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meds; inhalation agents Flashcards

1
Q

Sevo color

A

yellow

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2
Q

sevo mac

A

1.8%

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3
Q

sevo Blood;Gas

A

0.69

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4
Q

Sevo vapor pressure

A

157 torr

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5
Q

sevo brand name

A

ultane

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6
Q

sevo structure

A

fluorinated methyl isopropyl ether

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7
Q

sevo metabolism

A

metabolized to vinyl halide in organic fluoride -> no antibody formation

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8
Q

which inhalation is least likely to form CO

A

Sevo

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9
Q

Sevo effects on Co2 absorber

A

reacts w/ dry absorbent Baralyme -> produce methanold + formaldehyde -> combution

  • check temp of co2 absorber
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10
Q

which inhalation is most likely to form CO

A

des

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11
Q

VAA receptors

A

sc; ampa, nmda, increase glycine inhibition , affects NA channels that decrease glutamate release

brain ; GABA that increases glycine activation in brain stem

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12
Q

side effects of sevo

A

bradycardia in peds

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13
Q

when to use SEVO

A

neuro pts
cardiac pts
asthma pts

suppresses lidocaine induced sz activity

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14
Q

SEVO-specific CNS effect

A

muscle relaxation; enhancing glycine at SC
and increase NMBDs at nachr in NMJ

Less vasodilation effect -> less inc CBF/ICP

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15
Q

sevo-specific cardiac effect

A

increased HR at 1.5 mac

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16
Q

Desflurane color

A

Blue

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17
Q

Desflurane brand name

A

Suprane

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18
Q

Desflurane structure

A

fluorinated methyl ether
identical to iso but sub fl for Cl-

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19
Q

desflurane mac

A

6.6%

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20
Q

desflurane Blood;Gas

A

0.42

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21
Q

Desflurane vapor pressure

A

669 torr

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22
Q

atmospheric vapor pressure

A

760 torr

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23
Q

desflurane-specific cardiac effect

A

increased HR especially w/ overpressurization

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24
Q

Desflurane-specific respiratory effect

A

airway irritation esp in smokers

increase respiratory resistance due to pungency

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25
desflurane metabolism
cyp450 -> acetyl halide -> possible antibody reaction degrades to CO if absorbant dehydrated -> inc CO2
26
Desflurane specific side effects
Prolong QT during induction most pungent
27
who do we not give des to?
smokers & asthma
28
Isoflurane color
purple
29
Isoflurane brand name
furane
30
Isoflurane structure
isomer of enflurane
31
Isoflurane Vapor pressure
238 torr
32
Isoflurane MAC
1.17 %
33
Isoflurane Blood;Gas
1.46
34
isoflurane metabolism
CYp450 -> acetyl halide -> possible antibody rxn
35
Nitrous Oxide mac
104%
36
Nitrous structure
N2O
37
Nitrous Oxide blood;gas
0.46
38
Nitrous oxide vapor pressure
gas (38.770) torr
39
What is MAC
“the concentration at 1 atm that prevents skeletal muscle movement in response to supramaximal, painful stimulation in 50% of patients”
40
MACawake
(0.3-0.5 MAC) presumes that all we are giving is 1.3 mac when we turn the mac off and we let them wake up when they get to 0.3-0.5 = wake up.
41
MACbar
(1.7-2.0 MAC) blunts autonomic responses. If we had 2 mac of des on board w/ no pain and we intubated you, hr wouldnt respond, no sns response at mac bar. But will be very hypotensive. Mac bar = not used.
42
Biggest Factors that alter MAC
Biggest… Body temperature Age…6% per decade MAC peaks at 1 y/o
43
factors that increases in MAC
Hyperthermia Excess pheomelanin (redhead) production Drug-induced increase in catecholamine levels Hypernatremia
44
factors that Decreases in MAC
Hypothermia Preoperative medication, intraoperative opioids Alpha-2 agonists Acute alcohol ingestion Pregnancy anemia Post partum (early…12-72 hours) Lidocaine PaO2 <38 mm Hg Mean BP < 40mm Hg Cardiopulmonary bypass Hyponatremia
45
factors that have No change in MAC
Chronic alcohol abuse Gender Duration of anesthesia PaCO2 15-95 mm Hg PaO2 > 38 mm Hg Blood pressure > 40 mm Hg Hyper/hypokalemia Thyroid gland dysfunction
46
Second gas effect
nitrous + VAA High volume of N2O uptake into pulmonary capillary concentrates alveolis = increased VAA partial pressure
47
cases we dont give nitrous to
bowel case, ear or eye cases (ENT), pntx pregnancy and neonates
48
High flow anesthesia
FGF > MV * prevents rebreathing. cools/ dries volume
49
low flow anesthesia
FGF < MV
50
if the temperature of the blood increases…..
solubility of the drug increases Low blood solubility…… Minimal amounts must be dissolved; PA/Pa is rapid; induction is rapid High blood solubility…..Large amounts must be dissolved: PA/Pa is slow; induction prolonged
51
1.3 mac
the concentration at 1 atm that prevents skeletal muscle movement in response to supramaximal, painful stimulation in 99% of patients
52
What is vapor pressure
Pressure at which vapor, and liquid are at equilibrium
53
Nitrous oxide cv effects
potent vasodilator sympathomimetic no cardiac depression = increase CO be cautious with mitral stenosis
54
Nitrous oxide pulmonary effect
Check ETT cuff pressure regularly
55
Nitrous oxide metabolism
stomach bacteria
56
Nitrous oxide side effects
teratogenic air trapping (air/fluid filled) B12 deficiency megablastic bone marrow suppression SEVERE PONV increase PVR spont abortions
57
VAA with anaglesia effect
Nitrous xoide
58
General VAA effects
Dose-dependent skeletal muscle relaxation Potentiate depolarizing and non-depolarizing NMBDs nAch receptors at NMJ; Enhance glycine (inhibitory nt) at spinal cord ⬇️ CMRO2 and cerebral activity Begins approx 0.4 MAC as wakefulness changes to unconsciousness 1.5 MAC: burst suppression 2 MAC: electrical silence anticonvulsant decrease latency and amplitude of SSEP and MEP @0.5 mac ⬆️ CBF due to decreased cerebral vascular resistance May increase ICP. Onset > 0.6 MAC Occurs within minutes despite lack of BP change Autoregulatoin Dose-dependent ↑ rate, ↓ Vt; Apnea (1.5-2.0 MAC) Decreased MAP, SVR, contraction, SV, CO alters ca++ entry and SR function coronary steal Blunts baroreceptors Long QT because it inibits K+ current blunts hypoxic response and hypercarbia response
59
mac values based on
Based on 30-55y/o average; 37 degrees C; 760mmHg pressure (1 ATM)
60
Risk factors for bronchospasm
COPD, cough response with ETT, age <10, URI
61
Major VAA side effects
MH PONV agitation on emergence decrease uterine smm contractility -> worsen bleeding (given for placenta retention)
62
What gas needs a special heat vaporizer
des
63
What gas is the most lipid soluble
iso

Clinical prep (21 decks)

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