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Anesthesia Pharmacology > Neuromuscular Blocking Agents - NMBAs > Flashcards

Neuromuscular Blocking Agents - NMBAs Flashcards

1
Q

Pancuronium (Pavulon)

Chemical Classification
&
MOA

A

Chemical Classification
Aminosteroid - Non-depolarizing

MOA
Blocks ACh from binding to nACh receptors on motor endplate inhibiting depolarization

Long Acting

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2
Q

Pancuronium (Pavulon)

Dosing

A

IV: 0.1 mg/kg

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3
Q

Pancuronium (Pavulon)

Onset
Duration

A

Onset
2-5 min

Duration
60-120 min

Aminosteroid - Long Acting

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4
Q

Pancuronium (Pavulon)

Metabolism
&
Elimination

A

Metabolism
Hepatic: 50% metabolized

Elimination
50% secreted renally
80% eliminated unchanged in urine

↑ VD in liver disease
Need ↑ initial dose
↑ duration in liver & renal failure

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5
Q

Pancuronium (Pavulon)

Side Effects
&
Considerations

A

No histamine release

Cardiovascular
↑ HR MAP & CO d/t
vagal blockade &
SNS activation;
↑presynaptic NE &
↓NE uptake
NO Δ in SVR or intropy

Interactions
VA; diuretics; corticosteroids; metoclopramide; LA; magnesium
can cause dose-dependent NMBA enhancement

Hypokalemia
↑ NMBD sensitivity
HYPERkalemia
↓ NMBD sensitivity (resistant to blockade)

Hypothermia can prolong duration

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6
Q

Vecuronium (Nornuron)

Chemical Classification
&
MOA

A

Chemical Classification
Aminosteroid - Non-depolarizing

MOA
Blocks ACh from binding to nACh receptors on motor endplate inhibiting depolarization

Intermediate Acting

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7
Q

Vecuronium (Nornuron)

Dosing

A

IV: 0.1 mg/kg

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8
Q

Vecuronium (Nornuron)

Onset
Duration

A

Onset
2-3 min

Duration
45-90 min

Aminosteroid - Intermediate Acting

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9
Q

Vecuronium (Nornuron)

Metabolism
&
Elimination

A

Metabolism
Hepatic: 70%

Active metabolite is
50-80% potent

Elimination
Renal: 30%

Repeated dose & infusion have cumulative effects

E½ time prolonged in renal dysfunction

Better in liver failure only

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10
Q

Vecuronium (Nornuron)

Side Effects
&
Considerations

A

No histamine release

VA; diuretics; corticosteroids; metoclopramide; LA; magnesium
can cause dose-dependent NMBA enhancement

If ACIDOSIS occurs BEFORE administration;
No NMB Δ in action
If ACIDOSIS occurs AFTER administration; WILL prolong NMBD blockade

Hypokalemia
↑ NMBD sensitivity
HYPERkalemia
↓ NMBD sensitivity (resistant to blockade)

Hypothermia can prolong duration

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11
Q

Rocuronium (Zemuron)

Chemical Classification
&
MOA

A

Chemical Classification
Aminosteroid - Non-depolarizing

MOA
Blocks ACh from binding to nACh receptors on motor endplate inhibiting depolarization

Intermediate Acting

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12
Q

Rocuronium (Zemuron)

Dosing

A

IV: 0.6 mg/kg
RSI IV: 1.2 mg/kg

IBW

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13
Q

Rocuronium (Zemuron)

Onset
Duration

A

Onset
2-5 min
RSI: 1-2 min

Duration
35-75 min
RSI: 40-70 min

Aminosteroid - Intermediate Acting

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14
Q

Rocuronium (Zemuron)

Metabolism
&
Elimination

A

Metabolism
Hepatic: Remains unchanged in bile

Elimination
10-30% renal excretion

Greater hepatic involvement than Vecuronium

Good to use in renal failure

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15
Q

Rocuronium (Zemuron)

Side Effects
&
Considerations

A

No histamine release

Minimal vagolytic activity

VA; diuretics; corticosteroids; metoclopramide; LA; magnesium can cause dose-dependent NMBA enhancement

Hypokalemia
↑ NMDB sensitivity
HYPERkalemia
↓ NMBD sensitivity (resistant to blockade)

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16
Q

Cistatricurium (Nimbex)

Chemical Classification
&
MOA

A

Chemical Classification
Benzylisoquinolone - Non-depolarizing

MOA
Blocks ACh from binding to nACh receptors on motor endplate inhibiting depolarization

Intermediate Acting

17
Q

Cistatricurium (Nimbex)

Dosing

A

IV: 0.1 mg/kg

  • IBW in obese patients
18
Q

Cisatricurium (Nimbex)

Onset
Duration

A

Onset
2-5 min

Duration
40-75 min

Benzylisoquinoline - Intermediate Acting

19
Q

Cistatricurium (Nimbex)

Metabolism
&
Elimination

A

Metabolism
Ester hydrolysis

Elimination
Hoffman elimination;
pH & temp dependent

DOC: Hepatic & renal failure

20
Q

Cistatricurium (Nimbex)

Side Effects
&
Considerations

A

LEAST likely to have allergic reaction

VA; diuretics; corticosteroids; metoclopramide; LA; magnesium
can cause dose-dependent NMBA enhancement

21
Q

Atracurium (Tracrium)

Chemical Classification
&
MOA

A

Chemical Classification
Benzylisoquinoline - Non-depolarizing

MOA
Blocks ACh from binding to nACh receptors on motor endplate inhibiting depolarization

Intermediate Acting

22
Q

Atracurium (Tracrium)

Dosing

A

IV: 0.5 mg/kg

23
Q

Atracurium (Tracrium)

Onset
Duration

A

Onset
3-5 min

Duration
20-35 min

Benzylisoquinoline - Intermediate Acting

24
Q

Atracurium (Tracrium)

Metabolism
&
Elimination

A

Metabolism
Ester hydrolysis

Elimination
Hoffman elimination;
pH & temp dependent

Metabolite
Laudonosine; 70% hepatic excretion
via bile; 30% in urine

25
Q

Atracurium (Tracrium)

Side Effects
&
Considerations

A

Most likely to cause bradycardia

Greatest concern for histamine release

VA; diuretics; corticosteroids; metoclopramide; LA; magnesium can cause dose-dependent NMBA enhancement

26
Q

Mivacurium (Mivacron)

Chemical Classification
&
MOA

A

Chemical Classification
Benzylisoquinoline - Non-depolarizing

MOA
Blocks ACh from binding to nACh receptors on motor endplate inhibiting depolarization
| Short Acting

27
Q

Mivacurium (Mivacron)

Dosing

A

IV: 0.15 mg/kg

28
Q

Mivacurium (Mivacron)

Onset
Duration

A

Onset
2-3 min

Duration
12-20 min

Benzylisoquinoline - Short Acting

29
Q

Mivacurium (Mivacron)

Metabolism
&
Elimination

A

Metabolism/Elimination
Plasma cholinesterase

30
Q

Mivacurium (Mivacron)

Side Effects
&
Considerations

A

Histamine Release
MAP ↓ > in pts w/ HTN;
Possible bronchospasms

VA; diuretics; corticosteroids; metoclopramide; LA; magnesium can cause dose-dependent NMBA enhancement

31
Q

Succinylcholine (Anectine)

Chemical Classification
&
MOA

A

Chemical Classification
Depolarizing Neuromuscular Blocking Agent

MOA
Mimics Ach; produces sustained depolarization of motor endplate at NMJ

32
Q

Succinylcholine (Anectine)

Dosing

A

IV: 1-1.5 mg/kg*

1.5-2 mg/kg in myasthenia gravis

*ABW

33
Q

Succinylcholine (Anectine)

Onset
Duration

A

Onset
30-60 sec

Duration
3-5 min

34
Q

Succinylcholine (Anectine)

Metabolism
&
Elimination

A

Metabolism/Elimination

Hydrolyzed by butyrylcholinesterase
(Pseudocholinesterase)
Metabolite
Succinylmonocholine; can cause seizures

35
Q

Succinylcholine (Anectine)

Side Effects
&
Considerations

A

Histamine release
↑ K+ by 0.5 mEq/L

Dysrhythmias
Myalgia
Myoglobinuria
Masseter spasm
↑ intragastric; intraocular; intracranial pressure

MOST likely to have allergic reaction

Cardiovascular
Dysrhythmias: SB, JR, & sinus arrest
Subsequent doses: 2nd ↑ risk of dysrhythmias
↑ HR & SBP (ANS response)

HYPOkalemia
↓ SCh sensitivity
(resistant to blockade)
HYPERkalemia
↑ SCh sensitivity

Phase II block occurs w/
Sch dose 2-4 mg/kg

Can cause MH

20% less dose in Lambert-Eaton pts
1.5-2 mg/kg in myasthenia gravis

C/I in pediatrics & Pseudocholinesterase deficiency(prolonged neuromuscular blockade)

Anesthesia Pharmacology (16 decks)

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