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Pharmacology > IA #2 > Flashcards

IA #2 Flashcards

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
Q

What effect do IA have on NMB?

A

Enhance their effect! They already cause immobility so makes sense you would need less of these

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26
Q

Ischemic reconditioning of the heart happens at __ MAC

A

0.25

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27
Q

Ischemic preconditioning is mediated by adenosine. There is an increase in PKC activity and phosphorylation of ___. Increased production of ____.

A

ATP sensitive K channels
Reactive oxygen species

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28
Q

IA help to decrease ___ injury (heart)

A

Reprofusion

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29
Q

What do IA do to CMRO2? What MAC?

A

Decrease it. MAC 0.4

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30
Q

At what MAC does burst suppression happen? Electrical silence?

A

1.5
2

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31
Q

Which IA have anticonvulsant properties? Pro-convulsant?

A

Iso Des Sevo
Enflurane

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32
Q

Activity of IA r/t sz’s happens at high doses and ____ CO2

A

decreased

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33
Q

What effects do IA have on SSEP and MEP? At what MAC?

A

Decreased amplitude and increased latency

0.5

*So do not use more than 0.5 volitile MAC. Can combine with 1/2 MAC NO

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34
Q

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).

A

Increased.
0.6.
Halothane
Sevoflurane

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35
Q

Autoregulation of CBF to maintain normal ICP is maintained with BP ranges 60-160. What do Sevo and Des, Iso do this?

A

Sevo maintains the response until 1 MAC
The others maintain it until 0.5 MAC

Sevo is best :)

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36
Q

Since there is an increase in CBF, there is also an increase in ICP. Who has the highest risk?

A

Pt with space containing lesions

37
Q

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)

A

Increase minute ventilation to dilute the CO2 and lead to cerebral vasoconstriction

38
Q

At what MAC do we see increase in ICP?

A

0.8

39
Q

How much is ICP increased?

A

7 mmHg

40
Q

What are the changes in ventilation seen?

A

Increased respiratory rate and decreased tidal volume

41
Q

What are the changes in ventilation seen? Why decreased TV?

A

Interferes with ICM. Diaphragm gets pulled down but chest wall moves in instead of out

42
Q

At what MAC may the pt go apneic?

A

1.5-2

43
Q

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?

A

0.1 - 50%
1.1 - 100%

44
Q

Can NO blunt the hypoxic response?

A

Yes

45
Q

Why might your pt be desaturating in PACU if everything else checks out ok?

A

Hypoxic response is still blunted from IA (lasts several hours)

46
Q

Does NO blunt the hypercarbic response?

A

NO! All of the others do but dose dependent

47
Q

What happens to PaCO2 when giving IA?

A

Minute ventilation is over all decreased so the PaCO2 will be less diluted (goes up)

48
Q

At what MAC does HPV happen and how much does it decrease the response?

A

2 MAC
50%

49
Q

What happens to MAP with IA? The biggest decrease in MAP happens with ___

A

MAP decreases because the Ca ++ channels are blocked, and decreased Ca able to enter and cause contraction of the vessel!

Halothane

50
Q

The decrease in MAP is due to the decrease in ___

A

SVR

51
Q

Does Nitrous cause cardiac depression?

A

NO! MAP is maintained.

52
Q

What happens to HR with IA?

A

Increases (helps with decrease in MAP and CO)

53
Q

Sevo increases HR at a MAC > than _ while all the others increase HR at a MAC less than that

A

1.5

54
Q

What happens to CO with IA? It is due to _

A

Decreased
SVR decrease

55
Q

IA can lead to prolonged QT which can lead to _

A

Torsades

56
Q

All IA have proarythmic effects except for _

A

Nitrous

57
Q

Do you have to worry about arrythmias with NO?

A

Not particularly

58
Q

Which IA causes refractory accessory pathway so you would want to avoid in ablation? Which has no effect on AP?

A

Iso
Sevo :)))

59
Q

What effects do IA have on immunity?

A

Decrease T cells, monocytes, macorphages

Increased cortisol

Avoid giving to cancer pts

60
Q

What change do IA’s make to hepatic BF? At what MAC does that happen?

A

Increase portal vein flow due to vasodilation!

1.5

61
Q

Which volatile leads to a decrease in hepatic blood flow?

A

Halothane

62
Q

When there ia a decreased BF with Halothane, can lead to hepatotoxicity. What is Type I and type II?

A

I: more common, 1-2 weeks after first exposure, lower mortality

II: less common, 1 month after second exposure, higher mortality

63
Q

Which drugs are oxidized by P450 to acetyl halide? What can that lead to?

A

E > I > D

Antibody rxn

64
Q

Which drug is metabolized to vinyl halide? So it cannot stimulate ___ formation. Safe for ___ pts

A

Sevo!
antibody
Liver

65
Q

IA lead to a decrease in renal blood flow due to a decrease in _

A

CO

66
Q

IA have preconditioning effects on the heart and the _

A

kidneys

67
Q

Nephrotoxicity can be caused by _

A

Flouride

68
Q

The worst IA to cause nephrotoxicity was _

A

Methoxyflurane b/c 70% metabolized

69
Q

Do newer volatiles cause nephrotoxicity 2/2 flouride?

A

No, they are exhaled before they can be metabolized

70
Q

Why can sevo cause combustion?

A

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
Q

What was added to Sevo to decrease combustion?

A

Water! Too cool it off and decrease the rxn of producing MO and FH

72
Q

What % of mortality exists with MH if untreated?

A

80%

73
Q

If 2 triggering agents are given for GA, what % chance for PONV exists?

A

Opiod + Volitile = 25-30%

74
Q

At what MAC will NO cause PONV?

A

< 0.5 MAC

75
Q

NO leads to 3 things:

A
  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
Q

Volatiles lead to decreased uterine smooth muscle contractility at what MAC?

A

0.5-1.5

77
Q

When would VIA be useful in pregnancy?

A

Retained placenta –> decreased contractility to release it

78
Q

Does nitrous have effects on contractility of uterus?

A

No. Can give if an epidural is running out of meds. Give NO which also has analgesic proprieties

79
Q

Which IA are sweet and non pungent?

A

Halothane, NO, Sevo

80
Q

Which IA are pungent

A

Des, Iso

81
Q

Halothane can cause which 4 (-) rxns?

A
  1. Occasional hepatic necrosis
  2. Pedi brady arythmias
  3. Catecholamine induced arrythmias
  4. Decompesition to Hcl acid
82
Q

Which IA is stable with no deterioration after 5 years?

A

Iso

83
Q

Desflurane is identical to ___ (but sub a F for a Cl)

A

Iso

84
Q

Which IA would boil at OR room temp?

A

Des

85
Q

Which VIA is the most pungent so would be last choice for induction? What S/S would it cause?

A

Des
Coughing, salivation, golding your breath, laryngospasm

86
Q

IF absorbent is dry, Des will degrade to ___ . How will you know that is happening?

ETCO2 rises

A

CO (carbon monoxide)

87
Q

Which VIA would you choose for induction?

A

Sevo

88
Q

Which IA is the least likely to form Carbon monoxide?

A

Sevo

89
Q

What is the DOC for increased ICP in neuro pt’s?

A

Sevo :)

Pharmacology (6 decks)

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