exam 1 test rvw

Question 1

The sodium/potassium pump is responsible for? (choose 2)

Answer 1

Maintains oncotic equilibrium
Creates sodium gradient

Extra: 3 sodium out 2 potassium in, responsible for transmembrane electrical potential.

Question 2

Tell me about halothane in regards to potency, onset, recovery, and vapor malfuctions?

Answer 2

High potency, quick onset and recovery

Vapor malfunction caused by thymol

Question 3

Plasma fluoride concentration is higher after administration of sevoflurane than enflurane, but exposure of renal tubules to fluoride is limited because most elimination is through the?

Answer 3

Lungs

Question 4

what can you do with Sevo in order to prevent the breakdown of compound A?
How does Sevo eliminate hydrogen fluoride?

Answer 4

Though controversial, 2 L/min of fresh gas flow prevents the breakdown of compound A

CO2 absorbents react with sevoflurane to eliminate hydrogen fluoride

Question 5

The ratio between the LD50 and ED50?

Answer 5

Therapeutic index (TI)

Question 6

The time required to change the amount of drug in the by body by ½ during elimination (or during a constant infusion) represented by? (give me a formula)

Answer 6

0.7 x Vd/Cl

Question 7

Classification of propofol?

Answer 7

GABA agonist

Question 8

Malignant hyperthermia moa?

Answer 8

Constant leak of Ca through ryanodine receptors

Question 9

Greatest to least hepatic effects for volatile anesthetics?

order iso, enfl, halo, and des

Answer 9

Halothane>Enflurane>Isoflurane>Desflurane

Question 10

properties of inhaled anesthetics, what is true about concentration and effects?

Answer 10

The higher the concentration of gas, the quicker the effects take place

Question 11

what receptors do inhaled anesthetics work on? MOA?

Answer 11

Gaba receptor

influx of Cl- ions into the cell to hyperpolarize cells

Question 12

Most soluble anesthetic gas in blood, RANK the top 4.

Answer 12

Sevoflurane was the answer on the exam.

halo, enflurane, iso would be even more blood soluble correct?

Question 13

Which of the following was true in regards to Desflurane (Choose 2) tell me the boiling point and vapor pressure (also blood:gas)

Answer 13

Boiling Point 22.8
Vapor Pressure 669

Extra: blood:gas 0.42
molecular weight 168

Question 14

Sevo blood gas solubility?

Answer 14

0.69

Question 15

Formula for calculating plasma osmolarity.

Answer 15

2(Na)+0.055(GLU)+0.36(BUN)

Question 16

Which of the following is NOT a part of pharmacokinetics?

Answer 16

Bioavailability

Extra: pharmacokinetics would be absorption, distribution, metabolism, and excretion (what the body does to a drug).

Question 17

What is true of hydrolysis: (give me two)

Answer 17

hydrolysis does not involve P450
Succs is broken down in the plasma by hydrolysis

Extra: occurs outside of the liver, also remifentanil, esmolol and ester LA are broken down by plasma via ester hydrolysis like Succs.

Question 18

Na Atpase pump:(what goes in and what comes out)

Answer 18

3Na out

2K in

Question 19

Chronic Alcoholic requiring more anesthetic gases, why?

Answer 19

Chronic alcoholism causes increased metabolism due to enzymes that break down the drug faster.

Question 20

What is the order of potency for morphine? (order hydromorphone, morphine, sufent, and fent)

Answer 20

Sufentanil > fentanyl > Hydromorphone > morphine

Question 21

Which drug is the least Protein binding?

Answer 21

Procaine–exam answer

tech. chloroprocaine would be correct bc it has none but I assume it was not an option on exam?

Question 22

Exogenous epi dose

Answer 22

6mcg/kg

Question 23

Which volatile agent causes transient increase in HR?

Answer 23

Desflurane

Question 24

Malignant hyperthermia is caused from? (choose two)

Answer 24

Succinylcholine

Continuous release of calcium from the ryanodine receptor.

extra: volatile anesthetic gas would also be correct

Question 25

What is the process of allowing temporary pre-op myocardial ischemia to prepare a patient for surgery?

Answer 25

Ischemic preconditioning

Question 26

Which of the following gasses has a blood gas solubility that allows for rapid rise to equilibrium? (most rapid gas that we actually use)

Answer 26

Desflurane (most soluble)

Question 27

Which gas is used as the first gas of the second gas effect?

Answer 27

Nitrous oxide

Question 28

Gas that enters the mouth, pharynx, and trachea but does not reach the alveoli is referred to as?

Answer 28

Anatomical dead space

Question 29

What is not stable in soda lime? (gas wise)

Answer 29

Sevo

Question 30

The graph that has LD1 and ED99 and asks you which one does the CRNA want, where do you put the x?

Answer 30

you want it as close to ED99, like right on the line (third space basically), in between LD1 and ED 99

Question 31

what LD and ED describes the need for vigilance?

Answer 31

LD1, ED99

Question 32

Therapeutic index is not optimal. What is a more effective ratio for anesthesia?

Answer 32

LD1, ED99

Question 33

What is the therapeutic index?

Answer 33

LD 50, ED 50

Question 34

A drug infused at a constant rate reaches 94% of steady state after how many half lifes?

Answer 34

4

Question 35

What is involved in phase 1 metabolism? (choose 2) (which enzyme and products?)

Answer 35

Cytochrome P450 enzymes Yields water soluble metabolites extra: conjugation is phase two

Question 36

An 80 year old patient with liver disease is expected to have (choose 2)

Answer 36

Increase in volume of distribution Decrease in plasma protein extra: Vd is increased bc as you age you have more fat.

Question 37

Which of the following is descriptive of fetal ion trapping (choose 3) (Basically tell me everything you know about fetal ion trapping.)

Answer 37

a. Fetal ph lower than the mother b. Drug converting from non-ionized to ionized form in the fetus c. Drug becoming trapped in fetus leading to toxicity.

Question 38

Which of the following is associated with fetal ion trapping (choose 2)

Answer 38

a. Fetus being more acidic than the mother b. Specific amides extra: does not tend to happen with esters bc they are metabolized via ester hydrolysis.

Question 39

Definition of a prodrug?

Answer 39

Inactive until metabolized

Question 40

Chloropaine has no protein binding, what are two things you can assume about it?

Answer 40

Short duration or action | Dissociates from Na channels with ease

Question 41

Choose three characteristics of lipid soluble drugs that help them spread?

Answer 41

a. can pass through the blood brain barrier. b. high protein binding. c. because of Vd it does not get cleared out of the body as quickly.

Question 42

What are the correct definitions for efficacy and potency

Answer 42

a. Efficacy is max effect a drug can produce | b. Potency is amount of drug needed for a given effect

Question 43

What describes the liver metabolism before the drug enters circulation?

Answer 43

first pass effect

Question 44

Receptor theory, those that are responsible for no reaction at the receptor site? (when they attach nothing happens)

Answer 44

non competitive antagonist and competitive antagonist

Question 45

Responsible for moving morphine out of the CNS?

Answer 45

P-glycoprotein

Question 46

Most ions? (pick two)

Answer 46

Are insoluble to the cell membrane Cross through protein channels

Question 47

Glucose moves across cell membrane by: Choose 2

Answer 47

sodium co-transport system | Insulin

Question 48

O2 and CO2 move into the cell by?

Answer 48

Simple diffusion

Question 49

What are the two most abundant constituents in the cell membrane?

Answer 49

a. Protein | b. Phospholipids

Question 50

Cholesterol provides ____ and ____ to the cell membrane?

Answer 50

a. Flexibility | b. Stability

Question 51

WHAT provides specificity to the cell membrane?

Answer 51

Protein

Question 52

How many liters of plasma does average person have?

Answer 52

3 liters

Question 53

Constituent are identical but quantities varies

Answer 53

Plasma Interstitial fluid Intracellular fluid

Question 54

Total body weight is composed of?

Answer 54

65% water, 35% non-water

Question 55

What coefficient parallels anesthetic requirement?

Answer 55

Oil:gas partition

Question 56

Negative middle ear pressures may develop after discontinuation of nitrous oxide, then what can happen?

Answer 56

serous otitis.

Question 57

All of the following are part of phase I metabolism except? (hydrolysis, metabolism, conjugation, clearance, distribution, excretion)

Answer 57

Conjugation

Question 58

Tissue uptake is determined by?

Answer 58

pH

Question 59

Biotransformation occurs primarily in the? (what organ)

Answer 59

Liver

Question 60

Context sensitive half time: choose 2

Answer 60

a. Time it takes for the plasma concentration to decrease by 50% b. Depends on duration of the infusion

Question 61

Half time elimination: Choose 2 (what is it directly proportional to and inversely proportional to?)

Answer 61

a. directly proportional to volume of distribution | b. inversely proportional to clearance

Question 62

Term that describes when two drugs that produce the same effect are given together and one enhances the effect of the other?

Answer 62

Synergistic

Question 63

When two drugs are present in a mixture of 50/50 they are referred to as?

Answer 63

Racemic Mixture

Question 64

What the drug does to the body is known as?

Answer 64

pharmocodynamics

Question 65

What LA's has no protein binding?

Answer 65

The answer on the exam was procaine and chloroprocaine | but as we have learned now procaine does have a little protein binding (very little) and chloroprocaine has none.

Question 66

Generally decreases membrane fluidity and permeability?

Answer 66

Cholesterol

Question 67

A pt. Has a history of seizures. Which of the following gases would the CRNA avoid?

Answer 67

Enflurane

Question 68

Inhaled anesthetic that decreases cardiac contractility?

Answer 68

Halothane

Question 69

MOST POTENT inhaled anesthetic?

Answer 69

Isoflurane

Question 70

Osmotic Pressure goes from what tonicity to which tonicity?

Answer 70

Hypotonic to hypertonic | water is the only thing able to move, and it is trying to dilute the higher concentration

Question 71

Signs of diffusion hypoxia with decreased respirations. What gas could cause this?

Answer 71

Nitrous oxide

Question 72

Which stage of Anesthesia do you want your patient in?

Answer 72

3

Question 73

Induction, where does the gas start, go through, and then ultimate location to create anesthesia? (order Pbr, PA, and Pa)

Answer 73

PA → Pa → Pbr

Question 74

Pt. has divergent gaze, breath holding. What stage of general anesthesia is your pt. In?

Answer 74

2 (most at risk for laryngospasm in this stage, OR needs to be quite)

Question 75

100% MAC ?

Answer 75

Nitrous oxide

Question 76

What is minute ventilation?

Answer 76

Tidal Volume x Breath/min

Question 77

Sevoflurane vapor pressure and gas coefficient?

Answer 77

170 | 0.69

Question 78

Not stable in soda lime? (2 gasses)

Answer 78

Sevo and Halothane

Question 79

Old people have, in relation to protein binding and volume of distribution?

Answer 79

decreased protein binding and increased volume of distribution.

Question 80

Blood gas coefficient of each gas, which are intermediately soluble and which are poorly soluble in blood?

Answer 80

intermediately soluble in blood: halothane = 2.54 enflurane = 1.90 isoflurane = 1.46 poorly soluble in blood: Sevo = 0.69 Nitrous = 0.46 Desflurane = 0.42 Xenon = 0.115