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2nd Quarter > Pharm Quiz #6 > Flashcards

Pharm Quiz #6 Flashcards

1
Q

What is the current definition of Anesthesia?

A

Immobility in the face of noxious stimuli and amnesia for intraoperative events

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2
Q

The ___ the MAC of an anesthetic, the ___ the oil-gas partition.

A

lower, higher

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3
Q

The ___ the oil-gas partition coefficient, the ___ potent the vapor.

A

higher, more

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4
Q

How does the blood gas partition coefficient affect potency?

A

It doesn’t

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5
Q

What is the relationship between MAC and the oil-gas partition?

A

it is inverse

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6
Q

What is the relationship between lipid solubility and anesthetic potency?

A

The greater the lipid solubility, the greater its potency.

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7
Q

What is the “take-home” message about OGPC?

A

The higher the OGPC, the greater the lipid solubility is and the greater the potency is because OGPC x MAC in atmospheres = 1.8 atms

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8
Q

What is the modern theory of anesthesia?

A

Potency determined by position and orientation of anesthetic in the bilayer.

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9
Q

What are two ways pain is meditated by immobility?

A
  1. enhancing K+ ion channels

2. Glycine and GASBa receptors mediated reduction of spinal neuron action potentials

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10
Q

Where are Isoflurane sites of action in the brain(3)?

A
  1. brainstem
  2. cerebral cortex
  3. hippocampus
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11
Q

2 primary receptors of Isoflurane involved in the CNS.

A
  1. GABAa

2. Nicotinic acetylcholine receptors

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12
Q

What are the 3 goals of Isoflurane administration?

A
  1. reversible effect on the CNS producing immobility in the face of noxious stimuli AND amnesia
  2. immobility mediated via spinal cord anesthesia
  3. amnesia mediated by the brain
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13
Q 
What are the physical properties of Isoflurane?
racemic mixture?
odor?
BGPC?
OGPC?
vapor pressure?
metabolism rate?
A 
racemic mixture of 50:50(R and S optical isomers)
ethereal and pungent odor
BGPC of 1.46
OGPC of 91
vapor pressure of 238
metabolism rate of 0.2%
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14
Q

Does Isoflurane produce compound A?

A

No

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15
Q

What is the MAC value for Isoflurane?

A

1.2%

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16
Q

What factors reduce Isoflurane MAC?

A

age, opioids, benzos, clonidine, nitrous oxide, barbs, pregnancy, epidural anesthesia, local anesthesia, shock, trauma, major illnesses, hypothermia, hypothyroidism

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17
Q

Isoflurane prefers blood ___ times more than the gas phase, its blood gas partition coefficient would be ___?

A

1.4( or 1.4:1)

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18
Q

Isoflurane’s BGPC is ___ than des/sevo, suggesting induction and emergence ___ than des/sevo.

A

greater, slower

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19
Q

Isoflurane’s use on ___ cases will ___ recovery more than use on ___ cases.

A

longer, slow, shorter

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20
Q

How does Isoflurane compare to other volatile agents in speed emergence?

A

Isoflurane has greater solubility than sevo and des so more it enters the arterial side of circulation from the lungs, prolonging emergence. Likewise, obese patients may experience a slower emergence with Iso.

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21
Q

Does Isoflurane have any mutagenic affects?

A

No, although it may weakly decrease the body’s ability to fight infection.

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22
Q

How does the addition of nitrous oxide for an equal MAC fraction with Isoflurane affect ventilatory status?

A

It lessens the ventilatory depressant effects

23
Q

What is the state describing Isoflurane’s affect on the lungs?

A

breathing like a lizard on a hot rock

24
Q

The dose related to ventilatory depressant effects of Iso that leads to apnea is?

A

around 2 MAC

25
Q

Isoflurane causes airway irritation beginning at about what MAC?

A

1, so not at sub-MAC doses. By the time the patient is ready to extubate your much lower than this.
In the VA from greatest to less airway irritation: Des—>Iso—>Sevo

26
Q

Should Isoflurane be used for inhaled induction?

A

NO! it has a pungent odor

27
Q

For a deep extubation, what MAC Iso is needed?

A

at least 0.85

28
Q

How does Isoflurane affect ANS response to incubation as compared to Sevoflurane?

A

Iso blocks ANS response to intubation greater than Sevo

29
Q

What affect does Iso have on hypoxic pulmonary vasoconstriction(HPV)?

A

Iso alters HPV minimally @ routine anesthetic concentrations with minimal clinical significant. HPV is a mechanism that diverts blood flow from hypoxic areas to optimize gas exchange.

30
Q

How does Iso affect blood pressure and by what mechanism?

A

Iso drops your blood pressure by decreasing the SVR

31
Q

Iso has ___ vagolytic effects than Desflurane.

A

less, vacolytic = increased HR with abrupt increases in concentration

32
Q

How does adding N2O to Iso affect circulatory changes?

A

lower BP, reduced SVR, Lower CI—> from the ISO

BUT greater HR, higher PAPs and higher CVPs—>from the nitrous

33
Q

How does Iso administration affect temps?

A

the prolonged vasodilatation secondary to its acceptance of a broad range of temps before peripheral vasoconstriction occurs leads to lower temps and greater incidences of post-op shivering

34
Q

How does spontaneous ventilation under Isoflurane increase venous return?

A

lower intrathoracic pressures and greater sympathetic activity due to associated increases in PaCO2.

35
Q

What is the MAC BAR of Iso when combined with 60% nitrous? What is it with an additional combination of 3 mcg/kg fentanyl?

A

1.3 MAC —> with 3mcg/kg fentanyl lowers the MAC BAR to 0.4 MAC
Isoflurane and increase autonomic activity under anesthesia so you should give opioids!

36
Q

At what level MAC can Iso attenuate baroreflexes?

A

@ greater than 1 MAC

37
Q

At what level MAC does Iso cause circulatory collapse?

A

3 MAC

38
Q

At what level MAC does Iso cause apnea?

A

2 MAC—>so apnea would be seen before circulatory collapse

39
Q

What effect does Isoflurane have on the myocardium?

A

It depresses it

40
Q

What effects does Iso have on “coronary steal”?

A

Any reduction in regional coronary blood flow under anesthesia is due to hypotension not “coronary steal”.

41
Q

How does Iso affect hepatic and renal perfusion?

A

It dose not adversely affect either one

42
Q

How does Iso affect cerebral vascular resistance and ICP?

A

It decreases cerebral vascular resistance which may lead to increases in ICP

43
Q

How are increase ICP treated?

A

hyperventilate to about 30 mmHg pCO2

44
Q

What affect does Iso have on malignant hyperthermia?

A
  • Iso can trigger MH

- administration of succinylcholine may potentiate the MG triggering capacity of Iso

45
Q

What analgesic properties does Isoflurane have?

A

it has limited analgesic properties and @ 0.2 MAC Iso does not influence pain perception

46
Q

At what level MAC does Iso depress somatosensory evoked potentials and abolish them?

A

> 1.3 MAC

47
Q

How does Isoflurane affect cerebral metabolic rate?

A

it decreases it, while also decreasing CVR and increasing ICP

48
Q

How can Isoflurane administration affect the elderly?

A

may induce apoptosis(programmed cell death), aggression of amyloid beta protein and may contribute to postop cognitive dysfunction

49
Q

What % metabolism does Isoflurane undergo and why?

A

0.2% metabolism due to the fluorination of isoflurane(5 fluorine atoms)

50
Q

What can Isoflurane metabolism lead to via the cytochrome p450 pathway?

A

post anesthesia hepatitis

51
Q

How can Isoflurane affect the liver?

A

Iso may cause post-anesthesia hepatitis and hepatic necrosis!

This is caused by metabolism to trifluoroacetic acid which can form covalent attachments to hepatic proteins.

52
Q

How does Isoflurane affect the kidneys?

A

It DOES NOT produce compound A, avoiding the nephrotoxicity of theoretical concerns associated with Sevoflurane

53
Q

Are there any contraindications to low flow and closed circuit techniques?

A

No….and at identical flow rates, isoflurane is 1/2 the cost of des and sevo
Iso also resist metabolism and degradation by CO2 absorbents

2nd Quarter (27 decks)

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