Chem&phys Test 2

Front 1

Write out the IUPAC name for Halothane.

Back 1

2-bromo-2-chloro-1,1,1-trifluoro-ethane

Front 2

Which VAA is fluromethyl 1,1,1,3,3,3,-hexa-fluoro-isopropyl ether

Back 2

Sevoflurane

Front 3

Write the IUPAC for Isoflurane

Back 3

1-chloro-2,2,2-trifluoroethyl difluoromethyl ether

Front 4

Which VAA is 1,2,2,2-tetrafluoroethyl difluoromethyl ether

Back 4

Desflurane

Front 5

Which functional group is-COOH

Back 5

Carboxylic Acid

Front 6

Which functional group is R-O-R

Back 6

ether

Front 7

Which functional group is -OH

Back 7

alcohol

Front 8

Which functional groups are associated with a double bonded Oxygen to carbon? (5)

Back 8

Amide, Ketone, Aldehyde, Carboxylic Acid, and Ester (AKACE mnemonic)

Front 9

True/False. Enantiomers have the same pysical properties such as boiling point, melting point, and density?

Back 9

TRUE

Front 10

what is the only halogenated ALKANE used in anesthesia?

Back 10

Halothane

Front 11

Which functional group is
-CHO? and is there a double bond somewhere?

Back 11

Adlehyde, yes, C to O

Front 12

True or False. VAA are hydrocarbons with halogens?

Back 12

True

Front 13

What are the 2 main categories of halogenated hydrocarbons or VAA? (think about their different structures)

Back 13

alkane (halothane) and ethers (all the others R-O-R)

Front 14

Name the carbon chains from 1 Carbon to 10 Carbons.
Example 1 Carbon is methane

Back 14

1 carbon: named "methane"
2 carbons: named "ethane"
3 carbons: named "propane"
4 carbons: named "butane"
5 carbons: named "pentane"
6 carbons: named "hexane"
7 carbons: named "heptane"
8 carbons: named "octane"
9 carbons: named "nonane"
10 carbons: named "decane"

Front 15

what is the prefix if you have 4 of the same halogens such as in desflurane that has 4 fluorides?

Back 15

tetra

Front 16

Are these all the same compound? methyoxyethane or methoxy ethane or ethyl methyl ether or methyl ethyl ether. Draw it out

Back 16

yes. C-O-C-C.

Front 17

Can an ether be cyclic?

Back 17

Yes ethyoxycyclohexane or ethyl, cyclohexane ether (Not IUPAC correct) draw it out. See slide 34 and 23 on Dr. Welliver's ppt

Front 18

Whose law states: the solubility of a gas (amount of gas that dissolves in a liquid) is directly proportional to the concentration of that gas in the gas phase.

Back 18

Henry's Law

Front 19

What is a clinical application of Henry's Law

Back 19

Inhaled Anesthetics. The higher the concentration in the alveoli, the faster induction

Front 20

What is the ratio of the amount of substance present in equal volumes of two phases at a stated equilibrium temperature

Back 20

partition coefficient. Partition coefficients frequently used when phases are both solid & liquid ie. tissue-blood coefficient

Front 21

How many mg/ml are in 1.5% lidocaine?

Back 21

15mg/ml

Front 22

How many mg are in 15ml of 0.5% lidocaine?

Back 22

75mg (15ccx5mg/cc)

Front 23

how many mcg/cc are in 1:100,000 epinephrine?

Back 23

10mcg/cc

Front 24

How many mcg are in 1:1000 epi? How many mg?

Back 24

1000mcg and 1mg

Front 25

How many vials or mcg of 1:1000 epi do you need to make a 1:200,000 concentration in 100mls?

Back 25

X divided by 100 = 5 (because we know that 1:200,000 is = to 5mcg/ml) solve for X
answer: 0.5 vials or 500mcg (each vial has 1000mcg right?) So 500mcg divided by 100mls = 5mcg/ml.

Front 26

How many vials or mcg of 1:1000 epi do you need to make a 1:400,000 in 250mls?

Back 26

X divided by 250 = 2.5
answer: 0.625 vials or 625mcg

Front 27

How many mcg are in 25mls of epi 1:200,000

Back 27

125mcg (5x25)

Front 28

What is the movement of solvent called?

Back 28

Osmosis

Front 29

What is the movement of solute called?

Back 29

Diffusion

Front 30

In capillaries this osmotic pressure when caused by plasma proteins is called what?

Back 30

Oncotic Pressure

Front 31

What is the normal oncotic pressure?

Back 31

24-27mmHg

Front 32

What is an osmole and how many are in 1 mole of KCL?

Back 32

osmole is gram molecular weight of undissociated solute. KCL has 2 osmoles (1 K and 1 CL)

Front 33

True or false. Oncotic pressure (24-27mmHg) is the same thing as Serum osmolarity (285-295 mOsm/kg)

Back 33

True. see slide 14 under DIFFUSION ppt.

Front 34

Calculate the serum osmalarity given this formla:
(2 x (Na + K)) + (BUN / 2.8) + (glucose / 18). Na-130, K- 3.0 BUN-25 Glucose-90.
Is this high, low, or normal

Back 34

266 + 8.9 + 5 = 279.9
Low

Front 35

what is required to stop osmosis?

Back 35

Osmotic pressure

Front 36

At what osmolarity do RBCs begin to burst?

Back 36

200mOsm/kg

Front 37

Imagine a situation where one's serum osmolarity is less than 200mOsm/kg. Water intoxication. What would the electrolytes look like given this formula? (2 x (Na + K)) + (BUN / 2.8) + (glucose / 18).

Back 37

might look something like:
Na 90, K 2.0, BUN 10, glucose 50
184 + 3.6 + 2.7= 190.3

Front 38

What are the Osmolarities of NS and LR?

Back 38

NaCl=308 mOsmol/liter
LR=273 mOsmol/liter

Front 39

Which law is associated with diffusion?

Back 39

Fick's Law of Gas Diffusion across a fluid membrane.

Front 40

True or false? According to Ficks Law, diffusion rate of gas is DIRECTLY proportional to:
Partial pressure gradient
Membrane thickness
Solubility of gas in membrane

Back 40

False
It is DIRECTLY proportional to
Partial pressure gradient
Membrane area
Solubility of gas in membrane

Front 41

True or False? According to Fick's Law, the diffusion rate of gas is INVERSELY proportional to:
Membrane thickness
Square root of the molecular weight

Back 41

True

Front 42

Whose law explains diffusion hypoxia and concentration effect?

Back 42

Fick's Law

Front 43

Whose Law states: diffusion is inversely related to the square root of it’s molecular weight

Back 43

Graham's Law- Diffusion is inversely related to the square root of it’s molecular weight

Front 44

What is the MAJOR determinant of a gases diffusion? In other words, if you don't have this.....you will not have diffusion.

Back 44

concentration gradient

Front 45

What four factors are important for non-gas diffusion

Back 45

Concentration gradient for un-ionized substances,
Electrochemical gradient for ions (remember equivalents?),
Lipid solubility, and
Size

Front 46

Whose law when summarized states that big molecules diffuse slower than smaller molecules?

Back 46

Grahams

Front 47

What do Henry's Law, Fick's Law, and Graham's Law all have in common?

Back 47

they all apply to tissue diffusion.
Henry's says the more solute you have the more diffusion.
Fick is related to Partial pressure gradient, Membrane area, Solubility of gas in membrane, membrane thickness and square root of molecular weight.
Graham simply says the bigger the molecule, the slower it diffuses.(inversely related to square root of molecular weight)

Front 48

Transmembrane potential difference related to ION diffusion through a semi-permeable membrane can be calculated by who’s formula?

Back 48

Nernst equation (slide 24 in DIFFUSION ppt)

Front 49

Depolarization by flow of sodium ions is an application of what?

Back 49

Nernst equation.

Front 50

pKa is associated with what in LA?

Back 50

Onset

Front 51

True or False? The closer the pKa of a LA is to physiologic pH, the faster the onset?

Back 51

True!

Front 52

Bupivacaine's pKa is 8.1. Would the onset of this drug be faster or slower if the physiologic pH was 7.1 instead of 7.4

Back 52

slower

Front 53

True or false? Weak acids and weak bases completely dissociate in water?

Back 53

False......weak acid/base only partially dissociate, strong acid/bases essentially completely dissociate.

Front 54

When you hear lipid solubility, in relation to LA, what other word comes to mind (is strongly correlated)

Back 54

potency. the more lipid soluble, the more potent.

Front 55

Bupivacaine's lipid solubility coefficient is 3420 and Mepivacaine's is 130. Which is more potent?

Back 55

Bupivacaine

Front 56

What affects duration of LA?

Back 56

protein binding

Front 57

If the pKa of a LA is 8.1 does that mean there is more ionized or unionized drug when injected into physiologic pH (7.4)

Back 57

More Ionized

Front 58

Which form of the LA is responsible for binding to the Na channel once inside the cell? ionized or unionized?

Back 58

Ionized

Front 59

Which form crosses the lipid membrane?

Back 59

unionized

Front 60

What are the three basic structures of a LA?

Back 60

Amine, intermediate link (amide or ester) and the aromatic

Front 61

True or False? The aromatic group of a LA is lipophilic?

Back 61

True

Front 62

True or false? The amine group of a LA is lipophilic?

Back 62

False, it is hydrophilic.

Front 63

True or false? Amide LAs are metabolized by the liver and ester LA are metabolized by plasma cholinesterases (ester hydrolysis)?

Back 63

True

Front 64

what are most people allergic to with ester LA?

Back 64

PABA. p-aminobenzoic acid

Front 65

Why do we use preservative free LA?

Back 65

because some people are allergic to the preservatives used in amide LAs. (Methylparaben)

Front 66

Is bupivacaine and cocaine both amide LAs? How can you tell?

Back 66

No. one i means it is an ester. two i's means it is an amide.

Front 67

True or false? Once the LA is in the cell, the amine group becomes a quaternary amine, thus giving it a positive charge or "ionizing" it?

Back 67

true

Front 68

If the amine group on the LA becomes a quaternary amine (LAH+) OUTSIDE the cell, is it ionized or unionized and can it enter the cell?

Back 68

ionized and No. Quat does squat outside the cell.

Front 69

why are LA stored in acidic solutions?

Back 69

to prevent precipitation of free base local anesthetic

Front 70

Why does adding a base such as bicarb to LA just before administration increase onset?

Back 70

it will cause less ionization and more unionized will be available to cross lipid membrane. Similar to Henry's Law: the more available the faster the diffusion(except that it's not a gas)

Front 71

What does adding epinephrine to LA do to the duration?

Back 71

increase duration because the epi causes local vasoconstriction thereby decreasing the amout of systemic absorption, allowing it to stay where it was injected longer.

Front 72

Will a LA be effective in an area that is necrotic (acidic)?

Back 72

No, it will be nearly 100% ionized and cannot cross the lipid membrane. (look at the curve) (it would be almost like what it is preserved in)

Front 73

True or false? If the LAs pKa is 7.4 and the physiologic pH is 7.4 there will be 50% ionized and 50% unionized drug?

Back 73

true

Front 74

What areas of body should you not use epinephrine with LA?

Back 74

areas with no collateral flow such as digits.

Front 75

Define tachyphylaxis (Evers p517)

Back 75

if one has an epidural and waits til the pain comes back before redosing it can lead to tachyphylaxis where the subsequent doses are not as effective. If you redose before pain comes back it doesn't occur.

Front 76

Will a drug that is a weak acid have more or less drug available (unionized) in one who's pH is 6.9? How about 7.45?

Back 76

There will be more drug available in the pH of 6.9 that 7.45

Front 77

Which LA is only available in unionized form and its mechanism of action is thought to cause membrane expansion and closure of the sodium channel

Back 77

Benzocaine (S&M p 125)

Front 78

True or False? both ionized and unionized forms of LA can cause anesthetic effects?

Back 78

True. Benzocaine exists only in unionized form and is not affected by the pH.

Front 79

True or False? Potency and hydrophobicity increase with an increase in the total number of carbon atoms in the molecule

Back 79

True

Front 80

True or False? Most LA are racemic?

Back 80

True

Front 81

which enantiomer is associated with less toxic effects? sinister/levo or rectus/dextro

Back 81

S/Levo (generally)

Front 82

What do bupivacaine and ropivacaine have in common?

Back 82

Their pKa is 8.1

Front 83

Put these in order of their pKa: bupivacaine, lidocaine, mepivacaine, ropivacaine, chloroprocaine, tetracaine

Back 83

mepivacaine 7.6, lidocaine 7.8, bupivacaine 8.1 = ropivacaine 8.1, tetracaine 8.2, and chloroprocaine 9.0

Front 84

Which LA is only used in topical solutions or in lozenges?

Back 84

benzocaine is also anbesol

Front 85

True or false? Tetracaine can be used spinal or topically?

Back 85

True

Front 86

True or false? Chloroprocaine has a slow onset because its pKa is 9.0?

Back 86

False. It has a fast onset possibly because of the amount we use (3%)

Front 87

List all the different clinical uses of LA.

Back 87

Topical, infiltration, peripheral nerve block, epidural, caudal, spinal

Front 88

How is chloroprocaine used clinically?

Back 88

infiltration, peripheral nerve block and epidural or caudal

Front 89

How is lidocaine used clinically?

Back 89

Epidural, caudal, spinal
Infiltration
Peripheral nerve block
Topical

Front 90

True or False? Mepivacaine can be used in Obstetrics?

Back 90

False. Not used in obstetrics due to toxicity to neonates because of reduced metabolism

Front 91

True or False? Lidocaine is more toxic than procaine?

Back 91

True. Lidocaine toxicity initially manifests as drowsiness, tinnitus, and dizziness.

Front 92

What is Mepivacaine used for clinically?

Back 92

Epidural, caudal
Infiltration
Peripheral nerve bloc

Front 93

What is Bupivacaine used for clinically?

Back 93

Epidural, caudal, spinal
Infiltration
Peripheral nerve block

Front 94

True or false? Lidocaine is more cardiotoxic than bupivacaine?

Back 94

False

Front 95

What is Ropivacaine is used for clinically

Back 95

Epidural, caudal, spinal
Infiltration
Peripheral nerve block

Front 96

Which drug would theoretically be metabolized faster? Amide or ester?

Back 96

Ester because of plasma ester hydrolysis. Amides have to make it to the liver first.

Front 97

What are the 3 processes in Amide metabolism

Back 97

N-dealkylation-An enzyme detaches one or more carbon atoms from the amine group, making it either a 2° or 1° amine.
Amide Hydrolysis-Enzyme breaks down H2O into one H and an OH. Then uses OH to replace the N group in the amide.
Aromatic Hydroxylation-
Introduction of the OH (Hydroxyl group) to the benzene ring.

Front 98

Describe Ester Hydrolysis.

Back 98

Objective is to replace the OR group with an OH (Hydroxyl group) and form carboxylic acid. Enzyme (plasma cholinesterase) breaks down H2O into one H and an OH.
Then uses OH to replace the OR group in the ester

Front 99

Do VAA diffuse out of the body faster if one is cold or warm?

Back 99

Warm

Front 100

Does sugar dissolve better in warm water or cold?

Back 100

warm

Front 101

If the body is cold during surgery, does that increase or decrease MAC?

Back 101

Decrease because the body "holds" on to the VAA more so than if it is warm.

Front 102

Which type of Regional anesthetic block is associated with greater vascular absorption? subcutaneous or brachial plexus?

Back 102

Brachial plexus. In fact here's the order from most absorbed to least. Intercostal nerve block> caudal> epidural> brachial plexus> sciatic-femoral> subcutaneous

Front 103

What are these signs and symptoms of? light-headedness, tinnitus, perioral numbness, confusion, muscle twitching, hallucinations, tonic-clonic seizure, unconsciousness, respiratory arrest

Back 103

CNS toxicity from LA

Front 104

What are common S&S of cardiotoxicity from LA?

Back 104

HTN, tachycardia, decreased contractility and cardiac output, hypotension, bradycardia, ventricular dysrhythmias, circulatory arrest

Front 105

Which LA has the highest cardiotoxicity and should never give more than 0.5% in obstetrics?

Back 105

Bupivacaine

Front 106

Name some ways to treat LA toxicity.

Back 106

Use a test dose with epi to avoid inadvertent injection into vessel, secure airway and provide 100% oxygen, if seizures develop may give benzo like diazepam and maybe a short acting muscle relaxant, ACLS for ventricular dysrhythmias, Epi and Bretylium for V-fib, intravascular lipids

Front 107

Which LAs are associated with methemoglobinemia?

Back 107

Benzocaine and Prilocaine. more rarely lidocaine.

Front 108

What is the treatment for Methemoglobinemia?

Back 108

Methylene blue. Methemoglobin is reduced thru methemoglobin reductase which is accelerated by IV methylene blue.