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Fall'20 Pharmacology III > NCE part 1 > Flashcards

NCE part 1 Flashcards

1
Q

which two volatile anesthetics decrease SVR the most

A

Isoflurane and Desflurane

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2
Q

Isoflurane causes hypothermia …why

A

because it suppresses the hypothalamic temperature regulators

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3
Q

which agents are volatile

A 
Sevoflurane
Desflurane
Isoflurane
Enflurance
Halothane
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4
Q

how do volatile anesthetics affect cerebral vessels and cerebral blood flow.

A

Dilate cerebral vessels
Increase cerebral blood flow
Increase cerebral blood flow and ICP
Decreases neuronal function and cerebral metabolism

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5
Q

which three gases similarly depress cerebral metabolic rate

A

Iso, Des, Sevo

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6
Q

how do we negate the increase ICP with Isoflurance (remember its the least to dangerously increase ICP)

A

hyperventilate

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7
Q

Hypoxic Pulmonary Vasoconstriction is inhibited at what MAC

A

HPV is inhibited by a high concentration of volatile (1-1.5 or higher MAC)

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8
Q

What volatile is considered completely halogenated with fluorine?

A

Des is considered to be completely halogenated with fluorine

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9
Q

what volatile has fluorine substituting halogen

A

sevoflurance

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10
Q

which two volatile most depress ventilation

A

Des, Enflurane

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11
Q

which volatile depress ventilation the least

A

Halothane

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12
Q

what volatile agent Most depress the baroreceptor reflex

A

Halothane and Sevo: No increase in HR even with decreases in blood pressure

Baroreceptor: “DISH” least to greatest

  • S/H no increase in HR w/low BP
  • D/I increase in HR w/low BP
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13
Q

what volatile agent Least depress the baroreceptor reflex

A

Iso and Des: HR increases as a reflex to decrease in blood pressure

Baroreceptor: “DISH” least to greatest

  • S/H no increase in HR w/low BP
  • D/I increase in HR w/low BP
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14
Q

Acute ETOH intoxication effect on MAC

A

Decreases

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15
Q 
Rank opioids most lipid soluble to least lipid soluble
Meperidine
Remifentanil
Morphine
Fentanyl 
Sufentanil
alfentanil
A

Sufentanil &raquo_space; fentanyl&raquo_space;> alfentanil&raquo_space;> meperidine > remifentanil > morphine

“Single Females And Males Run Marathons”
23311 (arrow pattern)

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16
Q

What receptors do spinal opioids work

A

Primarily Mu-2 but work on mu-1, kappa, and delta to produce supraspinal analgesia

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17
Q

Stimulation of mu-1 receptors what responses:

A 
Spinal and supraspinal analagesia
Euphoria
Miosis
Bradycardia
Hypothermia
Urinary retention
pruritus
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18
Q

Mu-1 have a high or low abuse potential

?

A

Low abuse potential

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19
Q

Opioid can cause nausea and vomiting by

A

Stimulation of CTZ of the fourth ventricle (floor). The triggered CTZ activates vomiting center near the brain stem

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20
Q

Most opioids are metabolized by the liver. Which is not and what is it metabolized by?

A

Remifentanil and is metabolized by nonspecific esterases in the blood stream.

21
Q

Agonist/antagonist opioids work on what receptor(s) for therapeutic effect

A

Primarily Kappa

Also on delta

22
Q

Naloxone reverses what actions of opioids

A

Pruritus
Urinary retention
N/V

23
Q

Higher doses of naloxone are required to reverse what opioid issue

A

Reverse profound sedation and respiratory depression

24
Q

Does morphine produce arterial or venous dilation

A

Both due to histamine release

25
What two opioids cause histamine release
Morphine and Meperidine
26
There are 3 CV actions that may cause a decrease in BP in an anesthetized patient given a high dose of fentanyl
``` Decrease SVR (dilate arterial vessels Decrease venous return (dilate venous capacitance vessels Decrease in HR ```
27
how are esters hydrolyzed
Hydrolyzed by plasma and tissue cholinesterase
28
PABA is excreted where
urine
29
is there cross contamination between esters and amides
no
30
how could an ester be prolonged
plasma cholinesterase deficiency
31
what is responsible for esters reaction
PABA is responsible for the greater portion of allergic reactions to esters
32
Lipid solubility =
potency of LA
33
Protein binding =
duration of LA
34
pKa =
(50:50 ionized and unionized)
35
``` Which of the following are short acting local? Long acting local? Procaine Lidocaine Prilocaine Bupivacaine Tetracaine mepivacaine ```
Short: procaine Long: bupivacaine and tetracaine
36
What is the progression of blockade:
``` Autonomic -Temperature -Pain Sensation -Touch -Pressure Motor -Vibration -Proprioception ```
37
Treatment of LA Toxicity?
20% Intralipid: 1.5 mL/kg over 1 minute Continuous infusion of 0.25 mL/Kg until hemodynamically stable Limit: 10 mL/Kg over 30 minutes
38
nitrous administered alone does not cause hypotension but instead causes
When administered alone Nitrous does not cause hypotension but instead causes cutaneous vasoconstriction and increased SVR
39
when administered alone what does nitrous cause
Nitrous will cause an increase in cardiac output when administered alone
40
Dose limit for exogenous Epi
5-6 mcg/kg with these volatiles
41
Tissue trauma: fluid replacement Minimal? Moderate? Extensive?
Tissue trauma: Minimal – 5 ml/kg/hour Moderate - 6 ml/kg/hour Extensive – 8 ml/kg/hour
42
Goal Directed Fluid Therapy is guided by UOP
Keep 0.5 ml/kg/hour | Hemodynamics
43
These three depress cerebral metabolic rate the most... | these two depress it less
iso, des, sevo those three depress more than enflurane and halothane.
44
what gas is the least likely to dangerously increase ICP if the patient is kept moderately hypocapnic
Iso
45
volatile anesthetics do what to the ventilatory response to c02
Volatile anesthetics alter the ventilatory response to CO2 by decreasing that response when used in dose-dependent increments
46
how much MAC- will completely block the ventilatory response to hypoxemia
0.1 MAC
47
which gas has a slightly higher incidence of causing a cough reflex during maintenance when used with a LMA
isoflurance
48
will hypoxemia stimulate ventilation when using a volatile agent
no

Fall'20 Pharmacology III (14 decks)

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