NMB Flashcards

1
Q

Acetylcholine receptor structure

Where Ach binds

A

5 subunits, central core for cations. Ach binds to both “a” subunits, site of agonist and antagonism

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2
Q

What happens in a non depolarizing block at receptor level

A

Ach cant attach to receptor, ch cant open, no direct effect on channel

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3
Q

What happens at receptor level in depolarizing block

A

Sux binds to nicotinic receptor, ch opens, endplate depolarization and single contraction occurs. Ch stay open until Sux diffuses back into circ, not broken down by acetylcholinesterases

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4
Q

Sch metabolism

A

No reversal. Rapid hydrolysis by pseudocholinesterase (in plasma, made by liver)

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5
Q

Sch contraindication, why, management

A

In peds (bradycardia, salivation, MH trigger). If emergency case give IV atropine .02 mg/kg with it

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6
Q

Atropine dose to give with sux

A

0.02 mg/kg

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7
Q

Cardiac issues of Sch in peds

A

Bolus can lead to ventricular arrhythmias and cv arrest d/t hyperkalemia and rhabdo. OR bradycardia/asystole (more common after 2nd dose)

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8
Q

Sux SE

A

Hyperkalemia, muscle pain, inc ICP/IOP/IGP, masseter spasm, MH trigger

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9
Q

Hyperkalemia more likely in which pts getting sux

A

Burns, trauma, nerve damage, nm disease, renal failure

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10
Q

Dibucaine is what, what number indicates

A

LA- inhib pseudocholinesterase. # is qualitative to indicate genetic make up regarding pseudocholinesterase

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11
Q

Dibucaine #: homozygous typical

Incidence, #, duration

A

Normal. 70-80. 4-6 min

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12
Q

Dibucaine #: heterozygous atypical

Incidence, #, duration

A

1/50 pts. 50-60. 20-30 min

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13
Q

Dibucaine #: homozygous atypical

Incidence, #, duration

A

1/3000 pts. 20-30. 4-8 hours

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14
Q

NDMB:

___ ammonium. __ derivatives or ___

A

Quaternary, steroid, benzylisquinolones

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15
Q

NDMB:

Benzylisquinolones- inhib uptake into __ leads to lack of ___ elim due to what

A

Hepatocytes, liver, water solubility.

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16
Q

Short acting NDMR
Onset
Duration

A

Rapacuronium, mivacurium, rocuronium. 1-2 min. <30 min.

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17
Q

Intermediate acting NDMR
Onset
Duration

A

Vec, atracurium, cisatracurium, roc.
2-2.5 min
30-60 min

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18
Q

Long acting NDMR
Onset
Duration

A

Panc, pipe, doxacurium, d-turbo, metocurine, gallamine, alcuronium
2-6 min
60-120 min

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19
Q

Which agents are metabolized by: ester and plasma cholinesterase

A

Succ, atracurium

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20
Q

Which agents are ester metabolized

A

Mivacurium and vec

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21
Q

Which agents are biliary excreted

A

Vec and roc

22
Q

Which agents are elim by renal excretion

A

D-tubocurarine, metocurarine, panc, gallamine, doxacurium, pipecurium

23
Q

Elimination:
Atracurium
Cisatracurium

A
Ester hydrolysis (2/3) and Hoffman 
Hoffman
24
Q

Elim:
Succhs
Mivacurium

A

Both plasma cholinesterase

25
Sux Histamine Hr BP
Small, bradycardia, decrease BP
26
Mivacurium Histamine Hr BP
Small, tachy, decrease BP
27
Atracurium Histamine Hr BP
Small, tachycardia, no bp fx
28
Vec Histamine Hr BP
None, none, none
29
Roc Histamine Hr BP
None, none, none
30
D-tubo Histamine Hr BP
Moderate, reflex tachycardia, dec bp
31
Pancuronium Histamine Hr BP
None, tachycardia, inc bp
32
Agents we wouldn't give to asthmatic
Mivacurium or atracurium (histamine- also d-tubo)
33
Most popular drugs for: long procedure, short procedure
Vec, roc
34
Dont give to liver patient
Succhs, mivacurium (metabolism by cholinesterase)
35
Good for pts w renal disease
Cisatracurium
36
Factors effecting degree of relaxation: 6
Antihypertensives, renal dis, hepatic dis, cholinesterase inhib, ketamine, lithium
37
Abx | Fx: depol, nondepol
+, +
38
Cholinesterase inhibitor | Fx: depol, nondepol
+, -
39
Antidysrhythmics | Fx: depol, nondepol
+, +
40
Dantrolene | Fx: depol, nondepol
?, +
41
Inhalational agents | Fx: depol, nondepol
+, +
42
Ketamine | Fx: depol, nondepol
?, +
43
Locals | Fx: depol, nondepol
+, +
44
Causes of altered NDMB responses
Hypothermia (intermediate esp), acidosis (atra- inhib Hoffman), hypokalemia (prolongs)m burns (resistance to NDMR, need more)
45
Long acting agents Paralysis onset Procedure length maintenance Recovery
3-5 min. >2 hr long procedure. 40-70 min.
46
Intermediate acting | Useful for, DOA, onset time
Intubation. about 30 min. Varies.
47
Short acting agents | 2 ex
Sux (gtt), mivacurium (to avoid myalgia of succs, longer onset)
48
Succhs | Gtt: bag dose, rate
1 gm/500 ml NS or d5 | 2-4 mg/min
49
Priming principle: how to, why, have what
10% of intubating dose 5 min before induction. Speeds onset of NDMR. Have a/w equip
50
Defasciculating dose: | How, why
10% intubating dose to prevent fasciculations from sux.
51
Sux fasciculations inc risk of what
Hyperkalemia, muscle pain, intra gastric pressure, aspiration. Temp ICP increase
52
Dose of defasciculating agent: vec, roc
Vec- .01 mg/kg | Roc- .06-.01 mg/kg