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anesthesia pharm > Exam 3 Part III > Flashcards

Exam 3 Part III Flashcards

1
Q

liver receives ___________% of CO

A

25

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2
Q

hepatic artery supplies ___________% of blood flow to the liver, and the portal vein supplies _______% of blood flow to the liver, both supplying ____% of O2

A

25; 75; 50

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3
Q

prior exposure to _________________ can cause hepatitis with a current exposure to another (different) volatile

A

halothane

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4
Q

what is volatile induced hepatotoxicity

A
  1. decrease hepatic blood flow + increased O2 demand of enzyme induction –> liver dysfunction 2. develops 2/2 decreased hepatic blood flow 3. can occur hours - days post anesthetic
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5
Q

T/F: all volatile inhalational agents have very little liver metabolism

A

TRUE

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6
Q

s/sx of volatile induced hepatotoxicity

A
  1. fever 2. jaundice 3. increased LFTs
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7
Q

volatile induced hepatotoxicity is aka __________________

A

halothane hepatotoxicity

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8
Q

all volatile anesthetics produce a ___________________ relaxation of skM EXCEPT ___________ which may cause skM rigidity

A

dose-dependent ; N20

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9
Q

all volatile anesthetics _______________ the effects of DMR and NDMR

A

potentiate

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10
Q

mechanism at which volatiles produce skM relaxation

A
  1. decrease neural activity within the CNS 2. decrease effect at the NMJ (Predominantly post-synaptic membrane)
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11
Q

NDMR doses are decreased by _______________% in the presence of a volatile gas

A

15-50

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12
Q

time dependent potentiation of NDMR via volatile agent begins in ___________ min

A

10-May

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13
Q

after 30 minutes of exposure to sevoflurane, recovery from vecuronium to 25% of baseline is prolonged __________%

A

89

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14
Q

after 60 minutes of exposure to INH agent, the recovery from NDMR to 25% of baseline is prolonged by ________%

A

100

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15
Q

effects of Iso on: CO SVR MAP HR

A

CO - decreased SVR - decreased MAP - decreased HR - increased

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16
Q

effects of Sevo on CO SVR MAP HR

A

CO - maintained SVR - decreased MAP - decreased HR - maintained

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17
Q

effects of desflurane on: CO SVR MAP HR

A

CO - maintained SVR - decreased MAP - decreased HR - increased

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18
Q

effects of N20 on: CO SVR MAP HR

A

CO - decreased SVR - increased MAP - maintained HR - increased

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19
Q

ISO, SEVO, and DES ______ MAP, CO, CI via a ______ in SVR 2/2 ________________

A

decrease; decrease; reduction in intracellular free Ca

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20
Q

Halothane decreases MAP by?

A

direct myocardial depression

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21
Q

which volatile inhalational agent is SUPPORTIVE of HD

A

N2O

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22
Q

inhalational agents will cause dose dependent depression of what cardiac activity?

A
  1. myocardial contractility 2. peripheral vascular smooth muscle 3. inhibition of ANS activity
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23
Q

HR effects of inhalational agents

A
  1. antagonism of SA node automaticity 2. modulation of the baroreceptor reflex 3. SNS activation
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24
Q

which INH agent increases HR the most

A

desflurane

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25
Q

INH (ether) agents reduce intracellular free calcium this has what effect on the myocardium and peripheral vasculature

A

depression of myocardium and dilation of peripheral vasculature

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26
Q

inhalational agents, esp ____________ should be cautioned in those with ________ 2/2 HR effects

A

des; CAD

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27
Q

increase in HR with inhalational agents can be modulated (but not ablated) with ______________ 5 min prior to induction before an increase in desflurane concentration

A

fentanyl

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28
Q

what dose of fentanyl can give up to 70% modulation of increase in HR prior to increase desflurane concentration

A

1.5-4.5 mcg/kg

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29
Q

_________________ will block the increase in HR but not the decrease in MAP with inhalational agents

A

esmolol

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30
Q

INH agents effects on coronary blood flow

A
  1. produce vasodilation 2. cause coronary steal syndrome in diseased coronarys
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31
Q

which INH agent causes vasodilation the LEAST

A

sevo

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32
Q

which INH agents may be used in pts with hx of ischemic heart disease

A
  1. iso 2. sevo 3. des
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33
Q

common arrhythmias with inhalational agents

A

bradycardias and AV conduction abnormalities

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34
Q

which INH agents produce arrhythmias the most

A

sevo and halothane

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35
Q

sevo and halothane are c/i if the patient has what arrhythmias

A

2nd degree AV block type II, complete heart block

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36
Q

what is “sensitization” (with arrhythmias)

A

reduction in catecholamine threshold necessary to produce arrhythmias

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37
Q

_______________ may protect the myocardium from coronary steal syndrome

A

50% N20

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38
Q

what is hypoxic pulmonary vasoconstriction

A
  1. natural compensatory mechanism in response to hypoxia or atelectasis 2. pulmonary arterioles constrict w/ alveolar hypoxia –> diversion of blood flow away from poorly ventilated alveoli 3. reduces pulmonary shunt, reduces V/Q mismatch
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39
Q

when are INH agents at risk of decreasing hypoxic pulmonary vasoconstriction?

A

in one lung situations

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40
Q

Enflurane CNS effects

A
  1. increase CBF 2. increase ICP 3. increase CSF 4. produces seizure activity
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41
Q

MAC of enflurane

A

1.7

42
Q

B: G solubility of enflurane

A

1.9

43
Q

Vapor pressure of enflurane

A

175

44
Q

% of enflurane that is metabolized

A

8-Feb

45
Q

enflurane is toxic to the _______________

A

kidneys

46
Q

T/F: enflurane is stable and not effected by light, has no preservatives

A

TRUE

47
Q

which agent causes coronary vasodilation more than any other INH agent?

A

isoflurane

48
Q

which agent causes coronary steal more than any other agent

A

isoflurane

49
Q

which INH agent is the most potent (of commercially available agents in US)

A

isoflurane

50
Q

______________ increases CBF and ICP @ 1 MAC

A

isoflurane

51
Q

which agent increases CBF less than any other INH agent

A

isoflurane

52
Q

which agent decreases CMRO2 less than any other INH agent

A

isoflurane

53
Q

which INH agent is considered cerebral protective

A

isoflurane (means the CBF at which ischemic changes occur on EEG is lower with isoflurane than other agents)

54
Q

respiratory effects of isoflurane

A
  1. decrease TV 2. increase RR (slight) 3. decrease MV 4. increase PaCO2 5. bronchodilator
55
Q

what is the most widely used INH agent

A

isoflurane

56
Q

metabolism of isoflurane

A

0.20%

57
Q

isoflurane _________ RBF –> ______ GFR and UOP

A

decrease; decrease

58
Q

what is the only volatile that undergoes reductive metabolism

A

halothane

59
Q

which agent decreases MAP from direct myocardial depresson

A

halothane

60
Q

which agent increases the incidence of ventricular arrhythmias

A

halothane

61
Q

which agent has NO impact on SVR

A

halothane

62
Q

which agent increases the arrhythmic potential of epi

A

halothane

63
Q

respiratory effects of halothane

A
  1. bronchodilator 2. increased RR 3. decreased TV 4. decreased response to CO2 (less than other agents) 5. hypoxic drive severely depressed
64
Q

CNS effects of halothane

A
  1. increased CBF 2. increased ICP (more than all other agents) 3. decreased CMRO2 4. autoregulation is blunted and completely abolished at high concentrations
65
Q

which INH agent increases ICP the MOST

A

halothane

66
Q

which INH agent is metabolized more than any other agent

A

halothane (20%)

67
Q

which agent is the most hepatotoxic

A

halothane

68
Q

which inhalational agent is metabolized via oxidation/reduction reactions

A

halothane

69
Q

______________ is added as preservative to halothane to enhance stability

A

thymol

70
Q

major metabolites of halothane

A
  1. trifluoroacetic acid (TFA) 2. free bromide 3. free chloride
71
Q

T/F: metabolism of halothane increases with repeated exposures

A

true - 20% first exposure, increases from there

72
Q

which inhalational agent is the LEAST potent

A

desflurane

73
Q

which INH agent is the least soluble

A

Desflurane

74
Q

which INH agent (other than N2O) has the highest MAC

A

desflurane

75
Q

which INH agent is the most expensive

A

desflurane

76
Q

CV effects of desflurane

A
  1. rapid increase in des –> transient increase in HR 2. does NOT increase coronary artery blood flow
77
Q

why does desflurane require a special heated and pressurized vaporizer

A

because vapor pressure is so high (664) and close to atmospheric, it is a gas at room temperature

78
Q

____________________is pungent, airway irritant that has high risk of coughing and laryngospasm if administered while pt is awake

A

desflurane

79
Q

__________________ is a great gas for pts who are super morbidly obese and/or have liver dz

A

desflurane

80
Q

which INH agent is the LEAST irritating to the airway

A

sevoflurane

81
Q

sevoflurane is __________% metabolized

A

5-Feb

82
Q

metabolites of sevoflurane

A
  1. inorganic fluoride 2. hexafluoroisopropanol
83
Q

what gas is a methyl isopropyl ether

A

sevoflurane

84
Q

sevoflurane will spontaneously degrade in _______________ bottles, so must be kept in ___________ or __________ bottle

A

glass; plastic; metal

85
Q

what is the MAC of Xenon

A

71%

86
Q

what is the B:G solubility of Xenon

A

0.14

87
Q

why is xenon not able to be used as an inhalational anesthetic

A

because MAC = 71% so you would only be able to use 29% O2

88
Q

induction and emergence with xenon is _________________ x faster than desflurane or sevoflurane

A

4-Mar

89
Q

xenon advantages as inhalational agent

A
  1. non-explosive 2. minimal cardiac depression 3. no metabolic effects 4. not harmful to the environment
90
Q

disadvantages of xenon as inhalational anesthetic

A
  1. potential risk of recall 2. extremely high cost 3. MAC of 71%
91
Q

________________________ has hindered the acceptance of xenon into clincial practice

A

extremely high cost

92
Q

anesthetic effects of N2O and other volatile agents are _________________

A

additive

93
Q

N2O usually used in concentrations of __________ - ___________% to reduce the requirement of more potent agents

A

50; 70

94
Q

basic characteristics of N2O

A
  1. stored as a liquid and a gas in pressurized tanks (@ 50 atm) 2. Non flammable 3. BUT DOES support combustion 4. least potent of all gases 5. minimal toxicity 6. stable at room temperature 7. does not react with soda lime or other anesthetic drugs 8. almost entirely eliminated through the lung
95
Q

analgesic effect of 50% N20 is approximately equal to __________

A

10 mg morphine

96
Q

approximately __________% of N20 undergoes metabolism

A

1

97
Q

absolute c/i of N20

A
  1. known deficiency of enzyme or substrate in methionine synthase pathway 2. potential toxicity from expansion of gas filled space (emphysema, pneumothorax, middle ear surgery, pneumocephalitis, air embolus, bowel obstruction)
98
Q

relative C/I to use of N20

A
  1. increased ICP 2. pulmonary HTN 3. prolonged anesthetic (> 6 h) 4. first trimester of pregnancy 5. high risk PONV
99
Q

CNS effects of N2O

A
  1. increased CBF- potent cerebral vasodilator (not good for neuro cases) 2. minimal increase in CMRO2 3. minimal EEG changes 4. no effect on cerebral autoregulation 5. big increase in PONV (d/t activation of CTZ and vomiting center)
100
Q

CV effects of N20

A
  1. no effect on HR, CO, BP 2. no significant changes in EKG 3. mild, transient, stimulation of SNS 4. increase PVR (issue with pulm htn)

anesthesia pharm (18 decks)

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