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Clinical prep > meds; muscle relaxants > Flashcards

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
Q

Vec concentration

A

1 mg/ml

supplied as powder. mix with water

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26
Q

vec onset

A

2-3 min

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27
Q

Vec duration

A

45-90 min

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28
Q

Vec structure

A

Aminosteroid

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29
Q

Vec gtt dose

A

1 – 2 mcg/kg/min. Can be infused but not the best choice because of accumulation

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30
Q

Vec metabolism

A

liver
active metabolites thats 80% as potent

in renal failure E1/2 is prolonged

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31
Q

Vec specific side effect

A

respiratory acidosis after NMBD = prolonged blockade

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32
Q

Contraindications for Vec

A

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

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33
Q

Rocuronium brand name

A

zemuron

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34
Q

Roc gtt dose

A

5 – 12 mcg/kg/min. Much less accumulation then Vecuronium

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35
Q

Roc dose

A

0.6 mg/kg
1.2 mg/ kg(RSI)

*IBW

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36
Q

Roc concentration

A

10 mg/ml

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37
Q

Roc onset

A

2-3 (1.5) min

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38
Q

Roc duration

A

35-75 min

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39
Q

Roc structure

A

Aminosteroid

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40
Q

Roc metabolism

A

Excreted unchanged in bile / renal

41
Q

Roc contraindications

A

longer duration in Elderly and liver failure dt decreased clearance

prolonged in elderly and pregnancy

42
Q

pancuronium brand name

43
Q

Panc dose

44
Q

Panc concentration

45
Q

Panc onset

46
Q

Panc duration

A

60-120 min

47
Q

Panc structure

A

aminosteroid

48
Q

Panc metabolism

A

urine

renal failure - give less
liver dz; give inc initial dose/ lasts longer

49
Q

Panc side effects

A

inc hr map and co
vagal blockade/ inc sns activity

50
Q

MOA for non depol NMBD

A

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
Q

Common side effects amongst all non depol NMBD

A

increased hearing acuity, ptosis, diplopia, dysphagia, mandibular muscle wkns

52
Q

how is pseudocholinesterase activity affected in pregnancy?

A

decreased due to estrogen

53
Q

how is pseudocholinesterase activity affected in obesity

54
Q

how is pseudocholinesterase activity affected in renal failure?

55
Q

What drugs decrease pseudocholinesterase activity

A

neostigmine, reglan, chemo, insecticides, genetic atypical

or have decreased hepatic production

56
Q

What enhances/ prolongs blockade

A

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
Q

the effects of hypokalemia and hyperkalemia on NMBD

A

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
Q

Drugs that antagonize the actions of non depolarizing NMBs (decrease duration)

A

steroids
calcium chloride
carbamazepine

59
Q

Neostigmine dose

A

0.04-0.07 mcg/kg

60
Q

Neostigmine onset

61
Q

Neostigmine duration

62
Q

Neostigmine MOA

A

Bind to ache/ decrease ache activity -> inc ach in the NMJ -> out compete paralytics for R site

63
Q

neostigmine side effects

A

Bradycardia, dysrhythmias, decreased SVR, asystole
bronchoconstriction, increased salivation, hypoperistalsis, increased gastric fluid secretions, PONV, miosis

64
Q

Neostigmine metabolism

A

Renal and hepatic clearance

renal failure = decreased clearance/ prolonged action

65
Q

neostigmine max dose

A

5 mg (has ceiling effect)

66
Q

glycopyrrolate MOA

A

anticholinergic

wont cross BBB because its a quaternary amine = polar

67
Q

Glycopyrrolate dose

A

0.2 mg for every mg of neostigmine given

1 mg = max

68
Q

Sugammadex brand name

69
Q

sugammadex structure

A

Gama cyclodextrin

70
Q

sugammadex dose

A

2-16 mg/kg

71
Q

dose to give for sugammadex depends on

A

twitch response

fade = 2mg/kg
post tetanic = 4 mg/kg
extreme block = 8 mg/kg

72
Q

sugammadex onset

73
Q

sugammadex duration

74
Q

sugammadex works best on what meds?

A

Roc > Vec > Panc

75
Q

how soon after giving sugammadex can you redose roc

76
Q

Sugammadex MOA

A

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
Q

Who is sugammadex contraindicated in

A

renal impairment/dialysis

78
Q

Sugammadex side effects

A

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
Q

Sugammadex elimination

A

Urine
70% in 6 hrs
90% in 24 hrs

80
Q

Why is the adductor pollicis checked for TOF?

A

laynx reflexes lost before adductor pollicis, so if TOF is 2/4 twitches on adductor pollicis then larynx is beyond that.

81
Q

Where is the monitoring site that More closely reflects diaphragm and laryngeal muscle blockade

A

Orbicularis oculi

82
Q

Normal defasiculating dose

A

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
Q

Glycopyrolate onset

84
Q

What achEi is used in peds

A

Edrophonium

85
Q

Glycopyrrolate duration

86
Q

Edrophonium trade name

87
Q

Glycopyrrolate concentration

88
Q

Edrophonium onset

89
Q

Edrophonium DOA

A

5 – 20 minutes.
Larger doses: up to 60 minutes

90
Q

Edrophonium dose

A

max = 1-1.5mg/kg

91
Q

Pyridostigmine trade name

92
Q

Pyridostigmine dose

93
Q

Pyridostigmine onset

A

16 minutes

94
Q

Pyridostigmine DOA

A

90 minutes

95
Q

Neostigmine trade name

A

Prostigmine

96
Q

Vec after sux dose

97
Q

Roc after sux dose

98
Q

Nimbex after sux dose

Clinical prep (21 decks)

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