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Fall'20 Pharmacology III > NCE part 1 > Flashcards

NCE part 1 Flashcards

1
Q

which two volatile anesthetics decrease SVR the most

A

Isoflurane and Desflurane

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2
Q

Isoflurane causes hypothermia …why

A

because it suppresses the hypothalamic temperature regulators

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3
Q

which agents are volatile

A 
Sevoflurane
Desflurane
Isoflurane
Enflurance
Halothane
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4
Q

how do volatile anesthetics affect cerebral vessels and cerebral blood flow.

A

Dilate cerebral vessels
Increase cerebral blood flow
Increase cerebral blood flow and ICP
Decreases neuronal function and cerebral metabolism

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5
Q

which three gases similarly depress cerebral metabolic rate

A

Iso, Des, Sevo

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6
Q

how do we negate the increase ICP with Isoflurance (remember its the least to dangerously increase ICP)

A

hyperventilate

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7
Q

Hypoxic Pulmonary Vasoconstriction is inhibited at what MAC

A

HPV is inhibited by a high concentration of volatile (1-1.5 or higher MAC)

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8
Q

What volatile is considered completely halogenated with fluorine?

A

Des is considered to be completely halogenated with fluorine

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9
Q

what volatile has fluorine substituting halogen

A

sevoflurance

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10
Q

which two volatile most depress ventilation

A

Des, Enflurane

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11
Q

which volatile depress ventilation the least

A

Halothane

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12
Q

what volatile agent Most depress the baroreceptor reflex

A

Halothane and Sevo: No increase in HR even with decreases in blood pressure

Baroreceptor: “DISH” least to greatest

  • S/H no increase in HR w/low BP
  • D/I increase in HR w/low BP
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13
Q

what volatile agent Least depress the baroreceptor reflex

A

Iso and Des: HR increases as a reflex to decrease in blood pressure

Baroreceptor: “DISH” least to greatest

  • S/H no increase in HR w/low BP
  • D/I increase in HR w/low BP
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14
Q

Acute ETOH intoxication effect on MAC

A

Decreases

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15
Q 
Rank opioids most lipid soluble to least lipid soluble
Meperidine
Remifentanil
Morphine
Fentanyl 
Sufentanil
alfentanil
A

Sufentanil &raquo_space; fentanyl&raquo_space;> alfentanil&raquo_space;> meperidine > remifentanil > morphine

“Single Females And Males Run Marathons”
23311 (arrow pattern)

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16
Q

What receptors do spinal opioids work

A

Primarily Mu-2 but work on mu-1, kappa, and delta to produce supraspinal analgesia

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17
Q

Stimulation of mu-1 receptors what responses:

A 
Spinal and supraspinal analagesia
Euphoria
Miosis
Bradycardia
Hypothermia
Urinary retention
pruritus
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18
Q

Mu-1 have a high or low abuse potential

?

A

Low abuse potential

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19
Q

Opioid can cause nausea and vomiting by

A

Stimulation of CTZ of the fourth ventricle (floor). The triggered CTZ activates vomiting center near the brain stem

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20
Q

Most opioids are metabolized by the liver. Which is not and what is it metabolized by?

A

Remifentanil and is metabolized by nonspecific esterases in the blood stream.

21
Q

Agonist/antagonist opioids work on what receptor(s) for therapeutic effect

A

Primarily Kappa

Also on delta

22
Q

Naloxone reverses what actions of opioids

A

Pruritus
Urinary retention
N/V

23
Q

Higher doses of naloxone are required to reverse what opioid issue

A

Reverse profound sedation and respiratory depression

24
Q

Does morphine produce arterial or venous dilation

A

Both due to histamine release

25
Q

What two opioids cause histamine release

A

Morphine and Meperidine

26
Q

There are 3 CV actions that may cause a decrease in BP in an anesthetized patient given a high dose of fentanyl

A 
Decrease SVR (dilate arterial vessels
Decrease venous return (dilate venous capacitance vessels
Decrease in HR
27
Q

how are esters hydrolyzed

A

Hydrolyzed by plasma and tissue cholinesterase

28
Q

PABA is excreted where

A

urine

29
Q

is there cross contamination between esters and amides

A

no

30
Q

how could an ester be prolonged

A

plasma cholinesterase deficiency

31
Q

what is responsible for esters reaction

A

PABA is responsible for the greater portion of allergic reactions to esters

32
Q

Lipid solubility =

A

potency of LA

33
Q

Protein binding =

A

duration of LA

34
Q

pKa =

A

(50:50 ionized and unionized)

35
Q 
Which of the following are short acting local?  Long acting local?
Procaine
Lidocaine
Prilocaine
Bupivacaine
Tetracaine
mepivacaine
A

Short: procaine
Long: bupivacaine and tetracaine

36
Q

What is the progression of blockade:

A 
Autonomic
-Temperature
-Pain
Sensation 
-Touch
-Pressure
Motor
-Vibration 
-Proprioception
37
Q

Treatment of LA Toxicity?

A

20% Intralipid:
1.5 mL/kg over 1 minute
Continuous infusion of 0.25 mL/Kg until hemodynamically stable
Limit: 10 mL/Kg over 30 minutes

38
Q

nitrous administered alone does not cause hypotension but instead causes

A

When administered alone Nitrous does not cause hypotension but instead causes cutaneous vasoconstriction and increased SVR

39
Q

when administered alone what does nitrous cause

A

Nitrous will cause an increase in cardiac output when administered alone

40
Q

Dose limit for exogenous Epi

A

5-6 mcg/kg with these volatiles

41
Q

Tissue trauma: fluid replacement
Minimal?
Moderate?
Extensive?

A

Tissue trauma:
Minimal – 5 ml/kg/hour
Moderate - 6 ml/kg/hour
Extensive – 8 ml/kg/hour

42
Q

Goal Directed Fluid Therapy is guided by UOP

A

Keep 0.5 ml/kg/hour

Hemodynamics

43
Q

These three depress cerebral metabolic rate the most…

these two depress it less

A

iso, des, sevo

those three depress more than enflurane and halothane.

44
Q

what gas is the least likely to dangerously increase ICP if the patient is kept moderately hypocapnic

A

Iso

45
Q

volatile anesthetics do what to the ventilatory response to c02

A

Volatile anesthetics alter the ventilatory response to CO2 by decreasing that response when used in dose-dependent increments

46
Q

how much MAC- will completely block the ventilatory response to hypoxemia

A

0.1 MAC

47
Q

which gas has a slightly higher incidence of causing a cough reflex during maintenance when used with a LMA

A

isoflurance

48
Q

will hypoxemia stimulate ventilation when using a volatile agent

A

no

Fall'20 Pharmacology III (14 decks)

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