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Pharmacology Exam 4 > Inhaled Agents Pt. 1 > Flashcards

Inhaled Agents Pt. 1 Flashcards

0
Q

**What is Woodbridge’s definition of general anesthesia?

A

General anesthesia is depression of sensory, motor, reflex and mental function.
-Includes analgesia, skeletal muscle relaxation, freedom from troubled reflexes (tachycardia, airway protection, salivation), and unconsciousness(hypnosis & amnesia) either present or not.

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1
Q

What is the easiest sign of lightness that is abolished by muscle relaxants?

A

Withdrawal from noxious stimuli

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2
Q

What’s Prys-Robert’s definition of anesthesia?

A

State in which, as a result of DRUG-INDUCED UNCONSCIOUSNESS, the patient neither perceives nor recalls unpleasant stimuli.

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3
Q

Between somatic response to noxious stimuli and autonomic response, which is easier to suppress?

A

Somatic (Sensory/ pain& motor/ movement)

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4
Q

What is included in the autonomic response to noxious stimuli?

A

Breathing, hemodynamics, sudomotor, and hormonal

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5
Q

Recognition of unconsciousness is measured by_______ not______

A

Recognition of unconsciousness is measured by side effects not what’s going on in the mind

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6
Q

What does the word “anesthesia” mean?

A

Greek: “an” means “without”, “sthesia” means “feeling”

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7
Q

Which type of anesthesia is more reliable: rgional, general, or spinal?

A

General

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8
Q

Name & define stage I of anesthesia

A
  • “Analgesia & Sedation”
  • VA’s not used to produce this stage, except for N2O in dental
  • protective reflexes intact
  • eyes open to command, tolerate mild pain, normal breathing
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9
Q

Name & define stage 2 of anesthesia

A
  • “Excitement”
  • Associated with MAC awake
  • Rarely seen @ induction with increased VA’s dosing & induction agents
  • More so seen on emergence (transitions quickly)
  • Muscle movement, retching, heightened laryngeal reflexes, increased HR, B/P, Ve
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10
Q

Define MAC awake

A
  1. 3-0.4 MAC
    - the point below which subjects respond to command; above which they are amnestic. (point of opening eyes & following commands)
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11
Q

Name & define stage 3 of anesthesia

A
  • “Surgical Anesthesia”
  • MAC= that level of agent where there is no movement in response to skin incision in 50% of patients
  • Also associated with MAC95 & MAC bar
  • No behavior pain response
  • Amnesia
  • Reflex depression (HR, B/P, airway protection)
  • Skeletal muscle relaxation
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12
Q

Define MAC 95

A

at 1.3 MAC, 95% of patients will not move

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13
Q

Define MAC BAR (Block autonomic response)

A

Taking a higher concentration to “block autonomic response” in response to highly-stimulating events.

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14
Q

Why is assessing depth beyond MAC difficult?

A

Clinical signs of each VA differ beyond MAC, especially when modified by adjuvant drugs & PMH. Effects of drugs are also modified by time

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15
Q

***What are the primary means to assess depth?

A
  • Clinical signs: SBP (though this is monitoring a side effect); movement, and respirations, which is the best sign
  • Electronic monitoring: BIS monitor, End Tidal Gas analysis
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16
Q

What are the clinical signs that gauge anesthesia depth

A
  • Respiratory (Increased RR & decreased Tv)
  • Eye signs (Lacrimation, eye movement, change to disconjugated usually suggests light anesthesia)
  • Motor (Active expiration=light, soft abd. = deep enough)
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17
Q

Is BIS monitoring a monitoring standard for the ASA or AANA?

A

No

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18
Q

What is a monitoring standard for the ASA & AANA

A

End Tidal Gas analysis

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19
Q

What are some potential risk factors that would require less anesthetic admin. and/ or pt. at risk of becoming “light” or aware during case.

A
  • Trauma
  • Cardiac Sx.
  • Emergency Sx.
  • Cesarean Section
  • Paralysis
  • Planned use of muscle relaxants
  • Planned “Garbage”/ balanced Anesthesia (N2O & opioids)
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20
Q

What are the 3 levels End Tidal agent that examines VA that helps infer unmeasured alveolar & brain tension of VA

A

The time & relationship between:

  1. Dial setting
  2. Inspired VA
  3. Expired VA ( proportional to alveolar, arterial & brain once pt. is in equilibrium.
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21
Q

How does the level of anesthetic in the brain relate to the amount of agent shown on End tidal agent gas analyzer?

A

-It lags behind a few minutes (at induction the brain won’t have as much as shown on monitor. at emergence, brain will have more than what’s on monitor)

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22
Q

How has halogenation influenced volatile agents

A
  • Non-flammatory
  • Decreased blood solubility
  • Increased onset and offset
  • Increased resistance to metabolism & degradation
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23
Q

How does using only fluorine effect the VA? Which agent only uses fluorine?

A
  • Desflurane

- Nonflammable, with low solubility, and extreme resistance to metabolism

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24
What does low blood solubility yield?
- Rapid induction - More precise control - Rapid offset
25
What drives the cost of anesthetics
-Price per mL -Inherent characteristics (vapor pressure, potency, solubility) -Fresh gas flow (Increased potency= increased cost)
26
What cost factor is under the control of the anesthetist
Fresh gas flow
27
Which agent boils at room temperature?
Desflurane
28
Which agent has the highest vapor pressure: N2O, Desflurane, or Sevoflurane?
Desflurane
29
Which VA is the most potent?
Isoflurane
30
Which VA is the least potent?
Desflurane
31
Of all the VA we use, which 2 should have the quickest offset/ onset?
-Desflurane & N2O
32
What's the boiling point of N2O
-it's a gas so it doesn't have one
33
What's the MAC of Isoflurane
1.17%
34
What's the MAC of Desflurane
6.6 (6)
35
What's the MAC of Sevoflurane
1.8 (2)
36
What's the MAC of Enflurane
1.63
37
What's the MAC of N20
104
38
What is the Blood: gas partition coefficient of N2O
0.46
39
What is the Blood: gas partition coefficient of Enflurane
1.90
40
What is the Blood: gas partition coefficient of Isoflurane
1.46
41
What is the Blood: gas partition coefficient of Desflurane
0.42
42
What is the Blood: gas partition coefficient of Sevoflurane
0.69
43
What is the Vapor Pressure of Enflurane
172
44
What is the Vapor Pressure of Isoflurane
240
45
What is the Vapor Pressure of Desflurane
669
46
What is the Vapor Pressure of Sevoflurane
170
47
How does blood gas coefficient influence the effect of VA
The less the BGC> the less soluble the VA is in the blood> the quicker it goes into/ out of the brain> the faster onset/ offset
48
Define MAC
The minimum alveolar concentration which produces no movement in response to surgical stimulation in 50% of patients
49
What is the percentage of MAC dependent on?
- Age - Temperature - Atmospheric pressure
50
Characteristics of N2O
- Commonly admin. alone (sedation) or w/ opioids or VA for GA - Nonflammable, but supports combustion like O2 - Low molecular wt., low potency (MAC 104%), Low BGSC (0.46) - Odorless to sweet odor
51
N20 Advantages
- Poor gas solubility = rapid alveolar pressure & brain tension - Good Analgesic (equal to MSO4 10mg SC) - Additive MAC with VA's lead to lower cost by decreasing VA
52
Disadvantages of N2O
-Minimal skeletal muscle relaxation -Increased role in PONV -High problems r/t high volume absorption -Supports combustion (though it's nonflammable) -Toxic effects -
53
What are the toxic effects of N2)
*** depresses methionine synthetase (decreased DNA synthesis, polyneuropathy, B12). Leads to birth defects - Immunity (decreased PMNs & chemotaxis) - addictive potential - Greenhouse effect
54
Halothane characteristics worth noting
- ****Metabolized in liver >20% (very high) - Needs a preservative d/t susceptible to decomposition so 0.01% thymol added as a preservative -Increase blood solubility> slower offset/ onset
55
What is the "Gold Standard" for volatile agents
Isoflurane
56
Chemical make up of isoflurane
- Halogenated methyl ethyl ether. | - isomer of enflurane
57
***Why is Isoflurane limited in its usefulness for inhaled induction?
It's pungency causes coughing in awake people
58
How does Desflurane's chemical structure differ from Isoflurane and what are the effects?
- The Chlorine in Isoflurane is substituted for a Fluorine on alpha-ethyl carbon. - More stable & resistant to metabolism than Isoflurane - Onset/ offset is 1/3 of Isoflurane
59
Disadvantages of desflurane
- expensive - Pungency causes airway irritation, cough, salivation, breath-holding, and laryngospasm in awake patients. - ***Carbon monoxide generated in soda lime
60
***Opioid effect on MAC
Decreases MAC significantly
61
What patient population would receive the highest MAC dose
Newborns
62
Characteristics of Sevoflurane
- Least irritating r/t not pungent - bronchodilator - Slower onset & offset than Des - Low BGSC & MAC - No CO in soda lime
63
Disadvantages of Sevoflurane
- *****Degraded by soda lime - Cost - Metabolism 5% (Fluoride ion-potential RENAL TOXICITY) - Forms compound A after degraded in soda lime which is nephro toxic
64
Cautions to administering Fluorine r/t FGF & MAC
Do not go below 2L/min FGF. If so, don't give MAC >2. | insert states <2L/min
65
Are MAC doses set or additive? If so, how?
- Additive | - 1/2 MAC N2O + 1/2 MAC VA= 1 MAC
66
Are the dose response curves for all VA broad or steep
Steep (1MAC= 50%; 1.3 MAC= 95%; 2 MAC side effects prominent & dangerous)
67
As far as the dose response curve, do we measure MAC on the dial or expired MAC?
expired MAC
68
Are you aloud to mix VA, like change to a different agent in the middle of a case?
No except for N2O
69
What is the result of maintaing MAC at a high dose (>2)
Death/ damage
70
How is MAC effected per decade of age
Decreases 6% per decade
71
***How do VA produce progressive depression of CNS function
Unknown (? immobility mediated @ spinal cord; amnesia probably mediated supra-spinally; RAS a likely target; effects on voltage-gated and ligand-gated ion channels?)
72
***What are the effects of almost all injected & inhaled anesthetics on GABA?
enhance GABA
73
***What is the only anesthetic that doesn't enhance GABA activity
Ketamine
74
Which receptor has a probable role in immobility
GABA
75
Which measurement on gas analysis of VA is more/ less proportional to alveolar, arterial, and brain once patient is in equilibrium with outflow?
Expired VA
76
How has halogenation effected anesthetic gases
1. decreased flammability 2. Low (plasma) solubility 3. Extreme resistance to metabolism/ degradation (r/t #2) 4. quicker onset & offset
77
Which agent is not as stable in soda lime
sevoflurane
78
Which agent has the lowest boiling point?
Desflurane (room temp)
79
Which agent is the most potent
Isoflurane
80
Which agent is the least potent
Desflurane
81
Which agent has the highest vapor pressure
Desflurane (669)
82
What does the blood:gas solubility determine?
the rate of equilibration of the amount between the blood & gas phases
83
how would an agent with low blood-to-gas partition coefficient equilibrate compare to an agent with a high blood:gas partition coefficient? (O&J p. 165)
the low blood: gas will equilibrate more rapidly
84
Patient factors that influence effects $ side effects of VA
1. age 2. coexisting dz. 3. medications 4. intravascular fluid volume 5. body temp
85
Which 2 VA are most alike
Desflurane & Isoflurane (Des has aF for Cl on alpha-ethyl carbon). They often have same properties and effect in body.
86
How is apprehension HTN in preop affected by VA
Exaggerated hypotension

Pharmacology Exam 4 (2 decks)

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