Nagelhout Pharm 1 Exam 2 |76
Questions and Answers Distinction
Graded
Name the halogenated ether gas anesthetics? - -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? - -Nitrous oxide (no carbon)
- Why type of gas is Halothane? - -A hydrocarbon.
- What makes a gas an ether? - -the C-O-C chain
- How many F molecules are in Iso, Sevo, and Des? - -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? - -Unknown
- Which anesthetic gas is 3-6% metabolized by the liver? - -Sevoflurane
>>all others are less than 1% metabolized
- Which anesthetic drugs (gas and IV) potentiate the GABA receptor? - -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)? - -
Ketamine
>>acts on the glutamate receptor via antagonism
- What is GABA? Explain. - -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? - -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 are some anesthesia provider's interventions to counteract the
increased ICP from gas anesthetics? - -1. Keep anesthetic dose at minimum.
2. Hyperventilate to keep pCO2 30 - 35 (lower pCO2 vasodilates the cerebral
arteries)
3. Ensure good venous drainage (head-up posture) and avoid anything that
can increased the intrathoracic pressure (PEE
pneumothorax, obstructed ETT, bronchospasm, coughing)
4. Diuretics such as mannitol.
- What's the effect of CO2 in the cerebral vasculature? - -1. Vasodilates
cerebral arteries.
2. Increases ICP therefore decreases cerebral perfusion pressure
- What is the effect of gas anesthetics on cerebral blood flow regulation? - -
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? - -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? - -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.
Questions and Answers Distinction
Graded
Name the halogenated ether gas anesthetics? - -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? - -Nitrous oxide (no carbon)
- Why type of gas is Halothane? - -A hydrocarbon.
- What makes a gas an ether? - -the C-O-C chain
- How many F molecules are in Iso, Sevo, and Des? - -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? - -Unknown
- Which anesthetic gas is 3-6% metabolized by the liver? - -Sevoflurane
>>all others are less than 1% metabolized
- Which anesthetic drugs (gas and IV) potentiate the GABA receptor? - -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)? - -
Ketamine
>>acts on the glutamate receptor via antagonism
- What is GABA? Explain. - -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? - -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 are some anesthesia provider's interventions to counteract the
increased ICP from gas anesthetics? - -1. Keep anesthetic dose at minimum.
2. Hyperventilate to keep pCO2 30 - 35 (lower pCO2 vasodilates the cerebral
arteries)
3. Ensure good venous drainage (head-up posture) and avoid anything that
can increased the intrathoracic pressure (PEE
pneumothorax, obstructed ETT, bronchospasm, coughing)
4. Diuretics such as mannitol.
- What's the effect of CO2 in the cerebral vasculature? - -1. Vasodilates
cerebral arteries.
2. Increases ICP therefore decreases cerebral perfusion pressure
- What is the effect of gas anesthetics on cerebral blood flow regulation? - -
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? - -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? - -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.
