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SUMMER PHARM > NMB's > Flashcards

NMB's Flashcards

1
Q

_______________ is the only depolarizing block

A

Sch

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2
Q

How is Sch metabolized?

A

pseudocholinesterases

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3
Q

Non depolarizing agents are ______________

A

competitive inhibitors

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4
Q

What effect do non depolarizing blocks have on the channel?

A

NO direct effect

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5
Q

What is the reversal agent for Sch?

A

there is no reversal agent!

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6
Q

Where are pseudocholinesterases/ plasma cholinesterase’s found?

A

Liver and plasma

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7
Q

______________ NMB is c/i in Peds for ROUTINE cases. If it is given for Peds, give _____________ with it!!

A

Sch

atropine .02mg/kg

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8
Q

Why do we not give Sch to kids?

A

severe bradycardia and asystole reported

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9
Q

If you have to give a dose of Sch in Peds, don’t give _______________

A

a 2nd dose! higher incidence of bradycardia with 2nd dose

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10
Q

Sch looks like ______________

A

acetylcholine

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11
Q

________ is a potent MH triggering NMB

A

Sch

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12
Q

As far as labs go.. a major s/e of Sch is __________________

A

hyperkalemia

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13
Q

What does sch do to cns?

A

increase ICP, IOP

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14
Q

What does Sch do to muscles?

A

massetter spasm

fasciculations

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15
Q

A ______________ study is done to determined the genetic makeup of pseudocholinesterase activity before giving ____________

A

dibucaine

Sch

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16
Q

To block fasiculations with Sch, give __________ first. You will then need to _____ your dose of Sch.

A

nondepolarizer (defasiculating dose)

increase (to 1.5mg/kg)

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17
Q

A normal dibucaine # is between ____-____

A

70 - 80

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18
Q

The benzylisoquinolines are __________ soluble

A

water –DMCAT meds

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19
Q

The short acting NDMRs are: (3)

A

Mivacurium
Rocuronium
Rapacuronium

20
Q

The short acting NDMRs have an onset in ____-____ minutes and a DOA of ___________ minutes

21
Q

The intermediate acting NDMRs are: (4)

A

Vec
Atracurium
cisatracurium
-high dose Rocuronium

22
Q

What is the onset and DOA for intermediate acting NDMRs?

A

2- 2.5mins

30-60mins

23
Q

What is the onset and DOA for long acting NDMRs?

A

2-6mins

60-120mins

24
Q

All of the long acting NDMRs are excreted how?

25
Q

If you have a renal failure patient, avoid which highly used NDMR?

A

pancuronium or gall amine (or any long-acting d/t renal excretion)

26
Q

Hoffman degradation is dependent on what to factors?

A

pH and temperature

27
Q

Which 3 NDMRs are eliminated via Hoffman Elimination?

A

Cisatracurium
atracurium
mivcurium (maybe)

28
Q

What is the toxic metabolite produced by hoffman elimination? What does is cause?

A

laudanosine

seizures

29
Q

Which NDMR is 100% eliminated via Hoffman Degradation?

A

cisatracurium

30
Q

If your patient has a low dibucaine # you want to avoid ____________ & _____________

A

Sch

mivacurium

31
Q

Atracurium is eliminated how?

A

1/3 Hoffman Degradation and 2/3 nonspecific ester hydrolysis

32
Q

_____________ is a adequate alternative to Sch for RSI

A

Rocuronium

33
Q

What drugs effect the degree of muscle relaxation? What conditions?

A 
Cholinesterase inhibitors
Antihypertensives
Lithium
Inhalation agents
Ketamine
Antibiotics
Antidysrhythmics
LA's

Renal/hepatic failure

34
Q

Cholinesterase inhibitors will have what effect on NDMRs?

A

decrease effectiveness

35
Q

Cholinesterase inhibitors will have what effect on Depolarizing MRs (Sch)?

A

enhance it

36
Q

Hypothermia will do what to NDMR?

A

prolong it

37
Q

Acidosis will have what effect on NDMRs? Which ones?

A

Decrease pH will prolong action of cisatracurium and atracurium d/t the hoffman elimination in plasma

38
Q

What effect will hypokalemia have on NDMRs?

A

prolongs it.. be careful with diuretics

39
Q

What effect will burns have on NDMRs?

A

resistance to NDMRs - 3 degree burns by >30% for 60 days post injury

40
Q

Long actin gmuscle relaxants take ___-___ minutes for recovery

41
Q

Long acting muscle relaxants are best used for maintenance of anesthesia for greater than ______

42
Q

Intermediate acting relaxants are nice because of ________________

A

minimal circulatory effects ( vec & Roc)

43
Q

Sch can be run as a continuous drip mixed how? What dose?

A

1g in 500cc

2-4mg/min

44
Q

____________ is a good alternative to Sch to avoid myalgia but has a longer onset

A

mivacurium

45
Q

Use the priming principle to……?

A

To speed the onset of the NDMR

46
Q

The priming principle states to deliver ________ dose ______ minutes before induction

A

10% of induction dose

5

47
Q

The defasiculating dose of Vec is ______ and Roc is ________…. This is ___% of intubating dose of NDMR

A

.01mg/kg
.1mg/kg
10%

SUMMER PHARM (5 decks)

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