NMB

Question 1

Acetylcholine receptor structure

Where Ach binds

Answer 1

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

Question 2

What happens in a non depolarizing block at receptor level

Answer 2

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

Question 3

What happens at receptor level in depolarizing block

Answer 3

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

Question 4

Sch metabolism

Answer 4

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

Question 5

Sch contraindication, why, management

Answer 5

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

Question 6

Atropine dose to give with sux

Answer 6

0.02 mg/kg

Question 7

Cardiac issues of Sch in peds

Answer 7

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

Question 8

Sux SE

Answer 8

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

Question 9

Hyperkalemia more likely in which pts getting sux

Answer 9

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

Question 10

Dibucaine is what, what number indicates

Answer 10

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

Question 11

Dibucaine #: homozygous typical

Incidence, #, duration

Answer 11

Normal. 70-80. 4-6 min

Question 12

Dibucaine #: heterozygous atypical

Incidence, #, duration

Answer 12

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

Question 13

Dibucaine #: homozygous atypical

Incidence, #, duration

Answer 13

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

Question 14

NDMB:

___ ammonium. __ derivatives or ___

Answer 14

Quaternary, steroid, benzylisquinolones

Question 15

NDMB:

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

Answer 15

Hepatocytes, liver, water solubility.

Question 16

Short acting NDMR
Onset
Duration

Answer 16

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

Question 17

Intermediate acting NDMR
Onset
Duration

Answer 17

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

Question 18

Long acting NDMR
Onset
Duration

Answer 18

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

Question 19

Which agents are metabolized by: ester and plasma cholinesterase

Answer 19

Succ, atracurium

Question 20

Which agents are ester metabolized

Answer 20

Mivacurium and vec

Question 21

Which agents are biliary excreted

Answer 21

Vec and roc

Question 22

Which agents are elim by renal excretion

Answer 22

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

Question 23

Elimination:
Atracurium
Cisatracurium

Answer 23

Ester hydrolysis (2/3) and Hoffman 
Hoffman

Question 24

Elim:
Succhs
Mivacurium

Answer 24

Both plasma cholinesterase

Question 25

Sux
Histamine
Hr
BP

Answer 25

Small, bradycardia, decrease BP

Question 26

Mivacurium
Histamine
Hr
BP

Answer 26

Small, tachy, decrease BP

Question 27

Atracurium
Histamine
Hr
BP

Answer 27

Small, tachycardia, no bp fx

Question 28

Vec
Histamine
Hr
BP

Answer 28

None, none, none

Question 29

Roc
Histamine
Hr
BP

Answer 29

None, none, none

Question 30

D-tubo
Histamine
Hr
BP

Answer 30

Moderate, reflex tachycardia, dec bp

Question 31

Pancuronium
Histamine
Hr
BP

Answer 31

None, tachycardia, inc bp

Question 32

Agents we wouldn’t give to asthmatic

Answer 32

Mivacurium or atracurium (histamine- also d-tubo)

Question 33

Most popular drugs for: long procedure, short procedure

Answer 33

Vec, roc

Question 34

Dont give to liver patient

Answer 34

Succhs, mivacurium (metabolism by cholinesterase)

Question 35

Good for pts w renal disease

Answer 35

Cisatracurium

Question 36

Factors effecting degree of relaxation: 6

Answer 36

Antihypertensives, renal dis, hepatic dis, cholinesterase inhib, ketamine, lithium

Question 37

Abx

Fx: depol, nondepol

Answer 37

+, +

Question 38

Cholinesterase inhibitor

Fx: depol, nondepol

Answer 38

+, -

Question 39

Antidysrhythmics

Fx: depol, nondepol

Answer 39

+, +

Question 40

Dantrolene

Fx: depol, nondepol

Answer 40

?, +

Question 41

Inhalational agents

Fx: depol, nondepol

Answer 41

+, +

Question 42

Ketamine

Fx: depol, nondepol

Answer 42

?, +

Question 43

Locals

Fx: depol, nondepol

Answer 43

+, +

Question 44

Causes of altered NDMB responses

Answer 44

Hypothermia (intermediate esp), acidosis (atra- inhib Hoffman), hypokalemia (prolongs)m burns (resistance to NDMR, need more)

Question 45

Long acting agents
Paralysis onset
Procedure length maintenance
Recovery

Answer 45

3-5 min. >2 hr long procedure. 40-70 min.

Question 46

Intermediate acting

Useful for, DOA, onset time

Answer 46

Intubation. about 30 min. Varies.

Question 47

Short acting agents

2 ex

Answer 47

Sux (gtt), mivacurium (to avoid myalgia of succs, longer onset)

Question 48

Succhs

Gtt: bag dose, rate

Answer 48

1 gm/500 ml NS or d5

2-4 mg/min

Question 49

Priming principle: how to, why, have what

Answer 49

10% of intubating dose 5 min before induction. Speeds onset of NDMR. Have a/w equip

Question 50

Defasciculating dose:

How, why

Answer 50

10% intubating dose to prevent fasciculations from sux.

Question 51

Sux fasciculations inc risk of what

Answer 51

Hyperkalemia, muscle pain, intra gastric pressure, aspiration. Temp ICP increase

Question 52

Dose of defasciculating agent: vec, roc

Answer 52

Vec- .01 mg/kg

Roc- .06-.01 mg/kg