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Pharmacology > Volatile Anesthetics - Quiz 1 > Flashcards

Volatile Anesthetics - Quiz 1 Flashcards

1
Q

Who administered the first ether anesthetic and in what year?

A

Crawford Long

1842

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2
Q

Who administered NO for a tooth extraction and what year?

A

Horace Wells

1845

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3
Q

Who administered chloroform and when?

A

James Simpson

1847

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4
Q

When were modern gases introduced

A

Halothan 1956

Sevo/Des 1960

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5
Q

All inhalation agents share a common characteristic that promotes their clinical use today, what is it?

A

a low blood:gas solubility coefficient, which creates a favorable pharmacokinetic profile.

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6
Q

How are the carbon atoms bound?

A

by covalent bonds

the more sharing = stonger they are

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7
Q

c-c

A

alkane

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8
Q

c=c

A

alkene

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9
Q

c≡c

A

alkyne

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10
Q

c-o-c

A

Ethers

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11
Q

CH3

A

Methyl

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12
Q

CH2, CH3

A

Ethyl

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13
Q

All commonly used inhalation agents are ethers or aliphatic hydrocarbons with no more than ____ carbon atoms.

A

4

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14
Q

What is an aliphatic compound?

A

a hydrocarbon compound containing carbon and hydrogen joined together in straight chains, branched trains or non-aromatic rings.

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15
Q

If the chemical structure becomes longer than 4-5 carbons, what happens?

A

looses effect

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16
Q

Modern anesthetic agents are ______, but what is the exception

A

halogenated

nitrous oxide

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17
Q

What does the addition of fluorine [F], chlorine [Cl], bromine [Br], or iodine [I] do to the anesthetics characteristics?

A

Potency (lipid solubility)
Arrhythmogenic properties
Flammability
Chemical stability

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18
Q

When does potency increase?

A

increases when a halogen with a lower atomic mass unit (amu) is replaced by a heavier halogen

(bromine 80 amu substituted for fluorine at 19 amu)

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19
Q

What makes volatile anesthetics favor the occurance of arrhythmias?

A

increasing the number of halogen atoms within a volatile agent

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20
Q

What do anesthetics interact with that may facilitate arrhythmias?

A

K+, Ca+, and Na+ channels

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21
Q

What does substituting hydrogen atoms with halogens in regards to flammability?

A

flammability is reduced and chemical stability is enhanced.

if only hydrogen = very flammable

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22
Q

What is the best example of chemical stability?

A

desflurane – a compound that contains fluorine as its only halogen and thus strongly resists biodegradation

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23
Q

What are the 5 halogen elements?

A

fluorine (F), chlorine (Cl), bromine (Br), iodine (I), and astatine (At)

(group 17)

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24
Q

The group of halogens is the only periodic table group that contains elements in all three familiar states of matter at standard

A

temperature and pressure

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25
All of the halogens form _____ when bonded to hydrogen.
acids
26
The halogens are ALL
toxic
27
The chemical structure of each agent determines the extent to which it is metabolized. Typically , increasing the number of fluorine atoms on an anesthetic molecule
slows biodegradation
28
Biodegradation of all currently used inhalation agents is predominantly accomplished by way of
hepatic metabolism through oxidation (phase I)
29
Halothane is 45% metabolized, what did it use to cause?
halothane hepatitis
30
What is the % metabolized in Iso Des Sevo
Iso 0.2 Des 0.02 Sevo 4-5%
31
Absorption phase =
uptake
32
Metabolic phase =
biotransformation
33
Excretion phase =
elimination
34
_______ anesthetics are among the most rapidly acting drugs in existence
Inhaled
35
Of the inhaled anesthetics, only 2 are "true gases" the other potent agents are vapors of volatile liquids. Which 2 are they?
NO2 and O2
36
All gases are _________ and have a _____ molecular weight
non-ionized low
37
What is the goal of anesthetics?
to create a concentration and get it to the CNS. Happens by creating partial pressures. This is accomplished by creating a MAC - Minimum alveolar concentration to get it up to CNS
38
What 4 things does general anesthesia produce?
unconsciousness Amnesia analgesia Immobility
39
What are the secondary effects of general anesthesia?
Reduces stress response to surgical stimuli (if I was to take a knife and cut you – increased HR, BP, RR) - stops that Cause arrhythmias
40
What is the Meyer-Overton rule?
Lipid solubility is directly proportional to potency.
41
Reversal of anesthetic can be achieved with the application of
pressure
42
A reduction in body temperature does what to the anesthetic requirement?
lowers anesthetic requirement
43
What is unitary hypothesis?
The theory proposed that all inhalation agents work via a similar mechanism of action but not necessarily at the same site of action.
44
What is the current theory of how anesthetics work?
is interactions with multiple and diverse ion channels in the brain. Anesthetic sites of action include supraspinal and spinal anatomic structures - and on the molecular level, multiple protein structures (receptors, channels)
45
What does the spinal cord mediate?
immobility to painful stimulus weak inward-rectifying K+ Channels, and inhibiting glycine and GABA receptors
46
What does supra spinal mediate?
amnesia and immobility via glycine, sodium and NMDA receptors.
47
Amnesia requires the lowest followed by hat 3 (in order!!)
sedation, unconsciousness, and immobility If I want someone to not remember, I don’t have to give as much of the drug, I have to give way more if I want immobility
48
``` What is the MAC % of Nitrous Oxide Des Iso Sevo ```
Nitrous Oxide 104% (can't get to this) Des 6 Iso 1.4 Sevo 2
49
The potency of an anesthetic increases as the lipid solubility
increases
50
``` What is the oil:gas lipid solubility of Nitrous Oxide Des Sevo Iso ```
Nitrous Oxide 1.4 Des 19 Sevo 51 Iso 98
51
Why do agents of high solubility want to go to the brain?
the brain is made of fat
52
How do anesthetics probably work?
anesthesia by enhancing the function of inhibitory ion channels and by blocking the function of excitatory ion channels
53
Enhancing the function of inhibitory ion channels leads to hyperpolarization of the neuron. What does hyperpolarization mean?
slows everything down
54
What are the 2 inhibitory ion channels
glycerine and GABA
55
Where does glycerine work and what does it do?
Major inhibitory mediators in spinal cord | Mediate part of immobility
56
What does GABA control?
Hypnosis
57
hyperpolarization happens when ______ enters the receptors or when there is an efflux of ______
Cl K
58
What is the excitotory channel?
Glutamate
59
Explain glutamate receptors
``` Principle excitatory neurotransmitter G protein-coupled receptors Ligand-gated receptors NMDA *** (most familiar with) AMPA Kainate ```
60
What are the 2 pore potassium channels
Trek and Task Role and GA and deep sleep
61
What does the Voltage-gated sodium channels release?
neurotransmitter release
62
Immobility is mediated by the
spinal cord
63
Immobility IS measurable, what is this?
MAC (minimum alveolar concentration)
64
Immobility occurs via activation of the ________ ________ _________ which originate in periaqueductal gray matter of the brainstem. Activation of these pathways inhibit nociceptive input in the dorsal horn of the spinal cord.
descending noradrenergic pathways
65
The length of the anesthetic molecule is significant in that “immobility” is lost if _______ atom chain length exceeds a distance of ______ carbon atoms(5 angstroms)
Carbon 4-5
66
What is the a fundamental component of general anesthesia.
amnesia
67
What supra spinal structures are considered highly probable targets for the effects of anesthetics.
amygdala, hippocampus, and cortex
68
Does amnesia have a reliable measure?
NO
69
The limbic system of the brain is the primary part of the brain that regulates _______. The limbic system contains the amygdala complex the hippocampus the thalamus and the hypothalamus.
emotion
70
The amygdala complex is one of the main areas to process emotional content of ________ and ________.
Behavior and memory
71
What is the main purpose of the amygdala?
filter the important sensory information from the unimportant.
72
What does the hippocampus do?
converts objective versions of events from short term to long term memory.
73
Can analgesia be measured?
No Intraoperative measures of pain suggest that inhaled anesthetics do not suppress the perception of painful stimuli. (increased HR and BP)
74
At equilibrium, ______ partial pressure will equal ______ partial pressure, which in turn will equal _______ partial pressure.
CNS Blood Alveolar
75
Does metabolism, excretion and redistribution happen a lot with inhaled anesthetics?
No minimal
76
What is Vapor pressure
the pressure exerted by molecular collisions of the gas against the container walls
77
What happens to volatile anesthetics in a closed container?
molecules of the substance will equilibrate between the liquid and gas phases.
78
What is Daltons Law?
the sum of the partial pressures of each gas in a mixture of gases equals the total pressure of the entire mixture. Ptotal = Pgas1+Pgas2+...
79
What is the PP of Oxygen at sea level?
760 X .21 = 159.6
80
“partial pressure” is determined from the portion of volatile agent in the
gas phase
81
Gas equilibration is base on ________ not _________
partial pressures not gas concentration
82
Explain solubility
term used to describe the tendency of a gas to equilibrate with a solution
83
Which law describes the relationship of concentration of a gas in solution to the partial pressure of the gas with which the solution is in equilibrium
Henreys Law
84
What is solubility coefficient?
a certain volume of gas the is dissolved in a certain volume of liquid
85
The concentration of anesthetic in target tissue (brain) depends on the partial pressure at _______ and the _____ ______ ______
Equilibrium Target tissue solubility
86
Because inhaled anesthetics are gases, and partial pressures equilibrate throughout a system, monitoring the ______ _______ of inhaled anesthetics provides an index of their effects in the brain.
Alveolar concentration
87
What happens to gas in the brain when the agent is turned off
Turning the gas off creates a negative pull until equilibration
88
Which agent should we use on obese patients and why?
Des blood:gas coefficient is 0.42. (the amount of anesthetic bound to the blood and not readily released to tissues) this # is low. Therefore, does not readily go into the fat. (adipose tissue creates a reservoir for the gas)
89
Which inhaled anesthetic goes into the adipose tissue the most?
Sevo
90
What percent of CO goes to the fat, and what does this lead to?
6% goes to fat - explains another reason anesthetics stay in adipose tissue for long time
91
Where is the majority of the cardiac output going?
75% going to vessel rich group
92
Which inhaled anesthetic does not like to come out of muscle?
Sevo

Pharmacology (8 decks)

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