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Nurs 575 Anesthesia Pharmacology > Week 5 Inhaled Anesthetics > Flashcards

Week 5 Inhaled Anesthetics Flashcards

1
Q

MAC for Sevoflurane?

A

2%

Nagelhout, Ch. 7, pg 82, Table 7.1

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2
Q

MAC for Isoflurane?

A

1.15%

Or 1.17% in Ch. 8

Nagelhout, Ch. 7, pg 82, Table 7.1

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3
Q

MAC for Desflurane?

A

5.8%

Nagelhout, Ch. 7, pg 82, Table 7.1

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4
Q

MAC for N2O?

A

DEAD
104% or 105%
depending if you read Ch. 7 or 8

Nagelhout, Ch. 7, pg 82, Table 7.1

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5
Q

Blood/Gas Partition Coefficient of Sevo?

A

0.68

Nagelhout, Ch. 7, pg 82, Table 7.1

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6
Q

Blood/Gas Partition Coefficient of Iso?

A

1.43

Nagelhout, Ch. 7, pg 82, Table 7.1

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7
Q

Blood/Gas Partition Coefficient of Des?

A

0.42

Nagelhout, Ch. 7, pg 82, Table 7.1

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8
Q

Blood/Gas Partition Coefficient of N2O?

A

0.47

Nagelhout, Ch. 7, pg 82, Table 7.1

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9
Q

Oil/Gas Partition Coefficient of N2O?

A

1.4

Nagelhout, Ch. 7, pg 82, Table 7.1

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10
Q

Oil/Gas Partition Coefficient of Iso?

A

99

Nagelhout, Ch. 7, pg 82, Table 7.1

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11
Q

Oil/Gas Partition Coefficient of Des?

A

18.7

Nagelhout, Ch. 7, pg 82, Table 7.1

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12
Q

Oil/Gas Partition Coefficient of Sevo?

A

50

Nagelhout, Ch. 7, pg 82, Table 7.1

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13
Q

Does an increased Cardiac ouput increase or decrease induction onset?

A

Decrease

Nagelhout, Ch. 7, pg 82

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14
Q

What factors make induction faster?

6

A
  • Low blood gas solubility
  • Low CO
  • High minute ventilation
  • High FGF
  • High concentration
  • 2nd gas effect (N2O+Iso/Sevo/Des)

Nagelhout, Ch. 7, pg 84, Box 7.2

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15
Q

What factors make induction slower?

7

A
  • High blood gas solubilty
  • High CO
  • Low Minute Volume
  • Low FGF
  • Low Concentrations
  • V/Q deficits
  • Hypothermia

Nagelhout, Ch. 7, pg 84, Box 7.2

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16
Q

When an insoluble anesthetic exits the body via the lungs, & is replaced with nitrogen, displacing O2 & CO2 is called ________ _____?

A

Diffusion hypoxia

Nagelhout, Ch. 7, pg 84

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17
Q

What is MAC?

A

Minimum alveolar concentation is 50% of a population will not respond to surgical stimulation

Nagelhout, Ch. 7, pg 80 & Ch. 8, pg. 89

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18
Q

What is considered a reponse as it relates to MAC?

A

Gross/Purposeful movement of Head or Extremities

Nagelhout, Ch. 8, pg 89

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19
Q

What is the concern with N2O in neurosurgical procedures?

A

Reduces cerebrovascular tone significantly (vasodilation), & might influence surgical outcomes in patients with reduced intracranial compliance

Nagelhout, Ch. 8, pg 91

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20
Q

What can attenuate increases in CBF due to N2O use?

A

Mild Hyperventilation (goal PaCO2 30-35 mmHg)

Nagelhout, Ch. 8, pg 91

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21
Q

Hypocapnia(carbia) causes to cerebrovasculature to do what?

A

Vasoconstrict

Nagelhout, Ch. 8, pg 91

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22
Q

Hypercapnia(carbia) causes the cerebrovasculature to do what?

A

Vasodilate

Nagelhout, Ch. 8, pg 91

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23
Q

Sevo, Iso, & Des cause what changes to CMRO2 & dose dependent CBF?

A
  • Decrease in CMRO2
  • Dose dependent increase in CBF

Nagelhout, Ch. 8, pg 91

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24
Q

All inhalation anesthetics (Sevo, Iso, Des, N2O) cause _ _ _ _ between CMRO2 & CBF

A

Flow-metabolism Uncoupling

Nagelhout, Ch. 8, pg 91

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25
Q

Sevo, Iso, Des effects on hemodynamics?

A

Decrease MAP & CO

  • Due to decreased SVR

Nagelhout, Ch. 8, pg 94

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26
Q

N2O effects on hemodynamics?

A

Increase SVR, HR, CVP
Decreased CO

  • due to activation of sympathetic nervous system

Nagelhout, Ch. 8, pg 94
Nagelhout 7th ed, Ch. 8, pg. 97, table 8.5

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27
Q

Cellular effects of halogenated agents on hemodynamics?

A

Reduce intracelluar Ca2+ concentration in cardiac/vascular smooth muscle

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28
Q

Sevo, Iso, & Des all prolong the _ _ _ _ _ _ interval, leading too?

A
  • QT
  • TD Pointes

Nagelhout, Ch. 8, pg 96

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29
Q

Where do the arrhythmogenic properties of Sevo, Des, & Iso come from?

A

They depress slow response (SA/AV node) & fast response (Atrial/Ventricular musculature, purkinje fibers) action potentials.

  • Leads to bradyarrhthmias

Nagelhout, Ch. 8, pg 96

30
Q

Which inhaled anesthetic is safe to use in patients with a history of Malignant Hyperthermia?

A

N2O

Nagelhout, Ch. 8, pg 99

31
Q

Which drug is used in the treatment of MH?

A

Dantrolene (Ryanodex)

aye!

Nagelhout, Ch. 8, pg 99

32
Q

What is this drug?

A

Isoflurane

Nagelhout 7th ed, Ch. 8, pg. 88

33
Q

What is this drug?

A

Desflurane

Nagelhout 7th ed, Ch. 8, pg. 88

34
Q

What is this drug?

A

Sevoflurane

Nagelhout 7th ed, Ch. 8, pg. 88

35
Q

What is this drug?

A

Halothane

Notice, no ether bridge: R-O-R

Nagelhout 7th ed, Ch. 8, pg. 88

36
Q

What is an ether bridge?

A

R-O-R

Nagelhout 7th ed, Ch. 8, pg. 88

37
Q

What is Blood/Gas solubility?

A
  • Reflects proportion of anesthetic that will be soluble in the blood
  • Indicator of the speed of uptake and elimination

Nagelhout 7th ed, Ch. 7, pg. 81

38
Q

What is overpressuring?

A

During first minutes of gas administration, a higher concentration of drug, or loading dose, is delivered to speed initial uptake

Nagelhout 7th ed, Ch. 7, pg. 82

39
Q

What effect does a high CO have on anesthetic uptake?

A

Increased CO removes more anesthetic from the lungs, which slows the rise in lung and brain concentrations

Nagelhout 7th ed, Ch. 7, pg. 82

40
Q

How much Sevo is metabolized?

A

5-8%

Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4

41
Q

How much N2O is metabolized?

A

<1%

Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4

42
Q

How much Iso is metabolized?

A

<1%

Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4

43
Q

How much Des is metabolized?

A

<0.1%

Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4

44
Q

Hypothermia’s effect on anesthetic induction/emergence?

A
  • Slower induction & Emergence

Nagelhout 7th ed, Ch. 7, pg. 83

45
Q

Hyperthermia’s effect on anesthetic induction/emergence?

A
  • Increased CO –> a increased nesthetic requirement
  • therefore slower induction

Nagelhout 7th ed, Ch. 7, pg. 83

46
Q

How is emergence effected with longer durations of adminstration?

A
  • Emerges slower

Nagelhout 7th ed, Ch. 7, pg. 83

47
Q

In what order are anesthetic gases’s emergence times effected by longer administration?

A

Iso > > Sevo>Des

Higher solubility = more deposit in tissues

Nagelhout 7th ed, Ch. 7, pg. 83

48
Q

Between Sevo, Iso, & Des, which drug would a patient emerge from first?

A

Des

Nagelhout 7th ed, Ch. 7, pg. 84

49
Q

Between Sevo, Iso, & Des, which drug would a patient emerge from last?

A

Iso

Nagelhout 7th ed, Ch. 7, pg. 83

50
Q

What are some places N2O might wander off to?

7

A

Diffuses into air-containing cavities

  • LMA cuff
  • ET cuff
  • Air embolism
  • Pneumo
  • Intraocular air bubbles
  • Intestinal obstruction
  • pneumoperitoneum

Nagelhout 7th ed, Ch. 7, pg. 84

51
Q

Difference in pediatric anesthetic uptake than in adults?

A
  • Uptake is faster
  • Require higher MAC (1.5-1.8 x 40y/o dude)
  • Lower muscle mass -> more to brain

Nagelhout 7th ed, Ch. 7, pg. 84

52
Q

What are risk factors for Emergence Delirium?

A
  • Ages 2-5
  • Anxiety
  • Post-op pain
  • Difficult parent separation behavior

Nagelhout 7th ed, Ch. 7, pg. 84

53
Q

What drugs can be used to reduce Emergence delirium?

A
  • Dexmedetomidine is daddy
  • Fentanyl
  • Propofol
  • Ketamine

Nagelhout 7th ed, Ch. 7, pg. 85

54
Q

Your patient has a R->L shunt, what does this mean for your anesthetics?

A
  • Slows induction of anesthesia
  • Shunted blood mixes with and dilutes blood coming from ventilated alveoli resulting in reduction of alveolar partial pressure of the anesthetic

Nagelhout 7th ed, Ch. 7, pg. 85

55
Q

Your patient has a L->R shunt, what does this mean for your anesthetics?

A
  • Slightly increased rate of anesthetic delivery or uptake into the brain, muscle, and other tissue is a result
  • Causes anesthetic partial pressure in mixed venous blood to increase more rapidly than it would in the absence of a shunt

this is minimal; only with current R-L shunt - but Dr. C has this bolded

Nagelhout 7th ed, Ch. 7, pg. 85-86
Apex

56
Q

What is MAC-Awake?

A
  • Approx. 0.3-0.5 MAC
  • MAC at which 50% of subjects will respond to command “open your eyes”

Nagelhout 7th ed, Ch. 7, pg. 85, Table 7.6

57
Q

What is MAC-BAR?

A
  • MAC necessary to block adrenergic response to skin incision
  • Approx. 1.6-2.0 MAC

Nagelhout 7th ed, Ch. 7, pg. 85, Table 7.6

58
Q

You’re giving a patient anesthetic gas during Cardiopulmonary Bypass, will you have to give more or less, as compared to normal lung inhalation?

A

Higher concentrations of volatile agent are given

  • so more

Nagelhout 7th ed, Ch. 7, pg. 86

59
Q

What are the Halogen elements?

A
  • Fluorine
  • Chlorine
  • Bromine
  • Iodine

Nagelhout 7th ed, Ch. 8, pg. 87

60
Q

What effects does the addition of Halogens do to a gas?

A
  • Flammability
  • Potency
  • Arrhytmogenic properties
  • Stability

Nagelhout 7th ed, Ch. 8, pg. 88

61
Q

What is the EXACT Mechanism of Action of anesthetic gases?

A

It remains elusive

May result from multisite interactions with ion channels in brain

Nagelhout 7th ed, Ch. 8, pg. 88

62
Q

How much MAC do patients usually need during surgery?

A
  • 1.2 to 1.3 x MAC
  • 20-30% More than 1.0 MAC

Nagelhout 7th ed, Ch. 8, pg. 91

63
Q

What does not seem to occur with 1.0 or less MAC of Iso/Des

A
  • CMRO2/CBF uncoupling
    Decreased CMRO2 with increased CBF

Nagelhout 7th ed, Ch. 8, pg. 91

64
Q

What effect do Sevo, Iso, Des & N2O have on Evoked potentials?

A

Dose dependent reduction in EPs

Nagelhout 7th ed, Ch. 8, pg. 93, table 8.4

65
Q

Which evoked potential are the most sensitive to Volatile agents + N2O?

A

Visual evoked potentials (VEP)

Nagelhout 7th ed, Ch. 8, pg. 93, table 8.4

66
Q

Which evoked potential are the least sensitive to Volatile agents + N2O?

A

Brainstem evoked potentials (BEP)

Nagelhout 7th ed, Ch. 8, pg. 93, table 8.4

67
Q

What do Sevo, Iso, Des do to Hemodynamics?

A
  • Decrease CO/CI
  • Decreased MAP (via decreased SVR)
  • Increased HR (except for Sevo)

Nagelhout 7th ed, Ch. 8, pg. 94, 97 table 8.5

68
Q

Which volatile anesthetic(s) is/are implicated with Liver damage?

A

“Halothane Hepatitis”
Rare for Sevo/Iso/Des to cause clinically relevant liver damage

Nagelhout 7th ed, Ch. 8, pg. 98

69
Q

N2O exposure has been linked to what?

A
  • Spontaneous abortion
  • Reduced fertility
    in workers

Nagelhout 7th ed, Ch. 8, pg. 99

70
Q

What Machine related factors affect uptake of anesthetics?

A
  • Drug solubility in rubber/plastic parts
  • Total machine FGF of gases
    * Low FGF slows delivery

too lazy to find it right now

  • don’t worry I got you boo
    Nagelhout, pg. 80

Nurs 575 Anesthesia Pharmacology (9 decks)

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