Misc. Stuff from PPTs - Exam 1

Question 1

Factors that can prolong paralysis

Answer 1

Hypothermia
Aminoglycoside toxicity (MYCIN abx)
steroid myopathy
antihypertensives
antidysrhythmics
abx
steroids
volatile anesthetics
Dantrolene (do NOT give prophylactically)
Magnesium
Lithium

Question 2

T/F Most abx can cause NM blockade without the use of NMBD

Answer 2

true
-scary

Question 3

How do abx potentiate NMBD?

Answer 3

Inhibit PREjunctional release of ACh

Depress POSTjunctional nAChR sensitivity to ACh

Question 4

T/F cephalosporins and penicillins can potentiate NMBD

Answer 4

false

Question 5

Calcium antagonizes the interaction between NMBD and abx, should we use it to help with recovery?

Answer 5

No
-antagonism isn’t sustained and it can minimize positive effects of abx

Question 6

What can be given prophylactically to prevent histamine release for NMBD?

Answer 6

H1 and H2 blockers

Question 7

Amount of histamine release after administering a NMBD depends on _ and _ of injection

Answer 7

dose and speed

Question 8

Atracurium and Mivacurium release _ amounts of histamine

Answer 8

modest
-can cause HoTN and tachycardia

Question 9

Succinylcholine can release _ amounts of histamine

Answer 9

slight
-may see some tachycardia initially but repeat dosing can cause bradycardia

Question 10

Pancuronium is _ and causes slight _ release causing tachycardia.

Answer 10

vagolytic
catecholamine

-not histamine mediated

Question 11

If an allergic reaction happens, blocking _ helps prevent cardiovascular collapse

Answer 11

H2 (famotidine, etc)
-GIVE BOTH H1 AND H2 BLOCKERS THO

Question 12

If an allergic reaction happens, blocking _ helps with bronchoconstriction

Answer 12

H1 (benadryl)
-GIVE BOTH H1 AND H2 BLOCKERS THO

Question 13

Which medications metabolize via Hoffman Elimination?

Answer 13

Benzylisoquinoline Relaxants
-Cisatracurium(Nimbex)
-Atracurium

Question 14

T/F Drugs metabolized via Hoffman Elimination cause toxicity and metabolism varies pt to pt

Answer 14

false

Question 15

T/F Drugs that metabolize via Hoffman Elimination form toxic byproducts

Answer 15

True
-not of much concern tho

Question 16

The toxic byproducts formed by Hoffman Elimination are _ and _

Answer 16

LAUDANOSINE
Acrylates

Question 17

Hydrolysis via Hoffman Elimination requires which 2 factors:

Answer 17

-temperature change
-pH change

Question 18

Drugs that metabolize via Hoffman Elimination could be useful for patients with:

Answer 18

renal or liver disease

Question 19

Hoffman Elimination contributes to -% of the metabolism for Atracurium

Answer 19

10-40%
-remainder is metabolized by nonspecific ester hydrolysis

Question 20

Hoffman Elimination contributes to _% of the metabolism for Cisatracurium

Answer 20

77%
-remainder is metabolized by nonspecific ester hydrolysis

Question 21

NMBD that cause histamine release:

Answer 21

Succinycholine
Mivacurium
Atracurium

Question 22

NMBD that cause cardiac muscarinic effects (vagal block)

Answer 22

Succinylcholine (stim or block)
Pancuronium (moderate block)

Question 23

NMBD metabolized via hepatic and renal systems:

Answer 23

Roc
Vec

Question 24

NMBD eliminated via hepatic and renal systems:

Answer 24

Roc- R (10-30%) H (70-90%)
Vec - R (40-50%) H (50-60%)

Question 25

NMBDs that only are metabolized via the liver

Answer 25

Vec + Pancuronium

Question 26

NMBD metabolized via plasma cholinesterase

Answer 26

Succinylcholine
Mivacurium

Question 27

Steroidal NMBD with toxic metabolites

Answer 27

Vec (metabolite has 80% of potency of parent drug)

Pancuonium (has 66% potency of parent drug)

-both make 3-OH, accumulates, bad for renal and liver pts

Question 28

Pancuronium should be avoided in which patients

Answer 28

renal disease
-eliminated primarily via kidneys (~85%)

Question 29

T/F Sugammadex can reverse Cisatracurium, Mivacurium, and Atracurium

Answer 29

false, these are benzylisoquinoline relaxants and sugamadex only works on steroidals