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NU 624

Chemistry and Physics of Anesthesia - Exam 1 - Inhalational Agents

Name the volatile anesthetics. Diethyl-ether, desflurane, isoflurane, sevoflurane, halothane
Name the gaseous anesthetics Nitrous oxide, cyclopropane, ethylene
The molecular structure of volatile anesthetics is primarily based on what molecule? CH4
What 4 elements readily combine with the carbon molecule in methane? Nitrogen, hydrogen, oxygen, sulfur
What 4 halogens are used to stabilize volatile anesthetics? Fluoride, chloride, bromine, iodine
What is halogenation? A reaction that occurs when a halogen element is introduced into a substance
In what 4 ways do halogens affect volatile anesthetics? Decreased volatility, decreased flammability, increased potency, increased toxicity
What organ system toxicities can occur with halogenation? Liver and kidney
How does halogenation affect the weight of a hydrocarbon (i.e. methane (CH4))? Increases the molecular weight
What is vapor pressure? The pressure at which a fluid will immediately vaporize or boil if it is exposed to it or values of pressure below it
Halothane is comprised of what three halogens? Fluorine, chlorine, bromine
What is the trade name for halothane? fluothane
What type of organic functional group is halogenated to produce halothane? alkane
What is the vapor pressure of halothane? 244
Which bond creates the potency in halothane? carbon-bromine-chlorine
Which bond decreases the flammability in halothane? carbon-fluorine
What is the trade name for isoflurane? Forane
What two halogens give isoflurane its stability? Fluorine and chlorine
What is the molecular weight of isoflurane? 184
What is the vapor pressure of isoflurane? 240
What type of substance is halogenated in isoflurane? Methyl ethyl ether
What substance does not need to be added to isoflurane due its good stability? Preservatives
Why is it not good to mask ventilate a patient with isoflurane? Pungent odor
Desflurane trade name is … Suprane
What single halogen gives desflurane its stability? Fluorine
Which two volatile anesthetics are halogenated by fluorine to create stable compounds? Desflurane and sevoflurane
What type of substance is halogenated in desflurane? Methyl ethyl ether
What is the molecular weight of desflurane? 168
What is the vapor pressure of desflurane? 669
How does fluorine affect the methyl ether ether in its anesthetic qualities? Increases vapor pressure, enhance stability, decreases potency
Which anesthetic has the highest vapor pressure? The lowest? Desflurane; sevoflurane
Sevoflurane trade name is …. Ultane
Which halogen gives sevoflurane its stability? Fluorine
What is the vapor pressure of sevoflurane? 157
What type of substance is halogenated in sevoflurane? Methyl isopropyl ether
Why is sevoflurane a good medication to mask ventilate with? No odor, fast onset and offset
Do patients cough more with sevo or des? Desflurane
What are the two major metabolites of sevoflurane? Inorganic fluoride, (HI) hexafluor-isopropanol
What does sevoflurane break down into when exposed to CO2 absorbents? Compound A
Why is compound A dangerous? It is nephrotoxic
Compound A is nephrotoxic and causes damage to what part of the kidney? Renal tubules
What makes Compound A insidious? Toxic levels are not detectable at low doses
Which anesthetic is dyed blue for anesthetic purposes but can also be used as a degreaser? Trichlorethylene
Which anesthetic is nephrotoxic? Sevoflurane
Which anesthetic is a hepatic carcinogen and sometimes found in well water? Trichlorethylene
Which anesthetic is not compatible with CO2 absorbers? Trichlorethylene
What is the most important determinant in anesthetic metabolism? Genetics
Besides genetics, what are three other factors that determine anesthetic metabolism? Chemical breakdown, concentration of drug, hepatic enzyme activity
Nitrous oxide undergoes reductive metabolism: to breakdown into what substance in what area of the body? Nitrogen in the GI tract
How much nitrous oxide undergoes reductive metabolism in the GI tract? 0.004%
What type of bacteria is responsible for reductive metabolism? Pseudomonas
Does reductive metabolism in the GI tract occur by aerobic or anaerobic means? Anaerobic
The interaction of B12 and nitrous oxide in the gut inhibits which enzyme? Methionine synthase
Methionine synthase is involved in the metabolism of which two substances? Methionine and folate
Bone marrow suppression and neuro symptoms occur with what degrees of nitrous oxide exposure? Long exposure >6h, high concentrations
Bone marrow suppression can occur with long periods of exposure to what inhaled anesthetic? Nitrous oxide
In what metabolic pathway are ether bonds and carbon-halogen bonds broken down? Oxidative metabolism
What two parts of the molecular structure of halogenated agents are most susceptible to separating during metabolism? Ether bond and carbon-halogen
When is oxidation of the ether bond in a halogenated agent less likely to occur? When hydrogen atoms on the carbon atom of the COC bond (ether) are replaced by halogen atoms.
Where in a molecular structure do halogen atoms find an optimal arrangement for dehalogenation? On the terminal carbon (halogens connected to the carbons located at the end of a molecular chain)
What is the definition of a terminal carbon? A carbon molecule located at the end of a molecular chain
Which halogen is most resistant to oxidative metabolism and why? Fluorine because it has the strongest bond with carbon compared to chlorine and bromine
What are three metabolic processes by which halothane is broken down? Oxidation, dehalogenation, reduction
The oxidative metabolism of halothane forms …. TFA (Tri-fluoro-acetic acid)
The dehalogenative metabolism of halothane forms …. Inorganic halogens for bromine and chlorine
The reductive process of halothane metabolism forms …. Fluoride and volatile products
Reductive metabolism is the only pathway of breakdown that occurs for which halogenated anesthetic? Halothane
What are two conditions that have to be present in order for reductive metabolism to occur in halothane? Hepatocyte hypoxia and enzyme induction (halothane hepatitis)
What are the two reductive metabolites of halothane? Fluoride and volatile byproducts
The volatile byproducts of halothane are thought to contribute to what condition? Halothane hepatitis
What 2 molecular structures give isoflurane its stability? Trifluorocarbon and halogen atoms on the two sides of the ether bond
Stability and low solubility are properties that would lead to [minimal/maximal] drug metabolism of isoflurane. Minimal
What percent of isoflurane undergoes oxidative metabolism by CYP450 enzymes? 0.2%
Isoflurane undergoes (oxidative/reductive) metabolism. Oxidative
What is the principle metabolite of isoflurane? TFA
What percent of desflurane undergoes metabolism? 0.02%
The metabolic pathway of desflurane mimics that of what other medication? Isoflurane
What bond gives desflurane its strength, leading to less metabolism compared to other VAA? Carbon-Fluorine bond
When does metabolism begin to occur with desflurane? Insertion of an active oxygen atom between the alpha ethyl carbon of desflurane and its hydrogen
What are the 4 byproducts of desflurane metabolism? 1)inorganic fluoride 2)TFA 3)CO2 4)H20
What type of metabolism breaks down sevoflurane? Oxidative metabolism
What percent of sevoflurane undergoes oxidative metabolism? 5% 5%
What types of enzymes control the metabolic pathway of sevoflurane? CYP450 enzymes
What are the two major metabolites are formed from the breakdown of sevoflurane? Inorganic fluoride and hexafluoroisopropanol
To what product does hexafluoroisopropanol combine with in order to be excreted? Glucuronic acid
What type of metabolism occurs to breakdown hexafluoroisopropanol? Conjugation
How is hexafluoroisopropanol excreted? In the urine as a conjugate
Sevoflurane is also degraded by CO2 absorbers to become what substance? Compound A
What limits the exposure of the renal tubules to the fluoride that results from sevo metabolism? Rapid pulmonary elimination
What two things influence the amount of sevoflurane that is absorbed by CO2 absorbers? Temperature and type of CO2 absorbent
What happens to the amount of sevoflurane that is absorbed when the temperature of a CO2 absorbent increases? More sevoflurane is absorbed and degraded
Which CO2 absorbent produces more compound A, Baralyme or sodalime? Baralyme
Created by: philip.truong