chapter 18 - neuomuscular blocking Flashcards
when given an non-depolarizing agent is given, are patients still able to regain movement with their receptor sites still occupied?
yes
you can move with 75% of the sites occupied. >75% start to show effects.
Non-depolarizing agents block muscle contractions by what method?
Competitive inhibition
depolarizing agents block muscle contractions by what method?
Prolonged occupation and persistent binding
what is a train of 4?
a way to test level of paralysis
how is does train of 4 work?
the # of twitches that a patient gives dictates the level of paralysis. 4 out of 4 is no paralysis.
what can you say about non-depolarizing agents with regards to dosages and effect
non-depolarizing drugs are dose dependent. dosage are based on weight
what are the reversal agents for non-depolarizing agents?
neostigmine
Pyridostigmine
What do non-depolarizing reversal agents do at the neuromuscular junction?
they clear the NMJ of actylcholenesterase in order to flood the area with more ACH to knock out the drug.
what are some side effects of using Non-depolarizing reversal agents?
SLUD
bradycardia
bronchospasm
what must you give to a patient along with a Non-depolarizing reversal agent to reduce its side effects?
A vagolytic agent like atropine
what is a test doctors use to measure ach production during non-depolarizing agent weaning?
head neck lift test.
the ability of the patient to lift the neck can burn ACH and see if the patient has enough ability to replace it.
What Non-depolarizing agents have the most histamine release? highest release first
3 drugs
T.A.M.
Tubocurarine
Atracurium
Mivacurium
What neuromuscular blocking agent has the most vagal stimulation?
Succinylcholine
what drugs effect the autonomic ganglia the most?
which drug of the 2 gives the greatest efffect?
Tubocurarine (the greatest effect of the 2)
Pancuronium
What NMBAs release histamine?
All except for vecuronium
what NMBAs block vagal response?
which drug of the 2 gives the greatest block?
Pancuronium (the greatest effect of the 2)
Rocuronium
What Non-depolarizing agent has the GREATEST histamine release?
Tubocurarine
What NMBA would be the best choice for an Asthmatic?
think of histamine release
Vecuronium
what is the onset and duration of a depolarizing agent?
60-90 secs with a duration of 10-15 mins
what NMBA class has the longest duration?
non-depolarizing
what is a phase 1 block?
prolonged succinylcholine in the system that causes prolonged depolarization and fasciculations
what is a phase 2 block?
prolonged succinylcholine in the system that resembles a non-depolarizing block
Who do you not give a depolarizing agent to?
hyperkalemic patients (like burn patients and chest trama patients) patients who have a full stomach increased intraoccular pressure increased intacranial pressure
What NMBA drugs are best for patients with hepatic and renal failure?
Atracurium and Cisatracurium
what are 2 alternative metabolism pathways for NMBAs?
hoffman degradation and plasma cholinesterase
what is hoffman degradation?
degradation of the drug, dependent on the Ph of the blood and body temperature.
Which NMBA drugs have prolonged effect with renal failure?
Doxacurium
Pancuronium
Pipercuronium
Which drugs are metabolized by plasma cholinesterase?
Succinylcholine and Mivacurium
What are the adverse effects of using a neuromuscular blocking agent?
3 effects
- Vagolytic effect (tachycardia, increase MAP, vasoconstriction)
- histamine release
- inadequate ventilation due to muscle paralysis
