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Pharm II-Exam 3 > NMB > Flashcards

NMB Flashcards

1
Q

List the depolarizing NMB agent

A

Succinylocholine

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2
Q

List the two non-depolarizing NMB agents

A
  1. Isoquinoline

2. Steroid derivative

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3
Q

List the non-depolarizing steroid derivatives

A
  1. Pancronium
  2. Rocuronium
  3. Vecuronium
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4
Q

List the main non-depolarizing Isoquinoline derivatives

A

Tubocurarine

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5
Q

Does renal elimination or hepatic elimination have longer half lives?

A

Renal elimination= >35 minutes = longer duration of action

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6
Q

List the effects of Succinylcholine

A

Initially depolarizes=Transient contractions (fasciculation’s)
Followed by refractory depolarization=Flaccid Paralysis

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7
Q

What is the main indication for Succinylcholine

A

Rapid endotracheal intubation

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8
Q

What is the norma duration of Succinylcholine

A

Rapid=5 minutes

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9
Q

Succinylcholine ADE’s

A

Arrhythmias

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10
Q

Tubocurarine MOA

A

Non-Depolarizing Agent

Competitive ANTAGONIST @ nACh receptors

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11
Q

What is the effect of Tubocurarine

A

Prevents depolarization by ACh=Flaccid Paralysis

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12
Q

When do we use Tubocurarine and Panuronium

A
  1. Prolonged relaxation for surgical procedures

2. Facilitate intubation and maintain skeletal muscle relaxation during surgery

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13
Q

How can you overcome the effects of Tubocurarine and Panuronium?

A

Increase amount of ACh in synaptic cleft:

  1. Cholinesterase inhibitors: Neostigmine, Pyridostigmine
  2. Muscarinic receptor antagonist: atropine (voids bradydysrhthmias)
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14
Q

What drugs enhance the neuromuscular blocking effects?

A
  1. Aminiglycosides

2. Calcium Channel Blockers (verapamil)

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15
Q

Tubocurarine and Panuronium Toxicities

A
  1. Histamine release
  2. Hypotension
  3. Prolonged apnea
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16
Q

Define Minimum alveolar anesthetic concentration (MAC)

A

The alveolar concentration of an inhaled anesthetic that is required to prevent a response to a standardized painful stimulus in 50% of patients

17
Q

Define analgesia

A

state of decreased awareness of pain

sometimes with amnesia

18
Q

Define general anesthesia

A

state of unconsciousness, analgesia, and amnesia with skeletal muscle relaxation and loss of reflexes

19
Q

List the 4 stages of Anesthesia

A
  1. Analgesia: Decreased awareness
  2. Disinhibition: Delirious, excited; Amnesia; irregular respiration; incontinence
  3. Surgical Anesthesia: Unconscious, no pain; regular reparation and BP
  4. Medullary Depression: Severe respiratory & CV depression; mechanical and pharm support
20
Q

List the 5 Primary Effects produced by general anesthesia

A
  1. Unconsciousness
  2. Amnesia
  3. Analgesia
  4. Inhibition of autonomic reflexes
  5. Skeletal muscle relaxation
21
Q

List the main inhaled anesthetics

A
  1. Nitric Oxide
  2. Sevoflurane
  3. Isoflurane
  4. Methoxyflurane
22
Q

inhaled anesthetic MOA

A
  1. Facilitate GABA-mediated inhibition

2. Block brain NMDA and ACh-N receptors

23
Q

Effects of inhaled anesthetic

A

Increase cerebral blood flow, vasodilation

Decrease respiratory function

24
Q

What are potential SE’s of Nitric Oxide?

A

Increase CBF=Increase ICP

Caused by activation of sympathetic nervous system

25
Q

What is the drug of choice in patients with underlying airway problems? Why?

A

Halothane and Sevoflurane

Bronchodilators

26
Q

What is the preferred method of anesthesia induction in most settings?

A

IV Anesthetics

27
Q

List the IV Barbituates

A
  1. Thiopental
  2. Thioamylal
  3. Methohexital
28
Q

IV Barbituates MOA

A

Facilitate GABA-mediated inhibition @ GABA-A receptors

29
Q

IV Barbituates PK’s

A

High Lipid Solubility=Fast Onset & Short Duration

30
Q

List the IV Benzodiazepine

A

Midazolam

31
Q

Midazolam PK’s

A

Slower onset, but LONGER duration than barbituarates

32
Q

How can you reverse the postop respiratory depression effects of Midazolam?

A

Flumazenil

33
Q

What are the effects of Ketamine?

A
  1. Analgesia
  2. Amnesia
  3. Catatonia
  4. NOT unconscious
  5. CV Stimulation!
34
Q

Ketamine toxicities?

A

Increased ICP

35
Q

Is Ketamine long or short acting?

A

Long acting

36
Q

List the IV opioids used

A
  1. Fentanyl
  2. Alfentanil
  3. Remifentanil
  4. Morphine
37
Q

How do you reverse the respiratory depression effects of opioids?

A

Naloxone=Narcan

38
Q

List the IV Phenols

A
  1. Propofol

2. Fospropofol

39
Q

Phenols effects

A
  1. Vasodilation
  2. Hypotension
  3. Negative Inortopy= CV depression d/t decreased cardiac muscle contraction

Pharm II-Exam 3 (4 decks)

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