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Advanced Pharmacology ANE 8433 (Spring 2023) > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What 3 things does diffusion depend on?

A
  • Partial pressure gradient of the gas.
  • Solubility of the gas.
  • Membrane thickness
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2
Q

What is a good indicator of anesthesia depth & recover from anesthesia?

A

Alveolar pressure

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3
Q

What are the 3 partial pressure gradients?

A
  • Anesthetic machine to alveoli (Boyle).
  • Alveoli to Blood.
  • Arterial blood to brain
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4
Q

What affects VA uptake from alveoli to blood?

A
  • Blood: gas partition coefficient.
  • Cardiac Output.
  • A-v partial pressure difference
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5
Q

What affects VA uptake from blood to brain?

A
  • Brain: blood partition coefficient.
  • Cerebral blood flow.
  • a-v partial pressure difference.
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6
Q

What affects VA input from machine to alveoli?

A
  • Inspired partial pressure.
  • Alveolar ventilation (RR & volume).
  • FRC.
  • Anesthetic breathing system (re-breathing)
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7
Q

What is the main concept of Pt’s going to sleep?

A

Concentration effect

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8
Q

What is over pressurization?

A

Used in emergencies to get someone to sleep fast. Crank up VA for a few breaths until asleep then dial back down.

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9
Q

What is the second gas effect?

A
  • The use of N2O with another volatile gas.
  • N2O helps create a higher concentration gradient & increases uptake of 2nd volatile gases in the alveoli leading to faster equilibrium.
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10
Q

When should nitrous not be used & why?

A
  • In bowel, ear, eye Sx or Pt’s with a pneumothorax.
  • N2O diffuses very fast into air-filled cavities then expands creating pressure build-up.
  • Very bad in non-compliant areas like eyes & ears.
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11
Q

What does inhaled gases solubility look at?

A

A distribution ratio of VA between 2 compartments at equilibrium.

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12
Q

How does temperature affect solubility of VA?

A

Increased blood temp decreases solubility

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13
Q

If blood solubility is high, then induction is?

A

Prolonged as large amounts of the VA must be dissolved.

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14
Q

List the VA in order from high to low solubility.

A

Halothane,
Isoflurane,
Sevoflurane,
Desflurane,
N2O

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15
Q

What is the Blood: Gas Partition coefficient for Halothane?

A

2.54

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16
Q

What is the Blood: Gas Partition coefficient for Enflurane?

A

1.90

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17
Q

What is the Blood: Gas Partition coefficient for Isoflurane?

A

1.46

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18
Q

What is the Blood: Gas Partition coefficient for Sevoflurane?

A

0.69

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19
Q

What is the Blood: Gas Partition coefficient for Desflurane?

A

0.42

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20
Q

What is the Blood: Gas Partition coefficient for Nitrous oxide?

A

0.46

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21
Q

What 3 VA has the highest Fat: Blood coefficient?

A

Halothane
Sevoflurane
Isoflurane

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22
Q

What VA has the lowest Fat: Blood coefficient?

A

Nitrous oxide

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23
Q

What is 1.3 MAC?

A

The percentage of gas when 99% of Pt’s do not move.

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24
Q

What is MAC awake?

A
  • 0.3-0.5 MAC, the point a Pt may open their eyes.
  • Only VA is used.
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25
Q

What happens in MAC bar?

A

No SNS response when intubating only using a VA

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26
Q

MAC is based on what 3 things?

A
  • Age 30-55y/o
  • Temp of 37 degrees C.
  • Pressure of 1atm
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27
Q

What is the MAC of N2O?

A

104%

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28
Q

MAC changes how much per decade?

A

6%

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29
Q

MAC peaks at?

A

1 year old

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30
Q

What 4 things increase MAC?

A
  • Hyperthermia.
  • Excess pheomelanin.
  • Drug-induced increases in catecholamines.
  • Hypernatremia
31
Q

What decreases MAC?

A
  • Anything that decreases metabolism
  • Alpha-2 agonists
  • Acute EtOH
  • Pregnancy
  • Lidocaine
  • MAP <40 mmHg
  • Hyponatremia
  • Cardiopulmonary bypass
  • PaO2 <38
  • Post-partum <72hrs
32
Q

How do VA affect spinal mobility?

A
  • Depress AMPA & NMDA (glutamate receptors).
  • Enhance glycine.
  • Act on Na+ channels (block presynaptic glutamate release)
33
Q

How do VA act on the brain?

A
  • Inhibit GABA transmission (Especially in RAS).
  • Potentiate glycine activity in brainstem.
  • Do not affect AMPA, NMDA or kainite
34
Q

What is vapor pressure?

A

The pressure at which vapor and liquid are at equilibrium

35
Q

What does Henry’s law state?

A

The amount of dissolved gas in a liquid is proportional to its partial pressure above the liquid.

36
Q

What is the vapor pressure for desflurane?

A

669 torr

37
Q

What is the vapor pressure for sevoflurane?

A

157 torr

38
Q

What is the vapor pressure for halothane?

A

243 torr

39
Q

What is the vapor pressure for enflurane?

A

175 torr

40
Q

What is the vapor pressure for isoflurane?

A

238 torr

41
Q

List the VA from lowest to highest vapor pressure?

A
  • Sevoflurane,
  • Enflurane,
  • Isoflurane,
  • Halothane,
  • Desflurane
    (SEIH)
42
Q

An increased splitting ratio means?

A

More carrier gas is going through the vaporizer, picking up VA.

43
Q

What is the MAC & MAC 1.3 of Halothane?

A
  • 0.75%
  • 0.975%
44
Q

What is the MAC & MAC 1.3 of Enflurane?

A
  • 1.63%
  • 2.12%
45
Q

What is the MAC & MAC 1.3 of Isoflurane?

A
  • 1.17%
  • 1.52%
46
Q

What is the MAC & MAC 1.3 of desflurane?

A
  • 6.6%
  • 8.58%
47
Q

What is the MAC & MAC 1.3 of sevoflurane?

A
  • 1.8%
  • 2.34%
48
Q

When is a priming dose given?

A

When intubating with Scc

49
Q

NDMB are antagonized by?

A

Anticholinesterase drugs

50
Q

Why is there fade with NDMB?

A

Some fibers are more susceptible to NDMB

51
Q

What cardiac receptors are agonized by NDMBs?

A
  • Cardiac muscarinic
  • nACh-r at automatic ganglia
52
Q

Which NDMB’s ED95 is the same as the TD?

A

Pancuronium

53
Q

Who is at risk for critical illness myopathy?

A

Pt’s with MODS, who were ventilated > 6days

54
Q

What class of NDMB was given to someone that developed critical illness myopathy?

A

Aminosteroid blocker

55
Q

Altered response with VA happens due to?

A

Dose dependent inhibition of nACh-r –> prolonged response @ nACh-r

56
Q

What blocker is dosed on actual body weight?

A

Succinylcholine

57
Q

How do diuretics, corticosteroids, reglan & LA affect NDMB?

A
  • Prolong blockade.
  • Increase ACh release.
  • Depress cholinesterase activity.
  • Depress nerve conduction
58
Q

How does magnesium affect NDMB?

A
  • Enhance blockade.
  • Decrease presynaptic ACh release.
  • Decrease postsynaptic membrane sensitivity
59
Q

Which NDMB are very sensitive to hypothermia?

A

Vecuronium & Pancuronium –> doubles the duration

60
Q

How does acute hypo & hyperkalemia affect NMB?

A

Hypokalemia:
- leads to resistance to Scc.
- Increased sensitivity to NDMB.
Hyperkalemia:
- Increased effect of Scc.
- Resistance to NDMB.

61
Q

What is the timeframe of resistance to NDMB in burn Pt’s?

A

10 after burn up to 60 days.

62
Q

How can the resistance to NMB in burn Pt’s be overcome?

A

Give 1.2 mg/kg of Rocuronium

63
Q

Which NDMB is least & most likely to cause an allergic reaction?

A
  • Least: Cisatracurium
  • Most: Scc
64
Q

What is the dose, onset, duration & class for Pavulon?

A
  • Dose: 0.1 mg/kg
  • Onset: 3-5mins
  • Duration: 60-90mins.
  • Aminosteroid
65
Q

Which NDMB should not be given for renal transplant Sx?

A

Vecuronium(Norcuron)

66
Q

How do acidosis & NDMB relate?

A
  • If acidotic prior to NDMB then blockade will remain the same.
  • If NDMB is given and then Pt becomes acidotic then blockade is prolonged.
67
Q

Which NDMB’s degradation is affected by pH & temp?

A

Nimbex (Cisatracurium) & Atracurium

68
Q

When is a larger dose of Pancuronium dose needed?

A

In liver failure

69
Q

What are the pros of N2O?

A
  • Does not cause muscle relaxation
  • Does not blunt HPV
  • Does not cause cardiac depression / minimal arrhytmia
  • Slight increase in CO
  • No N/V with <0.5 MAC
  • Useful for mom’s post-delivery d/t analgesic effects without opioids
70
Q

What are the cons of N2O?

A
  • Do not give to pregnant ppl w/ B12 deficiency
  • Causes bone marrow suppression
  • Increase in myocardial events w. atherosclerosis
  • Increases PVR
  • Do not use in ear, eye, abdominal & pneumothorax cases
71
Q

Who should not receive N2O?

A
  • pregnant w/ low B12
  • atherosclerosis
  • osteoporosis
  • anemic Pt’s
  • immune suppressed
  • pulmonary HTN Pt’s
  • eye, ear or abd Sx
72
Q

What are the pros (2) of Halothane?

A
  • Bronchodilation
  • Low risk for N/V
73
Q

What are the cons (6) of Halothane?

A
  • Increases ICP & CBF
  • Decreases portal vein flow
  • Arrhythmias
  • Hepatic necrosis
  • Pediatric bradycardia
  • Decomposes into HCL acid
74
Q

Who should not receive Halothane?

A
  • Pt’s wtih ESRD
  • hepatic failure
  • neuro Pts
  • Pt’s w/ arrhythmias

Advanced Pharmacology ANE 8433 (Spring 2023) (16 decks)

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