Muscle Relaxants Flashcards
1
Q
Laudanosine
A
atracurium and cisatracurim (1/5th the amount)
2
Q
Laudanosine
A
atracurium and cisatracurim (1/5th the amount)
3
Q
Hoffman elimination?
A
Atracurium (1/3, and 2/3 ester hydrolysis); Cisatracurium
4
Q
CI in renal dysfunction?
A
Cisatracurium, Vecuronium, Pancuronium, d Tubo, Doxa, Piper. (miva and atra ok? )
5
Q
Eliminated by biliary?
A
vec and roc
6
Q
Eliminated by biliary 50% unchaged
A
Roc
7
Q
Dose decrease not required in RF, but decrease required in liver failure
A
Roc
8
Q
Do not mix with barbs?
A
Vecuronium rocuronium, atracurium
9
Q
Renal, biliary, hepatic disease prolongs E1/2t?
A
Roc, Vec, Pan
10
Q
3 metabolites, one is 50% as potent?
A
Pancuronium: desacetylpancuronium (avoid in renal failure)
11
Q
contraindicated in pseudocholinesterase deficiency or atypical plasma cholinesterases?
A
mivacurane
12
Q
Renal excretion?
A
D- tubo, meto, pan, gallamine, doxa, pipercurium
13
Q
100% unchaged by kidneys, contraindicated in renal failure?
A
gallamine
14
Q
Short acting?
A
Rapacuronium, mivacurium, roc
15
Q
How long is short acting?
A
16
Q
How long is intermediate actin?
A
30-60 min onset 2-2.5 min
17
Q
How long is long acting?
A
60-120 mins (onset 2-6 min)
18
Q
Intermediate acting agents?
A
Vec, atra, cis, roc
19
Q
Long acting agents?
A
pan, pip, dox, d- tubo, meto, gallamine, alcuro
20
Q
Hoffman metabolism affects from alkalosis?
A
alkalosis increases metabolis
21
Q
Hoffman effect from acidosis?
A
acidosis decreases metabolism
22
Q
What agents cause histamine release?
A
DAMS
23
Q
what agents decrease Bp?
A
M, D, Sux
24
Q
bronchospasm?
A
V,A,M,P
25
increase hr?
A,M,P,D
26
decrease hr?
Sux
27
Does hypothermia prolong or decrease block?
prolong
28
burns increase or decrease block?
decrease
29
what two things decrease DOA of blocks?
anticonvulsants and burns
30
Do dantrolene and ketamine affect depolarizing or non depolarizing?
NON- only.
31
What is the homozygous typical dibucaine number?
70-80; 4-6 mins
32
what is the heterozygous atypical number?
50-60; 20-30 mins
33
what is the homozygous atypical number?
20-30; 4-8 hours
34
What is the chemical structure of NDMR?
quarternary ammonium
35
What are the side effects of Sux?
Hyperkalemia, muscle pains, increased ICP, IOP, IGP, master spasm, MH trigger, salivation, myoglobinemia, arrythmias, trismus
36
What are the side effects of Sux?
Hyperkalemia, muscle pains, increased ICP, IOP, IGP, master spasm, MH trigger
37
increases risk for sux hyperkalemia?
burns, trauma, nerve damage, neuromuscular disease, renal failure
38
long acting muscle relaxants recovery time?
40-70 mins
39
how are long acting excreted?
kidneys unchaged, avoid in renal failure
40
Intermediate have ___ as long DOA than the long acting
1/2
41
mivacuriums DOA is _____% shorter than intermediates?
30-40%
42
Priming principle, administer 10% how many mins before induction?
5
43
dose of defasciculating Vec and Roc?
Vec: 0.01 mg/kg
Roc: 0.06-0.1mg/kg
44
Very cardiac stable, minimal HR increase and BP decrease
Rocuronium
45
Causes bronchospasm
Vec
46
hypercarbia after administration enhances NMB?
Vecuronium
47
Respiratory acidosis enchances DOA makes it resistant to neostigmine
Pancuronium
48
vecuronium is how much protein bound?
60-80%
49
vecuronium is how much protein bound?
60-80%
50
Hoffman elimination?
Atracurium (1/3, and 2/3 ester hydrolysis); Cisatracurium
51
CI in renal dysfunction?
Cisatracurium, Vecuronium, Pancuronium, d Tubo, Doxa, Piper. (miva and atra ok? )
52
Eliminated by biliary?
vec and roc
53
Eliminated by biliary 50% unchaged
Roc
54
Dose decrease not required in RF, but decrease required in liver failure
Roc
55
Do not mix with barbs?
Vecuronium rocuronium, atracurium
56
Renal, biliary, hepatic disease prolongs E1/2t?
Roc, Vec, Pan
57
3 metabolites, one is 50% as potent?
Pancuronium: desacetylpancuronium (avoid in renal failure)
58
contraindicated in pseudocholinesterase deficiency or atypical plasma cholinesterases?
mivacurane
59
Renal excretion?
D- tubo, meto, pan, gallamine, doxa, pipercurium
60
100% unchaged by kidneys, contraindicated in renal failure?
gallamine
61
Short acting?
Rapacuronium, mivacurium, roc
62
How long is short acting?
63
How long is intermediate actin?
30-60 min onset 2-2.5 min
64
What will increase DOA of anticholinesterases?
RF
65
Intermediate acting agents?
Vec, atra, cis, roc
66
Long acting agents?
pan, pip, dox, d- tubo, meto, gallamine, alcuro
67
Hoffman metabolism affects from alkalosis?
alkalosis increases metabolis
68
Hoffman effect from acidosis?
acidosis decreases metabolism
69
What agents cause histamine release?
DAMS
70
what agents decrease Bp?
M, D, Sux
71
bronchospasm?
V,A,M,P
72
increase hr?
A,M,P,D
73
decrease hr?
Sux
74
Does hypothermia prolong or decrease block?
prolong
75
burns increase or decrease block?
decrease
76
what two things decrease DOA of blocks?
anticonvulsants and burns
77
Do dantrolene and ketamine affect depolarizing or non depolarizing?
NON- only.
78
What is the homozygous typical dibucaine number?
70-80; 4-6 mins
79
what is the heterozygous atypical number?
50-60; 20-30 mins
80
what is the homozygous atypical number?
20-30; 4-8 hours
81
What is the chemical structure of NDMR?
quarternary ammonium
82
Are benzylisoquinolines water or fat soluble?
water
83
What are the side effects of Sux?
Hyperkalemia, muscle pains, increased ICP, IOP, IGP, master spasm, MH trigger
84
increases risk for sux hyperkalemia?
burns, trauma, nerve damage, neuromuscular disease, renal failure
85
long acting muscle relaxants recovery time?
40-70 mins
86
how are long acting excreted?
kidneys unchaged, avoid in renal failure
87
Intermediate have ___ as long DOA than the long acting
1/2
88
mivacuriums DOA is _____% shorter than intermediates?
30-40%
89
Priming principle, administer 10% how many mins before induction?
5
90
dose of defasciculating Vec and Roc?
Vec: 0.01 mg/kg
Roc: 0.06-0.1mg/kg
91
Very cardiac stable, minimal HR increase and BP decrease
Rocuronium
92
Causes bronchospasm
Vec
93
hypercarbia after administration enhances NMB?
Vecuronium
94
Respiratory acidosis enchances DOA makes it resistant to neostigmine
Pancuronium
95
82% protein bound?
atracurium
96
vecuronium is how much protein bound?
60-80%
97
How is doxacurium eliminated?
renal unchange
98
Avoid in asthma and COPD?
d-tubo, atracurium
99
is sux highly protein bound?
no
100
CI of sux
duchennes, myalgias, atypical pc, burns,
101
E/T and DOA of succinylcholine
E1/2T: 2-4 mins; DOA 8-15 mins
102
Dose for Atropine?
0.01 mg/kg
103
Dose for glycopyrolate:
0.01 -0.02 mg/kg
104
dose for scopolamine
0.3-0.6 mg/kg
105
Onset of anticholinergics in order of quickest to slowest
Atropine (1m)
106
what reversal agent do you pair atropine with?
edrophonium (0.5-1.0mg/kg)
107
What agent do you pair glycopyrolate with?
Neostigmine (0.05-0.07 mg/kg)
108
Dose for pyridostigmine?
0.2mg/kg with glycol 0.01mg/kg
109
how are anticholinesterases metabolized?
hepatic metabolism (25%) and renal (75)
110
Pyridostigmine peak:
12 min
111
Neostigmine peak:
7-10 mins
112
What will increase DOA of anticholinesterases?
RF
113
DOA and E1/t of Atropine:
Duration of action of 30-60 minutes; E½t is 2.3 hrs; 18% unchanged via urine the rest is undergoes hydrolysis
114
Glyco DOA and E1/2T?
slower onset of 2-3 minutes; duration of action of 30-60 minutes;
E½t is 1.25 hrs;
80% unchanged via urine (quaternary amine)
115
Scopolamine metabolism?
extensively to 1% uchgd kidneys. E12t is 5 hours
