ANes Pharm - NMB and Anticholinergics

Question 1

Pancuronium

Answer 1

long acting, 0.1mg/kg, DOA:60-90 mins, CV effetcs: inc HR, inc BP, inc MAP. ED95 CV effects

Question 2

Atracurium

Answer 2

intermediate. 0.4-0.5mg/kg. good for renal, pH 3.2 alkoltic faster breakdown, acidotic slower breakdown. mixed with thiopental will form crystals, Hoffman elimination - hypothermia inc DOA, Histamine release causes CV effects, Laudanosine - seizures

Question 3

Cisatracurium

Answer 3

good for renal pts, 0.1mg/kg, Hoffman elimination (no laudanosine)

Question 4

Vecuronium

Answer 4

10 mg powder, 0.08-.1mg/kg, metabolized by kidney and liver.

Question 5

Rocuronium

Answer 5

0.06-1.2mg/kg. no metabloites bc cleared by kidneys and liver unchanged

Question 6

Mivacurium

Answer 6

fast acting, used for peds intubation. Clearance: plasma chole

Question 7

Succ

Answer 7

2 Ach stuck together. Fast acting, Depolarizing, cleared by plasma chole. dec met by hypothyroidism, hypothermia, and high estrogen.

Question 8

Dibucaine

Answer 8

LA that decreaes function of plasma chole. #80 is normal any lower will prolong the effect.

Question 9

Anticholinesterase drugs

Answer 9

Reverse NMB, anatgonism of CNS effects of other drugs (atropine overdose). Treatment of MG or glaucoma.

Question 10

Anticholinesterase MOA

Answer 10

actylcholinesterase inhibitor (thus increasing the amt Ach in the NMJ)

Question 11

Endrophonium

Answer 11

reversible inhibition, reversibly binds actyl esterase. short onset 1-2 min

Question 12

Neostigmine

Answer 12

Formation of carbamyl esters. ester linkage to enzyme. Intermediate onset 7 mins DOA 80 mins
0.04-0.07mg/kg must have one twitch to reverse. excessive doses will prolong recovery.

Question 13

Physostigmine

Answer 13

Formation of carbamyl esters, Crosses BBB

Question 14

Pyridostigmine

Answer 14

Formation of carbamyl esters. onset 12 mins DOA 2 hrs

Question 15

Echothiophate

Answer 15

irreversible inactivation of acetylcholinesterase. Pesticides form irreversible bond with enzyme. Must make new enzyme to overcome.

Question 16

BBLUDS

Answer 16

bradycardia, bronchconstriction, lacrimation, urination, defication, salvation

Question 17

Anticholinesterase overdose

Answer 17

pesticide issue. effects are BBLUDS, weak muscles, TX atropine and pralidoxime

Question 18

Anticholinergics

Answer 18

Prevent ACh binding at the muscarinic recpetors. Atropine - crosses BBB. Glycopyrrolate. Scoplamine - crosses BBB.

Question 19

Anticholinergic effects

Answer 19

sedation (atropine and scopolamine-cross BBB) antisialagogue, inc HR, relax smooth muscle, mydriasis (dilate pupil), prevent motion sickness, dec gastric secretion.

Question 20

Anticholinergic pharmacokinetics

Answer 20

IV or IM. DOA 30-60 mins. lipid solubility, Glyco faster clearance. All cleared by the kidneys.

Question 21

Premed Anticholinergics Uses

Answer 21

Sedation, Bradycardia, Antisailaogogue.

Question 22

Scopolamine

Answer 22

Premed 0.4mg IV. most potent sedation. Antisailaogogue. Amnesia. Less HR changes than Atropine.

Question 23

Glycopyrrolate

Answer 23

0.2 IM antisailagogue effect than IV, doesnt inc HR as much. No sedation.

Question 24

Bradycardia treatment

Answer 24

Glyco = Atropine in effectiveness but onset of glyco is slower. Both block ACh at the SA node.

Question 25

Ipratroprium (atrovent)

Answer 25

anticholinergic - inhaled so works directly on the AW. Dec AW resistance.

Question 26

Central Anitcholinergic Syndrome

Answer 26

Too much. restlessness, hallucinations, unconscience. TX physostigmine - crosses BBB. Children and elderly most suseptible.

Question 27

Anticholinergic Overdose

Answer 27

rapid onset of symptoms. dry mouth, blurred vision. tachycardia, inc temp, flushing, irritability. = Seizures and coma. TX - physostigmine

Question 28

Reversal criteria

Answer 28

TOF ratio >0.7, tetanus with 100 Hz, grip strength, neg insp press >20cm H2O, Sustained head lift 5 sec.

Question 29

Sugammadex

Answer 29

binds to muscle relaxant itself. can reverse with no twitches. Cleared renally. Awaiting approval FDA.