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144 Cards in this Set
- Front
- Back
Name this structure.
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Desflurane
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Name this structure.
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Halothane
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Name this structure.
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Isoflurane
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Name this structure.
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Enflurane
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Name this structure.
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Sevoflurane
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Who wants some gas????
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Take a deep breath.....
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Name this structure.
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Nitrous-oxide
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What two inhalation gases are isomers to each other?
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isoflurane and enflurane
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N2O is a -------- at room temperature and a ------- under pressure.
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gas
liquid |
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Volatiles are ------- at room temperature but readily evaporate.
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liquid
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The birth of modern anesthesia dates back to the public use of ether by Wm. Morton in Boston on Friday, October 16 ------.
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1846
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Ether was earlier used by who in 1842.
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Crawford Long
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Who used nitrous oxide successfully in dental anesthesia in 1844?
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Horace Wells
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True or False
most of the modern volatile anesthetics are direct descendants of ether. |
True
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What is the name of the new gas that is not in general use and is a gas at room temperature?
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Xenon
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The solubility of inhalational anesthetics in blood is indicated by their blood --- --------- -----------.
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gas partition coefficient
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What does gas partition coefficient determine?
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the speed of onset and the rate of recovery of a gas
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True or False
Relatively insoluble agents act more rapidly. |
True
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Why does insoluble agents act more rapidly?
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a smaller quantity is removed by dissolving in blood. This leaves a higher alveolar concentration to facilitate induction.
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True or False
Solubility in blood is the inhalation equivalent of volume distribution. |
True
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What are the four physical properties of inhalational anesthetic agents ( for our purposes)?
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Solubility in blood
Lipid solubility Vapor pressure Structure |
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What indicates the solubility of an inhalational anesthetic in lipids?
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Oil:Gas partition coefficient
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True or False
The Meyer-Overton relationship suggests that volatile anesthetics act on a hydrophilic target. |
FALSE--- it suggests that they act on a hydroPHOBIC target.
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What does the oil:gas partition coefficient correlates to?
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with volatile anesthetic potency according to the Meyer-Overton relationship.
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What is the structure of Halothane?
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a halongenated alkane
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What structure are of Enflurane,Isoflurane,Desflurane, and Sevoflurane ?
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They are halogenated methyl ethers.
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What are the name of the two volatile agents that are structural isomers to each other?
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Isoflurane and Enflurane
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What is the difference in the structure of Desflurane and Isoflurane?
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You substitute the Cl atom in Isoflurane with a F atom in Desflurane
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Does the length of the molecule have an effect on the anesthetic effect? If so What is the effect?
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Yes.. if a chain is over 5 carbons long it will loose some anesthetic effect.
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True or False
Halothane is more potent then Desflurane due to it being a heavy molecule? |
True
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Does the lipid solubility of a volatile gas make it more potent? If so , Why? If not, why?
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YES... the more lipid soluble the more potent because it can get through the cell lipid bilayer easier.
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Why did we use to use Halothane for children?
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Because it smells good
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What is a common cardiac side effect of Halothane?
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cardiac arrhythmia's
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What are two major side effects of Enflurane?
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Nephro Toxic
seizures |
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True or False
Desflurane smells good, and a patient will easily breath it in. |
FALSE .... Des smells bad and will cause a patient to hold their breath and cough.
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Does the length of the molecule have an effect on the anesthetic effect? If so What is the effect?
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Yes.. if a chain is over 5 carbons long it will loose some anesthetic effect.
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Does the length of the molecule have an effect on the anesthetic effect? If so What is the effect?
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Yes.. if a chain is over 5 carbons long it will loose some anesthetic effect.
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Why is Isoflurane used more in 3rd world countries, and veteran hospitals?
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it is cheaper
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What is the name of the special vaporizer used for
Desflurane? |
TEC-6
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True or False
Halothane is more potent then Desflurane due to it being a heavy molecule? |
True
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True or False
Halothane is more potent then Desflurane due to it being a heavy molecule? |
True
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What is Desflurane heated with the TEC-6?
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boils at room temperature
help to control amount of gas given, if not heated you can give a hypoxic mixture. |
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Does the length of the molecule have an effect on the anesthetic effect? If so What is the effect?
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Yes.. if a chain is over 5 carbons long it will loose some anesthetic effect.
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Does the lipid solubility of a volatile gas make it more potent? If so , Why? If not, why?
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YES... the more lipid soluble the more potent because it can get through the cell lipid bilayer easier.
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Does the lipid solubility of a volatile gas make it more potent? If so , Why? If not, why?
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YES... the more lipid soluble the more potent because it can get through the cell lipid bilayer easier.
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Does the length of the molecule have an effect on the anesthetic effect? If so What is the effect?
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Yes.. if a chain is over 5 carbons long it will loose some anesthetic effect.
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True or False
Halothane is more potent then Desflurane due to it being a heavy molecule? |
True
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Does the lipid solubility of a volatile gas make it more potent? If so , Why? If not, why?
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YES... the more lipid soluble the more potent because it can get through the cell lipid bilayer easier.
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True or False
Halothane is more potent then Desflurane due to it being a heavy molecule? |
True
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Why did we use to use Halothane for children?
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Because it smells good
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Why did we use to use Halothane for children?
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Because it smells good
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Why did we use to use Halothane for children?
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Because it smells good
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Does the lipid solubility of a volatile gas make it more potent? If so , Why? If not, why?
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YES... the more lipid soluble the more potent because it can get through the cell lipid bilayer easier.
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What is a common cardiac side effect of Halothane?
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cardiac arrhythmia's
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What is a common cardiac side effect of Halothane?
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cardiac arrhythmia's
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What is a common cardiac side effect of Halothane?
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cardiac arrhythmia's
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Why did we use to use Halothane for children?
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Because it smells good
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What are two major side effects of Enflurane?
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Nephro Toxic
seizures |
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What are two major side effects of Enflurane?
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Nephro Toxic
seizures |
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What are two major side effects of Enflurane?
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Nephro Toxic
seizures |
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What is a common cardiac side effect of Halothane?
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cardiac arrhythmia's
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True or False
Desflurane smells good, and a patient will easily breath it in. |
FALSE .... Des smells bad and will cause a patient to hold their breath and cough.
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What are two major side effects of Enflurane?
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Nephro Toxic
seizures |
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True or False
Desflurane smells good, and a patient will easily breath it in. |
FALSE .... Des smells bad and will cause a patient to hold their breath and cough.
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True or False
Desflurane smells good, and a patient will easily breath it in. |
FALSE .... Des smells bad and will cause a patient to hold their breath and cough.
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Why is Isoflurane used more in 3rd world countries, and veteran hospitals?
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it is cheaper
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Why is Isoflurane used more in 3rd world countries, and veteran hospitals?
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it is cheaper
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True or False
Desflurane smells good, and a patient will easily breath it in. |
FALSE .... Des smells bad and will cause a patient to hold their breath and cough.
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Why is Isoflurane used more in 3rd world countries, and veteran hospitals?
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it is cheaper
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What is the name of the special vaporizer used for
Desflurane? |
TEC-6
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Why is Isoflurane used more in 3rd world countries, and veteran hospitals?
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it is cheaper
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What is the name of the special vaporizer used for
Desflurane? |
TEC-6
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What is the name of the special vaporizer used for
Desflurane? |
TEC-6
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What is Desflurane heated with the TEC-6?
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boils at room temperature
help to control amount of gas given, if not heated you can give a hypoxic mixture. |
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What is the name of the special vaporizer used for
Desflurane? |
TEC-6
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What is Desflurane heated with the TEC-6?
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boils at room temperature
help to control amount of gas given, if not heated you can give a hypoxic mixture. |
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Why is Desflurane heated with the TEC-6?
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boils at room temperature
help to control amount of gas given, if not heated you can give a hypoxic mixture. |
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What is Desflurane heated with the TEC-6?
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boils at room temperature
help to control amount of gas given, if not heated you can give a hypoxic mixture. |
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What gas is used now a days with kids instead of Halothane and why?
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Sevoflurane... smells good
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Which gas has a higher vapor pressure because it's boiling point is closer to room temperature?
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Desflurane
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TEC-6 is used with Desflurane because a conventional vaporizer would not be able to cope with the large changes in ----- -------- resulting from small variations in ambient temperature, and would be unable to supply sufficient ---- for the evaporation of an adequate amount of Des.
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vapor pressure
heat |
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What should you do if you are using Desflurane and the power goes out?
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switch to a different gas, because the TEC-6 vaporizer is not working ( it needs an electrical current to evaporate the agent which is then metered as a gas)
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True or False
The vaporizer dial setting does not necessarily reflect the concentration in the breathing circuit, alveoli, blood or brain. |
TRUE
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What is the definition of MAC ( Minimum alveolar concentration)?
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is the concentration necessary to abolish response( movement to incision) in 50% of the patient population ( relative potency)
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What does ED50 mean?
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is the 50% effective dose
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What is the ED95 mean?
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the alveolar concentration necessary to abolish movement in 95% of the population
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What is the MAC dos of ED95?
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1.2 to 1.5 MAC
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Name some factors that decrease MAC.
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a2 Agonists
barbiturates benzodiazepines opioid analgesics other anesthetics increasing age hypothermia hypoxia pregnancy hypotension |
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What factors that increase MAC?
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CHRONIC ETOH use
young age hyperthermia |
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TRUE OR FALSE
Lower MAC values indicate a more potent volatile anesthetic. |
TRUE
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Is MAC inversely related to potency?
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yes
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What kind of medication can you use with a volatile agent to decrease the MAC of the volatile agent?
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a Narcotic
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What major side effect can all of the halogenated volatile agents trigger in susceptible individuals?
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Malignant hyperthermia
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What is the only absolute contraindication to the use of halogenated volatile agents?
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a patient who is susceptible to Malignant hyperthermia
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What volatile agent undergoes the most metabolism? and what % ?
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Halothane 20%
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What volatile agent undergoes the least metabolism? and what %?
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Desflurane 0.02%
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In the presence of extremely dry soda lime, what can be produced by desflurane,enflurane, and isoflurane?
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Carbon monoxide
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What does soda lime degrade sevoflurane into?
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Compound A
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Compound A is nephrotoxic in rats at concentrations of --------.
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50 parts per million (ppm)
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What has been associated with a higher compound A production than soda lime?
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Baralyme
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How many segments does the right and left lung have?
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Right has 10 segments
Left has 8 segments |
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How many lobes does the right and left lung have?
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right has 3 lobes
left has 2 lobes |
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The terminal respiratory unit is distal to the terminal bronchiole and consists of a respiratory bronchiole branching into.........
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alveolar ducts
atria alveolar sac alveoli |
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Alveolar ducts are short and branch into 1-3 atria each leading to --- or ---- alveolar sacs and their alveoli.
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1 to 3
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There are about 300 million alveoli in the 2 lungs, each alveolus has an average diameter of what?
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0.12-0.25 mm in diameter
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How does Guyton describe the alveolar walls, due to them being very thin and are vascularized by a network of capillaries?
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" sheet of flowing blood"
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Where does gas exchange begin?
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in the partially alveolarized respiratory bronchioles
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What is the total surface of the respiratory membrane ( the membrane through which gas exchange occurs)?
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70 square meters
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What are the 5 cellular layers that make up the respiratory membrane?
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surfactant layer
alveolar epithelium epithelial basement membrane capillary basement membrane capillary endothelial membrane |
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What is the name of the fluid lipoprotein layer of the respiratory membrane that lines the alveolus and what is its function?
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Surfactant layer which reduces the surface tension which reduces the work required to expand the alveoli
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What are some factors that affect the rate of gas diffusion through the respiratory membrane?
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the thickness of the membrane, (an increased in thickness can decrease the rate of diffusion)
The surface area of the membrane ( a decrease in surface area will decrease diffusion) the diffusion coefficient of the gas in the substance of the membranes the pressure difference between the two sides of the membrane. |
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Define dead space.
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ventilation without perfusion
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What are the two types of dead space?
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anatomic and physiologic
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What is anatomic dead space?
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it represents the amount of air or volume of air present within the nose,mouth larynx and other structures above the terminal respiratory unit.
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What is physiologic dead space?
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the sum of the anatomic dead space and alveolar dead space
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What is alveolar dead space?
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the volume of alveolar gas that does not take part in gas exchange or diffusion
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In patients with moderate to severe COPD, the alveolar dead space is --------- due to destruction of alveolar septa.
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increased
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In patients with a pulmonary embolism physiologic dead space is ----------.
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increased
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What is the percentage of cardiac output that is not oxygenated called?
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shunt
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What is known as the increase in the partial pressure of the inhalational anesthetics in the alveoli?
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wash in
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What is the additive sum of the expiratory reserve volume in the lungs and the residual volume (2300ml) called?
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functional residual capacity(FRC)
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TRUE OR FALSE
Denitrogenation via pre oxygenation prior to induction of anesthesia replaces the the nitrogen within the FRC with oxygen. |
true
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If you have a decrease in FRC how does it effect wash in?
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it will increase, more rapid wash in
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Does cardiac output effect the uptake of inhalant anesthetics from the lung?
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yes, the movement of the anesthetic across the alveolar capillary membrane and its removal by the blood transversing the pulmonary capillaries is due to cardiac output
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The introduction of a certain concentration of drug into the system is the development of the inspired concentration is known as what abbreviation?
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FI-- inspired concentration
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The uptake of the drug into the lungs is development of the alveolar concentration, known as what abbreviation?
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FA-- alveolar concentration
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What is the time required for 63% wash in of a new gas to the lungs called?
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time constant
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What is the time constant of a normal lung with VA of 4 L/M and FRC of 2 liters ?
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0.5 min
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What are the three factors which determine the anesthetic uptake by the blood?
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solubility
cardiac output alveolar mixed venous blood partial pressure difference of drugs |
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What is the MAC, b/g,oil/gas of Halothane?
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0.77 mac
2.3 b/g 224 oil/gas |
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What is the biotransformation percentage of Halothane?
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18%
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What is the MAC, b/g, oil/gas and % of biotransformation of Enflurane?
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MAC= 1.7
b/g= 1.9 oil/gas= 98 3% |
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What is the MAC, b/g, oil/gas, and % of biotransformation of Isoflurane?
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MAC= 1.15
b/g= 1.4 oil/gas= 92 1% |
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Which gas is an ether-first synthesized in 1963 by Terrell, and is no longer used in the USA?
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Enflurane
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Which gas is a hydrogenated alkane and first synthesized in 1951 by Suckling and introduced into clinical practice by Johnstone in 1956?
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halothane
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What is the MAC, b/g, oil/gas and % of biotransformation of Sevoflurane?
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MAC= 2.05%
b/g = 0.6 oil/gas = 53 3.5% |
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What gas is an ether and first synthesized by Wallin et al int eh early 1970's?
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Sevoflurane
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What is the MAC, b/g, oil/gas, and % of biotransformation of Desflurane?
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MAC= 6 for age 30-65, 7.25 % for 18-30 year old
b/g= 0.42 oil/gas=19 1% |
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What gas is an ether, an analog of forane with an additional F- replacing the CL- on the ether alpha carbon atom and was introduced into clinical practice in 1992?
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Desflurane
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What is the MAC,b/g, oil/gas, of Nitrous Oxide?
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MAC= 104%
b/g=0.46 oil/gas= 1.4 |
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What gas is extensively metabolized, its major metabolite is trifluoroacetic acid via P450?
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halothane ( CF3-CHBrCL )
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What gas is slowly metabolized by the hepatic mixed function oxidase system, releases F- by oxidative dehalogenation?
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Enflurane ( CHF2-O-CF2-CHCIF)
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What gas is very slowly metabolized, and what little metabolism there is results from oxidation of the a-carbon?
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isoflurane ( CHF2-O-CHCI-CF3)
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Why is the wake time for desflurane about 50% less than observed with isoflurane?
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this is principally attributable to a blood/gas partition coefficient.
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