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Pharmacology > NMG, Reversal Agents, Antimuscarinic > Flashcards

NMG, Reversal Agents, Antimuscarinic Flashcards

1
Q

What are the mechanisms of action of NMBs?

A
  • depolarizing muscle relaxants act as ACh receptor agonists then antagonists
  • nondepolarizing muscle relaxants function as competitive antagonists
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2
Q

What are the 4 non-depolarizing, competitive muscle relaxants?

A

Pancuronium
Vecuronium
Atracurium
Rocuronium

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3
Q

What is phase I block of sux?

A

Depolarizing phase

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4
Q

What is phase II of Sux?

A

Desensitizing phase

-block converts from depolarizing to nondepolarizing block (occur with larger doses or prolonged infusion

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5
Q

What is surmountable antagonist?

A

Produce parallel rightward shifts of agonist dose–response curves with no alteration of the maximal response (can be overcome)

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6
Q

Is Sux susceptible to acetylcholinesterase?

A

NO

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7
Q

What are the 4 things that impact Sux duration of action?

A

Hypothermia
Low enzyme
Genetic
Clinical pearl

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8
Q

How to manage hyperkalemia for Sux?

A

Insulin + glucose to prevent hypoglycemia
Calcium gluconate to stabilize cardiac rhythm
Reduce K level with dialysis

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9
Q

When to NOT use Sux?

A 
Underlying NM disease
Risk of MH 
History of allergy to sux
Homozygous for atypical plasma cholinesterase 
High K concentration
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10
Q

Plasma cholinesterase metabolizes which ND agent?

A

Mivacurium

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11
Q

Nonezympatic metabolizes which NG agent?

A

Atracurium, cisatracurium

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12
Q

Hepatic metabolizes which NG agent?

A

Vecuronium

Rocuronium

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13
Q

Renal metabolizes which NG agent?

A

Pancuronium

Doxacurium

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14
Q

Which NG agent has an intermediate acting?

A

Atracurium
Rocuronium
Vecuronium

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15
Q

Which NG agent has long acting?

A

Pancuronium

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16
Q

Which NG agents cause histamine release?

A

Atracurium

Mivacurium

17
Q

Which NG agent have a vagal blockade?

A

Rocuronium

Pancuronium

18
Q

What does atracurium use for metabolite?

A

Laudanosine

19
Q

Key things about cisatracurium (5)

A 
Intermed onset and duration 
Does not affect histamine release 
Lacks HR and BP effects 
Laudanosine metabolite 
Sorted in refrigerator because loses potency at room temp
20
Q

Key things about pancuronium (5)

A 
Intermed onset and duration 
Metabolized by liver 
Elimination by kidney 
Stored in refrigerator, stable at room temp for 6months 
Hypertension and tachycardia
21
Q

Key things about vecuronium (3)

A

Intermed onset and duration
Stable BP and HR
Neonates

22
Q

Key things about rocuronium (4)

A

Faster (but longer than Sux) onset and intermed duration
No metabolism
Eliminated by liver and kidney
Less potent so requires bigger doses

23
Q

Monitoring of NM block?

A

Peripheral nerve stimulator

24
Q

When does single twitch stimulation completely disappear?

A

90-95% receptors occupied

25
Q

Train of four monitoring

A

1st 90-98% block
2nd 85-90% block
3rd 80-85% block
4th 75% block

26
Q

Recovery TOF ratio:

A

.9

27
Q

How does cholinesterase inhibitors work?

A

Increase ACh activity by increasing duration of time present to act at receptors

28
Q

What are the 3 types of AChE inhibitors?

A 
Reversible 
1 alcohol structure - edrophonium
2 carbamic acid esters (carbamates) - Neostigmine 
Irreversible 
3 organophosphates
29
Q

Mechanism for both AChE inhibitors?

A

Non depolarizing, competitive

Compete with Ach to bind with nicotinic receptor of motor end plate

30
Q

Neostigmine onset and duration

A

5 - 10 min

1 hour

31
Q

Pyridostigmine onset and duration

A

10-15min

>2hrs

32
Q

Edrophonium onset and duration

A

1-2min

1hr or less

33
Q

Mechanism of action for Sugammadex

A

Encapsulates or chelates the free molecule form of rocuronium (maybe vecuronium) to make soluble in plasma

34
Q

Sugammadex metabolism and elimination

A

No metabolites and really eliminated

35
Q

How long do you have to wait to redose Sugammadex with rocuronium and vecuronium?

A

24hrs

36
Q

What kind of effect does anti muscarinic have on body?

A

Inhibit Parasympathetic nervous system

37
Q

What is atropine onset and duration?

A

Faster onset

Shorter duration

38
Q

What is glycopyrrolate onset and duration?

A

Slower onset

Longer duration

Pharmacology (14 decks)

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