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Pharmacology > Volatile Anesthetics - Quiz 3 > Flashcards

Volatile Anesthetics - Quiz 3 Flashcards

1
Q

Equipotent concentrations of inhaled anesthetics have similar circulatory effects.. What does this mean?

A

Does matter the agent, 1 MAC of Iso or 1 MAC of Des will have similar effects.

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2
Q

with increases in concentration of desflurane, sevoflurane, and isoflurane in a dose dependent manner, what happens to MAP?

A

MAP decreases

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3
Q

A decrease in MAP reflects a decrease in

A

SVR

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4
Q

How does Halothan decrease MAP?

A

By decreasing the CO

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5
Q

What does NO do to MAP?

A

unchanged or mildly increases MAP

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6
Q

If you have a hypotensive patient, what combination of gas could you use?

A

Put at half MAC of gas and add nitrous

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7
Q

Incremental ______ in delivered concentrations of inhaled agents increase heart rates in patients

A

increases

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8
Q

Forane or Isoflurane increases heart rate at what MAC?

A

Starting at concentrations of 0.25 MAC

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9
Q

Desflurane increases heart rate at what MAC?

A

minimal to no increases in HR at <1 MAC

> or equal to 1 MAC has dose dependent linear increase in HR

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10
Q

Sevoflurane increases heart rate at what MAC?

A

HR does not increase until a MAC >1.5

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11
Q

Clinically, what happens why you try to wash in Des quickly?

A

tachycardia

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12
Q

If % dialed concentration multiplied by gas flow is greater than 24, what will you see?

A

tachycardia

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13
Q

How is cardiac index influenced by inhaled anesthetics?

A

Minimally

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14
Q

TEE demonstrates that _______ produces minor increase in EF compared with awake measurements.

A

desflurane

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15
Q

When you have surges in sympathetic nerves system activity from abruptly increasing an inhaled anesthetic, what is increased?

A

Plasma concentrations of epic and norepinephrine

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16
Q

Circulatory stimulation is not observed with abrupt increases in ______, _______, or _______ up to 2 MAC

A

Sevo, Halothan, or Ethrane

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17
Q

True or False: Inhaled agents do not predispose the heart to premature ventricular contractions

A

True ~ prolong refractory period (QTC)

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18
Q

What agent sensitizes the heart to PVCs?

A

Halothane

From:
Catecholamines
Hypercarbia

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19
Q

Since inhaled anesthetics prolong the QTC, which drug should you definitely avoid in pts with congenital long QT syndrome?

A

Sevo

but SAFE to give if on beta-blocker therapy

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20
Q

What is coronary steal?

A

Iso’s ability to dilate small-diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilatation

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21
Q

Volatile anesthetics exert a ______ _______ on the heart, limiting the area of myocardial injury and preserving function after exposure to ischemic insult.

A

protective effect

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22
Q

What is ischemic preconditioning?

A

Protective benefits of volatile anesthetics against myocardial ischemia in setting of compromised regional perfusion.

Exposure to a single or multiple brief episodes of ischemia can confer a protective effect on the myocardium against reversible or irreversible injury with subsequent prolonged ischemic insult.

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23
Q

True or False: Ischemic preconditioning is a protective mechanism present in all tissues, in all species.

A

True

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24
Q

Ischemic preconditioning offers 2 distinct phases, what are they?

A

First Period - 1-2 hours after conditioning episode

Second Period - Benefit appears 24 hours later and can last as long a 3 days

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25
Q

What confers the protective activity in ischemic preconditioning?

A

opening of mitochondrial ATP sensitive K channels (K-ATP)

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26
Q

As anesthetic concentration increase, what is the pulmonary effect?

A

Increased respiratory rate and decreased tidal volume

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27
Q

is minute ventilation preserved with inhaled anesthetics?

A

Yes

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28
Q

What does decreased TV lead to?

A

greater dead space ventilation

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29
Q

Gas exchange becomes more or less efficient as anesthetic depth increases.

A

less

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30
Q

______ increases proportionate to anesthetic depth.

A

PaCO2

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31
Q

Dose dependent – the more gas would mean _____ RR and ______ TVs

A

HIGHER

LOWER

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32
Q

Dose related blunting of the respiratory response to increased

A

CO2

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33
Q

Ventilatory stimulation response evoked by arterial hypoxemia is _____ by volatile anesthetics.

A

blunted

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34
Q

_______ displacement of the diaphragm and inward displacement of the rib cage occur from enhanced expiratory muscle activity. This results in a reduction in _____.

A

Cephalad

FRC

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35
Q

During anesthesia, ________ occurs in dependent areas of the lung and to a greater extent when ________ ventilation is permitted.

A

Atelectasis

spontanous

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36
Q

Inhalation agents have limited effect on the principle of “_______ _________ vasoconstriction”.

A

Hypoxic pulmonary

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37
Q

In the absence of bronchoconstriction, __________ properties of inhalation agents are limited.

A

bronchodilating

38
Q

Inhaled anesthetics differ in “pungency” or capacity to irritate airways. What are some ways this is shown

A

Coughing
Breath-holding
Laryngospasm
Arterial oxygen desaturation

39
Q

What 3 inhaled agents are non pungent

A

Sevoflurane, halothane, and nitrous oxide

40
Q

When inhaled agants are pungent

A

Des and Iso

** Des is the worst

41
Q

Which inhaled anesthetic is the “nicest” to breath

A

Sevo

42
Q

Which inhaled agent should you avoid in asthmatics, smokers or reactive airway disease?

A

Des

43
Q

Inhalation agents ______ CMRO2

A

Decrease

Decreased CMRO2 is good – tells brain we don’t need as much O2 right now

44
Q

In normocephalic patients, cerebral vasodilation occurs at concentrations about _____ MAC

A

0.6 MAC

45
Q

At ____ MAC, the decrease in CRMO2 offsets vasodilation such that cerebral blood flow ______ change significantly.

A

0.5

does not

46
Q

At concentration _____ MAC, vasodilating effects predominate and CBF ______

A

> 1

increases

47
Q

When is cerebral vasodilation good?

A

ischemic cases (we want to get blood to them)

48
Q

When is cerebral vasodilation bad?

A

high ICP – would lead to more volume

49
Q

in the CNS, what does nitrous oxide cause?

A

Causes cerebral vasodilation

Increases CMRO2

50
Q

How can you offset the effects of nitrous oxide?

A

Coadministration of opioids, barbiturates, or propofol (not ketamine

51
Q

ICP increases with all volatile anesthetics at doses ____ MAC

A

> 1

52
Q

Autoregulation is impaired at concentrations ______ MAC

A

<1

53
Q

Volatile anesthetics and nitrous oxide _____ the amplitude and _______ the latency of SSEP in a dose-dependent manner.

A

Depress

increase

54
Q

When can evoked potentials be abolished?

A

1 MAC

55
Q

If adding NO, what MAC can abolish evoked potentials

A

0.5 MAC

56
Q

Low concentrations ______ MAC decrease the reliability of motor evoked potentials.

A

0.2-0.3

57
Q

on an EGG- Increased depth of anesthesia is characterized by _______ amplitude and ______ on the EEG.

A

increased

synchrony

58
Q

What occurs with greater frequency as depth of anesthesia increases?

A

Burst supression

59
Q

If a doctors does says you can’t uses any more inhalation agent causes it is decreasing evoked potentials, what can you use?

A

TIVA

60
Q

This isoelectric pattern predominates at _____ MAC.

A

1.5-2.0

61
Q

Which inhaled anesthetic may be associated with epileptiform activity on the EEG, especially at high concentrations.

A

Sevo

62
Q

Inhalation agents produce a dose dependent skeletal muscle relaxation and enhance the activity of _______ _______ _______.

A

neuromuscular blocking drugs

63
Q

Elimination of volatile anesthetic agent enhances OR reduces recovery from neuromuscular blockade

A

enhances

64
Q

Which inhalation agent triggers MH?

A

ALL potent inhalation agents trigger MH

65
Q

Will nitrous oxide trigger MH?

A

no

66
Q

What is thought to be the immune mediated cause of liver injury?

A

trifluoroacetate metabolite.

67
Q

Halothane and Sevo more likely to cause liver injury because more of the agent is metabolized by the liver. What 2 compounds can they make?

A 
Trifluoroacetic Acid (TFA) 
Inorganic Fluoride Ions
68
Q

What can halothane cause?

A

Halothane hepatitis

69
Q

Are volatile agents are harmful to patients with preexisting liver disease unrelated to anesthesia?

A

probably not

70
Q

Breakdown of Sevo and halothane cause what?

A

Compound A - can be nephrotoxic

71
Q

What can compound A exposure cause?

A

proteinuria, enzymuria and glycosuria

72
Q

What should the fresh gas flow rate be on Sevo and how long should Sevo be ran?

A

FGF of > or = 2L

Ran < 2 hours

73
Q

NO inactivates methionine synthase, the enzyme that regulates

A

vitamin B12 and folate metabolism.

74
Q

N2O administration contraindicated in patients with preexisting __________ or _______________

A

preexisting vitamin B12 deficiency or underlying critical illness

75
Q

What is the blood:gass coefficient of NO

A

0.47

76
Q

NO is 34X greater than

A

nitrogen (0.014)

77
Q

Give nitric oxide in a
Compliant wall -
noncompliant wall -

A

Compliant wall - increases volume

noncompliant wall - increases pressure

78
Q

When would we not want to give NO? why?

A

pneumothorax, pneumoperotoneum, pneumocephalus,
crani

never want to give when worried about air being trapped

79
Q

Desiccated CO2 absorbants cause

A

carbon monoxide production from all volatile anesthetic agents regardless of temperature.

80
Q

What acceleratse the desiccation of CO2 absorbents

A

High fresh gas flow rates (exceeding normal minute ventilation)

81
Q

What type of process is degradation?

A

exothermic

82
Q

Which inhaled anesthetic is most likely to cause an increase in temperature and may lead to explosion and fire

A

Sevo

83
Q

____ produces Compound A when exposed to soda lime.

A

Sevo

84
Q

_______ produce Carbon Monoxide when exposed to desiccated absorbent

A

Iso and Des

85
Q

New absorbents with decreased or absent monovalent bases do not result in extensive degradation on exposure to volatile agents regardless of their hydration status. What is in them?

A

Sodium hydroxide

Potassium hydroxide

86
Q

which inhaled anesthetics use the variable bypass?

A

Isoflurane, sevoflurane, halothane

87
Q

What does tipping or overfilling of a variable bypass channel do?

A

may lead to overdose if liquid anesthetic gets into bypass channel

88
Q

What is des heated to?

A

2 atmospheres (1400)

89
Q

At high altitudes, the partial pressure of desflurane will be _____ at a given Tec 6 vaporizer setting and output concentration will be ______, leading to _________ if no adjustments are made to account for higher altitude.

A

Lower (less ATM pressure pushing down)

lower

underusing

90
Q

Does temperature effect gas concentration in the vaporizer?

A

No

91
Q

how do patients wake up with Iso and Des?

A

smooth continual wake up

92
Q

how do patients wake up with Sevo?

A

noting nothing nothing then very awake and pulling at ETT

Pharmacology (8 decks)

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