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meds; muscle relaxants Flashcards

1
Q

succ brand name

A

anectine

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2
Q

succ dose

A

1-1.5 mg/kg

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3
Q

succ concentration

A

20 mg/ml

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4
Q

succ onset

A

30-60 seconds

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5
Q

succ duration

A

5-10 min

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6
Q

succ structure

A

two ach molecules combined by and acetate methyl linkage

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7
Q

succ moa

A

depol muscle relaxant -> fasisculation
binds to alpha 1 subunit

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8
Q

succ phase 2 block

A

high dose for long time = screwed up receptors that dont work well

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9
Q

succ metabolism

A

pseudocholinesterase/ butyrylcholinesterase -> plasma cholinesterase (from liver)

hydrolyze acetate methyl -> succinylmonocholine-» succinic acid and choline

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10
Q

dibucaine and succ relationship

A

dibucaine inhibits the breakdown of plasma cholinesterase. The number reflects the % of normal enzyme that is inhibited by Dibucaine.

normal ; 80
< 20 = succ can last 3 hrs = atypical variant of plasmacholinesterase.

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11
Q

Succ side effects

A

MH
histamine release
inc K by 0.5meq/L
myalgia
increase ICP (hyperventilate)
increased IOP
cardiac dysrhythmia
myoglobinuria
inc ingragastric pressure
inc LES pressure
massetter muscle contraction

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12
Q

Contraindications for Succ

A

MG; inc dose of succ (fewer R)
stroke/ immobility
Duchcennes
Burns after 24 hrs
denervating Dz
skm trauma
upper motor neuron lesion
Peds
ELMS; give less
increased risk of allergic rxn

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13
Q

cisatricurium brand name

A

nimbex

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14
Q

Cis dose

A

0.1 mg/kg

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15
Q

Cis concentration

A

2 mg/ml

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16
Q

Cis onset

A

2-3 min

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17
Q

Cis duration

A

40-75 min

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18
Q

Cis structure

A

Benzylisoquinalone

cis isomer of atricurium

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19
Q

least likely NMBD to have an allergic rxn

A

cis

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20
Q

Cis gtt dose

A

1 – 2 mcg/kg/min

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21
Q

cis metabolism

A

hoffman elimination; ph/temp dependent

hypothermic and acidotic = prolonged elimination

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22
Q

Side effects of cis

A

elderly = delay in recovery d/t CO
obese= increased duration of action /t VD

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23
Q

Vec brand name

A

norcuron

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24
Q

Vec dose

A

0.1mg/kg

*IBW

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25
Vec concentration
1 mg/ml supplied as powder. mix with water
26
vec onset
2-3 min
27
Vec duration
45-90 min
28
Vec structure
Aminosteroid
29
Vec gtt dose
1 – 2 mcg/kg/min. Can be infused but not the best choice because of accumulation
30
Vec metabolism
liver active metabolites thats 80% as potent in renal failure E1/2 is prolonged
31
Vec specific side effect
respiratory acidosis after NMBD = prolonged blockade
32
Contraindications for Vec
renal failure/ ERCP liver failure Elderly = delayed recovery from gtt OB; difficult to clear in 3rd trimester because of progesterone and prolonged duration in post partum
33
Rocuronium brand name
zemuron
34
Roc gtt dose
5 – 12 mcg/kg/min. Much less accumulation then Vecuronium
35
Roc dose
0.6 mg/kg 1.2 mg/ kg(RSI) *IBW
36
Roc concentration
10 mg/ml
37
Roc onset
2-3 (1.5) min
38
Roc duration
35-75 min
39
Roc structure
Aminosteroid
40
Roc metabolism
Excreted unchanged in bile / renal
41
Roc contraindications
longer duration in Elderly and liver failure dt decreased clearance prolonged in elderly and pregnancy
42
pancuronium brand name
Pavulon
43
Panc dose
0.1mg/kg
44
Panc concentration
2 mg/ml
45
Panc onset
2-3 min
46
Panc duration
60-120 min
47
Panc structure
aminosteroid
48
Panc metabolism
urine renal failure - give less liver dz; give inc initial dose/ lasts longer
49
Panc side effects
inc hr map and co vagal blockade/ inc sns activity
50
MOA for non depol NMBD
bind to both alpha subunits on ach R and antagonize ach no depol binds to alpha autoreceptor on the presynaptic neuron that stimulates ach release and causes fade **Volatiles increase sensitivity
51
Common side effects amongst all non depol NMBD
increased hearing acuity, ptosis, diplopia, dysphagia, mandibular muscle wkns
52
how is pseudocholinesterase activity affected in pregnancy?
decreased due to estrogen
53
how is pseudocholinesterase activity affected in obesity
increased
54
how is pseudocholinesterase activity affected in renal failure?
decreased
55
What drugs decrease pseudocholinesterase activity
neostigmine, reglan, chemo, insecticides, genetic atypical or have decreased hepatic production
56
What enhances/ prolongs blockade
diuretics LA's magnesium metrocloprimide sns drugs; dec onset time dec sns drugs; increase onset time hypothermia= double duration women are more sensitive than men
57
the effects of hypokalemia and hyperkalemia on NMBD
Hypokalemia = hyperpolized cell depol; dec sensitivity= give more non depol; incr sensitivity= give less hyperkalemia = closer to depolarizing depol; inc sensitiivty = give less non depol = dec sensitiivty; give more (more resistance to keep from depolarizing)
58
Drugs that antagonize the actions of non depolarizing NMBs (decrease duration)
steroids calcium chloride carbamazepine
59
Neostigmine dose
0.04-0.07 mcg/kg
60
Neostigmine onset
5-10 min
61
Neostigmine duration
60 min
62
Neostigmine MOA
Bind to ache/ decrease ache activity -> inc ach in the NMJ -> out compete paralytics for R site
63
neostigmine side effects
Bradycardia, dysrhythmias, decreased SVR, asystole bronchoconstriction, increased salivation, hypoperistalsis, increased gastric fluid secretions, PONV, miosis
64
Neostigmine metabolism
Renal and hepatic clearance renal failure = decreased clearance/ prolonged action
65
neostigmine max dose
5 mg (has ceiling effect)
66
glycopyrrolate MOA
anticholinergic wont cross BBB because its a quaternary amine = polar
67
Glycopyrrolate dose
0.2 mg for every mg of neostigmine given 1 mg = max
68
Sugammadex brand name
bridion
69
sugammadex structure
Gama cyclodextrin
70
sugammadex dose
2-16 mg/kg
71
dose to give for sugammadex depends on
twitch response fade = 2mg/kg post tetanic = 4 mg/kg extreme block = 8 mg/kg
72
sugammadex onset
1-4 min
73
sugammadex duration
1.5-3 hrs
74
sugammadex works best on what meds?
Roc > Vec > Panc
75
how soon after giving sugammadex can you redose roc
5 min
76
Sugammadex MOA
selective relaxant binding agent w/ aminosteroid - highly water soluble intermolecular forces (van der walls), thermodynamic (hydrogen) bonds and hydrophobic interactive -> tight reversal by encapsulation. binds to free drug in plasma
77
Who is sugammadex contraindicated in
renal impairment/dialysis
78
Sugammadex side effects
N/V , pruritis, uticaria anaphylaxis, bradycardia doesn't work binds to progesterone so oral contraceptives won't work for up to 7 days tormefene (antiestrogen); displaces NMBD from sugammadex heparin/ LMWH; inc pt, PTT, INR recurrarization w/ lower than the recommended dose
79
Sugammadex elimination
Urine 70% in 6 hrs 90% in 24 hrs
80
Why is the adductor pollicis checked for TOF?
laynx reflexes lost before adductor pollicis, so if TOF is 2/4 twitches on adductor pollicis then larynx is beyond that.
81
Where is the monitoring site that More closely reflects diaphragm and laryngeal muscle blockade
Orbicularis oculi
82
Normal defasiculating dose
Defasciculating dose = give 20% of normal intubating dose early. 1-10mg of ROC or 1/10th dose of succ give lido, fent, defasic, prop, then rest of nmbd
83
Glycopyrolate onset
2-3min
84
What achEi is used in peds
Edrophonium
85
Glycopyrrolate duration
2 hrs
86
Edrophonium trade name
Tensilon
87
Glycopyrrolate concentration
0.2 mg/ml
88
Edrophonium onset
1-2 min
89
Edrophonium DOA
5 – 20 minutes. Larger doses: up to 60 minutes
90
Edrophonium dose
max = 1-1.5mg/kg
91
Pyridostigmine trade name
Mestinan
92
Pyridostigmine dose
0.5-2mg
93
Pyridostigmine onset
16 minutes
94
Pyridostigmine DOA
90 minutes
95
Neostigmine trade name
Prostigmine
96
Vec after sux dose
0.05mg/kg
97
Roc after sux dose
0.3mg/kg
98
Nimbex after sux dose
0.1mg/kg

Clinical prep (22 decks)

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