NMB Flashcards
List the depolarizing NMB agent
Succinylocholine
List the two non-depolarizing NMB agents
- Isoquinoline
2. Steroid derivative
List the non-depolarizing steroid derivatives
- Pancronium
- Rocuronium
- Vecuronium
List the main non-depolarizing Isoquinoline derivatives
Tubocurarine
Does renal elimination or hepatic elimination have longer half lives?
Renal elimination= >35 minutes = longer duration of action
List the effects of Succinylcholine
Initially depolarizes=Transient contractions (fasciculation’s)
Followed by refractory depolarization=Flaccid Paralysis
What is the main indication for Succinylcholine
Rapid endotracheal intubation
What is the norma duration of Succinylcholine
Rapid=5 minutes
Succinylcholine ADE’s
Arrhythmias
Tubocurarine MOA
Non-Depolarizing Agent
Competitive ANTAGONIST @ nACh receptors
What is the effect of Tubocurarine
Prevents depolarization by ACh=Flaccid Paralysis
When do we use Tubocurarine and Panuronium
- Prolonged relaxation for surgical procedures
2. Facilitate intubation and maintain skeletal muscle relaxation during surgery
How can you overcome the effects of Tubocurarine and Panuronium?
Increase amount of ACh in synaptic cleft:
- Cholinesterase inhibitors: Neostigmine, Pyridostigmine
- Muscarinic receptor antagonist: atropine (voids bradydysrhthmias)
What drugs enhance the neuromuscular blocking effects?
- Aminiglycosides
2. Calcium Channel Blockers (verapamil)
Tubocurarine and Panuronium Toxicities
- Histamine release
- Hypotension
- Prolonged apnea
Define Minimum alveolar anesthetic concentration (MAC)
The alveolar concentration of an inhaled anesthetic that is required to prevent a response to a standardized painful stimulus in 50% of patients
Define analgesia
state of decreased awareness of pain
sometimes with amnesia
Define general anesthesia
state of unconsciousness, analgesia, and amnesia with skeletal muscle relaxation and loss of reflexes
List the 4 stages of Anesthesia
- Analgesia: Decreased awareness
- Disinhibition: Delirious, excited; Amnesia; irregular respiration; incontinence
- Surgical Anesthesia: Unconscious, no pain; regular reparation and BP
- Medullary Depression: Severe respiratory & CV depression; mechanical and pharm support
List the 5 Primary Effects produced by general anesthesia
- Unconsciousness
- Amnesia
- Analgesia
- Inhibition of autonomic reflexes
- Skeletal muscle relaxation
List the main inhaled anesthetics
- Nitric Oxide
- Sevoflurane
- Isoflurane
- Methoxyflurane
inhaled anesthetic MOA
- Facilitate GABA-mediated inhibition
2. Block brain NMDA and ACh-N receptors
Effects of inhaled anesthetic
Increase cerebral blood flow, vasodilation
Decrease respiratory function
What are potential SE’s of Nitric Oxide?
Increase CBF=Increase ICP
Caused by activation of sympathetic nervous system
What is the drug of choice in patients with underlying airway problems? Why?
Halothane and Sevoflurane
Bronchodilators
What is the preferred method of anesthesia induction in most settings?
IV Anesthetics
List the IV Barbituates
- Thiopental
- Thioamylal
- Methohexital
IV Barbituates MOA
Facilitate GABA-mediated inhibition @ GABA-A receptors
IV Barbituates PK’s
High Lipid Solubility=Fast Onset & Short Duration
List the IV Benzodiazepine
Midazolam
Midazolam PK’s
Slower onset, but LONGER duration than barbituarates
How can you reverse the postop respiratory depression effects of Midazolam?
Flumazenil
What are the effects of Ketamine?
- Analgesia
- Amnesia
- Catatonia
- NOT unconscious
- CV Stimulation!
Ketamine toxicities?
Increased ICP
Is Ketamine long or short acting?
Long acting
List the IV opioids used
- Fentanyl
- Alfentanil
- Remifentanil
- Morphine
How do you reverse the respiratory depression effects of opioids?
Naloxone=Narcan
List the IV Phenols
- Propofol
2. Fospropofol
Phenols effects
- Vasodilation
- Hypotension
- Negative Inortopy= CV depression d/t decreased cardiac muscle contraction
