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anesthesia pharm > Exam 3 Part II > Flashcards

Exam 3 Part II Flashcards

1
Q

an INCREASE in CO will _______________ the onset of action of your INH agent during induction

A

slow

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2
Q

T/F: the more soluble the INH agent, the greater the impact CO has on its speed of onset

A

TRUE

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3
Q

majority of blood/agent from lungs goes to the ___________________

A

vessel rich group

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4
Q

N2O will increase ___________________ in closed spaces, and increase ____________ expandable tissues

A

pressure; volume

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5
Q

N2O is ___________x more soluble in the body than nitrogen

A

34

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6
Q

anywhere ______________ can exist in the body, N20 can occupy and expand

A

nitrogen

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7
Q

what areas would you expect an increase in pressure with N2O, thus its use is c/i with these procedures

A

Middle ear paranasal sinuses cerebral ventricles eyeball

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8
Q

T/F: you may have to adjust the volume of the cuff in cuffed equipment with nitrous use

A

TRUE

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9
Q

what equipment could be expanded with use of N20

A
  1. ETT cuff 2. LMA cuff 3. PA catheter tip
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10
Q

75% N2O will expand pneumothorax, ______________ size in 10 min, and __________ size in 30 min

A

double; triple

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11
Q

in compliant spaces (volume) - with use of N20 the space will expand until when?

A

sufficient pressure is generated to further oppose N2O flows

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12
Q

T/F: N2O is a great gas choice for your trauma patients

A

FALSE

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13
Q

why is uptake of INH agents faster in children than adults

A

INH agent is less blood soluble –> faster tissue uptake

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14
Q

neonates (first 28 days of life) have a _______________ MAC

A

decreased

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15
Q

infants and children have _____________x higher MAC than a 40 y/o adult

A

1.5-1.8x

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16
Q

during what age is MAC the highest?

A

1mo - 6 mo of age

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17
Q

adverse reaction of INH agents in pediatric

A

emergence delirium

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18
Q

the ____________ the child the greater risk of emergence delirium

A

younger

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19
Q

interventions to decrease emergence reactions/agitation in pediatrics

A
  1. allow parental presence on induction 2. pain control 3. meds: fentanyl, precedex, propofol, ketamine
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20
Q

T/F: precedex is FDA approved for emergence delirium prevention in pediatric populations

A

FALSE

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21
Q

T/F: obesity will have a clinical effect on INH uptake

A

FALSE

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22
Q

INH agent effects with obesity

A
  1. no clinical effect on uptake 2. may have prolonged emergence/recovery with long procedures (>4 hrs) d/t saturation of tissues
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23
Q

INH anesthetics effects with pregnancy

A
  1. increased uptake 2/2 increased MV 2. decreased uptake 2/2 increased CO these two things normally cancel eachother out –> uptake being similar to non-pregnant women
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24
Q

soda lime allows for rebreathing by conserving ________, ___________, & _________ without rebreathing ____________

A

O2, N20, & humidity; CO2

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25
Q

if you increase FGF = _____________ your absorption in your soda lime

A

decrease

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26
Q

soda lime will help prevent what metabolic imbalance

A

respiratory acidosis

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27
Q

if your soda-lime exhausts intraoperatively you should _________________

A

increase FGF to help blow off CO2

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28
Q

T/F: CO poisoning is difficult to detect under GA

A

TRUE

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29
Q

degradation of soda lime produces _______________ especially if the soda lime is _______________

A

CO; dry

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30
Q

what agents produce CO in soda lime

A

desflurane and isoflurane (w/ des > iso)

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31
Q

_____________ & __________ produce very little CO in soda lime

A

halothane and sevoflurane

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32
Q

sevoflurane degrades to __________________ which is toxic to the ____________

A

compound A; kidneys

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33
Q

you should not administer sevoflurane at _____ hrs due to nephrotoxicity

A

2; 2

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34
Q

you can have increased production of compound A in what situations?

A
  1. low flow 2. closed circuit systems 3. warm or very dry CO2 absorbant
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35
Q

drying of soda lime is a ________________ reaction

A

exothermic

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36
Q

all commonly used INH agents are either __________________ or ______________

A

ethers; hydrocarbons (alkanes)

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37
Q

which Inhalational agent is the only one that is an alkane

A

halothane

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38
Q

which inhalational agent is the only one that has Bromine added?

A

halothane

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39
Q

INH agents can be straight or branched hydrocarbons, but they cannot consist of more than ___________ carbon atoms

A

4

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40
Q

T/F: anesthetic effect of INH agent is lost if there are more than 4-5 carbon atoms

A

TRUE

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41
Q

halogenation of hydrocarbons and ethers include the addition of __________, __________, _________ or _________

A

flourine, bromine, chlorine, idodine

42
Q

isoflurane has __________ fluorine’s added to it, desflurane has __________ F added to it, and sevoflurane has _________ F added to it

A

5; 6; 7

43
Q

what are the effects (advantages) of halogenation

A
  1. reduces flammability 2. increase potency 3. increases brain solubility 4. decrease arrhythmias 5. more stable
44
Q

halogenation reduces __________________

A

flammability

45
Q

fluorination reduces _________________ in blood and fat

A

solubility

46
Q

triflourocarbon groups (to INH agents) add _________________

A

stability (longer storage)

47
Q

halogenated alkanes precipitate _______________

A

arrythmias (ex: halothane)

48
Q

___________ halogens = arrhythmogenic; __________ halogens, arrhythmias are no longer an issue

A

5 ; 6

49
Q

the more fluorines the ____________ resistant to biodegradation

A

less

50
Q

place the INH agents in order from most metabolized to least

A

halothane > enflurane > sevo > iso > desflurane > N20

51
Q

where do we THINK inhalational agents are working in the CNS?

A

neocortex hippocampus amygdala diencephalon (thalamus) brainstem (reticular formation) spinal cord

52
Q

effects of INH agents in the CNS

A
  1. sedation 2. amnesia 3. unconsciousness 4. immobility
53
Q

unitary hypothesis of how INH work?

A

all work via a similar although undefined MOA but not necessarily at the same site of action

54
Q

INH agents are defined as _________________ meaning they are both hydrophillic and lipophillic

A

amphipathic

55
Q

T/F: effects of INH agents are dose related

A

TRUE

56
Q

what is the meyer Overton Theory

A

correlation between lipid solubility and potency of gas has been debunked bc does not apply to all gases

57
Q

Unconsciousness effect of INH agents is due to effects where?

A

cortex, thalamus, and brainstem

58
Q

amnesia effects of INH agents is due to the effects where?

A

amygdala and hippocampus (working on GABA by increasing Cl conductance)

59
Q

analgesia effects of INH agents are due to the action where?

A

spinothalamic tract (of the spinal cord)

60
Q

immobility effects of INH agents are due to the action where?

A

spinal cord , central pattern generators (via potentiation of glycine R)

61
Q

volatile agents inhibit ______________ release and antagonize ______________ receptors –> CNS depression

A

glycine; glycine

62
Q

profile of the ideal INH agent

A
  1. able to produce unconsciousness, analgesia, and immobility 2. pleasant smell/non bronchial irritant 3. low B:G solubility 4. stable in storage 5. non-flammable; non-explosive 6. non-toxic, non-allergenic 7. readily reversible CNS effects 8. sufficient potency (so can use high FiO2/low MAC) 9. minimal depression of CV and respiration 10. no interactions with other drugs 11. eliminated completely, rapidly, unchanged via lungs
63
Q

how do you calculate pts MAC level

A

ET of the anesthetic agent /MAC of the agent

64
Q

factors that influence s/e of INH agents

A
  1. anesthetic concentration 2. patient age 3. coexisting dz 4. IV fluid volume (low vol –> Hypotension) 5. preoperative meds 6. additional IV anesthetics 7. variations from normocapnia 8. concomitant drug therapy 9. alteration in body temperature
65
Q

CNS effects of INH agents

A
  1. decreased CMRO2 2. increase or decrease or no effect on CBF 3. uncoupling 4. dose related suppression of EEG and Evoked potentials (increase latency or decrease amplitude) 5. cerebral vascular response to CO2 (normally vasoconstrict to hypocapnia, no effect with volatiles)
66
Q

effects on CBF is dependent on?

A
  1. dose of volatile 2. administration of other drugs (narcotics, propofol, nitrous 3. Mv - rate of change in CO2
67
Q

Which action potential (evoked potential) is the most resistant to changes in the presence of volatiles

A

brainstem evoked potentials

68
Q

which evoked potentials are the most sensitive to changes 2/2 volatile anesthetics

A

visual evoked potentials

69
Q

increased latency or decreased amplitude on evoked potentials is a sign of what

A
  1. ischemia 2. use of volatiles
70
Q

T/F: all volatiles effect latency of evoked potentials equally

A

TRUE

71
Q

what are your best INH agents for neuromonitoring cases

A

sevo or des

72
Q

__________________ can produce epileptiform changes on EEG during induction and emergence

A

sevoflurane

73
Q

the incidence of seizures with sevoflurane doubles in the presence of ________________

A

hypocapnia

74
Q

If increased ICP is suspected during your case, what should you do

A

turn off the volatiles & switch to TIVA

75
Q

T/F: INH agents are okay to use for patients with elevated ICP

A

FALSE

76
Q

cerebral autoregulation is maintained with all INH anesthetics except ____________________

A

halothane

77
Q

all volatiles decrease CMRO2 except _______________

A

N20 = slight increase in CMRO2

78
Q

CNS recieves _____________% of CO and consumes _____________% of oxygen under normal conditions

A

20; 20

79
Q

what two INH gases are the standard agents for inhalational inductions?

A

sevoflurane; N2O

80
Q

why are sevo and N20 used for inhalational inductions?

A

low incidence of breath holding, coughing, secretions, and laryngospasm

81
Q

respiratory effects of INH agents (in spont ventilating pt)

A
  1. dose dependent depressant effect 2. decrease TV and increase RR 3. increased PaCO2 & decreased Mv 4. bronchodilation
82
Q

dose dependent respiratory depression of INH anesthetics occurs in the _______________ and is due to ________________

A

medullary ventilatory center; blunts CNS response (2/2 increased PaCO2 and decreased PaO2)

83
Q

INH agents in the lungs cause ____________2/2 CNS effect, but locally are _________________

A

bronchodilation; bronchoconstriction

84
Q

why may you have increased secretions at the end of a general anesthetic case (with INH agents)

A

INH agents decrease ciliary movement –> increased secretions

85
Q

respiratory considerations with INH agents on emergence

A
  1. be mindful of hypercarbia 2. Et of volatiles may persist with recent narcotic administration 3. 0.1 MAC (except desflurane) can inhibit response to hypoxia
86
Q

T/F: PVR is unchanged by inhalational agents

A

TRUE

87
Q

kidneys recieve ___________% of CO

A

20

88
Q

T/F: autoregulation of kidneys stays intact with INH agent administration

A

TRUE

89
Q

what UOP is adequate for an anesthetic case?

A

0.5 mL/kg/hr

90
Q

which inhalational agent alters renal integrity the LEAST?

A

desflurane

91
Q

describe the effects of INH agents on the kidneys (general)

A

they decrease SBP –> decreased renal vascular resistance –> decreased GFR –> decreased intraoperative urine output

92
Q

compound A (from sevo) causes ________________________ in rats

A

proximal corticomedullary tubular necrosis

93
Q

sevo + dessicated soda lime = __________________

A

anesthesia machine fire

94
Q

sevo + soda lime = _______________________

A

compound A (theorized to be nephrotoxic) + compound B

95
Q

to determine renal damage, you would evaluate the level of increase in?

A
  1. Cr 2. BUN 3. serum inorganic fluoride concentrations
96
Q

which inhlational agent causes volatile induced hepatotoxicity THE MOST

A

halothane

97
Q

all volatile anesthetics _______________ total hepatic blood flow

A

decrease

98
Q

all volatile anesthetics ____________ hepatic artery blood flow EXCEPT ___________

A

increase/maintain; halothane

99
Q

T/F: volatile anesthetics decrease portal vein flow

A

false, portal vein flow changes are very limited by INH agents

100
Q

increased __________________ helps to resist hepatic degradation

A

fluroination

anesthesia pharm (18 decks)

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