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Pharmacology > Inhalational Anesthetics > Flashcards

Inhalational Anesthetics Flashcards

1
Q

What are the 2 factors that determine the depth of inhalation anesthetics?

A

Concentration
-> Partial pressure
Solubility

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2
Q

What are the 2 factors determines the rate of induction of inhalation anesthetics?

A

Physico-chemical properties of drug
- Solubility
Hemodynamic and pulmonary function

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3
Q

What happens when the anesthetic agent has low solubility?

A

Low solubility
-> Blood is rapidly saturated
–> Transfer to other compartment ( e.g. Brain )
—> Faster onset
—> Deeper depth

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4
Q

What does a high Blood/Gas Partition mean to Blood solubility?

A

High blood/gas partition = high blood solubility

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5
Q

What does higher blood solubility mean to the rate of change in depth of anesthesia?

A

Higher blood solubility
-> Slower the rate of change in depth of anesthesia

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6
Q

Match the following

Desflurane
Isoflurane Ultrashort acting
Enflurane
Halothane Short acting
Sevofllurane
Nitrous oxide Long acting
Methoxyflurane
Diethyl ether

A

Long acting
-> Diethyl ether
-> Methoxyflurane

Short acting
-> Halothane
-> Enflurane
-> Isoflurane

Ultrashort acting
-> Sevoflurane
-> Desflurane
-> Nitrous oxide

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7
Q

What do we have to remember about methoxyflurane is very slow?

A

Methoxyflurane is very slow
- Induction
- Recovery
- Changes in anesthetic depth

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8
Q

What is nitrous oxide used for during induction?

A

Nitrous oxide facilitates the induction

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9
Q

What is nitrous oxide effect called?

A

2nd gas effect

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10
Q

Why is Sevoflurane used in avian & small animals?

A

Rapid induction & recovery

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11
Q

What is MAC short for?
What does it mean?

A

Minimal alveolar concentration
-> 50% of patients don’t feel pain

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12
Q

The “higher” or “lower” the MAC, the more potent the anesthetic agent?

A

The lower the MAC
-> The more potent the anesthetic agent

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13
Q

How many times of the MAC is required for surgical anesthesia?

A

1.2 - 1.5 times the MAC

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14
Q

The “higher” or “lower” the lipophilicity, the more potent the anesthetic agent?

A

The higher the lipophilicity
-> The more portent the anesthetic agent

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15
Q

4 Factors that decrease MAC

A

Hypo ( anything )
-> Hypotension
-> Anemia
-> Hypothermia
-> Hypoxia
-> Hypothyroidism

Metabolic Acidosis
-> Kidney problems

Old Age

Pre med

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16
Q

2 Factors that increase MAC

A

Hyperthermia
-> Increase metabolic rate of brain

Hyperthyroidism

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17
Q

6 Factors that do not affect MAC

A

Duration of Anesthesia

Species
-> Difference are negligible

Sex

PaCO2
-> 14 - 95 mmHg

PaO2
-> 38 - 500 mmHg

Hypertension

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18
Q

Which of the following are Epileptogenic?

a) Methoxyflurane
b) Halothane
c) Enflurane
d) Sevoflurane

A

c) Enflurane

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19
Q

Are IHs potent “Vasodilators” or “Vasoconstrictor”?

A

IH
-> Potent vasodilators
–> Increase cerebral blood flow
—> Increase intracranial pressure

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20
Q

Does IH “Excites” or “Depress” cardiopulmonary function [ in a dose - dependent manner ]?

A

Depress cardiopulmonary function

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21
Q

What type of receptor reflex activity does IH inhibits?

A

Baroreceptor

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22
Q

What are 3 IH advantages?

A

Accurate control for anesthetic depth
-> During induction

Inhalant can be eliminated quickly
-> Through ventilations
–> Not metabolism

High - inspired oxygen can be provided

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23
Q

What are 3 IH disadvantages?

A

Not suitable for dogs
-> Healthy
-> W/o pre med

Pungent smell [ Isoflurane & Desflurane ]
-> Causes animal to hold their breath
–> Slow down induction

Pollutes work environment

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24
Q

Is IH suitable for ‘small’ or ‘big’ animals?

A

Small animals
&
Weakened Dogs & Cats
Dogs & Cats w/ strong pre med

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25
Q

What happens if healthy animals aren’t giving pre med before IH?

A

Excitement

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26
Q

Is ‘Sevoflurane’ or ‘Isoflurane’ better for Mask induction?

A

Sevoflurane
-> Induction
–> Quicker
–> Smoother

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27
Q

What animals are suitable for Chamber induction?

A

Small & Intractable animals

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28
Q

What is the advantage of Chamber induction?

A

“Hands free” induction
-> Safe
–> Animal
–> People

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29
Q

How many percentage of ‘Isoflurane’ & ‘Sevoflurane’ w/ O2 is used?

A

Isoflurane
- 5%

Sevoflurane
- 8%

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30
Q

Until when are we safe to enter the Chamber?

A

Until animal losses its righting reflex
-> Cannot stand straight

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31
Q

What are 4 advantages of IH for maintanence?

A

Protection of airway
-> Intubated

High - inspired O2
-> Maintains blood O2 content

Easy control of depth of anesthesia

Rapid recovery
-> Ventilation elimination
–> Not metabolism in Liver

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32
Q

Can pre med reduce maintenance concentration in IH?

A

Yes

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33
Q

What is the major elimination route of IH?

A

Respiration / Ventilation

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34
Q

What are the pharmacological effects of anesthetic action in these anatomic sites?

  • Spinal cord
  • Thalamocortical communication
  • Hippocampus
A

Spinal cord
-> Immobilization

Thalamocortical communication
-> Unconsciousness

Hippocampus
-> Amnesia

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35
Q

What is the most potent IH?

A

Methoxyflurane

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36
Q

Up to how many % of Methoxyflurane is Metabolized?

A

Up to 50%
-> Less elimination through Lungs

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37
Q

What is THE disadvantage of Methoxyflurane?

A

SLOWWW
-> Induction
-> Recovery

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38
Q

What does the metabolite of Methoxyflurane( F-, dichloroacetic acid…) do to kidney?

A

Kidney failure
-> Irreversible

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39
Q

Does nitrous oxide smell bitter, sweet or spicyyy?

A

Sweet

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40
Q

Is N2O flammable?

A

No
-> N2O
–> Nonflammable gas

41
Q

Is N2O a potent analgesic agent?

A

NOOO
-> High MAC ( > 100% )

42
Q

Does N2O provide Skeletal muscle relaxation?

A

No

43
Q

What happens after discontinuation of N2O?
Explain

A

Diffusion Hypoxia ( aka Dilutional hypoxia )
-> Discontinuation of N2O
–> Concentration of gradient between Lungs & Alveolar circulation rapidly reverse
—> O2 dilution in Lungs
—-> Hypoxia

44
Q

If N2O has such high MAC, what is it used as instead?

A

Adjuvant

45
Q

How many % of N2O + O2 can significantly reduce MAC for Halothane, Enflurane, Isoflurane?

How many % of the amount of Primary IH is reduced in general using N2O as adjuvent?

A

70% N2O + O2
-> Significantly reduce MAC for
–> Halothane
–> Enflurane
–> Isoflurane

Reduces 25 - 30 % of the amount of Primary IA used

46
Q

What is N2O ‘Second gas effect’?

A

Low blood insolubility
-> w/ High concentration
–> Rapid uptake
—> Enhance uptake of Primary IH
—-> Especially good for soluble IH

47
Q

What is the 4 advantages for N2O?

A

Second gas effect

Nonflammable

Minimal effect on circulation

Minimal effect on respiratory drive

48
Q

What is the 4 disadvantages for N2O?

A

No skeletal muscle relaxation

Weak anesthetic potency
-> MAC > 100%

Diffusion hypoxia

Cannot be used a sole anesthetic agent

49
Q

Does increased MAC of Halothane causes ‘Increased’ or ‘Decreased’ tidal volume in lungs

*Tidal volume is the amount of air that moves in or out of the lungs with each respiratory cycle

A

Decreased

50
Q

Up to how many % of Halothane is Metabolized?

A

Up to 25%

51
Q

What is Halothane Hepatitis?

A

Metabolites of Halothane
-> Trifluoroacetylated liver protein
( Tri | Fluoro | Acetylated )
–> Production of Antibodies against it
—> Halothane Hepatitis ( Immune response )
—-> 1 in 10,000 patients

52
Q

Can halothane induce skeletal muscle relaxation?

A

Yes

53
Q

What is the enzyme that metabolize Halothane into Trifluoroacetylated liver protein?

A

Cytochrome P450

54
Q

What is Malignant hyperthermia?

A

Inhalation anesthetics ( Halothane, Isoflurane, Sevoflurane )
+
Muscle relaxant ( Succinylcholine )
-> Uncontrolled released of Ca++
–> From SR ( Sarcoplasmic reticulum )
—> Sustained muscle contraction
—-> Hyperthermia

55
Q

What is the treatment for Malignant hyperthermia?

A

Dantrolene
-> Inhibits Ca++ release from SR

Rapid cooling

Provide supplemental oxygen

Control lactic acidosis

56
Q

How many F- are there in Enflurane?

A

5

57
Q

Is Enflurane flammable?

A

No
-> Not in room temperature
–> So.. technically yes?

58
Q

Does Enflurane has a pungent odor?

A

Yes

59
Q

Up to how many % of Enflurane is Metabolized?

A

2% metabolized

60
Q

Can Enflurane causes renal failure?

A

Yes
-> Too many F-
–> Avoid long cases

61
Q

Does Enflurane have ‘slow’, ‘quite rapid’ or ‘rapid’ onset and recovery,
due to its intermediate solubility and high potency?

A

Quite rapid

62
Q

Is Enflurane used for induction or maintenance of general anesthesia?

A

Maintenance**

63
Q

Can Enflurane cause Seizure?

A

Yes
-> Only when concentration > 3%

64
Q

How many F- are there in Isoflurane?

A

5

65
Q

Up to how many % of Isoflurane is Metabolized?

A

0.17% LOL

66
Q

Is Isoflurane flammable?

A

No
-> Not in room temperature

67
Q

Does Isoflurane has a pungent odor?

A

Yes

68
Q

What are the effects of Isoflurane on cardiovascular system?

A

Little effect

69
Q

Can Isoflurane cause Seizure?

A

No
-> Very good compared to Enflurane

70
Q

Can Isoflurane cause Malignant hyperthermia?

A

Yes

71
Q

Which of the following have well maintained cardiac output?

  • Halothane
  • Isoflurane
  • Enflurane
A

Isoflurane
-> Little effect on cardiovascular system

72
Q

What can enhance Isoflurane muscle relaxation?

A

Tubocurarine

73
Q

Other than _______ procedures, reduced amounts of tubocurarine may be required?

A

Abdominal procedures?

74
Q

What is the 5 advantages for Isoflurane?

A

Rapid & smooth adjustment of anesthetic depth

No Hepatic & Renal toxicity
-> Methoxyflurane
–> Irreversible renal failure
-> Halothane
–> Halothane Hepatitis
-> Enflurane
–> Renal failure

Little effect on cardiovascular system

Relaxation of Skeletal muscle

Arrhythmias is not unlikely
-> Irregular heartbeats

75
Q

What is the disadvantages for Isoflurane?

A

May cause Malignant hyperthermia

76
Q

How many F- are there in Sevoflurane?

A

7 ==

77
Q

Does Sevoflurane has a pungent odor?

A

No

78
Q

Does Sevoflurane have ‘slow’, ‘quite rapid’ or ‘rapid’ onset and recovery,

A

Rapid onset & recovery

79
Q

Does Sevoflurane cause airway irritation?

A

LEAST airway irritation
-> Among other volatile anesthetic

80
Q

Is Sevoflurane suitable for direct anesthesia induction?

A

Yesss
-> Minimal airway irritation goodgood

81
Q

Up to how many % of Sevoflurane is Metabolized?

A

3 - 5% metabolized

82
Q

Is Sevoflurane’s vapor pressure ‘similar’ or ‘different’ compared to Halothane and Isoflurane?
If so, what vaporizer is recommended?

A

Similar
-> Conventional, unheated vaporizer is fine

83
Q

Does Sevoflurane form trifluoroacetylated liver protein?

A

No :D
-> No Halothane Hepatitis

84
Q

Can Sevoflurane cause Malignant hyperthermia?

A

Yes

85
Q

Are Sevoflurane MAC decreased when pre med is used ?

A

Yes

86
Q

What is the clinical usage for Sevoflurane

A

First - line ( Commonly chosen )
Excellent induction agent

87
Q

How many F- are there in Desflurane?

A

6

88
Q

Is Desflurane’s vapor pressure ‘similar’ or ‘different’ compared to Halothane and Isoflurane?
If so, what vaporizer is recommended?

A

Different
-> Increased Vapor pressure
–> Boiling in room temp.
—> Requires a special vaporizer
—-> Temperature controlled vaporizer

89
Q

Fluorination instead of Chlorination means that Desflurane has ‘increased’ or ‘decreased’ molecular stability?

A

Increased molecular stability

90
Q

Up to how many % of Desflurane is Metabolized?

A

Too little there is no data .-.

91
Q

Does Desflurane have ‘increased’ or ‘decreased’ potency compared to Isoflurane due to its Fluorination?

A

Decreased potency
-> 5 times less than Isoflurane

92
Q

Does Desflurane has a pungent odor?

A

Yes
-> Less likely to be used for induction

93
Q

What is the feature that separates Sevoflurane & Desflurane from all other IH?

A

Low solubility
-> Rapid onset, recovery

94
Q

Does Diethyl Ether 乙醚 have a ‘quick’ or ‘slow’ induction and recovery?

A

Slow induction & recovery

95
Q

Is Diethyl ether has full spectrum of CNS depression?

A

Yes

96
Q

What is the advantages of Diethyl Ether?

A

Muscle relaxation
Analgesia
Non - toxic metabolites

97
Q

Why is Diethyl Ether no longer used in medical practices?

A

Flammable & Explosive
Irritation
-> Respiratory
-> GI

98
Q

Diethyl Ether was used in what animal for anesthesia?

A

Lab animal
-> Mouse
-> Rats

Pharmacology (5 decks)

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