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Inhaled anesthetics 2: Pharmacodynamics Flashcards

1
Q

What is placed to help tamponade a retinal break?

A

Gas bubble

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2
Q

Why is N2O dangerous when a gas bubble tamponade is placed over a retinal break.

A

Can expand the bubble, compromise retinal perfusion, and cause permanent blindness

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3
Q

What is the main kind of gas bubble used over the site of a retinal break?

A

SF6
Sulfur hexaflouride

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4
Q

When to avoid N2O with a SF6 bubble:

A

Before SF6 is placed: DC N2O at least 15 min before placement

After SF6 is placed: Avoid N2O for 7-10 days

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5
Q

When to avoid N2O after other types of gas bubbles for retinal breaks such as air & perfluoropropane & silicone oil

A

air= 5 days
Perfluoropropane= 30 days
Silicone oil= No contraindication to N2O

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6
Q

What will N2O do to volume and pressure in an ETT, LMA, balloon-tipped pulmonary artery catheter?

A

Increase it

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7
Q

What does N2O do to Vitamin B12?

A

Irreversibly inhibits it

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8
Q

Methionine synthase requires what vitamin to function?

A

Vitamine B12

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9
Q

Vitamin B12 deficiency can lead to what change in DNA synthesis

A

Decrease

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10
Q

What kind of anemia is caused by vitamin B12 deficiency

A

Megaloblastic
Pernicious

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11
Q

1 MAC of Isoflurane

A

1.2

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12
Q

1 MAC of Sevoflurane

A

2.0

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13
Q

1 MAC of Desflurane

A

6.6

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14
Q

1 MAC of N2O

A

104

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15
Q

Essential triad of anesthetic action:

A

1 Amnesia
2 Loss of consciousness
3 Immobility

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16
Q

Amnesia, unconsciousness, and immobility are all produced from inhaled anesthetics. At different MAC levels. What order do they occur in?

A

Amnesia first > then unconsciousness > then immobility

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17
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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18
Q

Movement is prevented in 95% of patients at what MAC

A

1.3

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19
Q

Do K+ and Mg++ affect MAC?

A

No

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20
Q

How do Na levels affect MAC

A

Increased Na –> Increased MAC

Decreased Na –> Decreased MAC

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21
Q

What does body temp do to MAC?

A

Increased temp –> Increased MAC
Decreased temp –> Decreased MAC

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22
Q

What does chronic alcohol consumption do to MAC

A

Increase

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23
Q

Any drugs that increase CNS transmitters do what to MAC?

A

Increase

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24
Q

MAC is increased in what ages

A

1-6 months

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25
How much does MAC decrease per decade after 40 years
6%
26
Is MAC higher or lower in a premature infant
lower
27
Is MAC increased or decreased in the post-partum period (24-48 hours)
Decreased
28
It is not until PaCO2 reaches what number that it will start to cause a decrease in MAC?
90
29
What does hypo and hyper thryoidism do to MAC
Nothing
30
What does the Meyer Overton Rule say?
Lipid solubility is directly proportional to the potency of an inhaled anesthetic
31
What is the unitary hypothesis
Says that all anesthetics share a similar MOA, but each may work at a different site
32
In the brain, what is the most important site of volatile anesthetic action?
GABA A
33
In the spinal cord, volatile anesthetics produce immobility where?
The ventral horn.
34
What are the 3 receptors where volatile anesthetics work?
Glycine NMDA Na +
35
What 2 receptors does N2O work on?
NMDA antagonism Potassium 2P channel stimulation *NOT GABA A
36
What areas of the brain do volatile anesthetics target to produce amnesia?
Amygdala Hippocampus
37
What areas of the brain do volatile anesthetics target to produce unconciousness?
Cerebral cortex Thalamus Reticular activating system
38
What effect do Volatile anesthetics have on the heart rate? Increase or Decrease
Increase
39
What does N2O do to heart rate?
Increase (like all the volatiles)
40
What does N2O do to SVR?
Increase
41
What happens to contractility when volatiles are used?
Small decrease in baseline
42
What happens to SVR with inhaled anesthetic use?
Decrease
43
Do coronary arteries vasodilate or constrict with inhaled anesthetic use?
Vasodilate
44
The central chemo-R in the medulla maintain tight control of PaCO2. Every 1 increase in PaCO2 above baseline will increase minute ventilation by:
3 L/min
45
What do halogenated agents do to airway resistance?
Bronchodilators
46
Where are peripheral chemo-R and what do they monitor for?
Peripheral chemo-R Hypoxia
47
What PaCO2 starts to stimulate increase minute ventilation to restore arterial O2
<60 mmHg
48
Carotid bodies relay afferent input to the respiratory center via ___. What is aortic bodies.
Glossopharyngeal n. (CN 9) Vagus n. (CN 10)
49
What do volatile anesthetics do to the peripheral chemo-R
impair
50
Response to hypoxia is impaired at what MAC?
0.1
51
Carotid bodies have what kind of cells in them?
Glomus type 1 cells
52
What does inhaled anesthetics do to icp!
Increase
53
What does inhaled anesthetics do to CBF?
Increase
54
How much of total brain oxygen consumption is consumed by electrical activity
60%
55
What MAC is needed to produce an isoelectric state?
1.5-2.0 MAC
56
Seizures can be caused by high levels of which gas? At what MAC?
Sevo 2
57
What do volatiles do to CBF and CMRO2
Uncouple
58
At what MAC does CBF and CMRO2 become uncoupled?
0.5
59
What does Nitrous do to CBF and CMRO2
increase
60
What effects do Iso Des and Sevo have on CSF production or absorption
Iso: Increase absoprtion Des: Increase production Sevo: Decrease production
61
MEPs monitor the integrity of which tract?
corticospinal
62
SSEPs monitor the integrity of which tract?
dorsal column
63
What is the amplitude of the evoked potential waveform
Strength of the nerve response
64
What is the latency of the evoked potential?
speed of nerve conduction
65
How much volatile can you use with evoked potentials?
0.5 MAC
66
What is the best anesthetic technique when evoked potentials are being used
TIVA without nitrous

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