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Pharmacology > inhaled 3 > Flashcards

inhaled 3 Flashcards

1
Q

when des/sevo/iso increase, MAP

A

decreases

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2
Q

decrease in MAP reflects a decrease in

A

SVR (dilation)

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3
Q

halothane decreases MAP by

A

decreasing CO

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4
Q

N20 causes ___ MAP

A

unchanged or mildly increased d/t activation of sympathetic nervous system

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5
Q

the substitution of nitrous for a portion of iso produces (cardiac)

A

less decrease in BP

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6
Q

increase gas concentration, HR will

A

increase

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7
Q

increase in HR during induction is seen with which gas

A

des .. (and iso?)

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8
Q

linear, dose dependent inc in HR is seen with iso starting at __ MAC

A

.25

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9
Q

linear, dose dependent inc in HR is seen with des at __ MAC

A

> 1

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10
Q

inc in HR is seen with sevo at ___ MAC

A

> 1.5 MAC

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11
Q

minimal increase in HR with des at concentrations __ MAC

A

<1 MAC

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12
Q

which gas effects EF

A

des- minor increase

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13
Q

do inhaled agents predispose the heart to PVC’s?

A

No, except halo

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14
Q

avoid ___ in patients with known long Qt syndrome

A

sevo

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15
Q

coronary steal

A

iso’s ability to dilate small-diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilation. not found valid

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16
Q

ischemic preconditioning

A

protective against myocardial ischemia in setting of compromised regional perfusion

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17
Q

first period of ischemic preconditioning

A

1-2 hours after the conditioning episode

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18
Q

second period of ischemic preconditioning

A

benefit reappears 24h later and can last as long as 3 days

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19
Q

as anesthetic increases, patients will breathe

A

faster and shallower (increased rate, decreased volumes)

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20
Q

anesthetic effect on minute ventilation

A

relatively preserved but the decreased TV leads to greater dead space ventilation relative to alveolar ventilation

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21
Q

gas exchange becomes ___ efficient as anesthetic depth increases

A

less

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22
Q

PaCO2 ___ proportionate to anesthetic depth

A

increases

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23
Q

anesthetic response to resp response to increased CO2 and arterial hypoxemia

A

blunted

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24
Q

anesthetic gases ___ FRC

A

decrease

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25
Q

which gases are non-pungent

A

sevo, halo, n2O

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26
Q

which gases are pungent

A

des and iso. avoid with asthmatics and smokers

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27
Q

inhalation agents ___ CMRO2 (cerebral oxygen demand)

A

decrease

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28
Q

Do anesthetic gases have an effect on cerebral vascular response to changes in PACO2? yes/no

A

no

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29
Q

in normocapnic patients, cerebral vasodilation occurs at concentrations above __ MAC

A

0.6 (think about half)

but this effect is offset by decrease in CMRO2= no net change in CBF

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30
Q

at higher concentrations, >1 MAC, cerebral blood flow ___

A

increases, esp if systemic BP is maintained at awake values (be careful with neuro pt!)

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31
Q

n20 ___ CMRO2

A

increases

32
Q

n20 causes cerebral ___

A

vasodilaton

33
Q

ICP increases with all volatile anesthetics at doses

A

> 1 MAC

34
Q

auto regulation is impaired at concentrations

A

< 1 MAC

35
Q

autoregulation maintains

A

MAP

36
Q

evoked potentials may be abolished at

A

1 MAC

37
Q

N20 and __ MAC inhalation abolish EP

A

0.5

38
Q

isoelectric occurs at __ MAC

A

1.5-2

39
Q

increased depth of anesthesia is characterized by___ amplitude and ___ synchrony on EEG

A

increased amplitude and synchrony on the EEG

40
Q

which gas is associated with epileptiform activity on the EEG (can cause seizures)

A

sevo

41
Q

neuromuscular effect of gases

A

dose dependent skeletal muscle relaxation and enhance the activity of neuromuscular blocking drugs

42
Q

causative agent of hepatic damage

A

trifluoroacetate metabolite

43
Q

compound A comes from the breakdown of

A

sevo and halo

44
Q

compound A is toxic to the

A

kidneys

45
Q

keep flows at at least ___ to prevent nephrotoxicity r/t compound A

A

2L/min

46
Q

n20 is contraindicated for people with pre-existing vitamin __ deficiency

A

B12

47
Q

nitrous inactivates methionine synthase…. affect on heart

A

its the enzyme that regulates vitamin b12 and folate metabolism. homocysteine levels also elevated, resulting in increased risk of adverse coronary events

48
Q

preferential transfer of N20 causes the volume/pressure of air-filled cavities to ___

A

increase . compliant wall it will increase volume, non compliant wall it will increase pressure.

49
Q

the blood gas coefficient for nitrous is ___ times greater than nitogen

A

34

50
Q

high fresh gas flow rates ___ the desiccation of CO2 absorbents

A

accelerate

51
Q

degradation is an ___ process, which may cause extremely high ___, esp with ___

A

exothermic , temps, sevo

52
Q

iso and des produce ___ when exposed to ___ absorbent

A

carbon monoxide , desiccated

53
Q

if you see an increase in inspiratory CO2, suspect

A

rebreathing - desiccated absorbent

54
Q

which agents do we use variable bypass vaporizers

A

iso and sevo

55
Q

variable-bypass is temperature ___

A

compensated

56
Q

des vapor pressure

A

700mmHg at 20degrees C

57
Q

heated vaporizer tec 6 heats des to ___ atm of pressure

A

2

58
Q

tec 6 and altitude

A

does not altitude adjust - you have to!

59
Q

___ causes bradycardia <1 mac *

A

sevo

60
Q

whats the physio behind ischemic preconditioning?

A

opening of mitochondrial adenosine triphosphate (ATP)-sensitive potassium channels

61
Q

how does the chest wall change

A

cephalad displacement of the diaphragm and inward displacement of the rib cage occur from enhanced expiratory muscle activity. this results in a reduction in FRC.

62
Q

atelectasis…

A

occurs in dependent areas of the lung and to a greater extent when spot vent is permitted

63
Q

at .5MAC, what happens to cerebral blood flow

A

the decrease in CMRO2 offsets the vasodilation such that cerebral blood flow does not change significantly

64
Q

low concentrations 0.2-0.3 MAC decrease the reliability of ____evoked potentials

A

motor

65
Q

which gas has lowest boiling point

A

des

66
Q

reduce compound A risk by

A

low sevo,. high flow, use soda lime

67
Q

inhaled moves CO2 response

A

down to the R

68
Q

sevo is broken down to

A

inorganic fluoride

69
Q

des and iso is broken down to

A

inorganic fluoride ions

70
Q

principal catalyst for CO2 absorption in soda lime and baralyme is

A

sodium hydroxide

71
Q

n20 ___ PVR

A

increases

72
Q

CO production highest in

A

des > nef > iso

73
Q

n20 __ CMRO2 and CBF

A

increases

74
Q

volatile anesthetics produce a dose dependent ___ in cbf

A

increase

75
Q

when vascular resistance is decreased, CBF, CBV, and CSFP ___

A

increase

76
Q

at high altitudes, partial pressure of des will be ___, so you will ___ someone If no adjustments are made.

A

lower, under dose.

Pharmacology (10 decks)

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