Exam 2 part VI Flashcards
DOA of atropine IM
2-4 hrs
adult dose of scopolamine adult IV/IM
0.3-0.6 mg
peds premed dose of scopolamine
6 mcg/kg IV/IM
DOA of scopolamine IV
30-60 min
DOA of scopolamine IM
4-6 hrs
transdermal scoplamine patch is a ____________ mg dose and should be applied __________ hrs prior to surgery
1.0; 4
which anticholinergic has the most potent: antisialagogue, sedation, amnestic effects?
scopolamine
which anticholinergic has pronounced ocular effects
scopolamine
scopolamine transdermal antiemetic onset is within __________ hrs and lasts up to _______________
4; 72
amnesia with scopolamine IV is achieved within ___________ minutes and lasts up to ____________ hrs
10; 2
antiemetic effects of scopolamine if given IM occurs within ___________ min and lasts up to ____________ hours
15-30; 4
Glycopyrolate adult dose premed IV/IM
0.1-0.2 mg
pediatric premed dose of glycopyrolate ________________ IV /IM
4-8 mcg/kg
onset of glycopyrolate
2-3 min
DOA of glycopyrolate IV
2-4 hours
DOA of glycopyrolate IM
6-9 hours
dose of ipratroprium bromide
0.5 mg metered dose inhaler
sugammadex aka __________
bridion
sugammadex is for the reversal of what NDMR
rocuronium or vecuronium
dose of suggamadex if you have 2/4 TOF twitches
2 mg/kg
dose of suggamadex if you have 0/4 twitches in TOF with 1-2 post-tetanic twitches
4 mg/kg
dose of suggamadex if you have to reverse a 1.2 mg/kg dose of rocuronium within 3 minutes of administration
16 mg/kg
if you administer sugammadex (bridion) you must wait to redose NDMR btwn ______ -________ depending on the dose given and pt renal fx
5 min; 24 hours
metabolism of sugammadex
no metabolites; 95% excreted in the urine unchanged
half life of sugammadex
2 hours
if pt has severe renal failure, what is the 1/2 life of sugammadex
19 hours
sugammadex is _______% protein boudn
0
contraindications of suggamdex
- hypersensitivity reactions (skin irritation - anaphylaxis) 2. severe renal impairment with dialysis 3. marked bradycardia
MOA of suggamadex
- modified gamma cyclodextrin 2. forms a roc/vec and reduces the amount of NDMR available to bind to the nicotinic receptor in the NMJ
s/e of suggamadex
- HA 2. N/V 3. pain 4. marked bradycardia 5. Hotension
sugammadex is incompatible with what meds
- zofran 2. verapamil 3. rantinidine
dose adjustment of suggamadex is only necessary for ______________ renal dz
SEVERE
if uses hormonal (oral / non-oral) contraceptive and you use suggamadex to reverse them in surgery, what should you educate them on?
use a different form of contraception for at least 7 days
recovery of NDMR even with suggamadex can be prolonged if the patient is on what medication
toremifene (estrogen receptor antagonist used for metastatic breast cancer in post menopausal women)
NDMR + NDMR = __________________ block
augmented
SUC + NDMR = _____________________
antagonism of depolarizing block
NDMR + anticholinesterase = ____________________
antagonize
SUC + anticholinesterase = ______________________
augment
what is the preferred site for PNS with emergence
adductor pollicis
which electrode is closest to the wrist when using adductor pollicis for PNS
black
preferred PNS site for intubation
facial
which PNS site is the best site for predicting vocal cord paralysis
facial
which PNS site closely mimics upper airway musculature
adductor pollicis
which PNS site is the Least reliable site?
peroneal placement
with peroneal PNS placement, the black electrode goes where
below the internal malleolus
single twitch sends _____________ stimuli over _______ seconds at __________ Hz
1; 0.2; 0.1-1
TOF sends ___________ stimuli over ___________ seconds at ____________ Hz
4; 2; 2 (0.5 sec apart)
Double burst sends _______________ stimuli over _____________ seconds at __________ Hz
6; 0.8; 50
Tetany sends ______________ stimuli for _____________ seconds at _________ Hz
250; 5; 50-100
what is the most commonly used PNS mode
train of four
double burst is used to determine _____________
fade
which PNS twitch mode needs a baseline prior to drug administration
single twitch
which PNS twitch mode is qualitative rather than quantitative assessment, thus has limited clinical usefulness
single twitch
PNS single twitch can be repeated when?
> 10 seconds
with TOF twitches fade as relaxation _________________
increases
TOF reflects blockade from _________ to ___________%
70; 100
TOF is useful during which parts of anesthesia
onset, maintenance, & emergence
TOF and double burst twitch patterns can be repeated in _______________ s
15-Dec
T/F: double burst is more sensitive than TOF for the clinical evaluation of fade
TRUE
w/ PNS tetany if the contraction is sustained for 5 seconds this indicates what
adequate reversal, but not necessarily complete
