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Anesthesia Pharm > Inhaled Anesthetics part 2 > Flashcards

Inhaled Anesthetics part 2 Flashcards

1
Q

Which anesthetic is an isomer of enflurane?

A

Isoflurane

Halogenated Methyl ethyl ether

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2
Q

Isoflurane:

MAC
Blood:Gas–??
Fat:Blood–??

Vapor pressure–??

A

1.17

1.46
45

240

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3
Q

What is the name of the preservative that is added to isoflurane to stabilize the compound?

A

Isoflurane is highly stable. Preservative (like thymol) DOES NOT need to be added.

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4
Q

What is the intermediate of isoflurane? What c/o can it cause?

A

Acyl Halide

Hepatic Necrosis

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5
Q

Sevoflurane:

MAC: ?
Blood:Gas: ??
Fat: Blood: ?

Vapor Pressure

A

1.8%

0.69
48

160mmHg

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6
Q

Which anesthetic is fully fluorinated methyl isopropyl ether?

A

Sevo

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7
Q

This anesthetic is nonpungent, has minimal odor and produces bronchodilation

A

Sevo the most—but all produces bronchodilation. Des the least

Least degree of airway irritation.

preferred for inhaled induction.

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8
Q

What are the metabolites of sevo?

A

Sevo

Least degree of airway irritation.

preferred for inhaled induction.

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9
Q

What are the metabolites of sevo?

A

Inorganic Fluoride (> enflurane)- nephrotoxin

Hexafluoroisopropanol

No TFA (No acyl halide metabolites)

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10
Q

True/False–Sevoflurane produces a nephrotoxic metabolite

A

True (inorganic fluoride) > enflurane.

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11
Q

Which inhaled anesthetic breaks down in the presence of strong bases in CO2 absorbents and produces this?

What are c/o of this toxin?

A

Sevo

Compound A [fluoromethyl-2,2-difluoro-1-(trifluoromethyl) vinyl- ether]

Renal proximal tubular injury in Rats.

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12
Q

Which VA produces hepatotoxicity?

A

None of the ones in use in the US.

Halothane does.

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13
Q

Ulceration of mucus membranes and skin is seen with what?

A

Hexafluroisopropanol

Sevo metabolite.

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14
Q

True/False– Sevoflurane produces TFA

A

False

No acyl halide metabolites.

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15
Q

During the 1st 2 MAC hours flow rates must be set to or > ____L/min

After 2 MAC hrs, flow must be increased to ______L/min.

During administration of what VA?

What have low flows been attributed to?

A

1

2

Sevoflurane

High temp/Canister Explosions during inductions using 100% O2 OR N2O in PEDS/monday

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16
Q

What VA’s have a fully fluorinated chemical structure?
How many Hydrogens in the structure?

What is the significance of this?

A

Sevo and Des

2

Molecular stability
Vapor pressure-up
Potency–down

17
Q

Desflurane
MAC: ?
Blood: Gas
Fat: Blood

Vapor pressure

A

6.6%
0.45
27

669mmHg

18
Q

Carbon monoxide is produced w/ Sevo > Des> iso

True/False

A

False

Des>Iso>Sevo

19
Q

Which VA is metabolized to TFA?

What is a c/o of TFA?

A

Iso & Des (serum & urine)

Des 1/5 of iso

Hepatic necrosis

20
Q

Tachycardia & coughing is seen at concentrations >1 MAC w/ this agent.

What can attenuate this response?

A

Des

fentanyl 1.5-3 mcg/kg

21
Q

Which Anesthetics are considered odorless?

A

N2O (& sweet smelling)

Sevo–Minimal odor

22
Q

Which anesthetic supports combustion?

A

N2O

non-flammable

23
Q

How is N2O metabolized?

A

Minimally in gut by reductive process

Mostly through expiration

24
Q

Which anesthetic provides analgesia?

Which increases incidence of PONV?

A

n20

25
Q

Inactivation of _______, impairs DNA synthesis and may cause _______ _____ –> death.

What pts are at higher risk?

A

it B12 (cyanocobalamin)

aplastic Anemia–Vegans & pernicious anemia

W/N2O

26
Q

What spaces can expand w/ this anesthetic?

_______ can enter gas filled spaces _____ x more rapidly than __.

A

N2O

Pneumothorax
ETT
Air Emboli
Cerebral ventricals
Ear (middle)

N2O//34//Nitrogen

PTX can double in 10min w/ 75% n2o

27
Q

What factors influence magnitude of volume expansion w/ this anesthetic?

A

Partial pressure
Blood flow
Duration

n2o

28
Q

________ gas bubble expansion can compress the ________ _______ —-> vision loss

A

Intraocular
retinal artery

w/ n2o

29
Q

(True/False) Desflurane can be used on a pt undergoing bowel obstruction sx

A

True

N2O CANNOT BE USED

30
Q

Tympanic rupture has been reported w/ the use of this anesthetic

A

n2o

31
Q

100% fio2 should be used after admin of this anesthetic. why?

A

N2O

Diffusion Hypoxia

N2O diffuses rapidly back into the alveoli diluting the gases present.

hypoxic mixture after the 1st 5 min after d/c

32
Q

Which anesthetics produce retrograde amnesia?

A

None

Only anterograde

33
Q

Which anesthetic increase CBF the most?

A

Iso=sevo=des> N2O

34
Q

Autoregulation is lost at what concentration

A

> 1 MAC

35
Q

(True/False) Des/iso/sevo increase CMRO2.

A

False

N2O increases it.

36
Q

Anesthetic preconditioning w/ cerebral protection _____>______

A

Des > iso

37
Q

increases in _______ parallel increases in CBF.

What is this offset by?

A

ICP

Hyperventilation to PaCO2 <30 torr

Anesthesia Pharm (2 decks)

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