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Clinical prep > meds; inhalation agents > Flashcards

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
Q

desflurane metabolism

A

cyp450 -> acetyl halide -> possible antibody reaction

degrades to CO if absorbant dehydrated -> inc CO2

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26
Q

Desflurane specific side effects

A

Prolong QT during induction
most pungent

27
Q

who do we not give des to?

A

smokers & asthma

28
Q

Isoflurane color

A

purple

29
Q

Isoflurane brand name

A

furane

30
Q

Isoflurane structure

A

isomer of enflurane

31
Q

Isoflurane Vapor pressure

A

238 torr

32
Q

Isoflurane MAC

A

1.17 %

33
Q

Isoflurane Blood;Gas

A

1.46

34
Q

isoflurane metabolism

A

CYp450 -> acetyl halide -> possible antibody rxn

35
Q

Nitrous Oxide mac

A

104%

36
Q

Nitrous structure

A

N2O

37
Q

Nitrous Oxide blood;gas

A

0.46

38
Q

Nitrous oxide vapor pressure

A

gas (38.770) torr

39
Q

What is MAC

A

“the concentration at 1 atm that prevents skeletal muscle movement in response to supramaximal, painful stimulation in 50% of patients”

40
Q

MACawake

A

(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
Q

MACbar

A

(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
Q

Biggest Factors that alter MAC

A

Biggest…
Body temperature
Age…6% per decade
MAC peaks at 1 y/o

43
Q

factors that increases in MAC

A

Hyperthermia

Excess pheomelanin (redhead) production

Drug-induced increase in catecholamine levels

Hypernatremia

44
Q

factors that Decreases in MAC

A

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
Q

factors that have No change in MAC

A

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
Q

Second gas effect

A

nitrous + VAA

High volume of N2O uptake into pulmonary capillary concentrates alveolis = increased VAA partial pressure

47
Q

cases we dont give nitrous to

A

bowel case, ear or eye cases (ENT), pntx
pregnancy and neonates

48
Q

High flow anesthesia

A

FGF > MV

  • prevents rebreathing. cools/ dries volume
49
Q

low flow anesthesia

A

FGF < MV

50
Q

if the temperature of the blood increases…..

A

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
Q

1.3 mac

A

the concentration at 1 atm that prevents skeletal muscle movement in response to supramaximal, painful stimulation in 99% of patients

52
Q

What is vapor pressure

A

Pressure at which vapor, and liquid are at equilibrium

53
Q

Nitrous oxide cv effects

A

potent vasodilator
sympathomimetic
no cardiac depression = increase CO
be cautious with mitral stenosis

54
Q

Nitrous oxide pulmonary effect

A

Check ETT cuff pressure regularly

55
Q

Nitrous oxide metabolism

A

stomach bacteria

56
Q

Nitrous oxide side effects

A

teratogenic
air trapping (air/fluid filled)
B12 deficiency
megablastic bone marrow suppression
SEVERE PONV
increase PVR
spont abortions

57
Q

VAA with anaglesia effect

A

Nitrous xoide

58
Q

General VAA effects

A

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
Q

mac values based on

A

Based on 30-55y/o average; 37 degrees C; 760mmHg pressure (1 ATM)

60
Q

Risk factors for bronchospasm

A

COPD, cough response with ETT, age <10, URI

61
Q

Major VAA side effects

A

MH
PONV
agitation on emergence
decrease uterine smm contractility -> worsen bleeding (given for placenta retention)

62
Q

What gas needs a special heat vaporizer

A

des

63
Q

What gas is the most lipid soluble

A

iso

Clinical prep (21 decks)

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