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Anesthesia Pharmacology > Volatile agents > Flashcards

Volatile agents Flashcards

1
Q

Desflurane (Suprane)

Class/ Category, use, MOA (how many florunes)

A

Class: volatile agent
use: maintenance of general anesthesia
MOA: unknown

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2
Q

Desflurine

MAC (adult)

A

6.6%

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3
Q

Desflurane

Blood: gas

A

0.42

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3
Q

Desflurane

CV effects

A

-Dose-dependent ↓ MAP (via ↓ SVR)
-Dose-dependent ↓ contractility
-Dose-dependent ↓/↔ CO
-↑ HR 5-10% from baseline, even at low concentrations (Des > Iso)
-Rapidly increased concentration → ↑ SNS and RAAS activity → ↑ MAP and HR*

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3
Q

Desflurane

% metabolism

A

0.02

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3
Q

Desflurane

vapor pressure

A

669

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4
Q

Desflurane

Pulm effects

A

-Dose-dependent ↑ RR
-Possible apnea at 1.5-2 MAC
-↓ Vt, ↓ MV
-↑ PaCO2, ↓ ventilatory response to PaCO2
-May promote bronchoconstriction, especially in smokers

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5
Q

Desflurane

CNS effects

A

-↓ CMRO2, ↑ CBF, ↑ CBV
-↑ ICP (especially if space-occupying lesion)
-Maintains CBF autoregulation up to 1 MAC
-Dose-related EEG changes; burst suppression at > 1.2 MAC

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6
Q

most pungent PIA and what does it cause

A

Desflurane
-promotes airway irritation, salivation, breath holding, coughing, or laryngospasm when > 6% given to awake patient

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7
Q

Degradation in a ____ CO2 absorber produces ______
(in what order of VA)

A

Desiccated, CO
Des>Iso»Sevo

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8
Q

signs of CO poisoning (carboxyhemoglobinemia)

Desflurane

A

↓ SpO2, mixed gas or Enflurane reading on gas analyze

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9
Q

T or F provides skeletal muscle relaxation

desflurane

A

True

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10
Q

Dose-Dependent potentiation of ____ by ____-____%

Order of volatile agents

A

NMBs by 30-40%
Des>Iso>sevo

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11
Q

Desflurane is a ____trigger and may be undesirable in pts with ____

A

MH, CAD

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12
Q

Des required vaporizor

A

Tec 6

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13
Q

Desflurane boiling point

A

22.8 C

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14
Q

Tec 6 heated to____, pressurized to ____

A

39C, 2 atm (1500psi)

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15
Q

What volatile agent requires vaporizor with power

A

Desflurane

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16
Q

T/F Isoflurane is MH trigger

A

true

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17
Q

Sevoflurane

Class/ Category, use

A

-volatile inhaled agent
-inhalation induction; maintenance of general anesthesia

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18
Q

Sevoflurane

MAC (adult)

A

2%

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19
Q

Sevoflurane

Blood:gas

A

0.65

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20
Q

Sevoflurane

% metabolism

A

2-5

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21
Q

Sevoflurane

Vapor pressure

A

157

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22
Sevoflurane | CV effects
-Dose-dependent ↓ MAP (↓ SVR) -Dose-dependent ↓ CO (at **1-1.5 MAC**) -Dose-dependent ↓ contractility -↑ HR at **1-1.5 MAC**
23
Sevoflurane | Pulm effects
-Dose-dependent ↑ RR -**Apnea at 1.5-2 MAC** -↓ Vt, ↓ MV -↑ PaCO2, ↓ ventilatory response to PaCO2 -Promotes bronchodilation
24
Sevoflurane | CNS effects
-↓ CMRO2, ↑ CBF (for **up to 4 hrs after stopping**), ↑ CBV -↑ ICP -No alteration of CBF autoregulation -Dose-related **EEG changes, burst suppression at > 1.2 MAC** -**Possible proconvulsant effect at high concentrations (1.5-2 MAC)**
25
List 4 things different about Sevo (than Des/Iso)
-non-pungent -minimal odor -sweet-smelling -least/no airway irritation
26
Degradation in desiccated CO2 absorber produces _______ rxn leading to ____and ____
exothermic, fire, carbon monoxide
27
When sevo breaks down in CO2 absorber can cause what? with what side effect
Compound A, nephortoxicity
28
how to prevent compound A (MAC hours, FGF, and LPM)
Exposure should NOT exceed 2 MAC hours at FGF 1-2 LPM, increase FGF >2LPM after 2 MAC hours
29
what does Sevo metabolize into and what is a potential concern
inorganic fluoride, nephrotoxic
30
T/F Sevo does NOT cause skeletal muscle relaxation
false
31
T/F Sevo has risk factor for emergence delrium
True
32
T/F Sevo is not MH trigger
False
33
Isoflurane | Class/ Category, use
volatile inhaled agent, maintenance of general anesthesia
34
Isoflurane | MAC
1.2%
35
Isoflurane | Blood:gas
1.46
36
Isoflurane | % Metabolism
0.2
37
Isoflurane | Vapor Pressure
238
38
Isoflurane | CV effects
-Dose-dependent ↓ MAP (↓ SVR) -Dose-dependent ↓ contractility -Dose-dependent ↓/↔ CO -**↑ HR 5-10% from baseline, even at low concentrations** (Des > Iso) -Rapidly increased concentration → ↑ SNS and RAAS activity → ↑ MAP and HR
39
Isoflurane | Pulm effects
-Dose-dependent **↑ RR up to 1 MAC (ceiling effect)** -↓ Vt, ↓ MV -↑ PaCO2, ↓ ventilatory response to PaCO2 -**Bronchodilator**
40
Isoflurane | CNS effects
-↓ CMRO2, ↑ CBF,↑ CBV -↑ ICP -Maintains CBF autoregulation up to 1 MAC -Dose-related EEG changes, burst suppression at > 1.5 MAC, isoelectric at 2 MAC -**Anticonvulsant properties, does not evoke seizures**
41
Describe coronary steal syndrome and what VA is associated
-diversion of blood from myocardial bed with limited or inadequate perfusion to a bed with greater perfusion -Isoflurane
42
Isoflurance is less ____than ____ and can cause_____
Pungent, Des, airway irriation
43
Nitrous Oxide (N2O) | class/ category, use, MOA
-Inorganic inhaled agent -adjuvant for general anesthesia/ sedation/ analgesia -NMDA antagonist
44
Nitrous Oxide | MAC
104%
45
Nitrous Oxide | Blood:gas
0.46
46
Nitrous Oxide | % metabolism
0.004
47
Nitrous Oxide | Vapor pressure
38,770 mmhg/ 745psi
48
Nitrous Oxide | CV effects
-↑/↔ BP -↑ CO -↔ SVR -↑ SNS activity
49
Nitrous Oxide | Pulm effects (5)
-↑ RR (equal or more than PIAs), -↓ Vt (less than PIAs) -No change or ↑ PaCO2 (less than PIAs) -↑ PVR -**Lacks bronchodilator effect**
50
Nitrous Oxide | CNS effects
-↑ CMRO2,↑ CBF,↑ CBV -↑ ICP
51
Nitrous Oxide is a good choice for what patient population | and when?
Obstetrics (3rd trimester)
52
Odorless to sweet smelling inhaled agent
Nitrous Oxide
53
Nitrous Oxide is non-flammable but is still a fire risk because?
supports combustion
54
____activity of Vit B12 dependent enzymes by irreversibly oxidizing the cobolt atom, which effects ____ and ____ synthetase
Nitrous oxide decreases, methionine, thymidylate
55
T/F Nitrous Oxide can cause spontaneous abortion/ fetal effects/ cogential abnormalities
true
55
May cause bone marrow suppression and neurological disturbances
Nitrous oxide
56
What can Nitrous oxide do to air filled spaces and causes risk for what?
-expands airfilled spaces, ↑ pressures, high-volume absorption into gas-filled spaces 34x faster than N2 can escape -risk for expansion of air-filled spaces, emboi
57
What can occur when discontinuing nitrous oxide
**Diffusion hypoxia for 1-5 min** following discontinuation may transiently lower alveolar O2 and CO2 concentration
58
Which inhaled agen can increase risk of PONV, and after how long
nitrous oxide, **>6 hours**
59
which trimesters is N2O contraindicated
first and second
60
List potential toxicity from expansion of gas-filled spaces from N2O
-Emphysema, pneumothorax, pneumocephalus, middle ear surgery, air embolus, bowel obstruction
61
T/F N2O used in tympanoplasty
false
62
T/F-Increased ICP and cerebral ischema can be caused by N2O
True
63
relative contraindications for nitrous oxide
Pulm HTN, foreign body aspiration, thoracic anesthesia
64
which inhaled agents do not cause MH
N2O and Xe
65
Which inhaled agent has modest acute analgesic effect
Nitrous oxide
66
Which inhaled agent does not provide skeletal muscle relaxation (potentiation of NMBs)
Nitrous oxide
67
what does nitrous oxide do when combined with volatile agents
reduces MAC of volatile agents
68
T/F nitrous oxide promotes uptake of second gas
true

Anesthesia Pharmacology (7 decks)

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