Neuromuscular Blocker Review

Question 1

What part of the Ach attaches to the Nicotinic receptor?

Answer 1

Binds to the alpha sub unit through the + charged Nitrogen atom

Question 2

What is the synthesis of Ach?

Answer 2

Its a reaction between Choline and Acetyl CoA via the enzyme cholineacetyltransferase

Question 3

What is the active structure of Ach?

Answer 3

The quaternary ammonium ester group with a + charged Nitrogen

Question 4

What are the 2 categories of NMB’s

Answer 4

NDNMB, DNMB

Question 5

Suc’s is metabolized by?

Answer 5

Pseudocholinesterase

Question 6

For Suc’s to work it must occupy _______ receptors?

Answer 6

Both Alpha receptors

Question 7

How many receptors do NDNMB occupy?

Answer 7

They only need to occupy 1 alpha subunit receptor

Question 8

When both alpha subunits are occupied by Suc’s causes the Na+ channels to stay_____by attaching to 2 alpha subunits?

Answer 8

open

Question 9

When a NDNMB attaches to a alpha subunit it causes the Na+ channels to stay______?

Answer 9

Closed

Question 10

Pancuronium and Vecuronium, are metabolized by?

Answer 10

deacetylation in the liver and excreated in the bile and via the kidneys

Question 11

Suc’s is metabolized into?

Answer 11

Choline and Succinylmonocholine

Question 12

What ends a NDNMB efect?

Answer 12

Redistribution, renal and hepatic metabolism, Hoffman elimination and plasma cholinesterase.

Question 13

What eliminates DNMB?

Answer 13

Pseudocholinesterase

Question 14

Which agents release Histamine?

Answer 14

(SAM) Suc’s, Atricurium, and Mivacurium

Question 15

Histamine release is attenuated by?

Answer 15

Administration of H1 and H2 blockers

Question 16

Major side effect of Suc’s?

Answer 16

faciculations releasing K+ and inhibiting the closure of the Na+ channels allowing leaking of K+ from the Cells

Question 17

How is the depolarization of Suc”s terminated?

Answer 17

Diffusion away from the the neuromuscular junction and metabolized by plasma cholinesterase (pseudocholinesterase)

Question 18

Is Ach metabolized by pseudocholinesterase?

Answer 18

No, it is metabolized by true cholinesterase or acetylcholinesterase

Question 19

Pseudocholinesterase deficiency will prolong Suc’s effects by?

Answer 19

Aprox 6-8 hours (PP slide 21)

Question 20

What drugs will potentiate NDNMB?

Answer 20

VAA, Aminoglycosides, LA, Antiarrythmics, Mag, Lithium, dantrolene

Question 21

Which muscle relaxants are ultra short acting?

Answer 21

Suc’s

Question 22

Which muscle relaxants are short acting?

Answer 22

Mivacurium

Question 23

Which muscle relaxants are intermediate acting?

Answer 23

Vec, Roc, Atracurium, Cisatracurium

Question 24

Which muscle relaxants are long acting?

Answer 24

Pancuronium

Question 25

Where do Muscle relaxants work?

Answer 25

Post synaptic motor end plate

Question 26

Depolarizers resemble and mimic _________?

Answer 26

Ach

Question 27

The sustained opening of receptor channels in a depolarized post-junctional membrane is called a _____?

Answer 27

Phase 1 block

Question 28

Desensitized repolarized post junctional membrane that remains unresponsive to Ach occurs after ___________ and is called _______?

Answer 28

Repeated or large doses of Suc’s and is called a Phase 2 block

Question 29

Types of Patients that would have extra junctional receptors?

Answer 29

Denervation p 24-28 hrs, Burns p 2 days, immobilization p 3 days.

Question 30

Up regulated junctional receptors can cause ________ when given Suc’s?

Answer 30

Massive release of K+ up to 0.5meq into the circulatory system

Question 31

NDNMB don’t cross the _____, _______, _____?

Answer 31

Blood brain barrier, Placental barrier and GI

Question 32

to decrease the side effects of Suc’s, pretreatment with a ______ may decrease cardiac arrythmias, Myalgias, and fasiculations

Answer 32

NDNMB

Question 33

Will pretreatment with a NDNMB before giving SUC’s decrease the K+ release?

Answer 33

NO, because K+ is released because the cells are depolarized and allow K+ to leak out while the Na+ channels are open

Question 34

To impair motor nerve conduction > then ______% of Ach receptors must be blocked

Answer 34

75

Question 35

Total flaccidity is at what % of Ach receptors are blocked?

Answer 35

99%

Question 36

Twitch monitoring on the head is using what nerve?

Answer 36

Facial Nerve( CN VII)

Question 37

The twitch monitor triggers what muscle through the facial nerve?

Answer 37

Curragator Supercilli

Question 38

The placement of the electrodes over the ulnar nerve stimulates what muscle?

Answer 38

Adductor Pollicis

Question 39

Stimulation of the Posterior tibia nerve stimulates what muscle?

Answer 39

Flexor Hallucis