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Pharmacology I > Inhaled Agents III > Flashcards

Inhaled Agents III Flashcards

1
Q

What is an equipotent concentration of a medication?

A

1 MAC for each med has same cardio effects.

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2
Q

Map _______ with ________ in concentration of Des, Sevo, and Iso in a dose dependent manner.

A

Decreases, Increases

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3
Q

Decrease in MAP reflects a _________ in SVR.

A

Decrease

Expect… Hal < MAP by CO, N20 not or small > MAP.

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4
Q

How to use inhaled agents on someone who is severely cardiac depressed?

A
  • N2O

- Less concentrations of gas.

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5
Q

___ MAC ___ SBP

A

> MAC < SBP (MAP)

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6
Q

(!) Incremental > in delivered concentrations of inhaled agents > or < HR?

A

> at unique concentrations for each agent.

Iso (Forane) - at 0.25 MAC, liner DD > HR

Des - min upto 1 MAC, at > 1 MAC a linear DD > HR. (SEEN WITH THE MOST @ INDUCTION) give slow flows for slower induction changes HR Less.

Sevo - at 1.5 MAC

(!) (SLIDE 9)

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7
Q

Is Cardia Index influenced by inhalation agents (IA)?

A

Minimally (dilates vessels)

Not much change

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8
Q

Des does not > HR or MAP at what concentration?

A

< 1 MAC

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9
Q

Iso has ______ circulatory effect as _____?

A

Similar, Desflurane

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10
Q

____ and _____ are increased with SNS activity surges.

A

Epi and norepinephrine

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11
Q

> concentrations of _______ and ________ will > SNS surge = > HR.

A

Des and Iso.

Sevo requires > MAC (2 MAC)

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12
Q

Do inhaled agents (AI) predispose the heart to PVCs?

A

No

Except Halo

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13
Q

Inhaled anesthetics (IA) _______ QT interval.

A

Prolong

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14
Q

Worst IA to use for pts with known long QT syndrome?

A

Sevo

*Zofran

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15
Q

Coronary Steal: thought to be caused by what IA ____?

A

Iso

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16
Q

Ischemic Preconditioning

A

Preparing the heart for an ischemic event by giving it a small ischemic event.

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17
Q

2 distinct periods of Ischemic Preconditioning

A

(1) 1-2 hours after conditioning episode.

(2) benefit reappears 24 hours later for up to 3 days.

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18
Q

As anesthetic concentration ___ Respiratory rate ___ and Tidal volume (TV) ___.

A

> , >,

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19
Q

< TV leads to greater _____ _____ ______.

A

Dead space ventilation

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20
Q

Does Gas exchange become more or less efficient and anesthetic depth increases?

A

Less

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21
Q

Does PaCO2 > or < to anesthetic depth proportionately?

A

>

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22
Q

Pt to worry about with tachycardia?

A 
Elderly
Previous event
Stents
> Risk (Smokers, DM, CAD)
< Mets score
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23
Q

What to worry about cardiovascularly with inhaled anesthetics?

A
  • Tachycardia

- Hypotension (SVR = constriction = no volume)

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24
Q

Does minute volume > or < with IA?

A

Stays the same

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25
Q

Do IA > or < FRC?

A

< FRC

Cephalosporins displacement of the diaphragm and inward displacement of rib cage > muscle activity = < FRC.

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26
Q

______________ occurs in dependent areas of the lung?

A

Atelectasis

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27
Q

IA have a _______ effect on principal of hypoxic pulmonary vasoconstriction.

A

Limited

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28
Q

_______, _______, and _______ are nonpungent.

______ and _____ are pungent.

A

Sevo, Halo, N2O

Des and Iso (forane).

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29
Q

IA _______ CMRO2, N20 _________ CMRO2.

A

Decreases, Increases

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30
Q

Is there an effect on cerebral vascular response to changes in PaCO2?

A

No

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31
Q

Cerebral vasodilation occurs at concentrations > _______ MAC.

A

> 0.6 MAC (on a normocapnic patient)

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32
Q

At _____ MAC, the < CMRO2 offsets vasodilation such that CBF does not change significantly.

A

0.5 MAC

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33
Q

At concentrations ______, vasodilation effects predominate and CBF >, especially if BP os maintained at awake value.

A

> 1 MAC

34
Q

____ causes cerebral vasodilation.

A

N2O

35
Q

Does N20 > or < CMRO2?

A

>

36
Q

Will ICP > or < with all IA at doses > 1MAC?

A

>

-Autoregulation is impaired even at lower concentrations < 1 MAC.

37
Q

IA and N2O _________ amplitude and ________ latency of SSEP in DD manner?

A

Depress, Increase

38
Q

EP may be abolished at ____ MAC.

A
  • 1 MAC

- N20 + 0.5 MAC IA

39
Q

< or > concentrations decreases reliability of motor EPs.

A

< (0.2-0.3 MAC)

40
Q

Increased depth is characterized by ________ amplitude and ________ on EEG?

A

> , synchrony

41
Q

Burst Suppression:

Isoelectric Line:

A
  • Periods of brief electrical silence then back on. XX____XX, XXX____.
  • XXX______ predominates at 1.5 - 2.0 MAC.
42
Q

____ and _____ are associated with epileptiform activity on EEG, especially at > concentrations.

A

Sevo and ethrane (better to use Des or Iso).

43
Q

IA produce a DD _____ ______ relaxation and ______ the activity of neuromuscular blocking drugs (Block lasts longer).

A

Skeletal muscle, enhance

44
Q

_________ of IA enhances recovery from neuromuscular blockade.

A

Elimination

45
Q

What IA is not a trigger for MH?

A

N2O

46
Q

Metabolism. ___>___>___

A

Hal > Iso > Des

47
Q

N20 inactivates __________ synthase.

A

Methionine

Enzyme that regulates Vit B12 and folate metabolism.

48
Q

Pt with previous Vit B12 deficiency …

A

Do not give N20.

49
Q

Elevated homocysteine levels are associated with > risk of ______ events.

A

Coronary

50
Q

Transfer to closed gas spaces (N2O vs N)

A

N20 b:g = 0.46
nitrogen b:g = 0.014

N20 leaves blood into an air filled cavity 34x faster.

51
Q

Compliment wall =

N20 vs N

A

> Volume

52
Q

Non-compliant wall =

N2O vs N

A

> Pressure

53
Q

CO2 Absorbents and Exothermic reactions

A

> FGF accelerate the desiccation of CO2 absorbents, thus > degradation if IA.

54
Q

Degradation is an _________ process

A

Exothermic

55
Q

Degradation of CO2 absorber produces…

A

Carbon Monoxide
Heat

From all IA.

56
Q

__________ produces the largest Exothermic reaction.

A

Sevo (higher incidence)

57
Q

Sevo produces…

A

Compound A when exposed to soda lime).

Desiccated absorbent speeds this up

58
Q

Iso and Des produce…

A

Carbon Monoxide when exposed to desiccated absorbent.

59
Q

Iso, Sevo and halo are _______ _______ vaporizers.

A

Variable bypass

60
Q

Variable bypass

A
  • Two streams of inflowing fresh gas.
    1: contacts reservoir of liquid anesthetic.

2: bypass the reservoir.

61
Q

Concentration of anesthetic is gas leaving the vapor or is determined by the relative flow to gas through the ________ _________ versus the ________ _______.

A

Reservoir channel, bypass channel

62
Q

Control of vaporizer concentration occurs by …

A

User adjustment of the vaporizer dial.

63
Q

Variable bypass vaporizers are calibrated for individual anesthetic due to…

A

Differing vapor pressures.

64
Q

Tilting or overfilling may lead to ______ if liquid gets into bypass channel.

A

Overdose

65
Q

Vapor pressure of Des is ______ mmHg?

A

700

66
Q

Suprane

A

Desflurane

67
Q

If Des is given in a variable bypass vaporizer it could produce __________ _________.

A

Unpredictable concentrations.

68
Q

Heated Vaporizer Tec 6

A

Heats Des to 2 atms of pressure.

69
Q

AT > altitudes, PP of Des will be ______, and output concentration will be ______, leading to _________.

A

Lower, lower, underdosing.

70
Q

All IA trigger MH highest - lowest

A

Hal > Forane > Sevo > Des

71
Q

> risk for immune mediated liver injury from IA _________.

A

> metabolism.

Hepatic necrosis

72
Q

Causative agent on immune mediated liver injury.

A

Trifluoroacetate metabolite

73
Q

MIld Liver Injury

A

Modest > of serum transaminase levels from (Halo) “halothane hepatitis”

More likely to occur after < hepatic BF + < O2 delivery to liver.

74
Q

Will we still give IA to pts with Hx of liver disease?

A

Yes

75
Q

Will we give IA to pt’s who report a Hx of hepatic dysfunction after previous inhalation anesthesia?

A

No

76
Q

___________ produces inorganic fluoride which caused sporadic incidence of nephrotoxicity and high output renal failure after prolonged anesthetic.

A

Methoxyflurane

77
Q

__________ is produced from the breakdown of Sevo and Halo.

A

Compound A (trifluoroethyl vinyl ether)

78
Q

Compound A exposure can cause … after prolonged Sevo at low flow rates (1L/min).

A
  • transient proteinuria
  • enzymuria
  • glycosuria
79
Q

Low FGF (<2L/min) be limited to less than ___ MAC hours of Sevo anesthesia.

A

2

80
Q

“_________ is ____ with brains”

A

Ketamine, bad

81
Q

> IA causes DD ______ of respiratory response to > CO2.

A

Blunting

81
Q

> IA _____ CO2 threshold.

A

Raise

Pharmacology I (6 decks)

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