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Pharmacology I > Inhaled Agents III > Flashcards

Inhaled Agents III Flashcards

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1
Q

What is an equipotent concentration of a medication?

A

1 MAC for each med has same cardio effects.

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2
Q

Map _______ with ________ in concentration of Des, Sevo, and Iso in a dose dependent manner.

A

Decreases, Increases

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3
Q

Decrease in MAP reflects a _________ in SVR.

A

Decrease

Expect… Hal < MAP by CO, N20 not or small > MAP.

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4
Q

How to use inhaled agents on someone who is severely cardiac depressed?

A
  • N2O

- Less concentrations of gas.

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5
Q

___ MAC ___ SBP

A

> MAC < SBP (MAP)

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6
Q

(!) Incremental > in delivered concentrations of inhaled agents > or < HR?

A

> at unique concentrations for each agent.

Iso (Forane) - at 0.25 MAC, liner DD > HR

Des - min upto 1 MAC, at > 1 MAC a linear DD > HR. (SEEN WITH THE MOST @ INDUCTION) give slow flows for slower induction changes HR Less.

Sevo - at 1.5 MAC

(!) (SLIDE 9)

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7
Q

Is Cardia Index influenced by inhalation agents (IA)?

A

Minimally (dilates vessels)

Not much change

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8
Q

Des does not > HR or MAP at what concentration?

A

< 1 MAC

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9
Q

Iso has ______ circulatory effect as _____?

A

Similar, Desflurane

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10
Q

____ and _____ are increased with SNS activity surges.

A

Epi and norepinephrine

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11
Q

> concentrations of _______ and ________ will > SNS surge = > HR.

A

Des and Iso.

Sevo requires > MAC (2 MAC)

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12
Q

Do inhaled agents (AI) predispose the heart to PVCs?

A

No

Except Halo

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13
Q

Inhaled anesthetics (IA) _______ QT interval.

A

Prolong

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14
Q

Worst IA to use for pts with known long QT syndrome?

A

Sevo

*Zofran

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15
Q

Coronary Steal: thought to be caused by what IA ____?

A

Iso

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16
Q

Ischemic Preconditioning

A

Preparing the heart for an ischemic event by giving it a small ischemic event.

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17
Q

2 distinct periods of Ischemic Preconditioning

A

(1) 1-2 hours after conditioning episode.

(2) benefit reappears 24 hours later for up to 3 days.

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18
Q

As anesthetic concentration ___ Respiratory rate ___ and Tidal volume (TV) ___.

A

> , >,

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19
Q

< TV leads to greater _____ _____ ______.

A

Dead space ventilation

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20
Q

Does Gas exchange become more or less efficient and anesthetic depth increases?

A

Less

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21
Q

Does PaCO2 > or < to anesthetic depth proportionately?

A

>

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22
Q

Pt to worry about with tachycardia?

A 
Elderly
Previous event
Stents
> Risk (Smokers, DM, CAD)
< Mets score
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23
Q

What to worry about cardiovascularly with inhaled anesthetics?

A
  • Tachycardia

- Hypotension (SVR = constriction = no volume)

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24
Q

Does minute volume > or < with IA?

A

Stays the same

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25
Do IA > or < FRC?
< FRC Cephalosporins displacement of the diaphragm and inward displacement of rib cage > muscle activity = < FRC.
26
______________ occurs in dependent areas of the lung?
Atelectasis
27
IA have a _______ effect on principal of hypoxic pulmonary vasoconstriction.
Limited
28
_______, _______, and _______ are nonpungent. ______ and _____ are pungent.
Sevo, Halo, N2O Des and Iso (forane).
29
IA _______ CMRO2, N20 _________ CMRO2.
Decreases, Increases
30
Is there an effect on cerebral vascular response to changes in PaCO2?
No
31
Cerebral vasodilation occurs at concentrations > _______ MAC.
>0.6 MAC (on a normocapnic patient)
32
At _____ MAC, the < CMRO2 offsets vasodilation such that CBF does not change significantly.
0.5 MAC
33
At concentrations ______, vasodilation effects predominate and CBF >, especially if BP os maintained at awake value.
> 1 MAC
34
____ causes cerebral vasodilation.
N2O
35
Does N20 > or < CMRO2?
>
36
Will ICP > or < with all IA at doses > 1MAC?
> -Autoregulation is impaired even at lower concentrations < 1 MAC.
37
IA and N2O _________ amplitude and ________ latency of SSEP in DD manner?
Depress, Increase
38
EP may be abolished at ____ MAC.
- 1 MAC | - N20 + 0.5 MAC IA
39
< or > concentrations decreases reliability of motor EPs.
< (0.2-0.3 MAC)
40
Increased depth is characterized by ________ amplitude and ________ on EEG?
>, synchrony
41
Burst Suppression: Isoelectric Line:
- Periods of brief electrical silence then back on. XX____XX, XXX____. - XXX______ predominates at 1.5 - 2.0 MAC.
42
____ and _____ are associated with epileptiform activity on EEG, especially at > concentrations.
Sevo and ethrane (better to use Des or Iso).
43
IA produce a DD _____ ______ relaxation and ______ the activity of neuromuscular blocking drugs (Block lasts longer).
Skeletal muscle, enhance
44
_________ of IA enhances recovery from neuromuscular blockade.
Elimination
45
What IA is not a trigger for MH?
N2O
46
Metabolism. ___>___>___
Hal > Iso > Des
47
N20 inactivates __________ synthase.
Methionine | Enzyme that regulates Vit B12 and folate metabolism.
48
Pt with previous Vit B12 deficiency ...
Do not give N20.
49
Elevated homocysteine levels are associated with > risk of ______ events.
Coronary
50
Transfer to closed gas spaces (N2O vs N)
N20 b:g = 0.46 nitrogen b:g = 0.014 N20 leaves blood into an air filled cavity 34x faster.
51
Compliment wall = | N20 vs N
> Volume
52
Non-compliant wall = | N2O vs N
> Pressure
53
CO2 Absorbents and Exothermic reactions
> FGF accelerate the desiccation of CO2 absorbents, thus > degradation if IA.
54
Degradation is an _________ process
Exothermic
55
Degradation of CO2 absorber produces...
Carbon Monoxide Heat From all IA.
56
__________ produces the largest Exothermic reaction.
Sevo (higher incidence)
57
Sevo produces...
Compound A when exposed to soda lime). | Desiccated absorbent speeds this up
58
Iso and Des produce...
Carbon Monoxide when exposed to desiccated absorbent.
59
Iso, Sevo and halo are _______ _______ vaporizers.
Variable bypass
60
Variable bypass
- Two streams of inflowing fresh gas. 1: contacts reservoir of liquid anesthetic. 2: bypass the reservoir.
61
Concentration of anesthetic is gas leaving the vapor or is determined by the relative flow to gas through the ________ _________ versus the ________ _______.
Reservoir channel, bypass channel
62
Control of vaporizer concentration occurs by ...
User adjustment of the vaporizer dial.
63
Variable bypass vaporizers are calibrated for individual anesthetic due to...
Differing vapor pressures.
64
Tilting or overfilling may lead to ______ if liquid gets into bypass channel.
Overdose
65
Vapor pressure of Des is ______ mmHg?
700
66
Suprane
Desflurane
67
If Des is given in a variable bypass vaporizer it could produce __________ _________.
Unpredictable concentrations.
68
Heated Vaporizer Tec 6
Heats Des to 2 atms of pressure.
69
AT > altitudes, PP of Des will be ______, and output concentration will be ______, leading to _________.
Lower, lower, underdosing.
70
All IA trigger MH highest - lowest
Hal > Forane > Sevo > Des
71
> risk for immune mediated liver injury from IA _________.
> metabolism. | Hepatic necrosis
72
Causative agent on immune mediated liver injury.
Trifluoroacetate metabolite
73
MIld Liver Injury
Modest > of serum transaminase levels from (Halo) “halothane hepatitis” More likely to occur after < hepatic BF + < O2 delivery to liver.
74
Will we still give IA to pts with Hx of liver disease?
Yes
75
Will we give IA to pt’s who report a Hx of hepatic dysfunction after previous inhalation anesthesia?
No
76
___________ produces inorganic fluoride which caused sporadic incidence of nephrotoxicity and high output renal failure after prolonged anesthetic.
Methoxyflurane
77
__________ is produced from the breakdown of Sevo and Halo.
Compound A (trifluoroethyl vinyl ether)
78
Compound A exposure can cause ... after prolonged Sevo at low flow rates (1L/min).
- transient proteinuria - enzymuria - glycosuria
79
Low FGF (<2L/min) be limited to less than ___ MAC hours of Sevo anesthesia.
2
80
“_________ is ____ with brains”
Ketamine, bad
81
> IA causes DD ______ of respiratory response to > CO2.
Blunting
81
> IA _____ CO2 threshold.
Raise

Pharmacology I (6 decks)

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