Depolarizing NMB- Succ

Question 1

does the depolarizing NMB bind to the post synpatic or pre synaptic

Answer 1

POST synaptic nicotinic receptor

Question 2

does the depolarizing drug work like an agonist or antagonist?

Answer 2

agonist

Question 3

how many acetylcholine molecules are in succ?

Answer 3

2

Question 4

what are the acetylcholine molecules in succ linked by?

Answer 4

acetate methyl groups

Question 5

what 4 Ach receptors are affected by succ?

Answer 5

1) nicotinic (cholinergic) receptors at the NMJ
2) parasympathetic nervous system
3) sympathetic ganglions
4) muscarinic receptors in the SA node

Question 6

which part of the NMB causes it to be highly ionized (charged as well) and NON-lipid soluble?

Answer 6

quarternary ammonium structure

Question 7

does succs cause rapid or long intubation?

Answer 7

rapid sequence intubation (RSI)

-aspiration risk
-diabetes
-hiatal hernia
-obesity (dose for total body weight)
-pregnancy
-severe pain
-trauma

Question 8

does succs have short or long duration of action?

Answer 8

short

-good for difficult airway (if unable to get it in, mask them, theyll come back to breathing)

Question 9

what does phase I include?

Answer 9

Lack of fade of tetanus*
Minimal fade of train-of-four*
Fasciculations
No posttetanic twitch
Blockade is enhanced by anticholinesterase
Rapid recovery, short duration of action

Question 10

when does tacyphylaxis occur (phase I or phase II)?

Answer 10

phase II

If NMJ is repeatedly exposed or continually exposed to SCh (such as a drip), tachyphylaxis occurs and blockade changes into one much like nondepolarizing NMB

Question 11

what does phase II include?

Answer 11

FADE of tetanus and train-of-four(>50%)
Posttetanic twitch
Prolonged duration in 50%
NOO fasciculations

can reverse with anticholinesterase (reduced level of SCh for 10 minutes)

Question 12

which drug do you use to check for phase I or II?

Answer 12

SMALL dose anticholinesterase drug, edrophonium

tiny dose, see how patient responds, does the block get worse?

Question 13

what does attenuated mean?

Answer 13

reversed

Question 14

what does accentuated mean?

Answer 14

increased

Question 15

is phase II block reversal with edrophonium attenuated or accentuated?

Answer 15

attenuated, give remainder of reversal dose for antagonization of the phase II block.

Question 16

is phase I block reversal with edrophonium attenuated or accentuated?

Answer 16

accentuated, assume a phase I block and avoid any additional anti-Cholinesterase

Question 17

what rapidly metabolizes succs when injected?

Answer 17

plasma/psuedo cholinesterase, very rapid

Question 18

when does paralysis with succs end?

Answer 18

when it DIFFUSES away from the muscle membrane

Question 19

what can be 2 issues with plasma/psuedo cholinesterase in the body?

Answer 19

1) bad quality (often hereditary)
2) low quality (deficit)

Question 20

what can cause a deficit in plasma/psuedo/butryl cholinesterase in the body?

Answer 20

-Liver disease must be SEVERE (on the transplant list)
-Pregnancy: increased water content, ends up being diluted out (the volume of distribution is BIGGER)
-malignancies, malnutrition, collagen vascular disease, and hypothyroidism

THIS DEFICIT CAUSES PROLONGED DURATION OF BLOCK, SUCC WILL LAST LONGER

Question 21

does neostigmine cause a decrease or increase in plasma cholinesterase activity (edrophonium to a lesser degree)

Answer 21

DECREASE

Question 22

what can cause decreased activity of plasma cholinesterase?

Answer 22

-insecticides
-treatment of glaucoma
-myasthenia gravis
-chemotherapy drugs
-alzheimers

Question 23

how can you help with increased intracranial pressure

Answer 23

try to offset this by hyperventilate and maintain good airway control

Question 24

what is effective pretreatment for myalgia?

Answer 24

NSAIDS
Nondepolarzing NMB (risks)
lidocaine (Na channel blocker)