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Anesthesia Pharm > Exam 2 part 1 > Flashcards

Exam 2 part 1 Flashcards

1
Q

________________ was the first muscle relaxant used, but was actually used as an anticonvulsant

A

curare

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2
Q

what is your depolarizing muscle relaxant

A

succinylcholine

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3
Q

how do you reverse succinylcholine

A

time

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4
Q

why do we give NMBA

A
  1. intubation - protect against vocal cord injury 2. facilitate surgical exposure 3. increase efficacy of mechanical ventilation
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5
Q

T/F: NMBA produce paralysis and anesthesia

A

false; only produce paralysis

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6
Q

muscle relaxation does not ensure ______________, ___________, or _______________

A

unconsciousness; amnesia; analgesia

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7
Q

Acetylcholine (Ach) is a _________________ ammonium ester

A

quarternary

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8
Q

Ach release is dependent on _____________

A

calcium

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9
Q

T/F: Ach is not recycled or reused so it must be synthesized constantly

A

TRUE

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10
Q

choline + ____________________ in a reaction controlled by ______________________ –> Ach

A

AcetylCoA; cholineacetyltransferase

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11
Q

vesicles in motor nerve endings contain _______________________ molecules of Ach

A

5000 - 10000

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12
Q

Ach is hydrolyzed in < __________ ms by _____________________

A

15; acetylcholinesterase

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13
Q

acetylcholinesterase breaks Ach into _____________ + ____________

A

choline + acetic acid

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14
Q

each molecule of acetylcholinesterase degrades _________________ molecules/s of Ach

A

25,000

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15
Q

________________ re-enters the motor nerve terminal to be resynthesized to Ach

A

choline

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16
Q

________________ nerves originate in the anterior (ventral) horn of the spinal cord and terminate in skeletal muscle

A

efferents (motor)

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17
Q

________________ nerves originate in the skeletal muscle and carry signals to the spinal cords posterior (dorsal) horn

A

afferents (sensory)

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18
Q

suggamadex reverses what NMBA

A

rocuronium and vecuronium (NDMR)

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19
Q

suggamadex can reverse certain NDMR without relying on inhibition of ______________________

A

acetylcholinesterase

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20
Q

Ach is released from what nerves?

A
  1. somatic motor nerves 2. preganglionic sympathetic nerves 3. preganglionic parasympathetic nerves 4. postganglionic parasympathetic nerves 5. postganglionic sympathetic sweat glands
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21
Q

resting transmembrane potential of the Neuromuscular junction is

A
  • (-)90 mV
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22
Q

what comprises the neuromuscular junction

A
  1. motor nerve terminal 2. synaptic cleft 3. motor end plate
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23
Q

what is the basis for normal neuromuscular transmission

A

flow of ions

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24
Q

______________ would decrease the amount of Ach that is released from the motor nerve terminal (presynaptic membrane)

A

hypocalcemia

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25
Q

________________ would increase the amount of Ach that is released from the motor nerve terminal (presynaptic membrane)

A

hypercalcemia

26
Q

on the motor end plate (neuromuscular jx) what receptor does acetylcholine bind to

A

nicotinic

27
Q

for the motor end plate of the muscle cell to depolarize what subunits of the nicotinic receptor have to be occupied? then ______________ flows through the receptor causing further depolarization of the membrane

A

both alpha subunits; cations (sodium and calcium into cell & potassium out of cell)

28
Q

describe the process of muscle contraction starting from the Ach binding with both Alpha subunits of the Nicotinic receptor on the motor end plate

A
  • causes depolarization and causes sodium and calcium to flow into cell and potassium out (further depol) - this action potential moves down Ttubule opening VG sodium channels –> SR to release more calcium - calcium binds with troponin allowing actin and myosin to interact –> muscle contraction
29
Q

after muscle contraction is conducted (actin and myosin interaction) what happens?

A
  1. Ach is hydrolyzed by AchE –> decreasing Ach in Synaptic cleft 2. causes ion channels to close –> membrane repolarization 3. calcium is actively resequestered to the SR 4. muscle cell relaxes awaiting another AP
30
Q

there are _________________ nicotinic receptors on the motor endplate, but for a muscle to contract only need __________________ activated

A

5 million; 500,000

31
Q

depolarizing muscle relaxants (succinylcholine) interrupt what part of the cycle of generating a muscle contraction?

A

after the muscle contracts and Ach is broken down by AchE, it inhibits the ion channels from closing. This inhibits another AP from being able to be generated

32
Q

what are the 5 subunit proteins of the fetal postjunctional nicotinic receptor

A

2 alpha, 1 beta, 1 gamma, 1 delta

33
Q

nicotinic receptor has how many subunits

A

5

34
Q

_______________ nicotinic receptor is described as immature and unstable because of the ______________ subunit

A

fetal; gamma

35
Q

what are the 5 subunits of the adult nicotinic receptor

A

2 alpha, 1 beta, 1 delta, 1 epsilon (epsilon replaces the fetal gamma subunit)

36
Q

in the adult nicotinic receptor, the fetal gamma subunit is replaced by the epsilon subunit, what advantages does this bring?

A
  1. mature, stable receptor 2. increases cation conductance 3. shortens the open ion time
37
Q

which nicotinic receptor can exist outside of the NMJ (fetal or adult)

A

fetal (gamma subunit)

38
Q

up-regulation of receptors is a response to _________________, and down regulation of receptors is a response to ________________.

A

antagonists; agonists

39
Q

situations/conditions where nicotinic Ach Receptors are upregulated (and show up extrajunctionally)

A
  1. SCI 2. ECT therapy 3. CVA 4. thermal injury 5. prolonged immobility 6. prolonged exposure to NMB 7. MS 8. Guillian barre
40
Q

situations/conditions where nicotinic Ach Receptors are down regulated

A
  1. myasthenia gravis 2. organophosphate poisoning 3. anticholinesterase OD
41
Q

extrajunctional nicotinic receptors have which subunits (gamma or epsilon)

A

gamma (so are immature fetal like nicotinic receptors)

42
Q

Burn patients begin to upregulate nicotinic Ach receptors as early as ________________ hours after the burn and last up to ________________months

A

24-48; 4-6

43
Q

which NMBA is avoided in situations of upregulated nicotinic Ach Receptors

A

succinycholine (it will hit the extrajunctional receptors)

44
Q

what is the function of prejunctional nicotinic receptors

A
  1. increase the synthesis and release of Ach (via positive fdbk) 2. prevents the depletion of Ach
45
Q

T/F: nicotinic receptors are present in the SNS and PNS

A

TRUE

46
Q

T/F: muscarinic receptors are present in the SNS and PNS

A

false; specific to the PNS

47
Q

MOA of succinylcholine

A

binds the alpha subunits of the nicotinic receptor keeping the ion channel open, thus keeping the cell depolarized

48
Q

succinylcholine is broken down by __________________in the _________________

A

pseudocholinesterase (aka plasmacholinesterase) ; blood

49
Q

______________________ is a chemical compound of 2 joined Ach molecules

A

succinylcholine

50
Q

succinylcholine is a ___________________ ammonium compound, meaning it does not cross the ________________ or the ____________________

A

quaternary; BBB; placenta

51
Q

describe the pharmacokinetics of succinylcholine

A
  1. low lipid solubility 2. highly ionized 3. water soluble 4. small Vd (quick on/off) 5. highly protein bound
52
Q

what is the NMBA drug of choice for RSI

A

succinylcholine

53
Q

___________________ is a nicotinic Ach receptor Agonist

A

succinylcholine

54
Q

___________________ is a NMBA that produces intense paralysis rapidly, but effects decrease before an adequately preoxygenated pt becomes hypoxic (d/t spontaneous breathing returning)

A

succinylcholine

55
Q

T/F: succinylcholine depolarizes the nicotinic Ach receptor over and over until degraded

A

false; it only depolarizes the receptor one time

56
Q

T/F: succinylcholine is degraded by Acetylcholinesterase

A

FALSE

57
Q

succinylcholine is a _________________ block

A

non-competitive

58
Q

succinylcholine keeps the cell in a depolarized state, which means what?

A
  • a depolarized post-junctional membrane cannot respond to a subsequent Ach stimulus
  • sodium channels remain in an inactive state
59
Q

typically NMBA are dosed via ____________________, but with obese pts succinylcholine is dosed via ____________________

A

lean body weight; total body weight

60
Q

onset of succinylcholine

A

30-90 seconds

Anesthesia Pharm (18 decks)

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