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Pharm 1 > Special Considerations? > Flashcards

Special Considerations? Flashcards

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1
Q

Special Considerations for Nitrous?

A

-Inhibits methionine synthase and folate metabolism which causes megaloblastic anemia

-Inhibits Vitamin B12

-Activates SNS

-Increases Pressure in closed spaces

-Do not use during evoked potentials

-Not flammable but is combustible

-Works on NMDA and P2P

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2
Q

Special Considerations for Sevo

A

-Seven Fluoride ions

-Can cause seizures at high MAC

-Least cardiac depressing and least coronary vasodilation

-Leads to Compound A

-Mac is 2%

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3
Q

Special Considerations for Iso

A

-Coronary steal

-Similar to Des

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4
Q

Special Considerations for Des

A

-High vapor pressure

-Needs Tec 6

-Need more drug at higher altitude

-Mac 6%

-Least metabolism by Liver

-Can lead to bronchoconstriction

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5
Q

If the patient can move their hands but not their feet during a wake up test, What should the surgeon do?

A

Reduce DISTRACTION

Other considerations - AIR EMBOLISM during wake up

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6
Q

Neuro considerations for Inhaled:

A

CMRO2 is reduced but only the electrical activity (can’t be reduced further)

60% is electrical
40% is homeostasis

1.5-2.0 Mac is needed for isoelectric

Do impact CSF

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7
Q

What are the inhibitory pathways?

A

GABA
Glycine
Potassium channels

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8
Q

Calculation of loading dose

A

Bioavailability

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9
Q

Calculation of Vd

A

Desired plasma

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10
Q

What is steady state and when is it achieved?

A

Rate of admin = rate of elim
5 half lifes

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11
Q

Is mom or baby more acidic?

A

baby

lidocaine is bad

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12
Q

Does albumin bind to acid or bases? How is albumin decreased?

A

Usually acids

Liver and Kidney disease
Malnutrition
Old age
Pregnancy

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13
Q

How is extraction ratio calculated?

A

A con

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14
Q

What does P450 CYP1A2 metabolize?

What are the inhibitors?

A

Theophylline

Erythromycin
Ciprofloxacin

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15
Q

What does P450 CYP2D6 metabolize?

What are the inhibitors?

A

Codeine
Oxy
Hydrocodone

Isoniazid
SSRI
Quinidine

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16
Q

What does P450 CY3A4 metabolize?

What are the inhibitors?

A

The rest of drugs

Grapefruit juice
cimetidine
Azole’s

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17
Q

What is metabolized by pseudocholinesterase

A

Succ
Ester locals

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18
Q

What is metabolized by nonspecific esterases?

A

Remi
Esmolol
Atracurium
Etomidate

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19
Q

What is metabolized by alkaline phosphatase?

A

fospropofol

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20
Q

what is metabolized by hofmann elimination

A

cisatricurium
atracurium

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21
Q

Low and intermediate hepatic extraction ratios?

Study These Flashcards
A

Muscle relaxants
Benzos
Alfentanil
Methadone
Barb

22
Q

Examples of R to L shunts

Study These Flashcards
A

Tetralogy of Fallot

Foramen Ovale

Eisenmenger’s syndrome

Tricuspid atresia

Ebstein’s anomaly

23
Q

In a R to L shunt what gas is affected the most?

Study These Flashcards
A

Lower solubility (Des)

24
Q

In R- L Is induction slower or faster with IV ? Inhaled?

Study These Flashcards
A

Inhaled - slower

IV - faster (by passes lungs)

25
In L-R Is induction slower or faster with IV ? Inhaled?
IV - slower Inhaled - N/A
26
Which volatiles contain chiral carbons
ISO AND DES, not sevo
27
What is the depth of anesthesia determined by?
The partial pressure of anesthetic agent in the brain
28
Does des or sevo have a HIGHER boiling point?
sevo Des has the lowest Nitrous is NEGATIVE
29
Molecular weights?
Sevo 200 Iso 184 Des 168 N2O 44
30
What is the triad of anesthesia?
Amnesia LOC immobility
31
MAC is decreased by how much per decade after 40?
6%
32
How does pregnancy affect MAC? Until when?
Decreases till 24-72 hours postpartum
33
Which gases do not cause a drop in BP? Which causes the most?
N2O Iso causes the most
34
Every 1mmHG increase in CO2 above baseline will increase MV by how much?
3L/min
35
Which volatile impairs the hypoxic drive the most and least?
Order by hepatic metabolism. Halothane Sevo Iso Des
36
SSEPs monitor the integrity of ?
Dorsal column and perfused by the posterior spinal arteries
37
MEPs monitor?
Corticospinal tract (Ventral) and is perfused by the anterior spinal artery
38
You should be concerned about nerve ischemia when amplitude decreases by --- or latency increases by ----
>50% Latency > 10%
39
What induction agent may enhance EPs?
Ketamine
40
Considerations for Fospropofol
-Causes burning and itching -Turned to prop by alkaline phosphatase -Dose is 6.5mg/kg -Onset 7 minutes -Duration 37 min -Metabolized to propofol, formaldehyde, phosphate
41
Considerations for Ketamine
-Secondary - opioid, MAO, serotonin, NE, muscarinic, Na channels -Dissociates thalamus and limbic -Increased SNS tone unless SNS is not intact, then myocardial depressant -Low dose does not increase SNS -Nystagmus, delirium, ulcerative colitis -Small protein binding
42
Risk factors for ketamine delirium?
age >15 Female >2mg/kg Psych hx
43
Considerations for Etomidate
.2-.4mg/kg Same onset as prop Liver and esterases Does not block SNS response to DL Mild resp and card effects Causes adrenal insufficiency - up to 24 hours Can causes seizures with patient Hx PONV
44
Pathway for Heme?
succinyl Coa Glycine ALA synthase Precursos Heme
45
What is heme a key component of?
Hgb, myoglobin, CYP 450
46
What makes porphyria worse?
Etomidate Ketamine Barbs CCB Birthday control Toradol Stress NPO CYP450 INDUCTION
47
How does porphyria present?
Abdominal pain psych seizures neuropathy
48
Treatment for porphyria
Hydration Glucose Heme arginate Prevent hypothermia
49
Considerations for thiopental ?
pH - 9 Arterial admin = intense vasoconstriction, crystal formation Give alpha blocker and sympathectomy block (stellate ganglion or brachial plexus) Causes histamine release
50
CV and resp effects of barbs?
hypotension * baroreceptor preserved *Histamine release Has neuroprotection for focal ischemia

Pharm 1 (4 decks)

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