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Inhalational Anesthetics


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What are Guedel's 4 Signs and Stages of Ether Anesthesia?
Stage 1: Analgesia
Stage 2: Excitement
Stage 3: Surgical anesthesia
Stage 4: Apnea (this is death)
What are 3 factors that v MAC?
1) CNS Depressants (barbituates, opiods, ethanol, etc)

2) Hypothermia

3) Old Age
What are 3 factors that ^ MAC?
1) ^ CNS neurotransmitter levels (amphetamines, cocaine, etc)

2) hyperthermia

3) Young Age
1 MAC desflurane = ?%
1 MAC isoflurane = ?%
1 MAC N2O = ?%
^ Na+ in DCT triggers what 4 responses?
1) ^ K+ secretion

2) ^ Renin

3) ^ Aldosterone

4) ^ H+ secretion

(metabolic alkalosis)
Addison's Disease results in ?
dont have enough aldosterone


2)volume contracted - HYPOtension

3) metabolic acidosis
Conn's Syndrome results in ?
too much aldosterone (i.e. adrenal tumor)

1) hypokalemia

2) HYPERtension

3) metabolic alkalosis
Why would you use a Acetazolamid (4)?
1) Treat glaucoma

2) Trap drugs/toxins with low pKa

3) Uric acid kidney stones

4) prophylactically for high altitude pulmonary edema
Side effects of Acetazolamid?
1) Metabolic ACIDOSIS W/ K+ WASTING (exception to the rule!)

2) NH3 intoxication (usually leaves w/ basic urine)

-Important for patiens w/ liver disease
What are 2 uses of Furosemide?
1) Volume overloaded (i.e. pulmonary edema)

2) Hypercalcemia

-make sure to give saline w/ furosemide!
3 SE of Furosemide?
1) K+ Wasting/Metabolic Alkalosis

2) Hypercalcinuria (bad for oxalate kidney stones)

3) Ototxicity
Electric Potential change of Asc limb? w/Furosemide?
"+" --> neutral

-therefore lose K+, Mg+, Ca+ in urine
Electric Potential change of DCT? w/ Thiazide
"-" --> neutral
What are the side effects of Triamterene?
1) Hyperkalemia

2) Metabolic acidosis

3) Prostatic hypertrophy (BPH)

4) Gynecomastia
When are K+ Sparing diuretics especially useful?
1) primary aldosteronism (Conn's Syn)

2) secondary aldosteronism (i.e. heart failure, chronic kidney dz (esp nephrotic syn), and chronic liver dz
ADH Antagonist

Used in syndrom of Inappropriate ADH Secration

Potential tx for polycystic kidney dz

SE: HYPERNATREMIA, Volume depletion
Osmotic Diuretic

Can Treat: conditions of solute overload from severe hemolysis or rhabdomyolysis

-also reduces intraocular pressure (glaucoma)

SE: hyponatremia, pulmonary edema, headache, nasea, vomitting
How is Spironolactone & Tolvaptan differnet from Amiloride & Triamterene?
All three are K+ sparing diuretics.

Spironolatone & Tolvaptan acts as an antagonist to aldosterone

Amiloride & Triamterene act as ENaC (channel) blockers
Serotonin derived from what AA?
NE derived from what AA?
What is a major advantage of Trazodone over other drugs that block 5-HT reuptake?
Trazodone (atypical antidepressant) doesn't have a lot of drug interactions
Side effect of SSRI's
Anxiety, Nervousness
Side effect of Mirtazapine?
SEDATION, weight gain

also dopamine agonists!
What are the 4 main chemical properties of LA's and their significance?
1) Lipid solubility - potency

2) Protein binding - duration of action

3) Ionization - onset & strength of binding

3) Stereochemistry - S>R
4 Clinical toxicities caused by chronic high dose glucocorticoid treatment.
1) Cushing-like habitus (truncal obesity, moon facies, ect)

2) Supression of immune system

3) Osteoporosis

4) Peptic ulcers

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