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Board Prep > Module 3- Neuromuscular > Flashcards

Module 3- Neuromuscular Flashcards

1
Q

Absolute refractory period corresponds to the time when gated sodium channel is in what state

A

Inactive state

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2
Q

Motor nerves exit the SC via ______

Sensory nerves enter the SC via ______

A

Motor- Ventral (anterior) horn

Sensory- Dorsal (posterior) horn

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3
Q

What is responsible for fade seen with NDNMB

A

Presynaptic nicotinic receptor responds to Ach in the cleft by increasing synthesis of Ach and mobilization of Ach

Positive feedback mechanism

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4
Q

What subunits of nicotinic receptor must be occupied for the channel to open

A

Both alpha subunits

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5
Q

Acetyl cholinesterase degrades what

A

Ach

Ester LA

Neostigmine

Edrophonium

Remi

Esmolol

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6
Q

Mechanism of action for NDNMB

A

Competitive inhibition

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7
Q

The presynaptic action of succinylcholine does what to its post synaptic action

A

Enhances it. The presynaptic action augments the release of Ach

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8
Q

Metabolism is the primary route of elimination for what NM relaxants

A

Succinylcholine
Atracurium
Cisatracurium
Mivacurium

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9
Q

Biliary excretion is the primary route of elimination for what NM relaxants

A

Rocuronium

Vecuronium

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10
Q

Difference in metabolism of Atracurium and Cisatracurium

A

Both eliminated by Hoffman elimination

But Atracurium is also eliminated by ester hydrolysis by non-specific esterases

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11
Q

Which NMB associated with histamine release

A

Succinylcholine
Mivacurium
Atracurium

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12
Q

Explain MOA of succinylcholine producing bradycardia

A

Succinylcholine mimics action of Ach and directly stimulates muscarinic receptors of SA node

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13
Q

Earliest sign of MH

A

Elevated ETCO2

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14
Q

Dose of dantrolene

Max dose

A

2.5mg/kg every 5 minutes until episode is terminated

Max dose 20mg/kg

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15
Q

Active cooling of patient with MH should be stopped at what temperature

A

38C

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16
Q

Antiarrhythmic of choice for MH patient having PVCs

A

Procainamide or Lidocaine

17
Q

Syndrome that mimics MH

Differences

A

Neuroleptic Malignant Syndrome

Develops over 24-72 hours

18
Q

Patients taking what drugs are at risk for neuroleptic malignant syndrome

A

Antipsychotics (haldol) due to dopamine depletion in CNS

19
Q

Disorder characterized by weakness and easy fatiguability of skeletal muscles caused by autoimmune destruction of nicotinic Ach receptors at NMJ

A

Myasthenia Gravis

20
Q

Drugs commonly used in treatment of myasthenia gravis

A

Anticholinesterases

Increases risk of cholinergic crisis

21
Q

Condition characterized by proximal skeletal weakness affecting the lower extremities typically

A

Eaton-Lambert myasthenic syndrome

Associated with small cell lung CA

22
Q

Differentiate myasthenia gravis from Eaton-lambert

A

Muscle strength deteriorates rapidly with repeated effort with MG. Improves with Eaton-lambert

Also MG symptoms improve with anticholinesterase but unchanged with Eaton-lambert

23
Q

What eye drop medication depresses plasma cholinesterase activity

A

Echothiophate (eye drop)

Irreversible cholinesterase inhibitor

24
Q

Significance of quaternary ammonium group on muscle relaxants

A

Completely ionized- lipid insoluble and highly water soluble

25
Q

Hoffman elimination is dependent on what 2 factors

A

Temperature and pH

26
Q

What is the metabolite of atracurium that can cause CNS stimulation

A

Laudanosine

27
Q

Myasthenia gravis sensitivity to NDNMB and succinylcholine

A

Increased sensitivity to NDNMB

Either very sensitive or resistant to succinylcholine

28
Q

How does pt with Eaton-Lambert respond to NDNMB and succinylcholine

A

Increased sensitivity to both

29
Q

What is the treatment for cholinergic syndrome

A

Atropine

30
Q

Which antimuscarinic cross the BBB and can cause central anticholinergic syndrome

A

Scopolamine and atropine

31
Q

Treatment for anticholinergic syndrome

A

Phyostigmine 15-60 mcg/kg

32
Q

Explain Dibucaine test and number interpretation

A

Dibucaine depresses activity of pseudocholinesterase. Normal is for 75-85% activity depressed by dibucaine

Normal 80
Heterozygous atypical plasma cholinesterase- 60
Homozygous atypical plasma cholinesterase -20

33
Q

What is the frequency of stimulation in TOF

A

2Hz (2 twitches per second or one every 0.5 seconds)

34
Q

How is tetany produced with nerve stimulator

A

50Hz for 5 seconds

Intense stimulus for release of Ach at NMJ

35
Q

What is the best stimulation pattern with nerve stimulator to determine fade during a block

A

Double burst stimulation

2 trains of 3 impulses 50Hz each separated by 750ms

Board Prep (19 decks)

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