Pharmacology > IA #2 > Flashcards

IA #2 Flashcards

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1
Q

Which circuit leads to rebreathing?

A

Bain. There is no absorbent

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2
Q

Which gas delivery system leads to no rebreathing?

A

BVM (has expiratory valve)

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3
Q

What can be added to bain circuit?

A

ETCO2, PEEP

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4
Q

Does Bain circuit have an APL valve?

A

Yes

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5
Q

What is the Bain circuit mostly used for?

A

Tx out of OR

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6
Q

What is the pop off valve of the Ambu?

A

built in pressure relief valve

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7
Q

What is the path air takes in the circle system?

A

Picture

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8
Q

If the APL valve is open the air goes into the _

A

Bag

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9
Q

If the APL valve is close the air goes into the

A

ventilator

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10
Q

High fresh gas flow with inhalation anesthesia means that the FGF exceeds the __

A

Minute ventilation.

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11
Q

Rebreathing is prevented with high or low FGF?

A

High

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12
Q

Do we make rapid changes in anesthetic with high or low FGF?

A

high

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13
Q

What are the good things about using high FGF with inhalation anesthesia?

A

Pt will go to sleep faster, prevents rebreathing

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14
Q

What are the cons of using high FGF?

A

Wasteful in the anesthetic, cooling

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15
Q

What does it mean to give low-flow inhalation anesthesia? What are th pros and cons?

A

The FGF is lower than the minute ventilation. Rebreathing will occur. There is less wastefulness and less cooling of the airway

Very slow changes in the anesthetic

Compound A production!

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16
Q

How do we charge for the volitiles?

A

In volume per hour

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17
Q

What are the colors associated with Sevo, Des, Iso, and Enflurane?

A

Yellow, Blue, Purple, Orange

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18
Q

Bronchodilation occurs with all of the IA at a MAC of _. What happens if the pt has baseline inflammatory process going on?

A

> 2

Will not have a bronchodilating effect.

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19
Q

Which IA is the best for causing bronchodilation? Second best?

A

Halothane
Sevo

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20
Q

Which IA may worsen pulmonary irritation?

A

Des because very pungent

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21
Q

How do IA cause bronchodilation?

A

Blocking Ca channels therefore Ca cannot get through to cause contraction of the smooth muscle

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22
Q

Which IA causes the most and least airway resistance?

A

Most: Des
Least: Sevo

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23
Q

IA cause dose dependent NM relaxation by enhancing _ and inhibiting _

A

glycine
glutamate

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24
Q

Does NO cause muscle relaxation?

A

No

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25
What effect do IA have on NMB?
Enhance their effect! They already cause immobility so makes sense you would need less of these
26
Ischemic reconditioning of the heart happens at __ MAC
0.25
27
Ischemic preconditioning is mediated by adenosine. There is an increase in PKC activity and phosphorylation of ___. Increased production of ____.
ATP sensitive K channels Reactive oxygen species
28
IA help to decrease ___ injury (heart)
Reprofusion
29
What do IA do to CMRO2? What MAC?
Decrease it. MAC 0.4
30
At what MAC does burst suppression happen? Electrical silence?
1.5 2
31
Which IA have anticonvulsant properties? Pro-convulsant?
Iso Des Sevo Enflurane
32
Activity of IA r/t sz's happens at high doses and ____ CO2
decreased
33
What effects do IA have on SSEP and MEP? At what MAC?
Decreased amplitude and increased latency 0.5 *So do not use more than 0.5 volitile MAC. Can combine with 1/2 MAC NO
34
What changes are seen in CBF with IA? At what MAC? Which gas causes biggest increase? Which gas causes smallest increase (b/c decreased vasodilatory effects).
Increased. 0.6. Halothane Sevoflurane
35
Autoregulation of CBF to maintain normal ICP is maintained with BP ranges 60-160. What do Sevo and Des, Iso do this?
Sevo maintains the response until 1 MAC The others maintain it until 0.5 MAC Sevo is best :)
36
Since there is an increase in CBF, there is also an increase in ICP. Who has the highest risk?
Pt with space containing lesions
37
Since there is an increase in CBF, there is also an increase in ICP. How can you fix this for a bit? (10-15 min)
Increase minute ventilation to dilute the CO2 and lead to cerebral vasoconstriction
38
At what MAC do we see increase in ICP?
0.8
39
How much is ICP increased?
7 mmHg
40
What are the changes in ventilation seen?
Increased respiratory rate and decreased tidal volume
41
What are the changes in ventilation seen? Why decreased TV?
Interferes with ICM. Diaphragm gets pulled down but chest wall moves in instead of out
42
At what MAC may the pt go apneic?
1.5-2
43
At what MAC do we see the hypoxic response blunted- how much of a decrease does that cause? How much MAC for it to be completely abolished?
0.1 - 50% 1.1 - 100%
44
Can NO blunt the hypoxic response?
Yes
45
Why might your pt be desaturating in PACU if everything else checks out ok?
Hypoxic response is still blunted from IA (lasts several hours)
46
Does NO blunt the hypercarbic response?
NO! All of the others do but dose dependent
47
What happens to PaCO2 when giving IA?
Minute ventilation is over all decreased so the PaCO2 will be less diluted (goes up)
48
At what MAC does HPV happen and how much does it decrease the response?
2 MAC 50%
49
What happens to MAP with IA? The biggest decrease in MAP happens with ___
MAP decreases because the Ca ++ channels are blocked, and decreased Ca able to enter and cause contraction of the vessel! Halothane
50
The decrease in MAP is due to the decrease in ___
SVR
51
Does Nitrous cause cardiac depression?
NO! MAP is maintained.
52
What happens to HR with IA?
Increases (helps with decrease in MAP and CO)
53
Sevo increases HR at a MAC > than _ while all the others increase HR at a MAC less than that
1.5
54
What happens to CO with IA? It is due to _
Decreased SVR decrease
55
IA can lead to prolonged QT which can lead to _
Torsades
56
All IA have proarythmic effects except for _
Nitrous
57
Do you have to worry about arrythmias with NO?
Not particularly
58
Which IA causes refractory accessory pathway so you would want to avoid in ablation? Which has no effect on AP?
Iso Sevo :)))
59
What effects do IA have on immunity?
Decrease T cells, monocytes, macorphages Increased cortisol Avoid giving to cancer pts
60
What change do IA's make to hepatic BF? At what MAC does that happen?
Increase portal vein flow due to vasodilation! 1.5
61
Which volatile leads to a decrease in hepatic blood flow?
Halothane
62
When there ia a decreased BF with Halothane, can lead to hepatotoxicity. What is Type I and type II?
I: more common, 1-2 weeks after first exposure, lower mortality II: less common, 1 month after second exposure, higher mortality
63
Which drugs are oxidized by P450 to acetyl halide? What can that lead to?
E > I > D Antibody rxn
64
Which drug is metabolized to vinyl halide? So it cannot stimulate ___ formation. Safe for ___ pts
Sevo! antibody Liver
65
IA lead to a decrease in renal blood flow due to a decrease in _
CO
66
IA have preconditioning effects on the heart and the _
kidneys
67
Nephrotoxicity can be caused by _
Flouride
68
The worst IA to cause nephrotoxicity was _
Methoxyflurane b/c 70% metabolized
69
Do newer volatiles cause nephrotoxicity 2/2 flouride?
No, they are exhaled before they can be metabolized
70
Why can sevo cause combustion?
Sevo + Baralyme --> formaldehyde + MO The rxn of those produces head + the expired air gets really hot --> could lead to fire *If CO2 absorber feels hot, change it out
71
What was added to Sevo to decrease combustion?
Water! Too cool it off and decrease the rxn of producing MO and FH
72
What % of mortality exists with MH if untreated?
80%
73
If 2 triggering agents are given for GA, what % chance for PONV exists?
Opiod + Volitile = 25-30%
74
At what MAC will NO cause PONV?
< 0.5 MAC
75
NO leads to 3 things:
1. oxidizes B12 --> baby could have decreased B12 which is needed for DNA synthesis. Do not give to pregnant pt in 1st trimester. 2. Bone marrow suppression if given for > 24 hr 3. Increases homocysteine levels which lead to decreased B vitamins and increased atherosclerosis --> Mi
76
Volatiles lead to decreased uterine smooth muscle contractility at what MAC?
0.5-1.5
77
When would VIA be useful in pregnancy?
Retained placenta --> decreased contractility to release it
78
Does nitrous have effects on contractility of uterus?
No. Can give if an epidural is running out of meds. Give NO which also has analgesic proprieties
79
Which IA are sweet and non pungent?
Halothane, NO, Sevo
80
Which IA are pungent
Des, Iso
81
Halothane can cause which 4 (-) rxns?
1. Occasional hepatic necrosis 2. Pedi brady arythmias 3. Catecholamine induced arrythmias 4. Decompesition to Hcl acid
82
Which IA is stable with no deterioration after 5 years?
Iso
83
Desflurane is identical to ___ (but sub a F for a Cl)
Iso
84
Which IA would boil at OR room temp?
Des
85
Which VIA is the most pungent so would be last choice for induction? What S/S would it cause?
Des Coughing, salivation, golding your breath, laryngospasm
86
IF absorbent is dry, Des will degrade to ___ . How will you know that is happening? ETCO2 rises
CO (carbon monoxide)
87
Which VIA would you choose for induction?
Sevo
88
Which IA is the least likely to form Carbon monoxide?
Sevo
89
What is the DOC for increased ICP in neuro pt's?
Sevo :)

Pharmacology (6 decks)

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