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Anesthesia Pharm > NMB > Flashcards

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
Q

Sux
Histamine
Hr
BP

A

Small, bradycardia, decrease BP

26
Q

Mivacurium
Histamine
Hr
BP

A

Small, tachy, decrease BP

27
Q

Atracurium
Histamine
Hr
BP

A

Small, tachycardia, no bp fx

28
Q

Vec
Histamine
Hr
BP

A

None, none, none

29
Q

Roc
Histamine
Hr
BP

A

None, none, none

30
Q

D-tubo
Histamine
Hr
BP

A

Moderate, reflex tachycardia, dec bp

31
Q

Pancuronium
Histamine
Hr
BP

A

None, tachycardia, inc bp

32
Q

Agents we wouldn’t give to asthmatic

A

Mivacurium or atracurium (histamine- also d-tubo)

33
Q

Most popular drugs for: long procedure, short procedure

A

Vec, roc

34
Q

Dont give to liver patient

A

Succhs, mivacurium (metabolism by cholinesterase)

35
Q

Good for pts w renal disease

A

Cisatracurium

36
Q

Factors effecting degree of relaxation: 6

A

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

37
Q

Abx

Fx: depol, nondepol

A

+, +

38
Q

Cholinesterase inhibitor

Fx: depol, nondepol

A

+, -

39
Q

Antidysrhythmics

Fx: depol, nondepol

A

+, +

40
Q

Dantrolene

Fx: depol, nondepol

A

?, +

41
Q

Inhalational agents

Fx: depol, nondepol

A

+, +

42
Q

Ketamine

Fx: depol, nondepol

A

?, +

43
Q

Locals

Fx: depol, nondepol

A

+, +

44
Q

Causes of altered NDMB responses

A

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

45
Q

Long acting agents
Paralysis onset
Procedure length maintenance
Recovery

A

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

46
Q

Intermediate acting

Useful for, DOA, onset time

A

Intubation. about 30 min. Varies.

47
Q

Short acting agents

2 ex

A

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

48
Q

Succhs

Gtt: bag dose, rate

A

1 gm/500 ml NS or d5

2-4 mg/min

49
Q

Priming principle: how to, why, have what

A

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

50
Q

Defasciculating dose:

How, why

A

10% intubating dose to prevent fasciculations from sux.

51
Q

Sux fasciculations inc risk of what

A

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

52
Q

Dose of defasciculating agent: vec, roc

A

Vec- .01 mg/kg

Roc- .06-.01 mg/kg

Anesthesia Pharm (12 decks)

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