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Anesthesia Pharm > Exam 2 part III > Flashcards

Exam 2 part III Flashcards

1
Q

with administration of succinylcholine IOP is increased by __________mmHg for _______________ min

A

5-15; 10-15

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2
Q

T/F: the IOP increase with succinylcholine administration is less than that one experiences with a cough or sneeze

A

TRUE

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3
Q

theory behind increased IOP with succinylcholine administration

A

dilation of choroidal vessel and the contraction of extraocular muscles

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4
Q

when would a small increase in IOP 2/2 succinylcholine administration be problematic?

A

with open globe injury, could –> extrusion of intraocular contents **avoid succ with open globe injury

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5
Q

what causes the increase in ICP with succinylcholine administration

A
  1. 2/2 increase in cerebral activity and cerebral blood flow 2. exact cause is unknown due to inconsistent observations
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6
Q

how can you prevent the increase in ICP with succinylcholine administration

A
  1. hyperventilation 2. NDMR pre-tx 3. lidocaine pre-tx
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7
Q

massester rigidity 2/2 to succinylcholine administration (and NOT MH) should stop when?

A

when fasciculations stop

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8
Q

if your pt has masseter rigidity is experienced by pt with succinylcholine, what are your options

A
  1. wait and see if rigidity stops with fasciculations 2. stop and reschedule with different anesthetic plan and test for MH 3. switch to TIVA and have MH meds prepped and on stdby
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9
Q

masseter rigidity as a side effect of succinylcholine administration (not MH) is most often seen in what pt population?

A

peds

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10
Q

histamine release with succinylcholine

A

is slight, but causes anaphylaxis more than any other anesthetic drug

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11
Q

what is the mechanism by which succinylcholine causes MH

A

unknown

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12
Q

contraindications for succinylcholine

A
  1. MH 2. hyperkalemia 3. burn pt with >35% TBSA; 3rd degree burn 4. severe muscle trauma 5. severe sepsis 6. muscle wasting, prolonged immbolization 7. extensive muscle denervation (ex: SCI) 8. DMD 9. atypical pseudocholinesterase 10. allergies 11. children and teens esp under the age of 8
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13
Q

why is succinylcholine c/i in kids under the age of 8

A

due to the risk of: 1. hyperkalemia 2. rhabdomyloysis 3. cardiac arrest 2/2 undiagnosed cardiomyopathies or dystrophies

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14
Q

why is succinylcholine c/i with DMD?

A

pts with DMD have leaky K channels (NOT extrajunctional receptors) so risk of hyperkalemia

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15
Q

Non-depolarizing Muscle relaxants are of 2 categories, what are they?

A
  1. benzoquinolones 2. steroids
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16
Q

NDMR are dosed by ____________________

A

Lean body mass (LBM)

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17
Q

how do you calculate LBM in men?

A

(1.10 x wt in Kg) - 128[weight^2/(100x ht in meters)^2]

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18
Q

how do you calculate LBM in women

A

(1.07 x weight in kg) - 148[wt^2/(100 x ht in meters)^2]

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19
Q

reasons why you would choose one NDMR over another

A
  1. profile of the drug 2. pt condition 3. procedure
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20
Q

MOA of NDMR

A

binds to one alpha subunit on the nicotinic receptor which prevents Ach binding and prevents the ion channel from opening –> no muscle depolarization

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21
Q

NDMR are described as ___________________ blocks, meaning an increase in Ach at the NM jx will have what effect?

A

competitive; increase in Ach will remove the NDMR from the receptor

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22
Q

when might you have a situation (molecularly) where succinylcholine is occupying one alpha subunit and a NDMR is occupying the other

A
  1. pretx with NDMR 2. use succ to induce, but use NDMR for case 3. used NDMR for case but had laryngospasm (which is tx’d with succinylcholine)
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23
Q

in the presence of volatile anesthetics your NDMR maintenace dose may be decreased by _____________%

A

15

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24
Q

T/F: an NDMR will augment another NDMR –> denser block

A

TRUE

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25
Q

T/F: 1st dose = roc, 2nd dose = vec –> denser block

A

TRUE

26
Q

if you give a NDMR and you notice flushing and pt is not easier to bag, you should think what is happening

A

histamine release 2/2 NDMR

27
Q

what NDMR at high doses cause the most histamine release

A

Atracurium and Mivacurium

28
Q

how do you decrease the risk of histamine release with NDMR ?

A
  1. slow injection rates 2. pretreat with antihistamines
29
Q

which NDMR causes the greatest vagolytic response –> tachycardia

A

pancuronium

30
Q

CV effects of NDMR (general)

A
  1. drug induced release of histamine & vasoactive substances 2. effects at cardiac muscarinic receptors –> vasolytic response –> tachycardia
31
Q

s/e of NDMR is histamine release, what are the s/sx of histamine release

A
  1. bronchospasm 2. skin flushing 3. bradycardia (isnt it actually tachycardia?)4. Hotn
32
Q

if your patient is hypokalemic, and you have to give NDMR, d/t _______________ duration of block (with hypoK) you should _________ dose of NDMR

A

increased; decrease

33
Q

if your patient is hypokalemic and you are going to induce with succinylcholine you should _______________ the dose

A

increase

34
Q

if your patient is hyperkalemic, and you induce with NDMR you should _______________ dose

A

increase; d/t the duration of block being decreased 2/2 hyperK

35
Q

what is a priming dose of NDMR

A

giving 10-15% of usual intubating dose 5 min before induction

36
Q

what is the purpose of a “priming dose” of NDMR

A

if give 10-15% of induction dose 5 min before; you will have some receptors occupied, so when you give the remaining dose paralytic effects will occur faster

37
Q

what are some issues that could occur with a “priming dose” of NDMR

A

may produce: distress, dyspnea, diplopia, and dysphagia O2 desaturation in patients with marginal pulmonary reserve

38
Q

what is a “defasciulating dose”

A

giving NDMR 5 minutes before administration of succinylcholine

39
Q

if you give a defasciculating dose of NDMR, you must ____________ dose of succinylcholine to _________mg/kg

A

increase; 1.5-2.0

40
Q

PNS monitoring intraop helps prevent

A
  1. over/under dosing of MR 2. residual paralysis in recovery/PACU
41
Q

repeat NMBA doses should be guided by what

A
  1. nerve stimulator 2. clinical signs (SV, movement, etc)
42
Q

T/F: clinical signs that muscle relaxant has worn off may precede twitch response

A

TRUE

43
Q

if you see __________________ on your EtCO2 waveform, or have _____________ on ventilator, you may need to redose your muscle relaxant

A

curare cleft; increased peak inspiratory pressures

44
Q

which NDMR are Benzylisoquinolones

A
  1. atracurium 2. cisatracurium
45
Q

intubating dose of atracurium

A

0.5 mg/kg

46
Q

onset of atracurium

A

2-3 min

47
Q

DOA of atracurium

A

20-60 min

48
Q

ED95 of atracurium

A

0.2-0.25 mg/kg

49
Q

intubating dose of cisatracurium

A

0.1-0.5 mg/kg

50
Q

onset of cisatracurium

A

2-4 min

51
Q

DOA of cisatracurium

A

40-75 min

52
Q

ED95 of cisatracurium

A

0.05 mg/kg

53
Q

cisatracurium is _______________ x as potent as atracurium and ___________x as potent as rocuronium

A

3-4; 5

54
Q

metabolism of atracurium

A
  1. 2/3 by ester hydrolysis via nonspecific esterases 2. 1/3 via hoffman elimination
55
Q

half life of atracurium

A

20 min

56
Q

atracurium is ______% protein bound

A

82

57
Q

metabolites of atracurium are secreted in the ____________& _____________

A

bile and urine

58
Q

metbolism of cisatracurium

A
  1. 77% hoffman elimination 2. 23% nonspecific esterases via ester hydrolysis
59
Q

half life of cisatracurium

A

20-25 min

60
Q

________% of cisatracurium is eliminated in the urine

A

7

Anesthesia Pharm (18 decks)

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