics Which drugs have bronchodilation effects

A

D-I-S-H -flurane Desflurane Isoflurane Sevoflurane Halothane

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27
Q

Inhalation anesthetics Which drugs show airway irritation

A

Desflurane in humans -Breath-holding -Coughing -Laryngospasm

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28
Q

Inhalation anesthetics Pharm effects at cardiovascular system

A

Dose-related decreased myocardial contractility Alteration of organ blood flow Sensitization of heart to catecholamines

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29
Q

Inhalation anesthetics Describe effect of decreased myocardial contractility

A

Stroke volume Cardiac output Hypotension (peripheral vasodilation) Halothane>isofluorane=desflurane=sevoflurane

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30
Q

Inhalation anesthetics Pharm effects at liver

A

Hepatocellular injury -Reduced blood flow -Direct toxicity - halothane?

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31
Q

Inhalation anesthetics Pharm effects at kidneys

A

Reduced blood flow & GFR -Transient increase in serum urea nitrogen, creatinine, inorganic phosphate -Direct toxicity - methoxyflurane

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32
Q

Inhalation anesthetics Which drug has direct toxicity to the kidneys

A

Methoxyflurane

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33
Q

Inhalation anesthetics Pharm effects at skeletal muscle

A

Relaxation Malignant hyperthermia (halothane in pigs) Enhance effects of competitive Neuromuscular Blockers

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34
Q

What medication can cause malignant hyperthermia in pigs?

A

Halothane

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35
Q

What can halothane cause in pigs?

A

Malignant hyperthermia

36
Q

Inhalation anesthetics Effect on body temperature

A

Hypothermia -Increased heat loss, vasodilation, decreased heat production, impaired shivering

37
Q

Inhalation anesthetics Vapor drugs

A

From liquids DISH -Desflurane -Isoflurane -Sevoflurane -Halothane

38
Q

Inhalation anesthetics Gases

A

NO warrior princess Nitrous Oxide Xenon

39
Q

Halothane Elimination

A

-Falling out of fashion -Most potent cerebral vasodilater -60-80% eliminated in exhale -Liver biotransformation by cytochrome p450

40
Q

Halothane Liver biotransformation

A

by Cytochrome p450 -Trifloroacetic acid, chloride, bromide

41
Q

Halothank Respiratory & CV effects

A

Respiratory & cardiovascular depression

42
Q

Which drug is the most potent cerebral vasodilator?

43
Q

Which drug is the most arrhythmogenic?

44
Q

Halothane Cardiac affect

A

The most arrhythmogenic -Sensitizes heart to epinephrine -Premature ventricular extrasystoles (VPCs)

45
Q

Halothane Hepatitis effects

A

Decreased hepatic blood flow Human vs. domestic animals Metabolite- immune-mediated reaction

46
Q

Halothane Thymol

A

Preservative Builds up in vaporizers

47
Q

Isoflurane Effects at CV and respiratory (Compared to halothane)

A

Less cardiac depression than halothane Same respiratory as halothane

48
Q

Isoflurane Renal effect

A

Renal blood flow decreased like halothane

49
Q

Isoflurane Liver & muscle effect

A

Liver & muscle blood flow less affected than with halothane

50
Q

Isoflurane Effects of NMB

A

More potent enhancer of NMB effects than halothane

51
Q

Isoflurane General info

A

Most used in USA Isomer of enfluane Almost no metabolism Anticonvulsant Cerebral circulation autoregulation maintained

52
Q

Isoflurane Choice drug for what conditions?

A

Choice for critically ill patients & neurosurgery

53
Q

What is the choice drug for critically ill patients and neurosurgery?

A

Isoflurane

54
Q

Isoflurane Cerebral effects

A

Less cerebral vasodilation than halothane

55
Q

Desflurane Vapor pressure

A

High vapor pressure = special vaporizer

56
Q

Desflurane Blood/Gas coefficient

A

The lowest. 0.45 Fast induction Change in depth & recovery

57
Q

Desflurane Metabolism

A

Does not undergo metabolism (0.02%)

58
Q

Desflurane Similarity to Isoflurane

A

Similar in cardiovascular effects & cerebral vascular effects

59
Q

Desflurane Respiratory effect compared to isoflurane

A

More respiratory depressant than isoflurane

60
Q

Desflurane Liver blood flow effect

A

Decreased Liver blood flow like isoflurane

61
Q

Desflurane Renal blood flow

A

Not substantially altered

62
Q

Desflurane Muscle relaxation

A

Similar to isoflurane

63
Q

Desflurane NMB effects

A

Similar to isoflurane *Potent enhancer of NMB effects*

64
Q

Sevoflurane Blood/gas coefficient

A

Low= 0.65 Fast induction, change in depth & recovery

65
Q

Sevoflurane Cerebral vasodilation

A

Less than isoflurane & desflurane

66
Q

Sevoflurane CV & respiratory effects

A

Similar to isoflurane

67
Q

Sevoflurane What absorbent does it react with

A

Soda lime (CO2) absorbent -Compound D (nephrotoxic LD50=400ppm in rates) -Flow rates of 2L/min in humans

68
Q

Sevoflurane What makes it nephrotoxic

A

Fluoride ion

69
Q

Sevoflurane Renal or hepatic injury in domestic animals?

70
Q

Sevoflurane NMB enhancement

A

Similar to isoflurane to enhance effects of competitive NMB

71
Q

Nitrous Oxide

A

AKA N2O, Laughing gas -Comes in cylinders -Low blood/gas coefficient (0.47) -Non-potent anesthetic -Builds up in circle systems

72
Q

Nitrous Oxide As an anesthetic

A

Not potent MAC= 200-250% Anesthetic adjuvant (give with inhalation anesthetic) 66% induction & maintenance

73
Q

Nitrous Oxide Second gas effect

A

Large % of volume of gas moves higher–>lower tension until @ equilibrium NO- more fresh, faster induction

74
Q

Nitrous Oxide Fink Effect

A

Diffusion hypoxia -Opposite to 2nd gas effect -Displacing alveolar gas (including Oxygen) -Give 100% O2 on recovery

75
Q

Nitrous Oxide As an analgesic

A

Good analgesic

76
Q

Nitrous Oxide CV & respiratory effects

A

Low CV & Resp depression

77
Q

Nitrous Oxide CNS effects

A

Increases cerebral blood flow Increases cerebral metabolic rate Increases intracranial pressure

78
Q

Nitrous Oxide Liver & Kidney effects

A

Minimal effect on function

79
Q

Nitrous Oxide Muscle relaxer

A

Poor relaxation Weak trigger of MH

80
Q

Nitrous Oxide Diffusion problems

A

Diffuses into air-filled spaces (pneumothorax, colic)

81
Q

Nitrous Oxide Risk to pregnant women

82
Q

Inhalation Anesthetics No longer used

A

Methoxyflurane Enflurane

83
Q

Methoxyflurane

A

No longer used inhalation anesthetic Good analgesic & muscle relaxant Slow induction & recovery Nephrotoxic (fluoride ions)

84
Q

Enflurane

A

No longer used inhalation anesthetic Seizure activity

85
Q

Inhalation Anesthetics Other delivery methods

A

Boxing down Masking down Intranasal cannula **For fractious animals, tiny animals, neonates, C-section**

RUSVM Pharmacology I (19 decks)

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