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RUSVM Pharmacology I > Inhalation Anesthetics > Flashcards

Inhalation Anesthetics Flashcards

(85 cards)

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1
Q

Inhalation Anesthetics Pros

A

Control of the airway Control ventilation Control drug uptake & elimination

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2
Q

Inhalation anesthetics Cons

A

Specialized *expensive* equipment Equipment failure

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3
Q

Inhalation anesthetics Dosage

A

Concentration (volume%) of inspired gas Partial Pressure

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4
Q

Partial Pressure conversion 4% Halothane

A

4% Halothane = 0.04 F1 hal = 4 kPa

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5
Q

Partial Pressure conversions kPa, atm, bar, mmHg, psi, cm water

A

101 kPa 1 atm 1 bar 760 mmHg 15 psi 1000 cm water

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6
Q

Inhalation anesthetics Uptake

A

Taken up by lungs

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7
Q

Inhalation anesthetics Elimination

A

Excreted mostly unchanged by lungs Alveolar concentration ~ brain concentration

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8
Q

Inhalation anesthetics Saturated vapor pressure

A

Ability of anesthetic to evaporate Match druge with proper vaporizer, varies greatly

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9
Q

Inhalation anesthetics Rubber & plastic solubility

A

Concern with older agents -Soluble into tubes

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10
Q

Inhalation anesthetics Blood/Brain coefficient

A

Concern with older agents

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11
Q

Inhalation anesthetics Blood/Gas coefficient

A

Solubility Influences rate of uptake/distribution Speed of induction, recovery, change of anesthetic level

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12
Q

Inhalation anesthetics Physical factors Solubility

A

Completely insoluble = not into brain Relatively insoluble = fast induction & recovery Soluble anesthetics = longer induction & recovery

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13
Q

Inhalation anesthetics Soluble anesthetics

A

Longer induction, recovery Large Vd = more drug to be absorbed More potent drugs

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14
Q

Inhalation anesthetics Physiologic factors

A

Ventilation Cardiac output

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15
Q

Inhalation anesthetics Ventilation

A

No breathing = no drug uptake -Induction drug –> apnea –> IPPV –> Large drug quantities -Lung disease (thickening of blood/gas barrier)

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16
Q

Inhalation anesthetics Cardiac output

A

No heartbeat = no systemic drug uptake Shock –> decreased CO Excitement –> increased CO

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17
Q

Inhalation anesthetics Distribution

A

All are fat-soluble Penetrate most tissues Fat reservoirs Cross placenta

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18
Q

Inhalation anesthetics MAC

A

Minimal alveolar concentration -Anesthetic at steady state which will prevent purposeful movement in response to supramaximal noxious stimulus in 50% of individuals (similar to ED 50) -Varies across species

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19
Q

Inhalation anesthetics MAC for maintenance

A

~1.3 for maintenance -Animal’s state of excitement/pain -Premedication

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20
Q

Table of MAC for species

A

Graph Below

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21
Q

Inhalation anesthetics Pharmacologic effects overview

A

General anesthesia Some muscle relaxation (not with NO) No analgesia Respiratory depression Cardiovascular depression

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22
Q

Inhalation anesthetics Pharm effects on CNS

A

Depression (anesthesia) Amnesia (Supraspinal site) Immobility / no response to noxious stimuli (spinal site) Predisposed to seizure activity (enflurane & sevoflurane) Vasodilation

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23
Q

What two drugs have a predisposiiton to seizure activity?

A

Enflurane & sevoflurane)

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24
Q

Inhalation anesthetics Describe vasodilation effects

A

Increased cerebral blood flow –> intracranial pressure

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25
Inhalation anesthetics Pharm effects on Respiratory
Dose-dependent depression (incr PaCO2) Bronchodilation Airway irritation
26
Inhalation anesthetics Which drugs have bronchodilation effects
D-I-S-H -flurane Desflurane Isoflurane Sevoflurane Halothane
27
Inhalation anesthetics Which drugs show airway irritation
Desflurane in humans -Breath-holding -Coughing -Laryngospasm
28
Inhalation anesthetics Pharm effects at cardiovascular system
Dose-related decreased myocardial contractility Alteration of organ blood flow Sensitization of heart to catecholamines
29
Inhalation anesthetics Describe effect of decreased myocardial contractility
Stroke volume Cardiac output Hypotension (peripheral vasodilation) Halothane\>isofluorane=desflurane=sevoflurane
30
Inhalation anesthetics Pharm effects at liver
Hepatocellular injury -Reduced blood flow -Direct toxicity - halothane?
31
Inhalation anesthetics Pharm effects at kidneys
Reduced blood flow & GFR -Transient increase in serum urea nitrogen, creatinine, inorganic phosphate -Direct toxicity - methoxyflurane
32
Inhalation anesthetics Which drug has direct toxicity to the kidneys
Methoxyflurane
33
Inhalation anesthetics Pharm effects at skeletal muscle
Relaxation Malignant hyperthermia (halothane in pigs) Enhance effects of competitive Neuromuscular Blockers
34
What medication can cause malignant hyperthermia in pigs?
Halothane
35
What can halothane cause in pigs?
Malignant hyperthermia
36
Inhalation anesthetics Effect on body temperature
Hypothermia -Increased heat loss, vasodilation, decreased heat production, impaired shivering
37
Inhalation anesthetics Vapor drugs
From liquids DISH -Desflurane -Isoflurane -Sevoflurane -Halothane
38
Inhalation anesthetics Gases
NO warrior princess Nitrous Oxide Xenon
39
Halothane Elimination
-Falling out of fashion -Most potent cerebral vasodilater -60-80% eliminated in exhale -Liver biotransformation by cytochrome p450
40
Halothane Liver biotransformation
by Cytochrome p450 -Trifloroacetic acid, chloride, bromide
41
Halothank Respiratory & CV effects
Respiratory & cardiovascular depression
42
Which drug is the most potent cerebral vasodilator?
Halothane
43
Which drug is the most arrhythmogenic?
Halothane
44
Halothane Cardiac affect
The most arrhythmogenic -Sensitizes heart to epinephrine -Premature ventricular extrasystoles (VPCs)
45
Halothane Hepatitis effects
Decreased hepatic blood flow Human vs. domestic animals Metabolite- immune-mediated reaction
46
Halothane Thymol
Preservative Builds up in vaporizers
47
Isoflurane Effects at CV and respiratory (Compared to halothane)
Less cardiac depression than halothane Same respiratory as halothane
48
Isoflurane Renal effect
Renal blood flow decreased like halothane
49
Isoflurane Liver & muscle effect
Liver & muscle blood flow less affected than with halothane
50
Isoflurane Effects of NMB
More potent enhancer of NMB effects than halothane
51
Isoflurane General info
Most used in USA Isomer of enfluane Almost no metabolism Anticonvulsant Cerebral circulation autoregulation maintained
52
Isoflurane Choice drug for what conditions?
Choice for critically ill patients & neurosurgery
53
What is the choice drug for critically ill patients and neurosurgery?
Isoflurane
54
Isoflurane Cerebral effects
Less cerebral vasodilation than halothane
55
Desflurane Vapor pressure
High vapor pressure = special vaporizer
56
Desflurane Blood/Gas coefficient
The lowest. 0.45 Fast induction Change in depth & recovery
57
Desflurane Metabolism
Does not undergo metabolism (0.02%)
58
Desflurane Similarity to Isoflurane
Similar in cardiovascular effects & cerebral vascular effects
59
Desflurane Respiratory effect compared to isoflurane
More respiratory depressant than isoflurane
60
Desflurane Liver blood flow effect
Decreased Liver blood flow like isoflurane
61
Desflurane Renal blood flow
Not substantially altered
62
Desflurane Muscle relaxation
Similar to isoflurane
63
Desflurane NMB effects
Similar to isoflurane \*Potent enhancer of NMB effects\*
64
Sevoflurane Blood/gas coefficient
Low= 0.65 Fast induction, change in depth & recovery
65
Sevoflurane Cerebral vasodilation
Less than isoflurane & desflurane
66
Sevoflurane CV & respiratory effects
Similar to isoflurane
67
Sevoflurane What absorbent does it react with
Soda lime (CO2) absorbent -Compound D (nephrotoxic LD50=400ppm in rates) -Flow rates of 2L/min in humans
68
Sevoflurane What makes it nephrotoxic
Fluoride ion
69
Sevoflurane Renal or hepatic injury in domestic animals?
No
70
Sevoflurane NMB enhancement
Similar to isoflurane to enhance effects of competitive NMB
71
Nitrous Oxide
AKA N2O, Laughing gas -Comes in cylinders -Low blood/gas coefficient (0.47) -Non-potent anesthetic -Builds up in circle systems
72
Nitrous Oxide As an anesthetic
Not potent MAC= 200-250% Anesthetic adjuvant (give with inhalation anesthetic) 66% induction & maintenance
73
Nitrous Oxide Second gas effect
Large % of volume of gas moves higher--\>lower tension until @ equilibrium NO- more fresh, faster induction
74
Nitrous Oxide Fink Effect
Diffusion hypoxia -Opposite to 2nd gas effect -Displacing alveolar gas (including Oxygen) -Give 100% O2 on recovery
75
Nitrous Oxide As an analgesic
Good analgesic
76
Nitrous Oxide CV & respiratory effects
Low CV & Resp depression
77
Nitrous Oxide CNS effects
Increases cerebral blood flow Increases cerebral metabolic rate Increases intracranial pressure
78
Nitrous Oxide Liver & Kidney effects
Minimal effect on function
79
Nitrous Oxide Muscle relaxer
Poor relaxation Weak trigger of MH
80
Nitrous Oxide Diffusion problems
Diffuses into air-filled spaces (pneumothorax, colic)
81
Nitrous Oxide Risk to pregnant women
Abortion
82
Inhalation Anesthetics No longer used
Methoxyflurane Enflurane
83
Methoxyflurane
No longer used inhalation anesthetic Good analgesic & muscle relaxant Slow induction & recovery Nephrotoxic (fluoride ions)
84
Enflurane
No longer used inhalation anesthetic Seizure activity
85
Inhalation Anesthetics Other delivery methods
Boxing down Masking down Intranasal cannula \*\*For fractious animals, tiny animals, neonates, C-section\*\*

RUSVM Pharmacology I (19 decks)

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