chapter 18 - neuomuscular blocking

Question 1

when given an non-depolarizing agent is given, are patients still able to regain movement with their receptor sites still occupied?

Answer 1

yes

you can move with 75% of the sites occupied. >75% start to show effects.

Question 2

Non-depolarizing agents block muscle contractions by what method?

Answer 2

Competitive inhibition

Question 3

depolarizing agents block muscle contractions by what method?

Answer 3

Prolonged occupation and persistent binding

Question 4

what is a train of 4?

Answer 4

a way to test level of paralysis

Question 5

how is does train of 4 work?

Answer 5

the # of twitches that a patient gives dictates the level of paralysis. 4 out of 4 is no paralysis.

Question 6

what can you say about non-depolarizing agents with regards to dosages and effect

Answer 6

non-depolarizing drugs are dose dependent. dosage are based on weight

Question 7

what are the reversal agents for non-depolarizing agents?

Answer 7

neostigmine

Pyridostigmine

Question 8

What do non-depolarizing reversal agents do at the neuromuscular junction?

Answer 8

they clear the NMJ of actylcholenesterase in order to flood the area with more ACH to knock out the drug.

Question 9

what are some side effects of using Non-depolarizing reversal agents?

Answer 9

SLUD
bradycardia
bronchospasm

Question 10

what must you give to a patient along with a Non-depolarizing reversal agent to reduce its side effects?

Answer 10

A vagolytic agent like atropine

Question 11

what is a test doctors use to measure ach production during non-depolarizing agent weaning?

Answer 11

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.

Question 12

What Non-depolarizing agents have the most histamine release? highest release first
3 drugs

Answer 12

T.A.M.
Tubocurarine
Atracurium
Mivacurium

Question 13

What neuromuscular blocking agent has the most vagal stimulation?

Answer 13

Succinylcholine

Question 14

what drugs effect the autonomic ganglia the most?

which drug of the 2 gives the greatest efffect?

Answer 14

Tubocurarine (the greatest effect of the 2)

Pancuronium

Question 15

What NMBAs release histamine?

Answer 15

All except for vecuronium

Question 16

what NMBAs block vagal response?

which drug of the 2 gives the greatest block?

Answer 16

Pancuronium (the greatest effect of the 2)

Rocuronium

Question 17

What Non-depolarizing agent has the GREATEST histamine release?

Answer 17

Tubocurarine

Question 18

What NMBA would be the best choice for an Asthmatic?

think of histamine release

Answer 18

Vecuronium

Question 19

what is the onset and duration of a depolarizing agent?

Answer 19

60-90 secs with a duration of 10-15 mins

Question 20

what NMBA class has the longest duration?

Answer 20

non-depolarizing

Question 21

what is a phase 1 block?

Answer 21

prolonged succinylcholine in the system that causes prolonged depolarization and fasciculations

Question 22

what is a phase 2 block?

Answer 22

prolonged succinylcholine in the system that resembles a non-depolarizing block

Question 23

Who do you not give a depolarizing agent to?

Answer 23

hyperkalemic patients (like burn patients and chest trama patients)
patients who have a full stomach
increased intraoccular pressure
increased intacranial pressure

Question 24

What NMBA drugs are best for patients with hepatic and renal failure?

Answer 24

Atracurium and Cisatracurium

Question 25

what are 2 alternative metabolism pathways for NMBAs?

Answer 25

hoffman degradation and plasma cholinesterase

Question 26

what is hoffman degradation?

Answer 26

degradation of the drug, dependent on the Ph of the blood and body temperature.

Question 27

Which NMBA drugs have prolonged effect with renal failure?

Answer 27

Doxacurium
Pancuronium
Pipercuronium

Question 28

Which drugs are metabolized by plasma cholinesterase?

Answer 28

Succinylcholine and Mivacurium

Question 29

What are the adverse effects of using a neuromuscular blocking agent?
3 effects

Answer 29

• Vagolytic effect (tachycardia, increase MAP, vasoconstriction)
• histamine release
• inadequate ventilation due to muscle paralysis