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Pharm 2 > MAC > Flashcards

MAC Flashcards

1
Q

2 main differences in modern anesthetics from ether/chloroform/nitrous?

A

fluorinated and nonflammable

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2
Q

why do we like low solubility of volatile agents?

A

low solubility means drug wants to stay in gas form in alveoli rather than moving to blood so med reaches side of effect and is able to be blown off
[we want these in gas form so they work]

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3
Q

What is added to decrease flammability of ether?

A

halogens - fluorine (F), chlorine (Cl), bromine (Br), iodine (I), astatine (At), and tennessine (Ts).

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4
Q

what halogen is in all modern anesthetics

A

flourine

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5
Q

advantages of halothane compared to ether?

A

nonflammable, less pungent, less soluble (quicker off), less toxic

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6
Q

disadvantages of halothane compared to ether?

A

decrease CO, increased arrythmias, hepatotoxic

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7
Q

main advantage of flourination?

A

decreased solubility
[dont want these meds to hang on]

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8
Q

effects of increased flourination?

A
  1. nonflammable
  2. decreased solubility
  3. decreased potency
  4. less toxic r/t degradation
  5. decreased % metabolized
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9
Q

list inhaled anesthetics

A

nitrous, halothane, enflurane, isoflurane, desflurane. sevoflurane

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10
Q

list volatile anesthetics

A

halothane, enflurane, isoflurane, desflurane, sevoflurane

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11
Q

explain MAC

A

minimum alveolar concentration of inhaled agent that prevents mvmt in response to stimulus in 50% of patients

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12
Q

how are MAC and potency related

A

higher the MAC, lower the potency
lower the MAC, higher the potency

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13
Q

How to do you get to a MAC of 95% or ED95?

A

multiply MAC by 1.3

[ex: sevo MAC 1.8 so ED95 is 2.34]

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14
Q

What determines MAC?

A

spinal cord

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15
Q

Why do we use alveolar concentration?

A

it reflects concentration at cord and brain more accurately r/t equilibration

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16
Q

law of overpressurization?

A

Henry’s

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17
Q

how does age alter MAC?

A

as age increases, MAC decreases [6% per decade] meaning: increased age, less drug given to produce immobility

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18
Q

What does nitrous do to MAC?

A

decreases MAC in all ages, especially geri

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19
Q

list MAC by age from highest MAC to lowest MAC

A

infants - children - neonates - adults

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20
Q

60% nitrous causes how much of a reduction in MAC?

A

60%

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21
Q

how does body temp affect MAC?

A

decreased body temp causes decreased MAC
[hypothermia basically anesthesia]
[lower body temp causes vapors to hang on]

22
Q

Why does pregnancy decrease MAC?

A

progesterone, decreases 30% thru early postpartum then normalizes 12-72 hours

23
Q

What does low sodium do to MAC?

A

decreases! Low sodium is CNS depressant.

24
Q

What medications decrease MAC?

A

-opioids (ceiling effect)
-benzos dd
-barbiturates
-prop
-acute ETOH
-LA

25
Q

how much does small dose fentanyl decrease MAC of des?

A

50% but not dd. ceiling effect so won’t see a big decrease with additional dosing

26
Q

Other drugs used that decrease MAC?

A

-clonidine and precedex
-some BB
-some CCB
-adenosine

27
Q

how to clonidine and precedex decrease MAC?

A

by decreasing CNS catecholamines (norepi) and hyperpolarization of cns cell membranes

28
Q

Factors that decrease MAC?

A

neuraxial opioids
pao2 <38 mmhg
bp <40 mmhg
cardiopulm bypass

29
Q

Factors that increase MAC

A

red hair
increased cns catecholamines (cocaine, amphet, ketamine)
hyperthermia
hypernatremia

30
Q

why does red hair increase MAC?

A

pheomelanin production (19%)

31
Q

factors that do NOT alter MAC?

A

gender
duration of anesthesia
body mass
pao2 >50
paco2 <80
hematocrit >10
bp > 40

32
Q

explain MAC awake

A

% MAC where pt can move and FOLLOW COMMANDS

33
Q

Nitrous MAC and MAC awake

A

MAC 104%
MAC awake .64

34
Q

halothane MAC and MAC awake

A

MAC .76%
MAC awake 55%

35
Q

isoflurane MAC and MAC awake

A

1.17%
awake 38% of MAC

36
Q

desflurane MAC and MAC awake

A

MAC 6.6%
awake 34% of MAC

37
Q

sevoflurane MAC and MAC awake

A

1.8%
awake 34% of MAC

38
Q

explain trend of ratio of MAC awake

A

the higher the ratio number, the shorter the distance between MAC and MAC awake and the quicker patient will be able to follow commands. Lower the ratio, more drug you will have to get out of system in order for pt to follow commands.

39
Q

explain ratio MAC and MAC awake and amnesia

A

the higher the ratio number (nitrous) the worse amnestic drug is and the quicker the patient will wake

40
Q

list different MACs from highest to lower

A

MAC bar
MAC te
MAC
MAC awake
MAC amnesia

41
Q

what % MAC of halothane is MAC awake

A

50%

42
Q

what % MAC of nitrous is MAC awake?

A

60% [poor amnestic]

43
Q

1/3 of MAC is MAC awake with these three drugs

A

isoflurane, sevoflurane, desflurane

44
Q

the higher the ratio the..

A

faster the recovery
worse the amnestic

45
Q

how do low dose opioids affect MAC awake?

A

minimally affects MAC awake, but does decrease MAC so the ratio increases and awakening should be quicker

46
Q

very important concept to know about MAC awake?

A

does not ensure return of esophageal sphincter tone or pharyngeal function, cannot always protect a/w

47
Q

what concentration of inhaled agent provides pt safety?

A

less than .1 MAC

48
Q

What is MAC te

A

MAC that will not allow tracheal stimulation to occur, exceeds or equal to MAC

49
Q

what is MAC bar?

A

blocks autonomic responses to surgical stimulus

50
Q

MAC bar of des with and w/o 60% nitrous

A

1.3 with
1.9 w/o
add fent .4 and 1

51
Q

MAC bar of iso with and w/o 60% nitrous

A

1.3 with
1.9 w/o
add fent and .55 and 1.15

52
Q

mac bar of sevo

A

2.2 of MAC

Pharm 2 (1 decks)

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