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Inhaled Flashcards

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1
Q

What gases are Ethers?

A

Des

Devo

Iso

Enflurane

Methoxyflurane

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2
Q

What gases are Alkanes?

A

Halothane

Chloroform

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3
Q

What gases are gases at room temp?

A

NO2

Propane

Xenon

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4
Q

Number of fluranes on each ?

A

Iso - 5

Des - 6

Sevo - 7

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5
Q

What two have chiral carbons?

A

Des + iso

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6
Q

Which gas has the lowest boiling point?

A

Des @ 22

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7
Q

Vapor pressure of each gas?

A

Sevo - 157

Iso - 238

Des - 669

N2O - 39,000

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8
Q

Boiling point of each gas

A

Des - 22

Iso - 49

Sevo - 59

N2O - Negative 88

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9
Q

Is it easier to boil at low or high altitude?

A

Easier to boil at high because of less atmospheric pressure

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10
Q

What is the blood gas coefficient ?

A

How much of the gas will be in the blood versus the lung

Blood is listed first

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11
Q

Blood/gas coefficient of each gas

A

N2O - .46

Des - .42

Sevo - .65

Iso - 1.46

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12
Q

What is the FA/FI

A

FA - partial pressure pf the gas in the alveoli

FI - How much gas exiting the vaporizer

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13
Q

Order of FA/FI of the gases on how fast they will enter

A
  1. N2O
  2. Des
  3. Sevo
  4. Iso
  5. Halothane
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14
Q

What causes the FA/FI to increase faster

A

High fresh gas flow
High alveolar ventilation
Low FRC
Low time constant
Low dead space
Low solubility
Low CO
Low Pa-Pv

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15
Q

What decreases FA/FI? Slower onset

A

Low fresh gas flow
Low alveolar ventilation
High FRC
High time constant
High dead space
High solubility
High CO
High Pa-Pv

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16
Q

Hepatic biotransformation of gases?

A

N2O - 0.004

Des - 0.02

Iso - 0.2

Sevo - 2

Halothane - 20

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17
Q

What three gases create metabolites in the liver? What are the metabolites?

A
  • Iso
    -Des
    -Halothane

Trifluoracetic Acid and Fluoride Ions

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18
Q

What gas creates one specific metabolite?

A

Sevo - Fluoride

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19
Q

What is the minimum fresh gas flow to prevent compound A build up?

A

1L/min for up to 2 MAC hours
2L/min for >2 MAC hours

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20
Q

What is the concentration effect?

A

Higher the concentration of gas delivered, the faster the onset

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21
Q

What does the Meyer Overton rule state?

A

The higher the potency, the higher the solubility

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22
Q

What is the concentrating effect?

A

When nitrous causes alveoli to shrink because the volume is much higher than nitrogen

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23
Q

How many more times soluble is nitrous than nitrogen ?

A

34

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24
Q

What is the augmented gas flow effect?

A

When the concentrating effect causes a second gas to replace the lost alveolar volume

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25
What is the ventilation effect?
How alveolar ventilation affects the rate of rise of FA/FI
26
How long should 100% of O2 be delivered for after N2O is d/c?
3-5 minutes
27
What are examples of R-L shunts?
Teratology of Fallot Foramen ovale Eisenmenger's syndrome Tricuspid atresia Ebstein's anomaly
28
How are IV anesthetics affected with R-L shunts?
Faster induction
29
How are inhaled anesthetics affected with R-L shunts?
Takes longer, especially with low solubility (des)
30
How anesthetics affect with L-R Shunts?
Slower IV No affect with Inhaled
31
Does the second gas effect have a larger impact on sevo or iso?
iso More effect of agents with higher blood:gas solubility
32
How does full fluorination affect a gases PK/PD?
Decreased potency Increased vapor pressure Increased resistance to biotransformation
33
What is Daltons law?
The total gas pressure exerted by the sum of all gases
34
Which p450 enzyme is chiefly responsible for halogenated anesthetic metabolism in the liver
CYP2E1
35
Why does nitrous have a faster uptake than des even though it has a higher blood:gas coefficient
Concentrating effect
36
When to avoid N2O with an SF6 bubble?
Before SF6 is placed - D/C at least 15 minutes After - avoid N2O for 9 days
37
When to avoid N20 with other eye bubbles?
Air - 5 days Perfluoropropane - 30 days Silicone oil - no contraindication
38
What vitamin does N2O inhibit?
b12 through methionine synthase
39
Diseases with b12 deficiency?
Anemia Vegan Alcoholism Recreational N2O
40
Is nitrous flammable or combustable?
combustible - risk with pneumoperitoneum with electrocautery
41
What is the triad of MAC anesthesia ? What is the order they occur?
1. Amnesia 2. Unconsciousness 3. Immobility
42
MAC awake Vs MAC vs MAC bar
Awake - 1/3 total MAC, when 50% of patients open their eyes (During induction this is .4 but during recovery this is .15) MAC - 1.0 - when 50% of patients do not respond to a noxious stimulus MAC BAR -1.5 - 50% of patients have a blunted sympathetic response to pain
43
At what MAC is awareness and recall prevented? At what MAC is movement prevented?
0.4-0.5 1.3
44
What does not effect MAC?
Potassium Magnesium Gender HTN Thyroid - some texts says this does
45
What inhibitory pathways are stimulated by our anesthetic gases?
GABA - A Glycine K channels
46
What stimulatory pathways are inhibited by our anesthetic gases?
NMDA Nicotinic NA channels Dendritic spine - ventral horn
47
What type of receptor is GABA? how does it produce inhibition ?
Ligand gated Increases chloride and hyperpolarizes the cell
47
Where do volatile anesthetics produce immobility in the ventral horn?
Glycine NMDA Na channels NOT GABA
48
What receptor does N2O and xenon work on?
NMDA and P2P channels
49
Where is amnesia produced in the brain?
Amygdala Hippocampus
50
Where is autonomic modulation occur?
Pons and Medulla
51
Where does unconsciousness occur?
Cerebral cortex Thalamus Reticular activating system
52
Where does immobility occur?
Ventral Horn
53
Where is analgesia produced?
Spinothalamic tract
54
Which gas reduces SVR and HR the least?
Sevo
55
Which gases reduce SVR
Des, Sevo, Iso
56
Which gases increase HR?
Des, Iso, N2O
57
Which gas can increase SVR?
N2O, thereby decreasing CO
58
Which gas irritates the lungs the most? 2nd most?
Des Iso
59
Order of coronary artery dilation from greatest to least?
Iso Des Sevo
60
What is coronary steal?
Healthy vessels dilate and take blood Stenotic vessels can't dilate
61
How much will a 1mmhg increase in PaCO2 above baseline, increase ventilation?
3L/min
62
What pushes a right shift in the CO2 response curve? What does this cause?
- General anesthetics - Opioids - Metabolic alkalosis - Denervation of peripheral chemoreceptors Decrease in response to CO2 Causes respiratory acidosis (more CO2 (acid))
63
How is the upper airway affected by anesthetics?
Impairs airway dilator muscles such as genioglossus or tensor palatine
64
How do anesthetics affect the respiratory drive?
-Increase in apneic threshold and decrease response to CO2 -Decrease TV and increase in RR -Decrease FRC - Bronchodilation -Obstruction
65
Which anesthetics can cause bronchoconstriction?
Des Prop - due to preservative
66
Which cause bronchodilation?
Sevo Iso Ketamine
67
What monitors for hypoxemia?
Ther peripheral chemoreceptors in the Carotid bodies and aortic bodies
68
What pathway is used for the carotid bodies? aortic bodies?
Carotid - glossopharyngeal (CN9) Aortic - Vagus (CN10)
69
Which is more sensitive to PaCO2?
Carotid The aortic are more for BP
70
Which cells are thought to monitor in the Carotid bodies?
Glomus type 1 through reactive oxygen species
71
Which gas has the least affect?
Des b/c it has the lowest hepatic metabolism
72
How do volatiles affect the cerebral system?
Increased blood flow - increased ICP Decreased CMRO2 and decreased autoregulation
73
Which gas an induce seizures?
Sevo at a 2.0 MAC
74
What is CMRO2 dependent on?
Electrical activity - 60% of O2 Cellular Homeostasis - 40% of O2
75
What MAC of gas can produce an isoelectric state?
1.5-2.0
76
Can volatiles affect CSF?
yes
77
What anesthetic should be used to preserve evoked potentials?
TIVA
78
When should you be concerned for ischemia with evoked potentials?
amplitudes decreases >50% or Latency increases by >10%
79
What are the vapor pressures of the gases?
Sevo - 157 Iso - 238 Des - 669 Nitrous - 38,770
80
What agents are stable in Soda Lime?
Just nitrous
81
What byproducts are made in soda lime from the agents?
Sevo - Compound A, all the time but worse in desiccated Iso+Des - Carbon monoxide but only in desiccated
82
What are the blood:gas solubilities of each gas
Iso 1.45 Sevo .65 Des .42 Nitrous .46
83
FDA recommended FGF for MAC hour?
1L/min for up to 2 MAC hours and 2L/min after 2 MAC hours
84
What is a MAC hour?
1% sevo for 2x hours 2% sevo for 1x hour 4% sevo for 30 min
85
What are theoretical consequences of Sevo?
-High fluoride ions produced in the liver -Compound A produced in the circuit
86
Concentration effect? Concentrating effect? Augmented gas flow effect?
-Higher the drug, the greater the concentration -Alveolus shrinks due to the rapid speed of nitrous moving from the lung to the blood -Another gas fills the unoccupied alveolar space
87
What alternative can be used for SF6?
Silicone oil
88
Does blood pressure affect MAC?
Just hypotension
89
What electrolyte effects MAC?
Na
90
Does gender affect MAC?
no
91
What is the most important MOA of volatile anesthetics?
GABA
92
What cerebral receptors are stimulated by nitrous?
NMDA and P2P
93
Does Nitrous activate the SNS?
yes
94

Pharm 1 (4 decks)

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