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