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Pharm Exam 2
NateDogg
43
Nursing
Graduate
11/06/2009

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Cards

Term
T or F: 70% Nitrous is equivalent to 10mg morphine.
Definition
False. 50% nitrous is equal to 10mg morphine
Term
What is the MAC of iso?
Definition
1.15%
Term
T or F: Iso has the most dramatic effect on reduction of SVR compared to all other volatiles.
Definition
True
Term
What is the blood/gas partition coefficient of Sevo?
Definition
0.6
Term
What is the blood/gas partition coefficient of Iso?
Definition
1.4
Term
What is the blood/gas partition coefficient of Nitrous?
Definition
0.47
Term
What is the blood/gas partition coefficient of Des?
Definition
0.42
Term
What is the oil/gas partition coefficient of Iso?
Definition
99
Term
What is the oil/gas partition coefficient of Sevo?
Definition
50
Term
What is the oil/gas partition coefficient of nitrous?
Definition
1.4
Term
What is the oil/gas partition coefficient of Des?
Definition
18.7
Term
T or F: The MAC of nitrous is a real number?
Definition
False. It is theoretical since you can't achieve 105%, which is the MAC of nitrous.
Term
T or F: Induction agents and volatiles work via inhibition of the GABA receptor.
Definition
False. These drugs work by increasing GABA activity. When GABA receptors are induced they send Cl- to the inside of the cell making the inside of the cell more negative, thus making it harder to reach the depolarization threshold.
Term
T or F: Volatiles decrease IOP and ICP.
Definition
False: Volatiles decrease IOP but INCREASE ICP via cerebral VASODILATION.
Term
T or F: Volatiles cause increase ICP by decreasing the brains to autoregulate cerebral blood flow.
Definition
True. The degree of autoregulation inhibition occurs in a dose-dependent manner.
Term
T or F: The blood compartment of the brain is the area that the anesthetist can have the greatest affect on.
Definition
True. The four compartments are: Cellular (manipulated by surgeon), CSF, Fluid (can be manipulated with steroids and diuretics), Blood (venous and arterial)
Term
T or F: Induction agents have the greatest effect on 2 of the 5 BP lowering mechanisms mentioned by Dr. Ball-scratcher. These are CNS depression and baro-receptor depression.
Definition
False: (DIRECT CARDIAC DEPRESSION and DECREASED SVR)
Term
T or F: All volatiles sensitize the myocardium to EPI and increase the incidence of arrythmias.
Definition
False: Halothane actually is the only one that does. This is where the rule regarding epi limits came from. However, we kept that rule around just to be safe.
Term
T or F: The CONCENTRATION rule for EPI is "don't use a concentration greater than 1:100,000 which contains 0.1mg per ml"
Definition
False. The rule is don't use a concentration greater than 1:100,000 corresponds to 0.01mg per ml. Tricky question!
Term
If you're using an acceptable concentration of epi (1:100,000) what is the maximum dose in ml you can use in a 10min period and how many mg does this correspond to?
Definition
10ml=0.1mg
Term
Giving Des, especially at initial high concentrations can cause tachycardia via a poorly understood mechanism. If this happens early in the case do you have to worry about it happening again later in the case?
Definition
No. Apparently the receptors that may be involved in causing this adapt and the tachycardia is transient and only happens once.
Term
If you give epi at a concentration of 1:100,000 while your patient is getting a volatile what is the maximum you can give in 1 hour in mls and how many mg would this be?
Definition
30mls per hour total (0.3 mg)
Term
T or F: Volatiles affect TIDAL VOLUME before they affect RESPIRATORY RATE.
Definition
True. The reverse is true for narcotics.
Term
T or F: All inhaled anesthetics decrease hypoxic pulmonary vasocontriction?
Definition
False. This question is worded a little tricky. All volatiles do reduce HPV via bronchodilation. However, nitrous is considered an inhaled anesthetic and as it does not cause bronchodilation it does not decrease HPV, thus the statement is false.
Term
T or F: Sevo releases free flouride ion because it is biotransformed or metabolized at a rate of 5-8%?
Definition
True. If it wasn't metabolized it wouldn't release flouride ion. Des is the most stable volatile and is metabolized at a rate of less than 0.1%.
Term
Sevo is a great agent but it has three properties that may cause it to be problematic in certian subsets of patients. What are these three "problems"?
Definition

1. Release of free-flouride ion

2. Compound A

3. Emergence delerium in Peds pts.

 

(b/c of FFI and cpd. A you may want to avoid the agent in pts. with severe renal issues although there really isn't enough data to suggest that these two problems have much significance outside of the lab)

Term
What's the name of the enzyme that's inhibited by nitrous? What does this enzyme make? What types of patients might we not want to give nitrous to as a result?
Definition

1. methionine synthetase

2. Vit B12 (cobalamin)

3. Nutritional disorders (elderly, vegans, alcoholics), people with malabsorption disorders
(prolonged proton pump ihhibitors, gastritis, chron's) Patients with a known enzyme deficiency!

 

Personally, I probably wouldn't care if it was a short case. 70% nitrous for 12 hrs is necessary for B12 suppression.

Term
What agent causes the most production of carbon monoxide when it contacts alkaline CO2 adsorbents?
Definition
Des. It's not a problem if you replace the soda lime when it turns purple and is dried out.
Term
What are the three factors affecting uptake of inhaled anesthetics in the lungs?
Definition
  1. blood solubility (blood:gas coefficient)
  2. cardiac output
  3. Partial pressure of the agent in the lungs

 

Term
Is emphysema an absolute contraindication for nitrous oxide?
Definition
Yes. (p. 105) He might not test this but I thougt it was pretty interesting and useful.
Term
What are the three main tissue groups that acts as depots for anesthetics within the body? Which one equilibrates fastest? Slowest?
Definition

1. vessel rich group, muslce group, fat group

2. VRG

3. Fat group

Term
Which volatile boils at room temp?
Definition
Des. Anytime you have a vapor pressure greater than 760mmHg it's gonna boil (At 20 degrees C Des has a VP of 38,770)
Term
A barbiturate with a sulfer at C-2 would be called what?
Definition
THIObarbiturate (thiopental=Pentothal)
Term
What's the generic name for Brevital? What type of barbiturate is it?
Definition
Methohexital. It's an N-methyl barbiturate (methyl group attached to the nitrogen molecule at N-1 or N-3).
Term
You wake up quickly from propofol because of _______?
Definition
REDISTRIBUTION
Term
How many half-lives does it take for a drug to essentially be "cleared" from the body?
Definition
 roughly 4 half-lives
Term
The beta half-life of propofol is roughly 2 hours. How long will it take before propofol is "cleared" from the body?
Definition
Clearance takes approximately 4 half-lives, so it takes about 8 hours before it's out of the body.
Term
Alpha half-life means the same thing as?
Definition
Distribution half-life
Term
T or F: Ketamine acts by antagonizing the effect of NMDA receptors.
Definition
True. Glutamate normally activates (agonist) this receptor. Ketamine antagonizes or inhibits this action.
Term
T or F: Romazicon is used to reverse benzos.
Definition
True (flumazenil)
Term
T or F: The generic BAXTER formulation of propofol contains metbisulfate.
Definition

True. Baxter=Bad for patients with SULFITE allergies (sulfites are found in some foods and red wine) NOT THE SAME AS SULFA ALLERGY.

 

Note: There are two generic forms of propofol. The other generic form (Bedford) contains benzyl alcohol. Therefore, not all generic have metabisulfate.

Term
What three drugs hurt the most on injection?
Definition

1. Pentothal (thiopental)

2. etomidate

3. Propofol

Term
T or F: Pentothal and etomidate cause myoclonus.
Definition
False. Etomidate and BREVITAL (METHOHEXITAL) cause myoclonus.
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