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Anesthesia Pharm Exam 3 KDH > Pharm Exam 3 Review > Flashcards

Pharm Exam 3 Review Flashcards

1
Q

What is the vapor pressure for isoflurane?

A

238

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2
Q

What is the vapor pressure for desflurane?

A

669

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3
Q

What is the vapor pressure for sevoflurane?

A

157

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4
Q

What is the blood gas coefficient for isoflurane?

A

1.46

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5
Q

What is the blood gas coefficient for desflurane?

A

0.42

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6
Q

What is the blood gas coefficient for sevoflurane?

A

0.69

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7
Q

What is the blood gas coefficient for Nitrous?

A

0.46

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8
Q

What is the MAC value for isoflurane?

A

1.17

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9
Q

What is the MAC value for desflurane?

A

6.6

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10
Q

What is the MAC value for sevoflurane?

A

1.8

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11
Q

What is the MAC value for Nitrous?

A

104

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12
Q

Which of the following applies to highflow anesthesia? Which applies to low flow?

FGF exceeds minute ventilation
FGF less than minute ventilation
Wasteful
Less cooling/drying
Cools/dries delivered volumes
Rapid changes in anesthetics
Very slow changes in anesthetics
Prevents rebreathing
Compound A production

A

Highflow Anesthesia:
FGF exceeds minute ventilation
Wasteful
Prevents rebreathing
Cool/dries delivered volumes
Rapid changes in anesthetics

Low-flow Anesthesia:
FGF less than minute ventilation
Less cooling/drying
Very slow changes in anesthetics
Compound A production

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13
Q

What is an isomer of enflurane?

A

Isoflurane

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14
Q

What causes brochodilation with inhaled anesthetics? (MOA)

What can this MOA also effect?

A

Blocking voltage gated Ca++ channels

Can also effect cardiac contractility

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15
Q

Which volatile is best for brochodilation following bronchoconstriction?

A

Sevoflurane

It is better than Isoflurane at causing bronchodilation.

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16
Q

Which volatile worsens bronchospasm?

Which patient population is more at risk for bronchospasm with this volatile?

A

Desflurane

Especially with smokers due to pungancy and irritation.

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17
Q

Which volatile has no relaxant effect on skeletal muscles?

A

Nitrous

All other volatiles do.

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18
Q

What is Standard MAC?

A

1.3

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19
Q

What is MACawake?

A

0.3 - 0.5

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20
Q

How much change in MAC is there per decade?

A

6% change in MAC per decade (increase younger than 30 and decrease older than 55)

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21
Q

At what MAC do you see burst suppression?

A

1.5 MAC

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22
Q

At what MAC does apnea begin?

A

1.5 MAC

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23
Q

Volatiles increase CBF due to what?

A

Vasodilation - decreased cerebrovascular resistance!

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24
Q

What is the concern for over-pressurization with Des?

A

HR major increase d/t SNS stimulation

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25
Q

What % PONV with Nitrous?

A

> 50%

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26
Q

Which gas is most pungent?

What happens due to its pungency? (4 answers)

A

Desflurane

Coughing, salivation, breath holding, and laryngospasm.

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27
Q

Which volatile is least likely to form carbon monoxide?

A

Sevoflurane

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28
Q

Which drug is best for induction and neuro?

A

Sevoflurane

It has less vasodilatory effects.

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29
Q

Which volatile has Compound A formation?

A

Sevoflurane

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30
Q

Which volatile is acceptable for ablation?

A

Sevoflurane

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31
Q

If a patient has a reaction on induction with sevoflurane, what should you do first?

A

Turn off the causative agent!!!

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32
Q

Which volatile cannot deliver 1 MAC and will therefore never be in equilibrium?

A

Nitrous

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33
Q

Does Nitrous have analgesia properties?

A

Yes

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34
Q

The Nitrous 2nd gas effect is dependent on what? (2 answers)

A

Blood flow to the area and Duration

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35
Q

What do you do if your TOF twitches are coming back and you still have more case left?

A

Give more of the drug

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36
Q

What do you do if you have 4/4 twitches and the case is over?

A

Extubate

There is no need to give a reversal.

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37
Q

Match the gas law to it’s definition.

Boyle’s law
Fick’s law
Graham’s law

Pressure and volume of gas are inversely proportional

Diffusion depends on partial pressure, solubility, and thickness of the membrane.

Smaller molecules diffuse faster (dependent on solubility)

A

Boyle’s Law: Pressure and volume of gas are inversely proportional

Fick’s Law: Diffusion depends on partial pressure, solubility, and thickness of the membrane.

Graham’s law: Smaller molecules diffuse faster (dependent on solubility)

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38
Q

PA -> Pa

Alveoli to blood variable (1 answer)

A

Blood gas partition coefficient

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39
Q

Pa -> Pbr

Arterial blood to brain variables (3 answers)

A

Brain blood partition coefficient
Cerebral blood flow
A-v pp difference

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40
Q

Which law deals with ventilation to the lungs?

A

Boyle’s Law

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41
Q

What is over pressurization used for?

A

Offsets slow induction from highly soluble volatiles.

42
Q

Which drug is most effected by overpressurization?

A

Desflurane? Maybe?

43
Q

What happens with the 2nd gas effect? (3 answers)

HINT:
What happens with N2O?
What happens with the concentration of the second gas?
What happens with the uptake of the second gas? Why?

A

Uptake of high volume of N2O
Increases concentration of second gas
Increased uptake of second gas due to gradient

44
Q

Nitrous diffusing into air-filled cavities effects what?

A

Magnitude of pressure based on the blood flow to the cavity!!!

Duration of administration

AND

Partial pressure of nitrous

45
Q

Define solubility in relation to inhaled anesthetics.

A

The ratio of how the inhaled anesthetic distributes between 2 compartments at equilibrium.

46
Q

What happens to solubility with increased temperature?

A

DECREASED solubility

47
Q

What happens when blood solubility is LOW?

A

Minimal amounts of volatile dissolved
So we have a rapid PA/Pa which means…
RAPID INDUCTION

48
Q

What happens when blood solubility is HIGH?

A

Large amounts must be dissolved
So we have a slow PA/Pa which means…
PROLONGED INDUCTION

49
Q

Cardiac fat????

A

Vessel rich groups

50
Q

What is ischemic preconditioning?

What does it prevent?

A

Brief periods of ischemia prior to longer periods

It prevents reperfusion injury.

51
Q

Which factors cause no change in MAC? (5 answers)

A

Gender
Duration of anesthesia
MAP > 40mm Hg
K+ changes
Thyroid issues

52
Q

Which factors decrease MAC? (4 answers)

HINT:
One answer is drugs. Which drugs? (3 answers)

A

Drugs: Alpha 2 agonists, Opioids, Lidocaine
Pregnancy
Hyponatremia
Alcohol acute injection

53
Q

Which factors increase MAC?

A

Hyperthermia
Hypernatremia
Drug induced increase in catecholamine levels
Pheomelanin production (redheads)

54
Q

What is partial pressure?

What law is it related to?

A

Mixture of gasses in a closed container exert pressure on walls

Dalton’s Law: Total sum of all partial pressures added together

55
Q

How does increased heat affect vapor pressure?

A

Increased heat = increased vapor pressure

56
Q

The higher the vapor pressure the more likely to evaporate (des)

This is not a question, there is no answer.

A

Hello there

The higher the vapor pressure the more likely to evaporate (des)

57
Q

What process does Henry’s Law describe?

A

Over-pressurizing

The amount dissolved in a liquid is proportional to the pressure above the liquid.

58
Q

Which volatile evaporates the quickest (has the highest partial pressure at a given temperature)?

A

Desflurane

Highest vapor pressure: 669

59
Q

What is the purpose of flow-overs/wicks in vaporizers?

A

Improves the efficiency of vaporization

60
Q

What does depolarizing MR (sux) mimic?

A

Mimics the action of ACh

61
Q

Non-depolarizing MR do what in relation to ACh?

How does it work?

A

Interfaces with the action of ACh

Competitive inhibition: it competes for alpha subunits POSTjunctional

62
Q

Match the MR to its type:

Aminosteroids
Benzylquinolones

Rocuronium
Cistatracurium
Vecuronium
Atracurium
Pancuronium
Mivacurium

A

AminosteRoids = -Roniums
BenzylqUinolones = -cUriums

63
Q

ED95 shows the dose necessary to what?

A

Suppress a SINGLE twitch

64
Q

What more closely reflects diaphragm and laryngeal muscle blockade on induction

A

Orbicularis Oculi

65
Q

What is the gold standard for recovery?

Why?

A

Adductor pollicis: adduction of thumb towards midline

Lasts longer and comes back LATER

66
Q

Why was Double Burst (DBS) developed?

A

To improve detection of residual blockade

67
Q

What does no PTS indicate?

A

Intense blockade

68
Q

Are each of the following related to depolarizing or nondepolarizing MR?

Decreased amplitude to continuous stimulation, but no fade
TOF < 0.7
FADE
TOF > 0.7
Absence of post-tetanic
Fasciculations
Potentiation of PTS

A

Depolarizing NM: Decreased amplitude to continuous stimulation, but no fade
TOF > 0.7
Absence of post-tetanic
Fasciculations

NDMR:
TOF < 0.7
FADE
Potentiation of PTS

69
Q

Which ions maintain NMJ postsynaptic? (2 answers)

A

Sodium and Potassium

70
Q

Depolarization is called a…

A

PHASE 1 BLOCK

71
Q

What happens with pseudocholinesterase activity in obese people?

A

INCREASED pseudocholinesterase activity in obese people

72
Q

What is a normal Dibucaine number when testing for normal cholinesterase levels?

A

Normal = 80

73
Q

Which NMB releases histamine?

A

Sux

74
Q

What are the side effects of Sux? (5 answers)

A

Hyperkalemia
Sustained muscle contraction
Aspiration (increased intragastric pressure = increased LES pressure)
Masseter muscle spasm
Increased intraocular and intracerebral pressures

75
Q

How do you decrease ICP with a patient who has been given Sux?

A

Hyperventilate your patient!

76
Q

What happens with Rhabdo?

A

Muscle destruction and myoglobinbinuria

77
Q

What triggers MH?

A

Sux and all volatiles

78
Q

What causes MH?

A

Mutations in ryanodine receptor RyR1

79
Q

What is the treatment for MH? What type of drug is it? Dosage? Max Dose?

A

Dantrolene
a CCB
2 mg/kg IV
Max 10 mg/kg IV

80
Q

At 70% postjunctional occupation what is happening with the blockade and twitches?

A

no blockade (4/4 twitches)

81
Q

What is the TOFR if the 4th twitch is 50% of the 1st twitch?

A

TOFR is 0.5

82
Q

What is happening with a Phase 2 block? (4 answers)

A

Decreased twitch response to a single stimulus
Unsustained response (fade) to continuous stimulus
Post tetanic potentiation
TOFR <0.7

83
Q

Which NMBD for CV?

A

Pancuronium, but NARROW margin of safety

84
Q

How does Hyperkelemia effect NMBDs (depolarizing and non-depolarizing)?

A

INCREASES effect of depolarizing NMBDs

RESISTANCE to NDMRs

85
Q

How do Burns effect NDMRs and why?

A

RESISTANCE to NDMRs because of increased extra-junctional receptors

86
Q

Who (on average) needs higher dose of NMBDs: men or women? Why?

A

Men because they have more muscle mass.

87
Q

Side effect of Pancuronium…

A

SNS activation
Release NE presynaptic and block reuptake postganglionic

88
Q

What is the dose and duration of action of Sux?

A

1 mg/kg

DOA: 3-5 min

89
Q

What is the dose of Vecuronium?

A

0.1 mg/kg

90
Q

What is the dose of Pancuronium? DOA?

A

0.1 mg/kg

DOA: 86 min (60-90)

91
Q

What is the dose of Rocuronium? DOA?

A

0.6 mg/kg
DOA: 36 min (20-35)

92
Q

What leads to a prolonged blockade with vecuronium?

A

Respiratory acidosis

93
Q

Which NDMR is eliminated by Hoffman elimination?

A

Cistatracurium

94
Q

Why do people with hepatic disease have prolonged elimination?

A

Increased volume of distribution

95
Q

An MVA patient comes in unconcious, which drug do we use to intubate? Whats the dose?

A

Rocuronium 1.2 mg/kg (double dose)

96
Q

Is aspiration a side effect of succinylcholine?

A

Yes

97
Q

What is pharyngitis?

A

An inflammation usually caused by bacterial infection

98
Q

How is cistatracurium metabolised?

A

Through Hoffman elimination and plasma esterases.

NOT BY Neostigmine :(

99
Q

How does Hyperthermia effect MAC?

A

Increases

100
Q

How does metabolic acidosis affect CO?

A

Decreases

101
Q

How does hyperthermia affect solubility?

A

Decreases

102
Q

Where is lidocaine metabolised?

A

the LIVER

Not metabolised by plasma esterases

Anesthesia Pharm Exam 3 KDH (6 decks)

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