NAGELHOUT PHARM 1 EXAM 2 QUESTIONS
Name the halogenated ether gas anesthetics? - Answer -1. Desflurane
2. Sevoflurane
3. Isoflurane
All are volatile gasses.
(improvement from non-ether halogenated hydrocarbon because they don't release as
much Fluoride ions which make them hepatotoxic)
Which gas is the only inorganic molecule? - Answer -Nitrous oxide (no carbon)
Why type of gas is Halothane? - Answer -A hydrocarbon.
What makes a gas an ether? - Answer -the C-O-C chain
How many F molecules are in Iso, Sevo, and Des? - Answer -5 in Isoflurane (Forane)
(F=FIVE)
6 in Desflurane (Suprane) (S=SIX)
7 in Sevoflurane (SEV=SEVEN)
What is the mechanism of action of anesthetic gas? - Answer -Unknown
Which anesthetic gas is 3-6% metabolized by the liver? - Answer -Sevoflurane
>>all others are less than 1% metabolized
Which anesthetic drugs (gas and IV) potentiate the GABA receptor? - Answer -1.
Propofol
2. Benzodiazepenes
3. Barbiturates
4. Gas Anesthetics
5. Etomidate
>>they are all GABA mimetic
Which IV induction agent acts on n-methyl-d-aspartate (NMDA)? - Answer -Ketamine
>>acts on the glutamate receptor via antagonism
What is GABA? Explain. - Answer -1. gamma-aminobutyric acid
2. It is the main inhibitory neurotransmitter in the brain.
3. Binds to GABA receptor, allowing Cl- to diffuse into the neurons and inhibiting the
generation of action potential by lowe
membrane potential (hyperpolarization)
What are the CNS effects of GAS anesthetics? - Answer -1. Dose dependent CNS and
ANS depression
2. Decreased O2 consumption (CMRO2)
, 3. Decreased Intraocular pressure (IOP)
4. Increased Intracranial pressure (ICP) from cerebral vasodilation
5. Amnesia
6. Decreased SSEP - somatosensory electro potential
7. Possible cerebral protection
What is the effect of gas anesthetics on cerebral blood flow regulation? - Answer -1.
Attenuation of autoregulatory capacity -- upper and lower threshold shifted to the left
2. There is dose dependent vasodilation.
>>note the cerebral autoregulation occurs between MAP 50-150
What are the cardiovascular effects of gas anesthetics? - Answer -1. Decreased blood
pressure (5 mechanisms)
2. Anesthesia Preconditioning (changes in the heart take place to protect it from
possible insult)
3. Increased in heart rate -- in young healthy patients (with DES > ISO secondary to
respiratory irritation)
Mechanisms for decreased blood pressure due to gas anesthetics? - Answer -1. CNS
depression
2. Direct cardiac depression
3. Decreased SVR -- vasodilation
4. Baro-receptor depression
5. Hormonal changes - decreased renin or vasopressin release
>>note Nitrous does not exhibit all 5 mechanisms.
Whats the effect of gas anesthetics when given with epinephrine? - Answer -1.
Sensitizes the myocardium to epineprine increasing the incidence of Vtach.
2. Halothane more than the other gas anesthetics.
Which gas anesthetic is preferred when the surgeon is planning to use epinephrine? -
Answer -1. SEVO, ISO and DES but with maximum epinephrine dose of 5 mcg/kg
(This is because HALOTHANE sensitizes myocardium to effect of Epi.)
What are the rules for epi with local in the OR? - Answer -1. No stronger than
1:100,000 or 0.01 mg/ml
2. No more than
0.1 mg in any 10 min period (10 ml)
0.3 mg per hr (30 ml)
Which gas anesthetic produces the greatest increase in heart rate? why? - Answer -1.
Desflurane
2. Desflurane is a respiratory irritant especially in young healthy children
Which gas anesthetic does not decrease the blood pressure? - Answer -Nitrous oxide
Name the halogenated ether gas anesthetics? - Answer -1. Desflurane
2. Sevoflurane
3. Isoflurane
All are volatile gasses.
(improvement from non-ether halogenated hydrocarbon because they don't release as
much Fluoride ions which make them hepatotoxic)
Which gas is the only inorganic molecule? - Answer -Nitrous oxide (no carbon)
Why type of gas is Halothane? - Answer -A hydrocarbon.
What makes a gas an ether? - Answer -the C-O-C chain
How many F molecules are in Iso, Sevo, and Des? - Answer -5 in Isoflurane (Forane)
(F=FIVE)
6 in Desflurane (Suprane) (S=SIX)
7 in Sevoflurane (SEV=SEVEN)
What is the mechanism of action of anesthetic gas? - Answer -Unknown
Which anesthetic gas is 3-6% metabolized by the liver? - Answer -Sevoflurane
>>all others are less than 1% metabolized
Which anesthetic drugs (gas and IV) potentiate the GABA receptor? - Answer -1.
Propofol
2. Benzodiazepenes
3. Barbiturates
4. Gas Anesthetics
5. Etomidate
>>they are all GABA mimetic
Which IV induction agent acts on n-methyl-d-aspartate (NMDA)? - Answer -Ketamine
>>acts on the glutamate receptor via antagonism
What is GABA? Explain. - Answer -1. gamma-aminobutyric acid
2. It is the main inhibitory neurotransmitter in the brain.
3. Binds to GABA receptor, allowing Cl- to diffuse into the neurons and inhibiting the
generation of action potential by lowe
membrane potential (hyperpolarization)
What are the CNS effects of GAS anesthetics? - Answer -1. Dose dependent CNS and
ANS depression
2. Decreased O2 consumption (CMRO2)
, 3. Decreased Intraocular pressure (IOP)
4. Increased Intracranial pressure (ICP) from cerebral vasodilation
5. Amnesia
6. Decreased SSEP - somatosensory electro potential
7. Possible cerebral protection
What is the effect of gas anesthetics on cerebral blood flow regulation? - Answer -1.
Attenuation of autoregulatory capacity -- upper and lower threshold shifted to the left
2. There is dose dependent vasodilation.
>>note the cerebral autoregulation occurs between MAP 50-150
What are the cardiovascular effects of gas anesthetics? - Answer -1. Decreased blood
pressure (5 mechanisms)
2. Anesthesia Preconditioning (changes in the heart take place to protect it from
possible insult)
3. Increased in heart rate -- in young healthy patients (with DES > ISO secondary to
respiratory irritation)
Mechanisms for decreased blood pressure due to gas anesthetics? - Answer -1. CNS
depression
2. Direct cardiac depression
3. Decreased SVR -- vasodilation
4. Baro-receptor depression
5. Hormonal changes - decreased renin or vasopressin release
>>note Nitrous does not exhibit all 5 mechanisms.
Whats the effect of gas anesthetics when given with epinephrine? - Answer -1.
Sensitizes the myocardium to epineprine increasing the incidence of Vtach.
2. Halothane more than the other gas anesthetics.
Which gas anesthetic is preferred when the surgeon is planning to use epinephrine? -
Answer -1. SEVO, ISO and DES but with maximum epinephrine dose of 5 mcg/kg
(This is because HALOTHANE sensitizes myocardium to effect of Epi.)
What are the rules for epi with local in the OR? - Answer -1. No stronger than
1:100,000 or 0.01 mg/ml
2. No more than
0.1 mg in any 10 min period (10 ml)
0.3 mg per hr (30 ml)
Which gas anesthetic produces the greatest increase in heart rate? why? - Answer -1.
Desflurane
2. Desflurane is a respiratory irritant especially in young healthy children
Which gas anesthetic does not decrease the blood pressure? - Answer -Nitrous oxide
