NMBAs pt II Flashcards
Rocuronium dose
0.6 mg/kg
MIvacurium dose
0.15 mg/kg
With the exception of Roc and Mivacurium the intubating dose for all other Non-depolarizing NMBAs is:
0.1mg/kg
What dose of Roc will mimic the onset time of succinylcholine
1.2mg/kg
Which non-depolarizing NMBA causes tachycardia, increased release of NE and increased CO
Pancuronium
Insert increases or decreases:
Hypokalemia __________ sensitivity to non-depolarizing NMBAs and __________ sensitivity to succinylcholine
increases;decreases
Insert increases or decreases:
HYPERkalemia ________ sensitivity to non-depolarizing NMBAs and __________ sensitivity to succinylcholine
decreases; increases
Which NMBA is known to potentially cause malignant hyperthermia?
succ
Which NMBA can cause histamine release (when given at a 3x dose/ rapidly)
Mivacurium
Which Non-depolarizing NMBA can cause bronchospasm?
Mivacurium
Which NMBA can cause dysrhythmias? Name the two specific rhythms mentioned in lecture
Succ; Sinus brady or sinus arrest
Vecuronium’s duration of action will be prolonged if it is given (before or after) acidosis occurs.
before
(if body is already acidotic it should theoretically per lecture have compensated to some degree)
Which Non-depolarizing NMBA is broken down via hoffman elimination?
Cisatricurium
Succ dose
1mg/kg
Succ dose for a MG pt
1.5-2mg/kg
How many sites does succinylcholine have to bind to on an n-ACh receptor? What about non-depolarizing agents?
1 for succ; 2 site non-depolarizing
What drugs may alter (prolong) the duration of some non-depolarizing agents? How?
Diuretics; corticosteroids; Metoclopramide; local anesthetics.
*MOA: Decrease cholinesterase activity / decrease ACh
A patient is on an esmolol infusion prior to their catheter ablation. What might the CRNA expect in regard to their Rocuronium during induction?
delayed onset
A patient had a dose of ephedrine in pre-op. What might the CRNA expect in regard to rocuronium during induction?
Increased onset
In the hypothermic patient the duration of vec/ pancuronium will be (prolonged/decreased)
prolonged (doubled)
What is the burn dose for Roc? How many days post-burn does it take before the dose adjustment is required? What is the suspected MOA ?
1.2 mg/kg
10 days
altered affinity of n-ACh receptors
a patient with a stroke history and right sided hemiplegia is given a dose of rocuronium. Which upper extremity would you expect to be more resistant?
RUE (due to increased amt of extra junctional n-ACh receptors)
Women need ____ % less Vec and ______ % less Roc
22% and 30%
What are the aminosteroid non-depolarizing NMBAs?
Pancuronium Vecuronium Rocuronium
Which non- depolarizing NMBA is broken down by plasma cholinesterase?
Mivacurium
Pancuronium duration of action
60-90 minutes
Vecuronium, Roc and cisatricurium duration of action
20-35 minutes
Atricurium duration of action
12-20 minutes
succinylcholine duration of action
3-5 minutes
Succinylcholine onset
30-60 sec
All of the non-depolarizing agents have an onset of 3-5 minutes with one exception. Which one is the exception and what is it’s onset?
Mivacurium; 2-3 minutes
A patient is on a non-depolarizing gtt in the ICU for several days. The patient has been off the gtt for several hours with no signs of movement or spontaneous respirations. Which drug is known to build up with prolonged infusion d/t its active metabolite?
Vecuronium (50-80% active metabolite)
