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Pharmacology > NMB, Reversal agents, antimuscarinic PPT > Flashcards

NMB, Reversal agents, antimuscarinic PPT Flashcards

1
Q

what kind of receptors are at the NMJ?

A

post synaptic nicotinic receptors

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2
Q

type of receptor found on PRESYNAPTIC membrane

A

alpha 3

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3
Q

how much do you need to get an initial action potential

A

10%

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4
Q

how much to produce fade? (percentage)

A

75%

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5
Q

how do you prolong the effects of succinylcholine? (3)

A
  1. high dose
  2. continuous infusion
  3. reduced rate of metabolism
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6
Q

how is succinlycholine metabolized?

A

by pseudocholinesterase

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7
Q

Factors that may impact duration of action of succinylcholine (4)

A
  1. hypothermia
  2. low enzyme- pseudocholinesterase
  3. genetic
  4. clinical pearl
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8
Q

things that inhibit pseudocholinesterase activity (9)

A
  1. echothiophate
  2. neostigmine, pyridostigmine
  3. phenelzine
  4. cyclophosphamide
  5. metoclopramide
  6. esmolol
  7. pancuronium
  8. oral contraceptives
  9. dibucaine
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9
Q

usual adult dose for intubation of succinylcholine

A

1-1.5 mg/kg IV

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10
Q

Will neonates have a lower or higher ECF/volume of distribution wt based dose?

A

higher/larger

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11
Q

when would you see a cardiovascular effect with sux in adults?

A

when you give SECOND dose of sux

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12
Q

how do you prevent fasciculations from sux?

A

pretreatment with small dose nondepolarizing agent

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13
Q

sux can increase serum potassium by how much ?

A

0.5 mEq/L

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14
Q

short term effect on hyperkalemia management

A

insulin (drives K+ intracellular) + glucose to prevent hypoglycemia

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15
Q

if someone has high enough K+ extracellularly it can lead to ___

A

cardiac arrest

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16
Q

describe the 4 things that happen when there is denervation injury.

A
  1. immature isoform (epsilon subunit)
  2. more receptors spread out (extrajunctional receptors)
  3. widespread depolarization and extensive K release
  4. Risk peak 7-10 days after injury (minimal after 2 days)
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17
Q

Sux adverse effects (10)

A
  1. ) bradycardia
  2. AV node arrhythmia
  3. ventricular arrhythmia
  4. increased pressure: IC, IO, IG
  5. hyperkalemia
  6. myalgia
  7. masseter spasm
  8. malignant hyperthermia
  9. precurarization
  10. allergic rxns
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18
Q

When should you NOT use sux? (6)

A
  1. underlying neuromuscular disease
  2. risk of MH
  3. hx of ax to sux
  4. homozygous for atypical plasma cholinesterase
  5. [K+] > 5.5 mEq/L
  6. after 2-3 days; denervation, immobilization, burns
19
Q

how can you quicken the effect of NONDEPOLARIZING NMB?

A

larger dose

20
Q

True/False: potency leads to a faster onset

A

FALSE; potency =slower onset; smaller dose

21
Q

how to enhance nondepolarizing NMB?

A

increase dose, risk AE’s and prolonged duration of action

22
Q

a repeated dose of nondepolarizing NMB would rely on ___

A

elimination

23
Q

which nondepolarizing nmb is metabolized by plasma cholinesterase?

A

mivacurium

24
Q

Which nondepolarizing drugs are eliminated renally?

A

pancuronium and doxacurium

25
Q

drugs that are intermediate acting

A
  1. atracurium
  2. rocuronium
  3. vecuronium
26
Q

short acting duration of action nondepolarizing nmb

A

mivacurium

27
Q

long acting duration of action nondepolarizing nmb

A

pancuronium

28
Q

how much (percentage) of the initial dose do you need to prevent fasciculations with sux?

A

10-15% of dose

29
Q

what agents are likely to cause a histamine release?

A

atracurium

30
Q

which drug is more likely to cause a vagal blockade?

A

rocuronium and pancuronium (panc ++)

31
Q

Factors that prolong Nondepolarizing NMB agent (4)

A
  1. hypothermia
  2. respiratory acidosis could potentiate blockade and antagonize reversal agent effects
  3. electrolytes (hypo kalemia and calcemia augment ND block) ; hypermagnesemia potentiates ND block
  4. ) age (bigger dose due to increased ECF?)
32
Q

which drug does NOT effect histamine release?

A

cisatracurium

33
Q

offset speed to recover from 25% to 75% twitch ht

A

recovery index

34
Q

percentage for full block of neurotransmission

A

95%

35
Q

complications for someone with a residual block (2)

A

1.) hypoventilation 2.) aspiration

monitor duration of reversal agent vs. NMB

36
Q

reduction of evoked response indicative of ND block

A

fade

37
Q

when does a single twitch stimulation disappear?

A

when 90-95% receptors are occupied by neuromuscular blocker

38
Q

determined by response to peripheral nerve stimulation

A

NMB reversal (sugammadex, neostigmine)

39
Q

Factors that affect dose and response for NM reversal (5)

A
  1. shorter acting; faster onset vs. longer acting
  2. larger doses vs. smaller doses
  3. duration of action of NMB
  4. clearance
  5. faster reversal- fewer complications
40
Q

fastest onset and shortest duration of action NM reversal and less muscarinic effect

A

edrophonium

41
Q

selective for aminosteroid non depolarizing relaxants

A

sugammadex

42
Q

dose for sugammadex for routine deep block

A

4 mg/kg

43
Q

what can happen to sugammadex if under dosed?

A

may wear off before NM blocker is completely cleared

Pharmacology (11 decks)

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