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Nurs 575 Anesthesia Pharmacology > Week 5 Inhaled Anesthetics > Flashcards

Week 5 Inhaled Anesthetics Flashcards

1
Q

MAC for Sevoflurane?

A

2%

Nagelhout, Ch. 7, pg 82, Table 7.1

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2
Q

MAC for Isoflurane?

A

1.15%

Or 1.17% in Ch. 8

Nagelhout, Ch. 7, pg 82, Table 7.1

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3
Q

MAC for Desflurane?

A

5.8%

Nagelhout, Ch. 7, pg 82, Table 7.1

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4
Q

MAC for N2O?

A

DEAD
104% or 105%
depending if you read Ch. 7 or 8

Nagelhout, Ch. 7, pg 82, Table 7.1

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5
Q

Blood/Gas Partition Coefficient of Sevo?

A

0.68

Nagelhout, Ch. 7, pg 82, Table 7.1

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6
Q

Blood/Gas Partition Coefficient of Iso?

A

1.43

Nagelhout, Ch. 7, pg 82, Table 7.1

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7
Q

Blood/Gas Partition Coefficient of Des?

A

0.42

Nagelhout, Ch. 7, pg 82, Table 7.1

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8
Q

Blood/Gas Partition Coefficient of N2O?

A

0.47

Nagelhout, Ch. 7, pg 82, Table 7.1

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9
Q

Oil/Gas Partition Coefficient of N2O?

A

1.4

Nagelhout, Ch. 7, pg 82, Table 7.1

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10
Q

Oil/Gas Partition Coefficient of Iso?

A

99

Nagelhout, Ch. 7, pg 82, Table 7.1

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11
Q

Oil/Gas Partition Coefficient of Des?

A

18.7

Nagelhout, Ch. 7, pg 82, Table 7.1

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12
Q

Oil/Gas Partition Coefficient of Sevo?

A

50

Nagelhout, Ch. 7, pg 82, Table 7.1

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13
Q

Does an increased Cardiac ouput increase or decrease induction onset?

A

Decrease

Nagelhout, Ch. 7, pg 82

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14
Q

What factors make induction faster?

6

A
  • Low blood gas solubility
  • Low CO
  • High minute ventilation
  • High FGF
  • High concentration
  • 2nd gas effect (N2O+Iso/Sevo/Des)

Nagelhout, Ch. 7, pg 84, Box 7.2

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15
Q

What factors make induction slower?

7

A
  • High blood gas solubilty
  • High CO
  • Low Minute Volume
  • Low FGF
  • Low Concentrations
  • V/Q deficits
  • Hypothermia

Nagelhout, Ch. 7, pg 84, Box 7.2

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16
Q

When an insoluble anesthetic exits the body via the lungs, & is replaced with nitrogen, displacing O2 & CO2 is called ________ _____?

A

Diffusion hypoxia

Nagelhout, Ch. 7, pg 84

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17
Q

What is MAC?

A

Minimum alveolar concentation is 50% of a population will not respond to surgical stimulation

Nagelhout, Ch. 7, pg 80 & Ch. 8, pg. 89

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18
Q

What is considered a reponse as it relates to MAC?

A

Gross/Purposeful movement of Head or Extremities

Nagelhout, Ch. 8, pg 89

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19
Q

What is the concern with N2O in neurosurgical procedures?

A

Reduces cerebrovascular tone significantly (vasodilation), & might influence surgical outcomes in patients with reduced intracranial compliance

Nagelhout, Ch. 8, pg 91

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20
Q

What can attenuate increases in CBF due to N2O use?

A

Mild Hyperventilation (goal PaCO2 30-35 mmHg)

Nagelhout, Ch. 8, pg 91

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21
Q

Hypocapnia(carbia) causes to cerebrovasculature to do what?

A

Vasoconstrict

Nagelhout, Ch. 8, pg 91

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22
Q

Hypercapnia(carbia) causes the cerebrovasculature to do what?

A

Vasodilate

Nagelhout, Ch. 8, pg 91

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23
Q

Sevo, Iso, & Des cause what changes to CMRO2 & dose dependent CBF?

A
  • Decrease in CMRO2
  • Dose dependent increase in CBF

Nagelhout, Ch. 8, pg 91

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24
Q

All inhalation anesthetics (Sevo, Iso, Des, N2O) cause _ _ _ _ between CMRO2 & CBF

A

Flow-metabolism Uncoupling

Nagelhout, Ch. 8, pg 91

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25
Sevo, Iso, Des effects on hemodynamics?
Decrease MAP & CO * Due to decreased SVR ## Footnote Nagelhout, Ch. 8, pg 94
26
N2O effects on hemodynamics?
Increase SVR, HR, CVP Decreased CO * due to activation of sympathetic nervous system ## Footnote Nagelhout, Ch. 8, pg 94 Nagelhout 7th ed, Ch. 8, pg. 97, table 8.5
27
Cellular effects of halogenated agents on hemodynamics?
Reduce intracelluar Ca2+ concentration in cardiac/vascular smooth muscle
28
Sevo, Iso, & Des all prolong the _ _ _ _ _ _ interval, leading too?
* QT * TD Pointes ## Footnote Nagelhout, Ch. 8, pg 96
29
Where do the arrhythmogenic properties of Sevo, Des, & Iso come from?
They depress slow response (SA/AV node) & fast response (Atrial/Ventricular musculature, purkinje fibers) action potentials. * Leads to bradyarrhthmias ## Footnote Nagelhout, Ch. 8, pg 96
30
Which inhaled anesthetic is safe to use in patients with a history of Malignant Hyperthermia?
N2O ## Footnote Nagelhout, Ch. 8, pg 99
31
Which drug is used in the treatment of MH?
Dantrolene (**Ryan**odex) | aye! ## Footnote Nagelhout, Ch. 8, pg 99
32
What is this drug?
Isoflurane ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
33
What is this drug?
Desflurane ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
34
What is this drug?
Sevoflurane ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
35
What is this drug?
Halothane | Notice, no ether bridge: R-O-R ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
36
What is an ether bridge?
R-O-R ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
37
What is Blood/Gas solubility?
* Reflects proportion of anesthetic that will be soluble in the blood * **Indicator of the speed of uptake and elimination** ## Footnote Nagelhout 7th ed, Ch. 7, pg. 81
38
What is overpressuring?
During first minutes of gas administration, a higher concentration of drug, or loading dose, is delivered to speed initial uptake ## Footnote Nagelhout 7th ed, Ch. 7, pg. 82
39
What effect does a high CO have on anesthetic uptake?
Increased CO removes more anesthetic from the lungs, which slows the rise in lung and brain concentrations ## Footnote Nagelhout 7th ed, Ch. 7, pg. 82
40
How much Sevo is metabolized?
5-8% ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4
41
How much N2O is metabolized?
<1% ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4
42
How much Iso is metabolized?
<1% ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4
43
How much Des is metabolized?
<0.1% ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83, Table 7.4
44
**Hypothermia**'s effect on anesthetic induction/emergence?
* Slower induction & Emergence ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83
45
**Hyperthermia**'s effect on anesthetic induction/emergence?
* Increased CO --> a increased nesthetic requirement * therefore slower induction ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83
46
How is emergence effected with longer durations of adminstration?
* Emerges slower ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83
47
In what order are anesthetic gases's emergence times effected by longer administration?
Iso > > Sevo>Des | Higher solubility = more deposit in tissues ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83
48
Between Sevo, Iso, & Des, which drug would a patient emerge from first?
Des ## Footnote Nagelhout 7th ed, Ch. 7, pg. 84
49
Between Sevo, Iso, & Des, which drug would a patient emerge from **last**?
Iso ## Footnote Nagelhout 7th ed, Ch. 7, pg. 83
50
What are some places N2O might wander off to? | 7
Diffuses into air-containing cavities * **LMA cuff** * **ET cuff** * Air embolism * Pneumo * Intraocular air bubbles * Intestinal obstruction * pneumoperitoneum ## Footnote Nagelhout 7th ed, Ch. 7, pg. 84
51
Difference in pediatric anesthetic uptake than in adults?
* Uptake is faster * Require higher MAC (1.5-1.8 x 40y/o dude) * Lower muscle mass -> more to brain ## Footnote Nagelhout 7th ed, Ch. 7, pg. 84
52
What are risk factors for Emergence Delirium?
* Ages 2-5 * Anxiety * Post-op pain * Difficult parent separation behavior ## Footnote Nagelhout 7th ed, Ch. 7, pg. 84
53
What drugs can be used to reduce Emergence delirium?
* **Dexmedetomidine is daddy** * Fentanyl * Propofol * Ketamine ## Footnote Nagelhout 7th ed, Ch. 7, pg. 85
54
Your patient has a R->L shunt, what does this mean for your anesthetics?
* **Slows induction of anesthesia** * Shunted blood mixes with and dilutes blood coming from ventilated alveoli resulting in reduction of alveolar partial pressure of the anesthetic ## Footnote Nagelhout 7th ed, Ch. 7, pg. 85
55
Your patient has a L->R shunt, what does this mean for your anesthetics?
* **Slightly increased rate of anesthetic delivery or uptake into the brain, muscle, and other tissue is a result** * Causes anesthetic partial pressure in mixed venous blood to increase more rapidly than it would in the absence of a shunt | this is minimal; only with current R-L shunt - but Dr. C has this bolded ## Footnote Nagelhout 7th ed, Ch. 7, pg. 85-86 Apex
56
What is MAC-Awake?
* Approx. 0.3-0.5 MAC * MAC at which 50% of subjects will respond to command “open your eyes” ## Footnote Nagelhout 7th ed, Ch. 7, pg. 85, Table 7.6
57
What is MAC-BAR?
* MAC necessary to **b**lock **a**drenergic **r**esponse to skin incision * Approx. 1.6-2.0 MAC ## Footnote Nagelhout 7th ed, Ch. 7, pg. 85, Table 7.6
58
You're giving a patient anesthetic gas during Cardiopulmonary Bypass, will you have to give more or less, as compared to normal lung inhalation?
Higher concentrations of volatile agent are given * so more ## Footnote Nagelhout 7th ed, Ch. 7, pg. 86
59
What are the Halogen elements?
* Fluorine * Chlorine * Bromine * Iodine ## Footnote Nagelhout 7th ed, Ch. 8, pg. 87
60
What effects does the addition of Halogens do to a gas?
* Flammability * Potency * Arrhytmogenic properties * Stability ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
61
What is the **EXACT** Mechanism of Action of anesthetic gases?
It remains elusive | May result from multisite interactions with ion channels in brain ## Footnote Nagelhout 7th ed, Ch. 8, pg. 88
62
How much MAC do patients usually need during surgery?
* 1.2 to 1.3 x MAC * 20-30% More than 1.0 MAC ## Footnote Nagelhout 7th ed, Ch. 8, pg. 91
63
What does not seem to occur with 1.0 or less MAC of Iso/Des
* **CMRO2/CBF uncoupling** Decreased CMRO2 with increased CBF ## Footnote Nagelhout 7th ed, Ch. 8, pg. 91
64
What effect do Sevo, Iso, Des & N2O have on Evoked potentials?
Dose dependent reduction in EPs ## Footnote Nagelhout 7th ed, Ch. 8, pg. 93, table 8.4
65
Which evoked potential are the **most** sensitive to Volatile agents + N2O?
Visual evoked potentials (VEP) ## Footnote Nagelhout 7th ed, Ch. 8, pg. 93, table 8.4
66
Which evoked potential are the **least** sensitive to Volatile agents + N2O?
Brainstem evoked potentials (BEP) ## Footnote Nagelhout 7th ed, Ch. 8, pg. 93, table 8.4
67
What do Sevo, Iso, Des do to Hemodynamics?
* Decrease CO/CI * Decreased MAP (via decreased SVR) * Increased HR **(except for Sevo)** ## Footnote Nagelhout 7th ed, Ch. 8, pg. 94, 97 table 8.5
68
Which volatile anesthetic(s) is/are implicated with Liver damage?
**"Halothane Hepatitis"** Rare for Sevo/Iso/Des to cause clinically relevant liver damage ## Footnote Nagelhout 7th ed, Ch. 8, pg. 98
69
N2O exposure has been linked to what?
* Spontaneous abortion * Reduced fertility *in workers* ## Footnote Nagelhout 7th ed, Ch. 8, pg. 99
70
What Machine related factors affect uptake of anesthetics?
* Drug solubility in rubber/plastic parts * Total machine FGF of gases * Low FGF slows delivery ## Footnote too lazy to find it right now * *don't worry I got you boo* Nagelhout, pg. 80

Nurs 575 Anesthesia Pharmacology (18 decks)

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