EXAM 1 NAGELHOUT COMPLETE
QUESTIONS AND ANSWERS (GRADED
A+)
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - ANSWER-What are the renal effects of all anesthetics except nitrous
oxide?
Halothane - ANSWER-What anesthetic is associated with hepatotoxicity in adults but
not children?
All except nitrous oxide - ANSWER-What inhalation anesthetics trigger malignant
hyperthermia and are contraindicated?
Nitrous Oxide - ANSWER-This inhalation anesthetic blocks DNA and RNA synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - ANSWER-How does Nitrous Oxide block DNA & RNA
production?
(1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors (H2 antagonists),
pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm - ANSWER-What patients are at risk with
Nitrous oxide due to possible prior Cobalamin Deficiency?
(1) Known deficiency of enzyme or substrate in methionine synthase pathway
(2) Potential toxicity from expansion of gas filled space - emphysema, pneumothorax,
middle ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure - ANSWER-What are the absolute contraindications to
Nitrous Oxide?
(1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV - ANSWER-What are the relative contraindications to Nitrous
Oxide?
Risk of myocardial ischemia - ANSWER-What is a putative relative contraindication to
Nitrous Oxide?
,after puberty - ANSWER-When does the risk of halothane hepatotoxity increase?
(1) Local anesthetics (reduced cancer recurrence and metastasis r/t anti-inflammatory
and direct effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced recurrence & metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in cancer cells; prevents angiogenesis)
- ANSWER-Is there a better anesthetic technique to use when performing surgery in
cancer patients?
(1) Opioids (angiogenesis; decreased long-term survival; inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors) - ANSWER-Is there any
anesthetic technique you should avoid using when performing surgery in cancer
patients?
Nitrous oxide (teratogenic in animals) - ANSWER-What anesthetic is contraindicated in
pregnancy?
first trimester - ANSWER-When is nitrous oxide most likely to cause teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - ANSWER-What is the
effect of all anesthetics in pregnant women?
spinal (less bleeding - inhalation = uterine relaxation and more bleeding) - ANSWER-
Would it be better to use an inhalation anesthetic or spinal for a uterine surgery? Why?
(1) masks
(2) high-pressure fittings
(3) exhalation valves - ANSWER-What are the three principle sources of waste
anesthetic gasses?
<25 ppm - ANSWER-Regulations in the USA require nitrous oxide levels to be
_________________.
<2 ppm - ANSWER-Regulations in the USA require halogenated gas levels to be
_____________.
False (exception dexmedetomidine) - ANSWER-T/F: All intravenous anesthetics
consistently produce adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - ANSWER-Which of the inhalation
anesthetics has analgesic effects?
(1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
, (4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation - ANSWER-What are the advantages of Nitrous Oxide?
(1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression - ANSWER-What are the disadvantages of Nitrous Oxide?
(Desflurane & Isoflurane - ANSWER-What inhalation anesthetics are respiratory
irritants?
Not codeine (rapidly converting = large amounts in breast milk) - ANSWER-Are opioids
okay to administer to lactating women?
tetracycline (antibiotics) - ANSWER-What medication can cause tooth discoloration and
inhibit bone growth if administered to pregnant women?
LMWH (does not cross placenta) - ANSWER-What is the anticoagulant of choice during
pregnancy?
31-71 days after first day of last menstrual period - ANSWER-When is the critical period
of organ development in a fetus?
reduced - ANSWER-General and local anesthetic requirements are (increased/reduced)
during pregnancy.
1) Moderate muscle relaxation
(2) Decreases cerebral metabolic rate
(3) Minimal biotransformation
(4) No significant systemic toxicity
(5) Inexpensive
(6) Possible neuro- and cardiac protection - ANSWER-What are the advantages of
Isoflurane?
(1) Pungent odor
(2) Airway irritant
(3) Trigger for malignant hyperthermia
(4) Slower induction and emergence - ANSWER-What are the disadvantages of
Isoflurane?
(1) Rapid uptake and elimination
(2) Stable molecules
QUESTIONS AND ANSWERS (GRADED
A+)
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - ANSWER-What are the renal effects of all anesthetics except nitrous
oxide?
Halothane - ANSWER-What anesthetic is associated with hepatotoxicity in adults but
not children?
All except nitrous oxide - ANSWER-What inhalation anesthetics trigger malignant
hyperthermia and are contraindicated?
Nitrous Oxide - ANSWER-This inhalation anesthetic blocks DNA and RNA synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - ANSWER-How does Nitrous Oxide block DNA & RNA
production?
(1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors (H2 antagonists),
pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm - ANSWER-What patients are at risk with
Nitrous oxide due to possible prior Cobalamin Deficiency?
(1) Known deficiency of enzyme or substrate in methionine synthase pathway
(2) Potential toxicity from expansion of gas filled space - emphysema, pneumothorax,
middle ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure - ANSWER-What are the absolute contraindications to
Nitrous Oxide?
(1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV - ANSWER-What are the relative contraindications to Nitrous
Oxide?
Risk of myocardial ischemia - ANSWER-What is a putative relative contraindication to
Nitrous Oxide?
,after puberty - ANSWER-When does the risk of halothane hepatotoxity increase?
(1) Local anesthetics (reduced cancer recurrence and metastasis r/t anti-inflammatory
and direct effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced recurrence & metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in cancer cells; prevents angiogenesis)
- ANSWER-Is there a better anesthetic technique to use when performing surgery in
cancer patients?
(1) Opioids (angiogenesis; decreased long-term survival; inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors) - ANSWER-Is there any
anesthetic technique you should avoid using when performing surgery in cancer
patients?
Nitrous oxide (teratogenic in animals) - ANSWER-What anesthetic is contraindicated in
pregnancy?
first trimester - ANSWER-When is nitrous oxide most likely to cause teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - ANSWER-What is the
effect of all anesthetics in pregnant women?
spinal (less bleeding - inhalation = uterine relaxation and more bleeding) - ANSWER-
Would it be better to use an inhalation anesthetic or spinal for a uterine surgery? Why?
(1) masks
(2) high-pressure fittings
(3) exhalation valves - ANSWER-What are the three principle sources of waste
anesthetic gasses?
<25 ppm - ANSWER-Regulations in the USA require nitrous oxide levels to be
_________________.
<2 ppm - ANSWER-Regulations in the USA require halogenated gas levels to be
_____________.
False (exception dexmedetomidine) - ANSWER-T/F: All intravenous anesthetics
consistently produce adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - ANSWER-Which of the inhalation
anesthetics has analgesic effects?
(1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
, (4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation - ANSWER-What are the advantages of Nitrous Oxide?
(1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression - ANSWER-What are the disadvantages of Nitrous Oxide?
(Desflurane & Isoflurane - ANSWER-What inhalation anesthetics are respiratory
irritants?
Not codeine (rapidly converting = large amounts in breast milk) - ANSWER-Are opioids
okay to administer to lactating women?
tetracycline (antibiotics) - ANSWER-What medication can cause tooth discoloration and
inhibit bone growth if administered to pregnant women?
LMWH (does not cross placenta) - ANSWER-What is the anticoagulant of choice during
pregnancy?
31-71 days after first day of last menstrual period - ANSWER-When is the critical period
of organ development in a fetus?
reduced - ANSWER-General and local anesthetic requirements are (increased/reduced)
during pregnancy.
1) Moderate muscle relaxation
(2) Decreases cerebral metabolic rate
(3) Minimal biotransformation
(4) No significant systemic toxicity
(5) Inexpensive
(6) Possible neuro- and cardiac protection - ANSWER-What are the advantages of
Isoflurane?
(1) Pungent odor
(2) Airway irritant
(3) Trigger for malignant hyperthermia
(4) Slower induction and emergence - ANSWER-What are the disadvantages of
Isoflurane?
(1) Rapid uptake and elimination
(2) Stable molecules
