NMB part two Flashcards
what dose for roc if you want it to work quick?
1-1.2 mg/kg
Out of vec, roc, and cis, which has the least cumulative effects?
cis
Supposedly, why does roc work faster?
“lack of potency”
since it is less potent than vec or cis, we inject 5x the dose / molecules (0.6-1.2 mg/kg) therefore more receptors are blocked faster due to greater number of roc molecules
tell me about a “priming dose”
give 10% of the ED95 about 4 minutes before the main dose to speed onset, the priming dose will occupy the spare receptors leaving the main dose to get right to work
not really applicable for roc
vec drug class, concentration, onset, duration
monoquaternary aminosteroid
0.1 mg/kg
3-5 minute onset
20-35 minute duration
“pancuronium minus the quaternary methyl group in the A-ring of the steroid nucleus”
vec metabolites and potency
3-desacetyl vec, 50% potent
3,17-desacetyl vec, less than 10% potent
since vec undergoes __ metabolism and __ excretion, if your patient doesn’t have those organs it’s probably not the best choice
hepatic metabolism
renal excretion
tell me about hypoventilation enhancing vec postop, or why you should always reverse your patients
let’s say you don’t reverse the vec, take the patient to the pacu where they get snowed with morphine and hypoventilate, become acidotic and re-paralyze
does vec has cardiovascular effects?
is vec a good choice for infusion?
no cv effects
not a good choice for infusion due to large Vd and cumulative effects
Can vec cross the placental barrier?
nope
should you dose vec on actual or ideal body weight?
ideal
does vec alter intraocular pressure or trigger MH?
no and no
what is roc’s drug class, dose, onset, and duration?
monoquaternary aminosteroid- basically vec with a hydroxyl group instead of an acetyl group on the A-ring of the steroid nucleus
0.6-1.2 mg/kg
1-2 minutes onset
20-35 minutes duration
what is the only non-depolarizer that serves as an alternative to succs for rapid sequence?
roc
roc metabolism and excretion
50% excreted unchanged in bile
hepatic metabolism and renal excretion, so duration prolonged with ESRD and lived dsfxn
Cis drug class, dose, onset, duration, concentration
benzylisoquinolinium 0.1 mg/kg onset 3-5 minutes duration 20-35 min 2mg/ml concentration
Is cis good for constant infusion?
yes, rate of recovery not influenced by prolonged infusion
How is cis metabolized? Metabolites?
(Cari) Hoffman elimination (77%)
laudanosine and a monoquaternary acrylate
Succs onset, duration, dose
30-60 seconds onset
3-5 minutes duration
1-1.5 mg/kg for intubation
is succs degraded by acetylcholinesterase like ACH or by pseudocholinesterase?
pseudocholinesterase- slower hydrolysis than ACH by acetylcholinesterase = prolonged depolarization
