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october exam > pharm 3 > Flashcards

pharm 3 Flashcards

1
Q

how many halogens does each of the volatiles have

A

halothane- 3 florine 1 bromine
iso- 5 florine 1 chlorine
des- 6 florine
sevo - 7 fluorine (sevo seven)

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2
Q

what does adding fluoride do

A

decrease potency, increase vapor pressure, increase resistance to biotransformation

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3
Q

why is sevo an exception to the adding fluoride rule

A

sevo is heavily fluorinated but 3x as potent as des- likely due to bulky propyl side chain

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4
Q

what is vapor pressure

A

pressure exerted by vapor in equilibrium with its liquid or solid phase inside of a closed container

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5
Q

vapor pressure is directly proportional to

A

temperature

increased temp= increased VP

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6
Q

explain how altitude changes affect gas delivered

A

as atm pressure decreases at higher elevations- partial pressure of gas decreases (which is what determines depth of anesthesia)

conventional variable bypass vaporizer automatically compensates for the elevation change

des is when you are worried about underdosing- tec 6 vaporizer does not compensate for elevation!

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7
Q

vapor pressure of sevo

A

157

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8
Q

vapor pressure of des

A

669

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9
Q

vapor pressure of iso

A

238

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10
Q

vapor pressure of n2o

A

38,770

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11
Q

what inhaled agents are stable in soda lime

A

only n2o

sevo-> compound a (can happen in dessicated or functional soda lime)
des and iso-> carbon monozide

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12
Q

what is solubility

A

tendency of a solute to dissolve into a solvent

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13
Q

blood: gas partition coefficient

A

relative solubility of an inhalation anesthetic in the blood vs in the alveolar gas (wgen the partial pressures between the 2 compartments are =)

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14
Q

blood gas solubility of sevo

A

0.65

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15
Q

blood gas solubility of des

A

0.42

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16
Q

blood gas solubility of iso

A

1.45

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17
Q

blood gas solubility of n2o

A

0.46

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18
Q

what is Fi

A

turn vaporizer on- concentration gradient pushing anesthetic agent from vaporizer towards alveoli

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19
Q

what is FA

A

ventilator washes anesthetic agent into alveoli

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20
Q

what is uptake

A

build up of anesthetic partial pressure inside the alveoli is opposed by continious uptake of the agent into the blood

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21
Q

what is distribution

A

CO distributes anesthetic agent throughout the bodu

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22
Q

FA/ Fi curve allows us to predict what

A

speed of induction

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23
Q

what does low solubility mean for speed of induction

A

low solubility-> less uptake into blood-> increased rate of rise-> faster equilibriation of Fa/ fi-> faster onset

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24
Q

what does high solubility mean for induction

A

high solubility-> more uptake into blood-> decreased rate of rise-> slower equilibriation of fa/fi-> slower onset

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25
what factors affect agent delivery to and removal from alveoli
- setting on vaporizer, time constant of delivery system, anatomic dead space, alveolar ventilation, frc -solubility of anesthetic in the blood, CO, partial pressure gradient between the alveolar gas and mixed venous blood
26
what conditions increase FA/FI. what decreases it?
for FA/Fi to increase, there needs to be a greater wash in and/or reduced uptake for it to decrease- there needs to be reduced wash in and/ or increased uptake
27
anesthetic agents and CO
directly proportional!! a high CO removes mroe anesthetic agent from the alveoli and slows the rate of rise of fa/fi (slows anesthetic induction) so if you are comparing 2 patients the one with the lower CO will have the faster onset of agent
28
what are the 4 tissue groups the body can be divided into
vessel rich muscle fat vessel poor
29
what are the 3 ways the body eliminates inhaled anesthetics
-elimination from alveoli (most important!!) -hepatic biotransformation -percutaneous loss (minimal)
30
least to most hepatic biotransformation per agent
DISH and rule of 2s des 0.02 iso 0.2 sevo 2 halo 20
31
fda recomendation for sevo min fresh gas flow
1 l/min up to 2 mac hours 2 l/min after 2 mac hours
32
what is a mac hour
1 mac hour = 1% sevo x 2 hours 2% sevo x 1 hr 4% sevo x 30 mins
33
concentration effect
2 parts: 1. concentrating effect- nitrious oxide into lungs- volume of nitrous going from alveolus into pulm blood is higher than nitrogen moving in opposite direction causing alveolus to shrink- reduction in alveolar volume causes increase in FA 2. augmented gas inflow- next breath- concentrating effect causes increased inflow of tracheal gas containing anesthetic agent to replace lost alveolar volume- increases alveolar ventilation and augments FA- volume restores quick so this is only temporary
34
what is the second gas effect
use of nitrous oxide to hasten onset of second gas
35
diffusion hypoxia
-risk during emergence!! -n2o moves from body toward lungs- dilutes alveolar o2 and co2- decreased respiratory drive and hypoxia
36
how can you prevent diffusion hypoxia
administer 100% o2 for 3-5 mins after d/c n2o
37
what agent is more affected by R-> L shunt
fa/fi with lower solubility (des) is more affected than one with higher solubility (iso)
38
which inhalation anesthetic is more greately affected by L to R shunt
does not have any meaningful effect on anesthetic uptake or induction time
39
why does n2o accumulate in closed air spaces
nitrous oxide is 34x more soluble than nitrogen. will enter a space 34x faster than nitrogen can exit the space
40
blood gas parition coefficient of n2o vs nitrogen
n2o 0.45 nitrogen 0.014
41
what spaces does n2o accumulate
closed air: middle ear, bowel, pneumothorax can also increase volume and pressure in a ett cuff, lma cuff and balloon tipped pa cath
42
iso mac
1.2
43
sevo mac
2.0
44
des mac
6.6
45
NITROUS oxide mac
104
46
what is mac bar
alveolar concentration required to block autonomic response following a supramaximal painful stimulus 1.5 MAC
46
47
what is mac awake
alveolar concnetration at a which a patient opens his/her eyes 0.4-0.5 during induction during recoveery it is as low as 0.15 mac
48
factors that increase mac
-chronic alcohol consumption, acute amphetamine intoxication, acute cocaine, maois, ephedrine, levodopa hyperNa infants 1-6M (sevo is the same for neonates and infants) hyperthermia red hair
49
what factors decrease MAC
acute alcohol intoxication, iv anesthetics, n2o, opioids, alpha 2 agonists, lithium, lidocaine, hydoxyzine hypoNa hotn hypoxia anemia cpb metabolic acidosis hypo osmolarity pregnancy-> 24-72 hrs postpartum paco2 > 95
50
factors that dont affect mac
changes in mag or K changes in thyroid (but changes in CO from this will affect it) gender paco2 15-95 htn
51
what is the meyer overton rule
lipid solubility is directly proportional to the potency of an inhaled anesthetic
52
unitary hypothesis
all anesthetics share a similar moa but work at a diff site
53
most imporant site of inhaled anesthetic in the brain
gaba a
54
how do halogenated anesthetics produce immobility
ventral horn of spinal cord
55
nitrous oxide works on what receptors
nmda antagonism k 2p-channel stimulation nitrous oxide does not stimulate gaba a
56
in what regions does halogenated anesthetics produce unconsciousness
cerebral cortex, thalmus, reticular activating system
57
in what regions of the brain do halogenated anesthetics produce amnesia
amygdala and hippocampus
58
where do halogenated anesthetis produce autonomic modulation
pons and medulla
59
how do halogenaed agents reduce BP
primary cause: low intracell ca in vasc smooth muscle-> vd-> low svr and venous return secondary cause: low intracell ca in myocyte-> myocardial depression-> decre inotropy
60
how do halogenated anesthetics affect HR
decreased SA node automaticity, decreased conduction velocity through AV node, his purkinje system, ventricular conduction pathways, increased duration of myocardial repolarization by impairing outward k current, altered baroreceptor function
61
why does des and iso sometimes increase HR
from sns activation from resp irritation can be minimized with opioids, a2 agonists, beta1 antagonists
62
iso and coronary steal
iso is most postent coronary artery dilator- fear iso can contribute to coronary steal syndrome atherosclerotic vessels cannot dilate when normal ones can- preferentially divert blood away from areas of higher resistance starving regions of oxygen
63
how do volatiles change co2
cause dose dependent depression of central chemoreceptor and resp muscles-> hypercarbia impairs response to co2 - shifts curve down and to right
64
when does isoelectric eeg occur with volatiles
1.5-2 mac
65
halolgenated anesthetics and cerebral blood flow
uncouple! usually: when metabolic demand inreases- blood vessels dilate- cerebrovascular resistance decreases when metabolic demand decreases- blood vessels constrict - cerebrovascular resistance increases
66
what evoked potential is most sensitive to effects of volatile anesthetics? what is most resistant?
visual evoked potentials are most sensitive to volatile anesthetics. most resistant is brainstem evoked potential ssep and meps are somewhere in the middle
67
n2o and bone marrow depression
nitrous oxide inhibits methionine synthase and folate metabolism-> can cause megaloblastic anemia

october exam (12 decks)

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