Chemistry and Physics of Anesthesia - Exam 1 - Chemical Bonding
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| What is the joining of elements into molecules called? | Chemical bonding
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| What does chemical bonding depend on? | The distribution of electrons in the outermost shell
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| The distribution of electrons among available shells of an atom or molecule is known as the ___________. | Electron configuration
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| Which group of elements are not able to combine and recombine with other elements? | The inert group
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| How many outer shell electrons does it take to create a stable element? | 8
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| Which element has a stable outer shell number of 2? | Helium
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| Elements with what number outer shell electrons react in ways to become more stable? | Elements with 1 to 7 outer shell electrons react to create a stable 8 electron outer shell
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| Elements with 1, 2, or 3 electrons in their outer shell tend to ___________ electrons to gain stability. | Lose (oxidize)
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| Elements with 5, 6, or 7 electrons in their outer shell tend to ___________ electrons to gain stability. | Gain (reduce)
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| An element that loses an electron is [reduced/oxidized]. | oxidized
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| An element that gains an electron is [reduced/oxidized]. | reduced
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| A good reducing agent readily [gains/loses] an electron. | loses
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| A good oxidizing agent readily [gains/loses] an electron. | gains
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| A substance that undergoes oxidation [loses/gains] an electron. | loses
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| A substance that undergoes reduction [loses/gains] an electron. | gains
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| An ionic bond is formed between 2 atoms that have been ________. | charged
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| An ionic bond requires 2 elements with what types of charges? | 1 positive and 1 negative
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| Attractive forces in drug receptor binding is attributed to what types of bonds? | Ionic bonds
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| The molecule NaCl is a good example of what type of bond? | ionic
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| Why is NaCl considered to be a weak or unstable bond? | Because it will readily dissociate back into its component parts when placed in solution
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| What are weak bonds called? | Loose or unstable
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| What is a covalent bond? | A bond between two elements that share an equal number of electrons in the outer shell
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| What is one of the most important non-covalent bonds in the living system? | The hydrogen bond
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| Hydrogen bonding is responsible for what two characteristics of water? | Its high boiling point and ability to float in frozen form
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| How is hydrogen bonding important in DNA structure? | It gives DNA its double helix shape and holds proteins in their functional forms
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| Give four examples of hydrogen bonds holding elements together in the human body. | 1)Holds the two strands of DNA together 2)Holds polypeptides together 3)Helps enzymes bind to substrates 4)Helps antibodies bind to antigens
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| When do covalent bonds usually form? | When 2 nonmetals or a metalloid and a nonmetal combine
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| What ocular disease do miotics help to treat? | Glaucoma
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| How many covalent bonds can phosphorus create? | 5
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| Phosphorus establishes [reversible/irreversible] bonds with substances to which it attaches to. | Irreversible
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| Phosphorus uncoupling may take up to __________ weeks. | 6
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| Carbon and phosphorus combine to make up what types of compounds? | Organophosphates
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| Echothiophate is a type ______________. | Organophosphate
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| What condition is echothiophate primarily used to treat? | Glaucoma
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| What is acetylcholine? | A neurotransmitter that activates or stimulates nerve impulses
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| What does echothiophate inhibit? | cholinesterase
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| What is the cholinesterase enzyme responsible for? | The hydrolysis and inactivation of succinylcholine and the ester-type local anesthetics.
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| Succinylcholine consists of an attachment of two molecules of ___________. | Acetylcholine
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| Echothiophate is a cholinesterase inhibitor and therefore prolongs the action of what neurotransmitter? | Acetylcholine
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| Succinylcholine should not be given to patients receiving which miotic? | Echothiophate
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| Patients on echothiophate should not receive _____________ during anesthesia. | Succinylcholine
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| Echothiophate affects what type of receptors? | Nicotinic
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| Administering succinylcholine to a patient on echothiophate would cause what type of nicotinic action? | Nicotinic stimulation of skeletal muscle to the point of fatigue and paralysis
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| Administering succinylcholine to a patient on echothiophate would cause _____________ symptoms in the autonomic nervous system. | Cholinergic
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| What are three cardiovascular cholinergic symptoms? | 1)Bradycardia 2)Hypotension 3)Asystole
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| What are two airway related cholinergic symptoms that make anesthesia more difficult? | 1)Increased secretions 2)Bronchospasm
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| How are organophosphates used in the industrial setting? | As insecticides
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| Giving succinylcholine to a patient on echothiophate can cause ____________ toxicity. | Organophosphate
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| Organophosphate insecticides produce a/an [reversible/irreversible] enzyme inhibition and have ______________ effects as well. | Irreversible, CNS
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| Atropine counters the effects of echothiophate at what type of receptors? | Muscarinic
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| What are the two main types of cholinergic receptors? | Nicotinic and muscarinic
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| The autonomic symptoms of organophosphate poisoning are treated with what medication? | Atropine
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| Atropine is a competitive antagonist of what neurotransmitter and at which sites? | acetylcholine at muscarinic receptors
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| Succinylcholine causes ______________ symptoms, atropine causes ______________ symptoms. | Cholinergic, anticholinergic
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| What medication uncouples phosphorous bonds? | Pralidoxime protopam (PAM)
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| What medication is used to treat neuromuscular symptoms of organophosphate poisoning? | Pralidoxime protopam
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| What is the dose of pralidoxime protopam? | 1-2 grams
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| What is the concentration and infusion rate of pralidoxime protopam? | 8mg/ml, 500mg/hr
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| An ion is an atom with either a __________ or ___________ charge. | Positive, negative
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| Give one example of a positive and negative ion combination. | NaCl
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| Give two examples of biological barriers. | Blood-brain and placental barriers
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| Drugs with either a + or – charge [can/cannot] usually cross biological barriers. | Cannot
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| Common ionized drugs used in anesthesia are the ____________ agents. | Neuromuscular blocking
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| [Ionized/Nonionized] drugs have the ability to cross biological barriers. | Nonionized
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| Nonionized drugs are ___________ compounds and not easily excreted by the ___________. | lipid, kidneys
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| Give 4 examples of nonionized medications used in anesthesia. | 1)Morphine 2)Ketamine 3)Atropine 4)Scopolamine
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| Glycopyrolate is a type of [ionized/nonionized] drug. | ionized
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| Atropine and scopolamine are not ionized drugs, therefore they [can/cannot] cross biological barriers. | can
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| Glycopyrrolate is an ionized drug, therefore it [can/cannot] cross biological barriers. | cannot
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| What two things determine the ease at which a drug can be absorbed? | Its physical and chemical forms
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| Most drugs are either _____________ or _______________ and are physically present in solution in both ____________ and ___________ forms. | Weak acids, weak bases, ionized, nonionized
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| What ratio is important in determining the rate at which a drug passes across a biologic membrane? | The percentage of nonionized to ionized drug
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| The [ionized/nonionized] form is usually lipid soluble (lipophilic) and will readily cross lipid membranes. | nonionized
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| Nonionized medications are usually [lipophobic/lipophilic]. | lipophilic
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| The [ionized/nonionized] form is usually water soluble (hydrophilic) and does not readily cross biologic membranes. | Ionized
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| Ionized medications are usually [hydrophobic/hydrophilic]. | Hydrophilic
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| The pKa represents the [ionized/nonionized] fraction of a drug. | Nonionized
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| The pKa is known as the _______________ whereby a drug exists at ___________% of ionization. | Dissociation constant, 50
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| What equation describes the relationship between ionized and nonionized forms of a drug? | Henderson-Hasselbalch
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| What is the Henderson-Hasselbalch equation for an acid? | pH – pKa=log[(A-)/(HA)]
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| In the Henderson-Hasselbaclh equation for an acid, what do the [A-] and [HA] variables represent? | [A-] is the concentration of ionized acid, [HA] is the concentration of nonionized acid
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| What is the Henderson-Hasselbalch equation for a base? | pH – pKa=log[(B)/(BH+)]
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| In the Henderson-Hasselbalch equation for a base, what do the variables [B] and [B+] represent? | [B] is the concentration of a non-ionized base and [BH+] is the concentration of an ionized base.
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| For each drug, the pKa is [constant/variable]. | Constant
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| Since the pKa is a physical constant for each drug, what factor determines the ultimate ratio of ionized to nonionized drug? | The pH of the solution in which the drug dissolves
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| Weak acids are acids with a pKa above _________. | 3
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| A solution with a pH of less than 3 will [increase/decrease] a weak acid’s ability to be absorbed. | increase
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| A solution with a pH of less than 3 will [increase/decrease] a weak base’s ability to be absorbed. | decrease
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| What is the disassociation formula to calculate the pK? | [Ionized form of a drug] / [Nonionized form of a drug]
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| If the pH of an environment is low and acidic, a weak acid will have a [greater/lower] chance of dissociating into its ionic forms. | lower
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| When a weak base is added to a strongly basic solution, it has a [greater/lower] chance of dissociating into its ionic forms. | lower
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| Acidic drugs are highly ionized in __________ solutions. | basic
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| Basic drugs are highly ionized __________ solutions. | acidic
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| Adjusting the pH to be [equal to/greater than/less than] a drug’s pKa can help improve a drug’s ability to be absorbed. | Equal to
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| The [ionized/nonionized] portion of a drug is the portion that will easily cross biologic membranes. | Nonionized
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| Medications that are lipid soluble [will/will not] cross biologic membrans. | will
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| What are the two major classifications of local anesthetics? | Amino esters and amino amides
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| Which local anesthetic group has higher pKa values? | Amino esters
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| What are the 3 amino esters? | 1)procaine 2)Chloroprocaine 3)Tetracaine
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| What are the 4 amino amides? | 1)Bupivicaine 2)Ropivicaine 3)Lidocaine 4)Mepivacaine
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| How can the addition of sodium bicarbonate affect the onset and quality of a local anesthetic? | 1)speed the onset 2)improve the potency 3)prolong the block
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| Why does sodium bicarbonate improve the quality and potency of local anesthetics? | Increases the environmental pH, bringing it closer to the pKa value of the local anesthetics and increasing the amount of nonionized drug.
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| Which local anesthetic has the highest pKa value? | Procaine at 8.9
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| Which local anesthetic has the lowest pKa? | Mepivicaine at 7.6
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