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Pharmacology Exam 4 > Part 2-4 > Flashcards

Part 2-4 Flashcards

0
Q

What are CNS effects of VA

A
  1. No retrograde amnesia, but
  2. No prolonged effects
  3. Luxury perfusion (blood flow in excess of metabolic needs)
  4. Occupational exposure causes decrease reaction times after 10-20% N2O is breathed; 0.0016%(0.002MAC) Halothane-no mental impairment
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1
Q

What are VA cardiopulmonary effects

A

Prominent cardiopulmonary depression

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2
Q

At what MAC is amnesia probable?

A

0.04

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3
Q

***VA effect on evoked potentials

A

Decrease amplitude & increase latency

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4
Q

***How to dose VA while doing evoke potentials

A
  • don’t go greater than 1MAC total.

- With 60% N2O,may use 0.5-1 MAC Isoflurane

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5
Q

What agent most likely will be avoided during evoke potential monitoring

A

N20

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6
Q

How do VA effect seizure activity

A
  • No seizure activity generally seen
  • agents are tested for sz. prior to release
  • Not seen with Des, Iso, Sevo (2 cases reported w/ sevo.)
  • May see clonus or even opisthotonus with N2O
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7
Q

***Effect of cerebral blood flow with a VA > 0.6 MAC

A
  • Cerebral dilation***
  • Decreased CVR (Cerebral vascular resistance)
  • Increased CBF, despite of decreases in CMRO2(cerebral metabolic response of O2)
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8
Q

Which agent causes the least cerebral vasodilation

A

isoflurane

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9
Q

***How would you combat increased CBF?

A
  • Hyperventilation (increased CO2> vasodilation)

- May limit by prior (or with Isoflurane simutaneous)

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10
Q

***What is Isoflurane’s effect on CBF

A

-It preserves auto-regulation therefore, no change to cerebral blood flow

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11
Q

***VA aapproach to cerebral aneurysm clipping

A

-Controlled hypotension favorable balance btw. lush O2 supply(increased blood flow) & reduced demand (decreased CMRO2)

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12
Q

***Effects of VA on ICP

A

they all produce increase ICP in parrallel w/ increased CBF

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13
Q

***What patients are most vulnerable to increased ICP from VA. What should be done to help prevent it?

A
  • Pt. with space-occupying lesions(Munroe-Kellie hypothesis)

- Use agent but hyperventilate

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14
Q

What are Servoflurane’s effect on awareness

A

-produces emergence delirium

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15
Q

in what patient populations has a decline in cognitive function been noted?

A
  • Post CABG
  • Children with multiple surgeries (repeat anesthetics)
  • Elderly
  • Patients with frequent repeat anesthetics (ex. burn pts.)
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16
Q

What influences differences in circulatory/ cardiovascular effects of VA?

A
  • Control vs. spontaneous breathing
  • Preexisting cardiac dz.
  • Drugs acting directly/ indirectly on the heart.
17
Q

VA have what type of circulatory effects?

A

(they are drug-specific, dose-dependent, prominent cardiovascular effects):

  • Myocardial contractility
  • Peripheral vascular smooth muscle tone
  • ANS activity
18
Q

VA effect on MAP

A

Increased agent > decrease MAP (Sx. stimulation opposes this effect)

19
Q

What changes, if any, are noted in hypertension preop after induction?

A

exaggerated hypotension after inductiob

20
Q

N2O effect on MAP

A
  • No change or slight increase (doesn’t decrease or support B/P)
  • (Substituting N20 for a portion of MAC, & decreases in MAP will be less than if using VA alone)
21
Q

***Effect of Isoflurane & Desflurane on HR @ 1 MAC

A

Increase HR

22
Q

****Effect of Sevoflurane on HR @ 1 MAC

A

No increase in HR

23
Q

Des, Sevo, and Iso effects on cardiac output.

A
  • They don’t decreased CO in a dose dependent fashion

- Decrease stroke volume 15-30%, but preserve CO better r/t increase HR & decrease SVR

24
Q

***What VA is TOTALLY CONTRAINDICATED in pediatrics & why

A
  • Nitrous
  • Increased PVR especially in pts. with pre-existing pulmonary HTN
  • If. pt. ahas congenital heart disease it will worsten right to left shunt
25
Q

Nitrous effects on SVR vs. PVR

A
  • No effect on SVR

- Increase PVR

26
Q

***What is the ED50 dose of epi. for an adult

A

3mcg/kg

27
Q

ED50 dose for pediatrics

A

7.8-10 mcg/kg (kids are protected and can take a higher dose)

28
Q

Iso, des, and sevo effects on cardiac dysrythmias

A

Minimal to abscent

29
Q

How does hypoxia influence VA effect in the body

A

Increases the effect of VA on cardiac depression

30
Q

Which types of heart conditions can benefit from VA, and which VA can be used?

A

Aortic & mitral valve regurgitation (Des, Iso, Sevo). Iso good for regurg. (full, fast, forward”

31
Q

VA are indicated in what types of heart conditions

A

Mitral valve & aortic stenosis

32
Q

Using Nitrous to help pull a 2nd agent into the alveolar faster is referred to as__________

A

2nd gas effect

33
Q

Characteristics of the breathing circuit influencing rise of FA

A
  • lower volume
  • higher FGF (and their ratio)
  • lower solubility of VA in rubber or plastic
34
Q

When would you use “overpressure”

A
  • Increased dialed VA above MAC to attain MAC in alveoli &brain
  • Expected & NEEDED with low flows (@ low flow dial turned past what pt. would normally need)
35
Q

What is Nitrous oxide transfer to closed spaces

A
  • Lg. volumes can transfer up to 10L in a few minutes
  • N20 34x more soluble than Nitrogen
  • Risk for air embolism
  • If compliant space> volume expands; if non-compliant space> pressure rises
36
Q

What type of surgeries would you NOT use N20

A
  • Lg. bowel cases
  • Craniotomy
  • When wound is higher than the heart (ex. beach chair position, steep trendelenberg)
37
Q

Why does high cardiac output slow induction

A

It slows the rate of rise of FA (alveolar concentration)> depresses myocardial contractility further

38
Q

Why are infants at greater risk for overdose than adults

A

Higher VRG perfusion

39
Q

What MUST be done after nitrous oxide is discontinued?

A

100% O2 for 3-5 minutes

Pharmacology Exam 4 (2 decks)

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