Pharm Quiz #6 Flashcards Preview

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Flashcards in Pharm Quiz #6 Deck (53)
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1

What is the current definition of Anesthesia?

Immobility in the face of noxious stimuli and amnesia for intraoperative events

2

The ___ the MAC of an anesthetic, the ___ the oil-gas partition.

lower, higher

3

The ___ the oil-gas partition coefficient, the ___ potent the vapor.

higher, more

4

How does the blood gas partition coefficient affect potency?

It doesn't

5

What is the relationship between MAC and the oil-gas partition?

it is inverse

6

What is the relationship between lipid solubility and anesthetic potency?

The greater the lipid solubility, the greater its potency.

7

What is the "take-home" message about OGPC?

The higher the OGPC, the greater the lipid solubility is and the greater the potency is because OGPC x MAC in atmospheres = 1.8 atms

8

What is the modern theory of anesthesia?

Potency determined by position and orientation of anesthetic in the bilayer.

9

What are two ways pain is meditated by immobility?

1. enhancing K+ ion channels
2. Glycine and GASBa receptors mediated reduction of spinal neuron action potentials

10

Where are Isoflurane sites of action in the brain(3)?

1. brainstem
2. cerebral cortex
3. hippocampus

11

2 primary receptors of Isoflurane involved in the CNS.

1. GABAa
2. Nicotinic acetylcholine receptors

12

What are the 3 goals of Isoflurane administration?

1. reversible effect on the CNS producing immobility in the face of noxious stimuli AND amnesia
2. immobility mediated via spinal cord anesthesia
3. amnesia mediated by the brain

13

What are the physical properties of Isoflurane?
racemic mixture?
odor?
BGPC?
OGPC?
vapor pressure?
metabolism rate?

racemic mixture of 50:50(R and S optical isomers)
ethereal and pungent odor
BGPC of 1.46
OGPC of 91
vapor pressure of 238
metabolism rate of 0.2%

14

Does Isoflurane produce compound A?

No

15

What is the MAC value for Isoflurane?

1.2%

16

What factors reduce Isoflurane MAC?

age, opioids, benzos, clonidine, nitrous oxide, barbs, pregnancy, epidural anesthesia, local anesthesia, shock, trauma, major illnesses, hypothermia, hypothyroidism

17

Isoflurane prefers blood ___ times more than the gas phase, its blood gas partition coefficient would be ___?

1.4( or 1.4:1)

18

Isoflurane's BGPC is ___ than des/sevo, suggesting induction and emergence ___ than des/sevo.

greater, slower

19

Isoflurane's use on ___ cases will ___ recovery more than use on ___ cases.

longer, slow, shorter

20

How does Isoflurane compare to other volatile agents in speed emergence?

Isoflurane has greater solubility than sevo and des so more it enters the arterial side of circulation from the lungs, prolonging emergence. Likewise, obese patients may experience a slower emergence with Iso.

21

Does Isoflurane have any mutagenic affects?

No, although it may weakly decrease the body's ability to fight infection.

22

How does the addition of nitrous oxide for an equal MAC fraction with Isoflurane affect ventilatory status?

It lessens the ventilatory depressant effects

23

What is the state describing Isoflurane's affect on the lungs?

breathing like a lizard on a hot rock

24

The dose related to ventilatory depressant effects of Iso that leads to apnea is?

around 2 MAC

25

Isoflurane causes airway irritation beginning at about what MAC?

1, so not at sub-MAC doses. By the time the patient is ready to extubate your much lower than this.
In the VA from greatest to less airway irritation: Des--->Iso--->Sevo

26

Should Isoflurane be used for inhaled induction?

NO! it has a pungent odor

27

For a deep extubation, what MAC Iso is needed?

at least 0.85

28

How does Isoflurane affect ANS response to incubation as compared to Sevoflurane?

Iso blocks ANS response to intubation greater than Sevo

29

What affect does Iso have on hypoxic pulmonary vasoconstriction(HPV)?

Iso alters HPV minimally @ routine anesthetic concentrations with minimal clinical significant. HPV is a mechanism that diverts blood flow from hypoxic areas to optimize gas exchange.

30

How does Iso affect blood pressure and by what mechanism?

Iso drops your blood pressure by decreasing the SVR