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Pharm Fall 2019 > Ex4 NMBA 2 > Flashcards

Ex4 NMBA 2 Flashcards

1
Q

long acting NDMR

A

pancuronium

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2
Q

pancuronium ED95

A

0.07 mg/kg

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3
Q

pancuronium intubating dose

A

0.1mg/kg

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4
Q

pancuronium onset

A

slow

3-5minutes

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5
Q

pancuronium DOA

A

long

60-90min

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6
Q

DOA pancuronium will be prolonged with

A

renal dz
cirrhosis
biliary obstruction
aging

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7
Q

Pancuronium metabolism

A 
Renal elimination: 80% unchanged in urine
Hepatic deacetylation (10-40%)
*3-desacetylpancuronium =50% as potent
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8
Q

Pancuronium - CV effects

A

Increased HR, MAP, CO, myocardial O2 consumption

  • more profound increases w/ AV conduction abnormalities
  • avoid in CAD pts (ischemia)
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9
Q

Pancuronium CV effects are due to

A

antagonism of cardiac mAChRs (SA node)

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10
Q

Pancuronium structure

A

bisquaternary aminosteroid

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11
Q

priming dose - intmd NMDR

A

hastens speed of onset
20% ED95 prior to induction
after induction: remaining balance adm

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12
Q

why is a priming dose used?

A

onset of intubating conditions is faster

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13
Q

defasciculating dose

A

20% of ED95 of NDMR prior to induction

** larger dose of Sux required

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14
Q

intermediate acting NDMRs

A

Vecuronium
Rocuronium
Atracurium
Cisatracurium

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15
Q

Vecuronium bromide structure

A

monoquaternary aminosteroid

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16
Q

Vecuronium ED95

A

0.05 mg/kg

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17
Q

Vecuronium intubating dose

A

0.1 mg/kg

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18
Q

Vecuronium onset

A

3-5 minutes

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19
Q

Vecuronium DOA

A

20-35min

20
Q

Vecuronium elimination

A

renal + hepatic

21
Q

vecuronium metabolism

A

deacetylation to 3-desacetylvecuronium (50-70%) as potent as vec

22
Q

rocuronium structure

A

monoquaternary aminosteroid

23
Q

rocuronium intubating:
dose
onset
DOA

A

0.6 mg/kg
1-2minute onset
20-35minute DOA

24
Q

rocuronium RSI:
dose
onset
DOA

A

1.2 mg/kg
30-45s onset
60-90minute DOA

25
Q

rocuronium metabolism

A

excreted
-unchanged in bile
-renally (30%)
liver/renal dz can prolong effects

26
Q

rocuronium side effects

A

no CV effects

no histamine release

27
Q

atracurium structure

A

bisquaternary benzylisoquinolinium

mix of 10 stereoisomers in solution

28
Q

atracurium ED95

A

0.2 mg/kg

29
Q

atracurium intubating dose

A

0.5mg/kg

30
Q

atracurium onset

A

3-5min

31
Q

atracurium DOA

A

20-35min

32
Q

atracurium elimination

A

Cleared by:

Hofmann Elimination + hydrolysis by non-specific esterases

33
Q

atracurium metabolism

A

laudanosine produced = CNS stimulant

-increases MAC, epileptogenic, cleared renally

34
Q

atracurium rapid admin of 2xED95 results in

A

increased HR

decreased BP

35
Q

atracurium rapid admin of 3xED95 results in

A

facial/truncal flushing (histamine release)

36
Q

atracurium pediatric considerations

A

infants 1-6months = decrease dose 50% for same effect as full dose in adults
–recovery more rapid in infants

37
Q

atracurium elderly considerations

A

no change in pharmacokinetics

38
Q

cisatracurium bromide structure

A

benzylisoquinolinium

purified form of one of 10 stereoisomers of atracurium

39
Q

cisatracurium ED95

A

0.04 mg/kg

40
Q

cisatracurium onset

A

3-5min

41
Q

cisatracurium DOA

A

20-35min

42
Q

cisatracurium elimination

A

Hoffman –> laudanosine

*NO metabolism by nonspecific esterases

43
Q

cisatracurium is similar to which other NMDA?

A

atracurium

*except slower onset, no histamine release

44
Q

cisatracurium may be given to?

A

pts w/ renal/hepatic dz w/o prolonged effect

45
Q

Which two NMDAs are indistinguishable regarding CV effects in CAD

A

cis + vec

Pharm Fall 2019 (33 decks)

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