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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
Q

what factors affect agent delivery to and removal from alveoli

A
  • 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
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26
Q

what conditions increase FA/FI. what decreases it?

A

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

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27
Q

anesthetic agents and CO

A

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

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28
Q

what are the 4 tissue groups the body can be divided into

A

vessel rich
muscle
fat
vessel poor

29
Q

what are the 3 ways the body eliminates inhaled anesthetics

A

-elimination from alveoli (most important!!)
-hepatic biotransformation
-percutaneous loss (minimal)

30
Q

least to most hepatic biotransformation per agent

A

DISH and rule of 2s

des 0.02
iso 0.2
sevo 2
halo 20

31
Q

fda recomendation for sevo min fresh gas flow

A

1 l/min up to 2 mac hours

2 l/min after 2 mac hours

32
Q

what is a mac hour

A

1 mac hour =
1% sevo x 2 hours
2% sevo x 1 hr
4% sevo x 30 mins

33
Q

concentration effect

A

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
Q

what is the second gas effect

A

use of nitrous oxide to hasten onset of second gas

35
Q

diffusion hypoxia

A

-risk during emergence!!
-n2o moves from body toward lungs- dilutes alveolar o2 and co2- decreased respiratory drive and hypoxia

36
Q

how can you prevent diffusion hypoxia

A

administer 100% o2 for 3-5 mins after d/c n2o

37
Q

what agent is more affected by R-> L shunt

A

fa/fi with lower solubility (des) is more affected than one with higher solubility (iso)

38
Q

which inhalation anesthetic is more greately affected by L to R shunt

A

does not have any meaningful effect on anesthetic uptake or induction time

39
Q

why does n2o accumulate in closed air spaces

A

nitrous oxide is 34x more soluble than nitrogen. will enter a space 34x faster than nitrogen can exit the space

40
Q

blood gas parition coefficient of n2o vs nitrogen

A

n2o 0.45
nitrogen 0.014

41
Q

what spaces does n2o accumulate

A

closed air: middle ear, bowel, pneumothorax

can also increase volume and pressure in a ett cuff, lma cuff and balloon tipped pa cath

42
Q

iso mac

A

1.2

43
Q

sevo mac

A

2.0

44
Q

des mac

A

6.6

45
Q

NITROUS oxide mac

A

104

46
Q

what is mac bar

A

alveolar concentration required to block autonomic response following a supramaximal painful stimulus

1.5 MAC

46
Q
A
47
Q

what is mac awake

A

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
Q

factors that increase mac

A

-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
Q

what factors decrease MAC

A

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
Q

factors that dont affect mac

A

changes in mag or K
changes in thyroid (but changes in CO from this will affect it)
gender
paco2 15-95
htn

51
Q

what is the meyer overton rule

A

lipid solubility is directly proportional to the potency of an inhaled anesthetic

52
Q

unitary hypothesis

A

all anesthetics share a similar moa but work at a diff site

53
Q

most imporant site of inhaled anesthetic in the brain

A

gaba a

54
Q

how do halogenated anesthetics produce immobility

A

ventral horn of spinal cord

55
Q

nitrous oxide works on what receptors

A

nmda antagonism
k 2p-channel stimulation

nitrous oxide does not stimulate gaba a

56
Q

in what regions does halogenated anesthetics produce unconsciousness

A

cerebral cortex, thalmus, reticular activating system

57
Q

in what regions of the brain do halogenated anesthetics produce amnesia

A

amygdala and hippocampus

58
Q

where do halogenated anesthetis produce autonomic modulation

A

pons and medulla

59
Q

how do halogenaed agents reduce BP

A

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
Q

how do halogenated anesthetics affect HR

A

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
Q

why does des and iso sometimes increase HR

A

from sns activation from resp irritation

can be minimized with opioids, a2 agonists, beta1 antagonists

62
Q

iso and coronary steal

A

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
Q

how do volatiles change co2

A

cause dose dependent depression of central chemoreceptor and resp muscles-> hypercarbia

impairs response to co2 - shifts curve down and to right

64
Q

when does isoelectric eeg occur with volatiles

A

1.5-2 mac

65
Q

halolgenated anesthetics and cerebral blood flow

A

uncouple!

usually:
when metabolic demand inreases- blood vessels dilate- cerebrovascular resistance decreases

when metabolic demand decreases- blood vessels constrict - cerebrovascular resistance increases

66
Q

what evoked potential is most sensitive to effects of volatile anesthetics? what is most resistant?

A

visual evoked potentials are most sensitive to volatile anesthetics.

most resistant is brainstem evoked potential

ssep and meps are somewhere in the middle

67
Q

n2o and bone marrow depression

A

nitrous oxide inhibits methionine synthase and folate metabolism-> can cause megaloblastic anemia

october exam (12 decks)

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