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!!!!! Summer Pharm Exam 1 !!!!! > Inhaled anesthetics > Flashcards

Inhaled anesthetics Flashcards

1
Q

Causes tonic clonic seizures. Exacerbated by?

A

Enflurane - hypocarbia and repetitive auditory stimuli

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2
Q

Only IA that suppresses seizure activity

A

Isoflurane

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3
Q

Used in neurosurgery at 0.5 MAC

A

Isoflurane

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4
Q

Can compensate for increase in ICP by hyperventilation

A

Desflurane

Isoflurane as well - but at the time the induction agent is given

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5
Q

CANNOT compensate for increased ICP by hyperventilation

A

Enflurane - Hypocarbia can cause tonic clonic seizures

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6
Q

Highest amount of CO production

A

Desflurane

Then Iso and enflurane

Trace with sevo and halo

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7
Q

Compound A

A

Sevoflurane

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8
Q

Safest for CAD with the supplementation of opioids

A

Sevoflurane

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9
Q

NO increase in CVP or RAP

A

Sevoflurane

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10
Q

SNS stimulation

A

Nitrous oxide

Transient with desflurane and Isoflurane

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11
Q

Giving opioids with this agent may unmask undiagnosed myocardial depression, CAD and severe hypovolemia

A

Nitrous oxide - opioids take away the SNS stimulation and these patients get a profound SUDDEN bradycardia and hypotension

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12
Q

Autoregulation to CO2 remains UNCHANGED with these agents up to what MAC?

A

Sevoflurane up to 1.5 MAC

Naglhout also states Desflurane as well.

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13
Q

Which agent offers the greatest cerebral protection from ischemia?

A

Isoflurane - at >1 MAC it is often used for Neurosurgery but at 0.5 MAC

Due to the unchanged CBF at >1 MAC (still increased CBF) and decreased cerebral metabolic oxygen requirements

Greatest uncoupling of CMRO2 and CBF

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14
Q

Which agent produces only a mild increase in ICP

A

Nitrous oxide - likely due to the inability to administer 1 MAC

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15
Q

Isoflurane is and Isomer of Enflurane with these key differences

A
  1. Does not induce seizures, but rather supresses seizure activity
  2. It does not increase CSF production and allows CSF outflow
  3. Iso has minimal myocardial depression
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16
Q

IA that increases CSF production and increases resistance to CSF outflow

A

Enflurane

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17
Q

Which agents cause direct myocardial depression

A

Halothane

Nitrous oxide

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18
Q

Which agents decrease BP is a result of the agents ability to primarily decrease SVR and have minimal myocardial depression?

A

Sevoflurane
Isoflurane
Desflurane

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19
Q

Gasses that have baroreceptor reflex intact

A

Ennflurane, Isoflurane, Desflurane

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20
Q

Volatile anesthetic that typically increases HR but in Elderly and Neonates this effect is blunted and Heart rate is decreased

A

Isoflurane

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21
Q

This volatile anesthetic suppresses SA node depolarization (junctional rhythm) and decreases conduction in the bundle of his and purkinge fibers

A

Halothane

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22
Q

Increases BP, HR, SVR and CO d/t SNS stimulation

A

Nitrous oxide

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23
Q

Volatile anesthetic that produces DOSE DEPENDENT decrease in CO

A

Halothane

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24
Q

LVSV is decreased __________% for all volatile anesthetics. Our notes say a specific one.

A

15 - 30% for desflurane

Often times increased HR is enough to offset the decrease in stroke volume

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25
Q

This volatile anesthetic has a wider margin of safety between that which anesthetizes the brain and that which produces cardiovascular collapse. This means it has minimal cardiac depressant effects in the doses we use it.

A

Isoflurane

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26
Q

Does Not have an increase in CVP or RAP

A

Sevoflurane

27
Q

Has minimal effects on SVR

A

Halothane

all other volatile anesthetics decrease SVR

28
Q

_____________ increases blood flow to ____________ and ____________ areas. This distribution is similar to a ___________ effect. There is an excess perfusion relative to oxygen needs. It may manifest in the OR as ____________ due to _____________ blood flow. There also may be enhanced _______________ like NM blockers.

A 
Isuflurane  
skeletal muscles and cutaneous areas  
ß-agonist  
loss of heat due to cutaneous
delivery of drugs.
29
Q

What is a possible explanation for the increase in cutaneous blood flow produced by all volatile gasses?

A

May reflect a central inhibitory action on temperature regulating mechanisms.

30
Q

should be avoided in the neonate with congenital heart disease

A

Nitrous - d/t increased PVR which may increase the magnitude of a right to left shunt causing further decrease in arterial oxygenation.

31
Q

Two volatile gasses that sensitize the heart to Epi

A

Halothane

Enflurane ≥ 4.5 mg/kg

32
Q

Dilate the small coronaries and cause a redistribution of flow from the ischemic area to that of non ischemic areas, but it is not clinically significant and thus still cardioprotective

A

Isoflurane - causing coronary steal

33
Q

An abrupt Increase this volatile gas to cause neurocirculatory response.

A

Desflurane -irritates airway and will cause a transient increase in BP and HR d/t SNS stimulation - this can be blunted by opioids/esmolol/clonidine prior to increasing MAC

Also consider this for Isoflurane - but des has a faster onset

34
Q

T or F

Volatile anesthetics produce the same amount of myocardial depression in the healthy and diseased myocardial muscle?

A

TRUE - the significance is just greater in the diseased heart because they are starting form a lower baseline (baseline decreased contractility).

35
Q

Neurocirculatory responses by abruptly increasing Desfluarane want to be avoided in which patient

A

CAD

36
Q

Causes a myocardial depression in CAD patients that does not occur with healthy individual

A

As little as 40% of nitrous oxide

37
Q

What anesthetic may not be good for aortic stenosis but good for mitral or aortic regurgitiation? Why?

A

Isoflurane - because of the peripheral vasodilation decreasing after load

38
Q

what may enhance the myocardial depressant effects of volatile anesthetics

A

arterial hypxemia

39
Q

Drugs that can influence the magnitude of cardiac depression and circulatory effects

A

CCB- already decrease contractility and make the heart more vulnerable to myocardial depression

antihypertensives and ß-blockers may make patients more vulnerable to the circulatory effects

40
Q

What is it called when volatile anesthetics activate the K ATP pump causing hyper polarization. Which has negative inotropic effects and relax vascular smooth muscle

A

Ischemic preconditioning - which is cardiaoprotective

41
Q

All inhaled anesthethetics except _______________ produce DOSE DEPENDENT increases in respiratory rate. What does this gas do?

A

Isoflurane Increases RR up to 1 MAC

At concentrations >1 MAC it does not further increase the frequency of breathing

42
Q

What is the net effect of the respiratory changes produced by anesthetic gasses to a patient under anesthesia

A

Rapid shallow breathing, with decreased minute ventilation and increased PaCo2

(increased RR not enough to offset the decreased TV)

43
Q

Which anesthetic gas has MINIMAL changes in minute ventilation and MINIMAL changes in resting CO2 levels?

A

Nitrous oxide

44
Q

why would adding nitrous to an anesthetic plan of a COPD patient be beneficial?

A

COPD may attenuate the magnitude of the increase in PaCO2 by volatile anesthetics. Nitrous however does not increase PaCO2 and using it may result in less of a depression of ventilation.

This ventilatory-sparing effect is detectable with all volatile anesthetics

45
Q

How do volatile anesthetics effect minute ventilation and CO2

A

Dose dependent decrease in minute ventilation and dose dependent increases in PaCO2

46
Q

What can be used to asses upper airway reactivity

A

the presence of a cough to ETT cuff inflation

47
Q

Volatile anesthetic that causes hepatic artery vasoconstriction and decreases hepatic blood flow

A

Halothane

48
Q

Volatile anesthetics that maintain hepatic blood flow.

A

Sevoflurane, Isoflurane and Desflurane

49
Q

Why is maintenance of hepatic blood flow important?

A

Hepatocyte hypoxia is a significant etiology of post-op hepatic dysfunction

50
Q

Blunts Baroreceptor response, so not increase in HR

A

Halothane

51
Q

Volitile anesthetic NOT metabolized by CYP450 2EI

A

Sevoflurane - but is metabolized by CYP450

52
Q

Because of its chemical structure Sevoflurane cannot undergo metabolism to an ______________. Therefore it does not result in the formation of ______________ and cannot stimulate the formation of _______________. However, Halothane, desflurane, and enflurane are metabolized to ___________ and therefore are susceptible to ________________ and _____________.

A

Acetyl Halide,

trifluroacetylated proteins,

anti-fluroacetylated protein antibodies.

Acetyl Halides,

Immune mediated hepatotoxicity and cross sensitivity.

53
Q

In a patient with preexisting renal failure which VA should be avoided and which are best and why?

A

Sevoflurane should be avoided. There is potential that it could accentuate pre-existing renal disease. It has no be confirmed, but just to be safe. It is metabloized to inorganic fluoride which MAY cause inability to concentrate urine.

Use Desflurane or Isoflurane because they are less likely to aggravate preexisting renal disease

54
Q

What may be enhanced by opioids in patients who are receiving nitrous oxide?

A

Skeletal muscle rigidity.

Normally rigidity occurs at doses >1 MAC, delivered in a hyperbaric chamber, but ant normal atmospheric pressure and at lower doses, it can occur with the administration of opioids

55
Q

VA that least potentiates the effects of NMB

A

Isoflurane

Its effects are similar to halothane per Stoelting*

56
Q

Nitrous oxide irreversibly binds what?

A

Cobalt atom in B12 leading to a b12 deficiency and deficiency in B12 dependent enymes that facilitate DNA synthesis and myelin formation

(pernicious anemia, birth defects, megaloblastic anemia which is bone marrow depression and neuropathies).

57
Q

0.004% Metabolized in GI tract by reductive metabolism bu anaerobic bacteria such as pseudomonas

A

Nitric oxide

58
Q

15 - 20% metabolized by CYP 2EI oxidation (acetylation of hepatocellular molecules, trifluocedic acid) when enough 02 is present but undergoes reductive metabolism when 02 is insufficient

A

Halothane

59
Q

2.3 - 3% metabolism via CYP450 2EI oxidation, the free fluoride comes from the fluorine on the terminal carbon

A

Enflurane

60
Q

0.2 - 2% metabolism via CYP450 2EI oxidation to trifluocedic acid- susceptible to auto antibodies in susceptible patients.

A

Isoflurane

61
Q

0.02% metabolism via CYP450 2EI oxidation to trifluocedic acid- susceptible to auto antibodies in susceptible patients.

A

Desflurane

62
Q

The VA that break down to CO have contain a CHF2 moiety , which anesthetics are these

A

Desflurane>Enfluane and Isoflurane

63
Q

5-20% undergoes oxidative metabolism via CYP450 system to for organic and inorganic FLUORIDE metabloites

A

Sevoflurane - it DOES NOT undergo metabolism to an acetyl halide - like ALL other volatile gasses of

!!!!! Summer Pharm Exam 1 !!!!! (5 decks)

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