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5230 > Muscle Relaxants > Flashcards

Muscle Relaxants Flashcards

1
Q

Muscle Relaxants - Ultra Short Acting

A

succinylcholine

5-15 minutes

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2
Q

Muscle Relaxants - Short Acting

A

mivacurium

20-40 minutes

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3
Q

Muscle Relaxants - Intermediate Acting

A

atracurium
cisatracurium
vecuronium
rocuronium

30-60 minutes

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4
Q

Muscle Relaxants - Long Acting

A

pancuronium

60-90 minutes

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5
Q

Muscle Relaxants - onset time

A

time from administration to maximal effect

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6
Q

Muscle Relaxants - clinical duration

A

time from administration to 25% recovery of the twitch response

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7
Q

Muscle Relaxants - total duration of action

A

time from administration to 90% recovery of the twitch response

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8
Q

Muscle Relaxants - recovery index

A

time from 25% to 75% recovery of twitch response

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9
Q

Train of 4 Ratio

A

compares the 4th twitch with the 1st twitch; recovery is indicated with the ratio is 90%

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10
Q

neuromuscular blockage tests that reflect diaphragm paralysis

A

orbicularis oculi of facial nerve

upper airway muscle are more sensitive than peripheral muscles

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11
Q

neuromuscular blockage - best site to measure recovery

A

ulnar nerve

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12
Q

neuromuscular blockage - best site to measure onset

A

facial nerve - orbicularis oculi or corrugator supercilii*

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13
Q

sequence of loss of muscle function

A
  1. eye lids
  2. extremities
  3. chest - intercostals
  4. abdominal muscles
  5. diaphragm
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14
Q

blockade responses

A 
4 responses, no fade = <70%
4 responses, fade = 70-75%
3 responses = 75-80%
2 responses = 80-85%
1 response = 90-95%
**want surgery here
0 responses = 100%
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15
Q

twitches with depolarizing drug

A

no fade or post-tetanic count

sustained response to tetany

muscle fasciculation

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16
Q

Post Tetanic Count

A
  1. 50 Nz for 5 seconds
  2. Wait 3 seconds
  3. Single twitches every second for up to 20 seconds

number of twitches inversely proportional with recovery time, 1 twitch 15-30 minutes

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17
Q

TOF ratio when fade is no longer detected, which leads to

A

0.4-0.9

“blind paralysis”

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18
Q

Esterase Enzymes

A

cholinesterase: acetyl and pseudo (plasma)

non-specific: RBC, paraoxonase, albumin

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19
Q

metabolism - succinylcholine

A

pseudocholinesterase

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20
Q

metabolism - mivacurium

A

pseudocholinesterase

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21
Q

metabolism - atracurium

A

Hoffman elimination and non-specific esterase

elimination - 10-40% renal

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22
Q

metabolism - cisatracurium

A

Hoffman elimination and non-specific esterase

elimination - 15% renal

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23
Q

test for determining cholinesterase variants

A

dibucaine - inhibits typical but not atypical and measure activity

low number - indicates atypical enzymes
low activity - indicates low levels of enzyme

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24
Q

succinylcholine side effects

A 
hyperkalemia
dysrhythmias: tachycardia, bradycardia in repeat doses
myalgia
elevated intragastric pressure
elevated ICP
elevated intraocular pressure
myoglobinemia
massester spasm
malignant hyperthermia
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25
Q

atracurium
cisatracurium
mivacurium

A

benzylisoquinoline relaxants

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26
Q

pancuronium
vecuronium
rocuronium

A

steroidal relaxants

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27
Q

metabolism - vecuronium

A

liver (40%) - removed by kidneys and liver

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28
Q

metabolism - rocuronium

A

not metabolized - removed by liver (70%) and kidney (25%)

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29
Q

metabolism - pancuronium

A

liver (20%) - removed by kidneys (85%)

30
Q

which relaxant releases histamine

A

atracurium > mivacurium

small amount released with succinylcholine

31
Q

factors prolonging paralysis

A 
hypothermia
aminoglycoside toxicity
penicillin toxicity
steroid myopathy
clindamycin
tetracycline
volatile anesthetics
dantrolene
magnesium
lithium
32
Q

intubating dose - succinylcholine

A

1-1.5 mg/kg

33
Q

intubating dose - mivacurium

A

0.2 mg/kg

34
Q

intubating dose - atracurium

A

0.5 mg/kg

35
Q

intubating dose - cisatracurium

A

0.1 mg/kg

36
Q

intubating dose - rocuronium

A

0.6-1 mg/kg

37
Q

intubating dose - vecuronium

A

0.1 mg/kg

38
Q

intubating dose - pancuronium

A

0.08-0.18 mg/kg

39
Q

time to onset - succinylcholine

A

30-60 sec

40
Q

time to onset - mivacurium

A

3 min

41
Q

time to onset - atracurium

A

2-4 min

42
Q

time to onset - cisatracurium

A

2-4 min

43
Q

time to onset - rocuronium

A

1-1.5 min

44
Q

time to onset - vecuronium

A

2-4 min

45
Q

time to onset - pancuronium

A

2-4 min

46
Q

sugammadex reversal doses

A

2 mg/kg if >2 twitches
4 mg/kg if 1 twitch
16 mg/kg after intubation dose

47
Q

dose - neostigmine

A

0.03-0.07 mg/kg

48
Q

dose - edrophonium

A

0.5-1 mg/kg

49
Q

dose - atropine

A

0.01 mg/kg

50
Q

dose - glycopyrrolate

A

0.01 mg/kg

51
Q

max dose - neostigmine

A

5 mg

52
Q

max dose - edrophonium

A

1 mg/kg

53
Q

time to onset - neostigmine

A

7-10 min

54
Q

time to onset - edrophonium

A

5-10 min

55
Q

time to onset - atropine

A

1-1.5 min

56
Q

time to onset - glycopyrrolate

A

2 min

57
Q

time to onset - sugammadex

A

1-1.5 min

58
Q

duration - neostigmine

A

55-75 min

59
Q

duration - edrophonium

A

15-60 min

60
Q

duration - atropine

A

15-30 min

61
Q

duration - glycopyrrolate

A

1-2 hours

62
Q

why does fade occur?

A

the presynaptic receptors are being blocked

63
Q

sugammadex adverse drug reactions

A 
dry mouth
dysgeusia 
n/v
coughing
hypotension
abnormal levels of N-acetylglucosaminidase in urine
chills
inactivate birth control
64
Q

relaxants - response when 80% of receptors are occupied

A

tidal volume of 5 ml/kg

single twitch is as strong as baseline

65
Q

relaxants - response when 70% of receptors are occupied

A

TOF and sustained tetanus for 5 seconds - no fade

vital capacity of 20 ml/kg

66
Q

relaxants - response when 60% of receptors are occupied

A

double burst no fade

67
Q

relaxants - response when 50% of receptors are occupied

A 
hand grip
head lift
sustained bite
sustained tetanus @ 100 htz
inspiratory force at least -40 cm H2O
68
Q

characteristics of neuromuscular blockade - phase 1 vs phase 2

A
  • phase 1 = depolarizing

- phase 2 = non-depolarizing

69
Q

anti-cholinesterase drugs ______ phase 1 drugs and _____ phase 2 drugs

A
  • potentiate

- reverse

70
Q

medications that inhibit cholinesterase

A 
donepezil
rivastigmine
galantamine
tacrine
physostigmine 
phospholine iodide (anticholinesterase eye drops)

5230 (12 decks)

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