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Pharmacology Exam 1 > Inhaled Anesthetics > Flashcards

Inhaled Anesthetics Flashcards

1
Q

What is MAC-awake?

A

the alveolar concentration where a patient opens his or her eyes
~0.4-0.5 MAC for induction
~0.15 MAC for recovery

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2
Q

What is MAC-bar?

A

the alveolar concentration required to block the autonomic response following a supramaximal painful stimulus
~1.5 MAC

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3
Q

What is a MAC-hour?

A

one times the minimum alveolar concentration that prevents movement in response to a noxious stimulus in 50% of subjects administered for 1 hour
Sevo @ 2 MAC x 1 hour
Sevo @ 1 MAC x 2 hours

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4
Q

What factors increase MAC?

A

chronic alcohol consumption
increased CNS neurotransmitters
hypernatremia
infants 1-6 months
hyperthermia
red hair

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5
Q

What factors decrease MAC?

A

acute alcohol intoxication
IV anesthetics
N2O
opioids
alpha-2 agonists
lithium
lidocaine
hydroxyzine
hyponatremia
prematurity
older age (6% decrease per decade after 40)
hypothermia
hypotension
hypoxia
anemia
CPB
metabolic acidosis
postpartum (24-72 hours)
PaCO2 >95

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6
Q

What factors have no effect on MAC?

A

hyper/hypo kalemia
hyper/hypo magnesemia
hyper/hypo thyroidism
gender
PaCO2 15-95
hypertension

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7
Q

What was the first inhaled anesthetic used on a wide scale?

A

ether

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8
Q

How was the first inhaled anesthetic administered?

A

using a drop mask

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9
Q

Why was ether a bad anesthetic?

A

strong emetic properties, airway irritant, and highly flammable

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10
Q

Why is halogenation a good thing?

A

increases stability aka not flammable
forms on 3 sides of ethers

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11
Q

Which halogenation is the most stable?

A

fluorination

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12
Q

Which was the first halogenated ether?

A

halothane

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13
Q

Which is the most potent inhalation agent in history?

A

methoxyflurane (MAC 0.16%)

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14
Q

Why was methoxyflurane a bad anesthetic?

A

high metabolism leading to high output renal failure, pungent, respiratory depressant

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15
Q

When is methoxyflurane used today?

A

Penthrane inhaler as an emergency analgesic

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16
Q

Why was enflurane a bad anesthetic?

A

caused Ethrane shakes, tonic-clonic seizure with deep anesthesia and PCO2 <30

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17
Q

Why was cyclopropane a bad anesthetic?

A

powerful respiratory depressant, sensitized myocardium, emetic, explosive

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18
Q

What receptor does Xenon inhibit?

A

NMDA

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19
Q

What is the MAC and B:G of Xenon?

A

MAC 71%
B:G 0.11

20
Q

Why is Xenon a good anesthetic?

A

rapid induction and emergence
good analgesic
no CV depression
cerebral autoregulation
no hepatic or renal metabolism/toxicity
no MH trigger
does not sensitize myocardium

21
Q

What are the disadvantages of Xenon?

A

increased CBF
increased PVR
cost and availability

22
Q

Which gas lasts the longest in the environment?

A

desflurane

23
Q

Which gas accounts for the most greenhouse gas emissions of all the anesthetic gases?

A

nitrous oxide

24
Q

What is directly proportional to potency?

A

O:G

25
Q

What is inversely proportional to MAC?

A

O:G

26
Q

Does a lower body temperature lead to a slower or faster induction?

A

slower

27
Q

What three things lead to increased alveolar concentration?

A

increased gas flow, increased concentration, increased RR

28
Q

Does a lower B:G coefficient lead to slower or faster induction?

A

faster

29
Q

Does increased CO lead to slower or faster induction?

A

slower

30
Q

Does a lower B:G coefficient lead to a slower or faster emergence?

A

faster

31
Q

What does decreasing CO2 do to clearance of inhaled anesthetics?

A

decrease clearance due to decreased cerebral perfusion

32
Q

What is the MAC, B:G, and O:G of desflurane?

A

6.6%
0.42
19

33
Q

What is the MAC, B:G, and O:G of sevoflurane?

A

2%
0.65
55

34
Q

What is the MAC, B:G, and O:G of isoflurane?

A

1.2%
1.46
91

35
Q

What is the MAC, B:G, and O:G of halothane?

A

0.75%
2.3
225

36
Q

What is the MAC, B:G, and O:G of nitrous oxide?

A

104%
0.47
1.4

37
Q

What is the MAC, B:G, and O:G of enflurane?

A

1.68
1.8
???

38
Q

Which of the modern anesthetics has the fastest induction and emergence?

A

nitrous oxide (B:G 0.47)

39
Q

Which of the modern anesthetics has the slowest induction and emergence?

A

isoflurane (B:G 1.46)

40
Q

Which of the modern anesthetics is the most potent?

A

isoflurane (O:G 91)

41
Q

Which of the modern anesthetics is the least potent?

A

nitrous oxide (O:G 1.4)
xenon (O:G 0.14)

42
Q

Which of the modern anesthetics has the lowest molecular weight?

A

nitrous oxide (44 g)

43
Q

Which of the modern anesthetics has the highest vapor pressure and why does it matter?

A

desflurane (VP 667 mmHg)
needs special vaporizer (heated)

44
Q

Which of the modern anesthetics has the lowest boiling point and why does it matter?

A

nitrous oxide
stored as a compressed liquid

45
Q

List the anesthetics in order from least to most in terms of liver metabolism.

A

nitrous oxide, desflurane, isoflurane, sevoflurane, halothane

Pharmacology Exam 1 (5 decks)

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