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Anesthesia Basics > Pharm: Inhaled Anesthetic Drugs > Flashcards

Pharm: Inhaled Anesthetic Drugs Flashcards

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1
Q

Isoflurane (Flurane) vapor pressure

A

238

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2
Q

Isoflurane (Flurane) MAC

A

1.15

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3
Q

Isoflurane (Flurane) B:G coefficient

A

1.4

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4
Q

Isoflurane (Flurane) O:G coefficient

A

90-99

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5
Q

Isoflurane (Flurane) chemical structure

A

1-chloro-2,2,2-trifluroethyl difluoromethyl ether

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6
Q

Isoflurane (Flurane) vapor pressure

A

238

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7
Q

Isoflurane (Flurane) pharmacodynamics

A

Pharmacodynamics
- Cardiac = maintain CO, vasodilation, HR increases @ MAC >1,
dose-dependent arterial BP decrease, prolong QT
- Respiratory = less tachypnea, respiratory irritant, resp
depression, breath holding, laryngospasm
- Neurologic = may decrease intellectual function 2-3 days,
decrease CMR, does not evoke seizure activity
- Neuromuscular = potentiates muscle relaxant, moderate
muscle relaxation, malignant hyperthermia
- Renal = transient increase Cr and BUN, no renal metabolites
- Liver = metabolized 0.2%

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8
Q

Isoflurane (Flurane) adverse effects

A

Shivering
N/V
Ileus
Transient elevation in WBC

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9
Q

Isoflurane (Flurane) clinical advantage

A

moderate muscle relaxation
decrease CMR
minimal biotransformation
no significant systemic toxicity
inexpensive
possible neurologic and cardia protection

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10
Q

Isoflurane (Flurane) clinical disadvantages

A

pungent odor
airway irritant
trigger for MH
slower induction and emergence

**

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11
Q

Isoflurane (Flurane) inspired concentration and surgical anesthesia

A

concentration 1.5-3% produce surgical anesthesia in 7-10min

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12
Q

Desflurane (Suprane) vapor pressure

A

669

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13
Q

Desflurane (Suprane) MAC

A

5.8-6

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14
Q

Desflurane (Suprane) B:G coefficient

A

0.42

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15
Q

Desflurane (Suprane) O:G coefficient

A

18.7

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16
Q

Desflurane (Suprane) chemical structure

A

1,2,2,2, - tetrafluoroethyl difluoromethyl ether (6 fluorides)

totally fluurinated methyl either inset

low solubility

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17
Q

Desflurane (Suprane) vaporizer type

A

Tech 6 Vaporizer
- high VP of 669
- heated to 39 C, approx. 2 atms
- dual-gas blended vaporizer (heated and pressurized)
- does not account for altitude changes
- blended with FGF to dilute
- concentration dial: 1-18%

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18
Q

Desflurane (Suprane) pharmacodynamics

A

-Cardiac = >1 MAC increase HR, dose-dependent in MAP & CO,
minimal predisposition to PVCs w/ epi
-Respiratory = Airway irritant when >6%, dose-related resp depression, bronchodilation, increase upper airway events in peds
Neurologic = increased ICP, give < 0.8 MAC
Neuromuscular = synergistic with NMBD, trigger for MH
-Renal = urinary metabolites less than 0.02%
-Liver = minimally bio transformed in liver

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19
Q

Desflurane (Suprane) delivery

A

-low FGF rates are beneficial with less soluble anesthetics (allows for better control and less depletion of anesthetic from inspired gas)
-frequent starting concentration = 3% ().5 MAC)
-Increased 0.5-1% every 2-3 breaths until desire depth
-maintenance 2.5-8.5%

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20
Q

Desflurane (Suprane) adverse effects

A

N/V
respiratory irritant
CO production with desiccant absorbent

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21
Q

Desflurane (Suprane) clinical advantages

A

rapid wash-in/wash-out
stable molecular structure
no sig systemic toxicity
possible neurologic and cardiac protection

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22
Q

Desflurane (Suprane) clinical disadvantages

A

carbon monoxide production possible with CO2 absorbents
not recommended for pediatrics d/t upper airway events
caution if concern for for increase HR and BP
Resp irritant

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23
Q

Sevoflurane (Ultane) Vapor pressure

A

157

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24
Q

Sevoflurane (Ultane) MAC

A

1.8-2.0

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25
Sevoflurane (Ultane) B:G coefficient
0.68
26
Sevoflurane (Ultane) O:G coefficient
50
27
Sevoflurane (Ultane) pharmacodynamics
Cardiac = dose-related depression, no inc HR < 2 MAC - Respiratory = dose-related resp depression, bronchodilation - Neurologic = slight increase in CBF, if MAC > 1.5 autoregulation affected - Neuromuscular = synergistic with NMBD, trigger for MH - Renal = slight dec RBF & GFR, fluoride HL prolonged in renal -Liver = dec portal vein flow, inc hepatize artery flow, metabolized by CYP450 to hexafluoro isopropanol, 5% metabolized
28
Sevoflurane (Ultane) warnings
-proteinuria & glycosuria noted with admin exceeding 2 MAC-hours and at FGF rates of <2L/min -FGF rates <1L/min are NOT recommended -Degradation of sevoflurane to compound A & B
29
Sevoflurane (Ultane) clinical advantages
rapid uptake and elimination excellent for inhalation induction bronchodilation cardidovascular effects comparable to iso
30
Sevoflurane (Ultane) clinical disadvantages
reacts with soda-lime = compound A trigger for MH some biotransformation emergence delirium & agitation
31
What is Compound A
vinyl ether - nephrotoxic with exposure of 1-3 hours
32
Sevoflurane (Ultane) chemical structure
fluoromethyl and 1,1,1,3,3,3-hexafluoroisopropyl as the two alkyl groups
33
Halothane (Fluothane) vapor pressure
244
34
Halothane (Fluothane) MAC
0.75
35
Halothane (Fluothane) B:G coefficient
2.54
36
Halothane (Fluothane) O:G coefficient
224
37
Halothane (Fluothane) Pharmacodynamics
Cardiac = dose-related depression, slowing of SA node, decrease HR, increased arrhythmogenic effect of epi - Respiratory = dose-related resp depression, bronchodilation - Neurologic = slight increase in CBF, autoregulation affected - Neuromuscular = synergistic with NMBD, trigger for MH - Renal = slight dec RBF & GFR, and UOP - Liver = cellular dysfn, hepatotoxicity, metabolized 12-25%
38
Nitrous Oxide MAC
104
39
Nitrous Oxide B:G coefficient
0.42
40
Nitrous Oxide O:G coefficient
1.4
41
Nitrous Oxide Pharmacodynamics
- Cardiac = no change in BP, CO, and HR - Respiratory = inc RR, dec TV, dec hypoxic drive - Neurologic = Inc CBF, inc CBV, and ICP - Neuromuscular = no muscle relaxation, not a trigger for MH - Renal = slight dec RBF, inc renal vascular resistance - Liver = midl decrease in blood flow
42
Nitrous Oxide contraindications
-air embolus - pneumothorax - acute bowel obstruction - intracranial air - intra-ocular gas bubble (perfluoropropane or sulfur hexafluoride) - tympanic membrane
43
Nitrous Oxide clinical advantages
-analgesia, anxiolysis - rapid uptake and elimination - second gas effect - decrease MAC requirements - minimal resp or cardiac depression - nonpungent
44
Goal of inhaled anesthetics
Establish a constant optimal partial pressure of anesthetic in CNS CNS partial pressure = blood partial press= alveolar partial press Produce: 1.Amnesia 2.Unconscious 3.Immobility
45
Challenges of inhaled anesthetics
- Airway irritation - SNS stimulation - Compound A (sevoflurane) - CO production with CO2 absorbent - Complex desflurane vaporizer - Perioperative hyperkalemia - Cost
46
Advantages of inhaled anesthetics
- Rapid induction - Precise control of end tidal concentrations during maintenance of anesthesia - Prompt recovery at end of case
47
Stages of anesthesia: One
Begins with Induction of anesthesia & ends with loss of consciousness. Pain perception threshold not lowered
48
Stages of anesthesia: two
Uninhibited excitation. Agitation, delirium, irregular breathing pattern including breath-holding, dilated & divergent pupils. Noxious stimuli can cause HTN, ↑HR, laryngospasm, vomiting, uncontrolled movements
49
Stages of anesthesia: three
Target anesthesia depth: painful stimulation does not elicit somatic reflexes & autonomic responses. Central eye gaze, constricted pupils, regular respirations
50
Stages of anesthesia: four
Includes hypotension, dilated & nonreactive pupils, onset of apnea
51
MOA: Meyer-Overton (traditional)
- lipid solubility is proportional to potency - thought general anesthetics work by binding directly to proteins - revised: anesthetics have a polar and nonpolar side
52
MOA: Enhanced inhibitory receptors
- GABAa, glycine, NMDA receptors - sodium channels, calcium channels, potassium channels, 5HT3
53
MOA: Inhibitory effect on excitatory channels
neuronal nicotine & glutamate receptors
54
Sites of action producing unconsciousness, amnesia, analgesia, immobility
Sites of action: -supraspinal (sedation, amnesia) -spinal (immobility) - suppress withdrawal effect in dorsal horn Unconscious = cortex, thalamus, and brainstem Amnesia = amygdala, hippocampus Analgesia = spinothalamic tract Immobility = spinal cord
55
MAC
MAC = minimum alveolar concentration at equilibrium (1 atm) in which 50% of subjects will not respond to a painful stimulus (such as skin incision) 🡺 Mirrors brain partial pressure
56
MAC-awake
minimum alveolar concentration at which 50% of persons will follow the command to “open your eyes” 🡺 0.3-0.4 MAC associated with awakening from anesthesia 🡺 Loss of awareness & recall approx. 0.4-0.5 MAC
57
MAC-Bar
exceeds requirements for ablation of skeletal muscle movement with surgical stimuli. Blunts hemodynamic responses (heart rate, MAP) to incision 🡺 Roughly 1.3 MA
58
MAC-Bar for desflurane, sevoflurane, isoflurane
- Des 7.8 MAC - Sevo 2.6 MAC - Iso 1.5 MAC
59
Loss of recall: desflurane, sevoflurane, isoflurane
-Des 2.4-3.0 MAC -Sevo 0.8-1.0 MAC -Iso 0.46-0.57 MAC
60
Halogenated ethers
- Isoflurane (Forane) - Sevoflurane (Ultane) - Desflurane (Suprane)
61
Halogenated Hydrocarbons
Halothane (fluothane)
62
Impact of drugs halogenated with fluorine
are less soluble in blood -> allows for faster induction & emergence

Anesthesia Basics (7 decks)

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