Term
| T or F: 70% Nitrous is equivalent to 10mg morphine. |
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Definition
| False. 50% nitrous is equal to 10mg morphine |
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Term
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Definition
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Term
| T or F: Iso has the most dramatic effect on reduction of SVR compared to all other volatiles. |
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Definition
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Term
| What is the blood/gas partition coefficient of Sevo? |
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Definition
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Term
| What is the blood/gas partition coefficient of Iso? |
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Definition
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Term
| What is the blood/gas partition coefficient of Nitrous? |
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Definition
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Term
| What is the blood/gas partition coefficient of Des? |
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Definition
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Term
| What is the oil/gas partition coefficient of Iso? |
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Definition
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Term
| What is the oil/gas partition coefficient of Sevo? |
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Definition
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Term
| What is the oil/gas partition coefficient of nitrous? |
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Definition
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Term
| What is the oil/gas partition coefficient of Des? |
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Definition
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Term
| T or F: The MAC of nitrous is a real number? |
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Definition
| False. It is theoretical since you can't achieve 105%, which is the MAC of nitrous. |
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Term
| T or F: Induction agents and volatiles work via inhibition of the GABA receptor. |
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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. |
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Term
| T or F: Volatiles decrease IOP and ICP. |
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Definition
| False: Volatiles decrease IOP but INCREASE ICP via cerebral VASODILATION. |
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Term
| T or F: Volatiles cause increase ICP by decreasing the brains to autoregulate cerebral blood flow. |
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Definition
| True. The degree of autoregulation inhibition occurs in a dose-dependent manner. |
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Term
| T or F: The blood compartment of the brain is the area that the anesthetist can have the greatest affect on. |
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Definition
| True. The four compartments are: Cellular (manipulated by surgeon), CSF, Fluid (can be manipulated with steroids and diuretics), Blood (venous and arterial) |
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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. |
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Definition
| False: (DIRECT CARDIAC DEPRESSION and DECREASED SVR) |
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Term
| T or F: All volatiles sensitize the myocardium to EPI and increase the incidence of arrythmias. |
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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. |
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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" |
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Definition
| False. The rule is don't use a concentration greater than 1:100,000 corresponds to 0.01mg per ml. Tricky question! |
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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? |
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Definition
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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? |
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Definition
| No. Apparently the receptors that may be involved in causing this adapt and the tachycardia is transient and only happens once. |
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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? |
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Definition
| 30mls per hour total (0.3 mg) |
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Term
| T or F: Volatiles affect TIDAL VOLUME before they affect RESPIRATORY RATE. |
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Definition
| True. The reverse is true for narcotics. |
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Term
| T or F: All inhaled anesthetics decrease hypoxic pulmonary vasocontriction? |
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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. |
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Term
| T or F: Sevo releases free flouride ion because it is biotransformed or metabolized at a rate of 5-8%? |
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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%. |
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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"? |
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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) |
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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? |
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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. |
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Term
| What agent causes the most production of carbon monoxide when it contacts alkaline CO2 adsorbents? |
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Definition
| Des. It's not a problem if you replace the soda lime when it turns purple and is dried out. |
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Term
| What are the three factors affecting uptake of inhaled anesthetics in the lungs? |
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Definition
- blood solubility (blood:gas coefficient)
- cardiac output
- Partial pressure of the agent in the lungs
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Term
| Is emphysema an absolute contraindication for nitrous oxide? |
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Definition
| Yes. (p. 105) He might not test this but I thougt it was pretty interesting and useful. |
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Term
| What are the three main tissue groups that acts as depots for anesthetics within the body? Which one equilibrates fastest? Slowest? |
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Definition
1. vessel rich group, muslce group, fat group
2. VRG
3. Fat group |
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Term
| Which volatile boils at room temp? |
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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) |
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Term
| A barbiturate with a sulfer at C-2 would be called what? |
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Definition
| THIObarbiturate (thiopental=Pentothal) |
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Term
| What's the generic name for Brevital? What type of barbiturate is it? |
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Definition
| Methohexital. It's an N-methyl barbiturate (methyl group attached to the nitrogen molecule at N-1 or N-3). |
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Term
| You wake up quickly from propofol because of _______? |
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Definition
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Term
| How many half-lives does it take for a drug to essentially be "cleared" from the body? |
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Definition
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Term
| The beta half-life of propofol is roughly 2 hours. How long will it take before propofol is "cleared" from the body? |
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Definition
| Clearance takes approximately 4 half-lives, so it takes about 8 hours before it's out of the body. |
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Term
| Alpha half-life means the same thing as? |
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Definition
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Term
| T or F: Ketamine acts by antagonizing the effect of NMDA receptors. |
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Definition
| True. Glutamate normally activates (agonist) this receptor. Ketamine antagonizes or inhibits this action. |
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Term
| T or F: Romazicon is used to reverse benzos. |
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Definition
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Term
| T or F: The generic BAXTER formulation of propofol contains metbisulfate. |
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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. |
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Term
| What three drugs hurt the most on injection? |
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Definition
1. Pentothal (thiopental)
2. etomidate
3. Propofol |
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Term
| T or F: Pentothal and etomidate cause myoclonus. |
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Definition
| False. Etomidate and BREVITAL (METHOHEXITAL) cause myoclonus. |
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