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Block 3 Pharm > Inhaled anesthetics > Flashcards

Inhaled anesthetics Flashcards

1
Q

Therapeutic index for inhaled anesthetics

A

Very low therapeutic indices: LD50/ED50 values are 2-4!

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2
Q

What determines the concentration gradient of inhaled anesthetics

A

Rather than a concentration gradient across a barrier, the partial pressure of the anesthetics determines transmembrane movement

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3
Q

When is equilibrium of anesthetics reached

A

equilibrium is reached when partial pressures are the same, this is not necessarily equivalent to equal concentrations on each side of the membrane

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4
Q

Measure of the solubility of the anesthetic in an aqueous versus gaseous environment

A

Blood:gas coefficent

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5
Q

Low blood:gas partition coefficient results in

A

rapid equilibration in blood and relatively few molecules are required to raise its partial pressure

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6
Q

rate of induction is______ related to the blood:gas partition coefficient

A

inversely

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7
Q

recovery is ____ with a low blood:gas coefficient

A

quick

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8
Q

with a low blood:gas PC, we need ____ amounts in the inspired ar

A

HIGH

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9
Q

witha high blood:gas PC we need _____ amounts in inspired air

A

LOW

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10
Q

induction and recovery are _____ with a high blood:gas PC

A

SLOW

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11
Q

In a high fat:blood PC we see a _____ 1/2 life of drug

A

LONG

—cuases hangover bc more gets into brain

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12
Q

Anesthetic concentration in the inspired air determines the gas pp in the air which affect:

A

ii) Also affects the partial pressure in the blood

also affects the rate of movement of gas into the blood

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13
Q

The rate of transfer will increase as the concentration is _______ Therefore, rapid induction can be achieved with _________

A

increased

higher concentrations

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14
Q

Pulmonary ventilation

Affects moderately blood soluble anesthetics _______ than low soluble agents

A

more

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15
Q

Increased blood flow______ the rate of rise in arterial partial pressure
— Effect is most dramatic for moderately soluble anesthetics

A

slows

(the drug has less time to get into the blood)

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16
Q

During induction, highly perfused tissues exert

A

the greatest effect and get most drug… like the brain

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17
Q

Elimination is reverse of induction –________partition coefficient is the most important determinant

A

blood:gas

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18
Q

_______anesthetics are eliminated fastest

A

Low solubility

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19
Q

The longer the exopsure to a drug:

A

the more accumulation and the longer it takes to eliminate

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20
Q

Anesthesia is achieved when

A

the brain partial pressure is equal to MAC

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21
Q

Because the brain is well perfused, the partial pressures of the anesthetic in alveolar gas and in the brain become equal in a

A

short period of time

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22
Q

NO net movement of gas at steady state:

Quick for gases with _____ blood:gas PC

A

LOW blood:gas

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23
Q

steady state is Low for gases with _____ fat:blood PC

A

HIGH fat:blood

24
Q

how is steady state determined in clinic

A

Equilibration occurs when the concentration of anesthetic in the inspired gas mixture is the same as the end-tidal (alveolar) concentration

25
Q

Rate of elimination is dependent upon

A

blood: gas PC

- -Lowest will be eliminated the fastest

26
Q

What determines the 1/2 life of anesthetic

A

the blood:fat PC bc the gas needs to get into the blood before it can be eliminated

27
Q

For agents with low blood and tissue solubility, recovery is _____and unrelated to the length of anesthetic exposure

A

rapid

28
Q

For agents with high blood and fat solubility, the recovery will be

A

a function of the duration of anesthetic administration (because of fat accumulation of the anesthetic)

29
Q

Isoflurane (Forane®) Pharmacokinetics
______blood:gas PC
and excreation

A

Moderate blood:gas partition coefficient–mod rates of induction and recovery
99% exreated unchanged from lungs

30
Q

Clinical uses of isoflurane

A

inhalation anesthetic for incudction and maintenece but mostly for MAINTENENCE

31
Q

Isoflurane is often used with NO to

A

reduce the amount needed

32
Q

Respiratory Side effects of Isoflurane

A

Is an airway irritant, can cause coughing
Decreases tidal volume and increases respiratory rate
All volatile anesthetics are respiratory depressants and increase PaCO2.

33
Q

CV side effcts of Isoflurane

A

Mycocardial depression; see decrease of BP
Arrythmias (sensitizes heart to catecholamines)
Cerebral vessel vasodialation = increase intracranial pressuer

34
Q

very volatile at room temperature, requires special equipment to administer

A

Desflurane

35
Q

Desflurane

blood:gas PC

A

Very low blood:gas partition coefficient; therefore very rapid induction and recovery

36
Q

Can cause coughing and bronchospasm in awake patients so anesthesia is usually induced with intravenous agent

A

Desflurane

37
Q

Desflurane cause coughing and bronchospasm in awake patients so anesthesia is usually

A

induced with intravenous agent

38
Q

Produces direct skeletal muscle relaxation

A

Desflurane

39
Q

Great for outpatient surgeries but cuases bronchospasm

A

Desflurane

40
Q

CV effects of Desflurane

A

Mycocardial depression; see decrease of BP
Arrythmias (sensitizes heart to catecholamines)
Cerebral vessel vasodialation = increase intracranial pressuer

41
Q

Respiratory effects of Desflurane

A

Is an airway irritant, can cause coughing
Decreases tidal volume and increases respiratory rate
All volatile anesthetics are respiratory depressants and increase PaCO2.

42
Q

Has a very low blood:gas PC adn about 5% adminstered dose is metabolized to flouride ion in the liver

A

Sevoflurane

43
Q

Issures with Sevoflurane metabolism

A

metabolized to fluoride ion that can cause renal damage and is degraded to compound A by administration apparatus that is nephrotoxic

44
Q

metabolized to fluoride ion that can cause renal damage and is degraded to compound A by administration apparatus that is nephrotoxic

A

Sevoflurane

45
Q

Good for inpatient and outpatient and isn’t a respiratory irritant

A

SEvoflurane

46
Q

CV side of Sevoflurane

A

simular to isoflurane

47
Q

Respiratory Sides of Sevoflurane

A

simular to iso but less respiratory depression

48
Q

Very insoluble in blood and other tissues so results in a rapid equilibration; therefore, very rapid induction and recovery

A

Nitrous Oxide

49
Q

Its rapid uptake from the alveolae results in the “concentration” of gases that are administered at the same time.

A

NO

50
Q

NO is a weak anesthetic because

A

weak anesthetic bc we can’t get enough into air to produce MAC

51
Q

Uses of NO

A

sedation and analgesia in 50% conc in inspired air and reduces conc of inhaled anesthetic dose needed.

52
Q

Side effects of NO

A

contr: pneumothorax

negative ionotrope but also sympathomimetic with abuse liability

53
Q

USed for induction and maintenence on inpatient

is slower and is an airway irritant

A

Isoflurane

54
Q

Used for outpt, maintenence only and causes coughing and bronchospasm… given IV

A

Desflurane

55
Q

Used for lots of stuff, induction and main…. but had fluoride ion and toxicity

A

Sevoflurane

56
Q

Used in dentistry as adjunct and need oxygen dilution

A

NO

Block 3 Pharm (19 decks)

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