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Drug Cards > Non Depolarizing NMBs > Flashcards

Non Depolarizing NMBs Flashcards

1
Q

What are the chemical properties of NDMBs?

A

Quaternary ammonium

-steroid derivatives or benzylisoquinolines

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2
Q

Tell me about the Benzylisoquinolines? Which ones are they? What is different about their metabolism?

A

Mivacurium, Cisatracurium, Atracurium

  • WATER SOLUBLE
  • inhibits uptake into hepatocytes leads to lack of liver eliminaton
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3
Q

What is the principle route of elimination of the NDMBs?

A

URINARY

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4
Q

Which NDMBs have biliary excretion in addition to renal?

A

Vecuronium

Rocuronium

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5
Q

How is Atracurium metabolized? Cisatracurium? Mivacurium?

A

Atracurium:2/3 nonspecific ester hydrolysis and 1/3 Hoffman elimination
Cisatracurium: Hoffman elimination
Mivacurium: plasma cholinesterase

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6
Q

Which NDMBs cause histamine release?

A

Mivacurium
Atracurium
D-tubo

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7
Q

Which NDMBs can cause tachycardia?

A

Mivacurium
Atracurium
D-tubo (reflex tachy)
Panuronium

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8
Q

Which NDMBs can cause a drop in BP?

A

Mivacurium

D-tubo

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9
Q

Which NDMB can cause and increase in BP?

A

Pancuronium

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10
Q

Which drugs can prolong the NDMBs?

A

Antibiotics (aminoglycosides!, tetracycline, clindamycin, Cyclosporine)
Antidysrhythmics (procanamide, Quinidine)
Dantrolene
IAs
Ketamine
Locals
Magnesium sulfate
Ca Channel blockers/corticosteroids (atracurium)

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11
Q

What can alter your response to NDMBs?

A
  • hypothermia (prolongs block)
  • Acidosis (inhibits hoffman elimination)
  • Hypokalemia (prolongs effects)
  • Burns (3rd degree bursn >30% of body have resistance to NDMBs (40-60 days post injury
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12
Q

What is the intubating dose of Rocuronium?

A

0.6-1.2 mg/kg

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13
Q

What is the Onset of Roc?

A

60-90 sec (1-2 min)

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14
Q

What is the DOA of Roc?

A

30-90 min (15 - 85 min)

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15
Q

What is the e 1/2 Life of Roc?

A

60-120 min (87 min)

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16
Q

What is the maintenance dose of Roc?

A

0.1-0.2mg/kg

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17
Q

What patients should you avoid NDMBs?

A
  • myasthenia gravis

- Hemiparesis/hemiplegia (affected side shows resistance as compared to the unaffected side

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18
Q

What is the dose of Vecuronium?

A

0.08-0.1 mg/kg

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19
Q

What is the Maintenance dose of Vec?

A

0.01-0.015mg/kg q 25-45 min

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20
Q

What is the cont. infusion dose of Vec?

A

0.8-1.2 mcg/kg/min

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21
Q

What are the contraindications to NDMBs?

A
  • hypersensitivity

- Liver disease and renal disease are relative contraindications

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22
Q

Which patients should you use caution when using Pancuronium?

A
  • pts with underlying CV disease
  • hypokalemia, hypermagnesemia, severe hyponatremia, severe hypocalcemia potentiate blockade
  • hyperparathyroidism
  • geriatric pts
  • Burns
  • MG/ Myasthenic syndrome
  • impaired renal function
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23
Q

What is the intubating dose of Pancuronium?

A

0.1 mg/kg

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24
Q

What is the maintenance dose of Pancuronium?

A

0.01 - 0.02 mg/kg q 20-60min

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25
Q

What is a contraindication to giving the benzylquinolines?

A
  • Asthma

- atypical acetylcholinesterase

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26
Q

What is the dosage and onset of Mivacurium?

A

0.15 mg/kg and the onset is 2-3 minutes

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27
Q

What is the intubating dose of Cis-Atracurium?

A

0.1 5- 0.2 mg/kg IV

28
Q

What is the maintenance dose of Cis-atracurium?

A

0.02 mg/kg IV

29
Q

What is a major side effect of Cis-Atracurium and Mivacurium? When is this a concern?

A

Laudanosine production which can cause Seizures; may accumulate in Renal failure

30
Q

What is the onset of Cis-Atracurium?

A

3-5 min (2-3?)

31
Q

What is the e 1/2 life of Cis-atracurium?

A

22-30 minutes; prolonged in elderly due to increased Vd

32
Q

What is the DOA of cis-atracurium

A

return to TOF>0.9: 60-90 min

33
Q

What is the maintenance dose of Cis-atracurium

A

0.03 mg/kg q40-60 min

34
Q

What is the intubating dose of atracurium?

A

0.4-0.5 mg/kg

35
Q

What is the maintenance dose of atracurium?

A

0.08-0.1 mg/kg q 20-40 min

36
Q

What is the infusion rate of atracurium?

A

5-9 mcg/kg/min

37
Q

What is the intubating dose of Doxacurium?

A

0.05mg/kg (-0.08 mg/kg )

38
Q

What is the DOA of Doxacurium?

A

100-160 min

39
Q

What is the maintenance dose of Doxacurium?

A

0.005-0.01 mg/kg for 30-45 min

40
Q

Which NDMBs are short acting?

A

Mivacurium
Rocuronium
Rapacuronium

41
Q

What is the infusion rate for Rocuronium?

A

0.01-0.012 mg/kg/min

42
Q

What are the intermediate acting NDMBs?

A

Atracurium
Cisatracurium
Pancuronium
Vecuronium

43
Q

What are the long acting NDMBs?

A

Doxacurium
Pipecuronium
Tubocurarine

44
Q

What is the trade name for atracurium

45
Q

What is the trade name for mivacurium?

46
Q

What is the trade name for Rocuronium?

47
Q

What is the trade name for Cisatracurium?

48
Q

What is the trade name for Vecuronium?

49
Q

What is the trade name for doxacurium?

50
Q

What is the trade name for Pipecuronium?

51
Q

What is the onset of Vecuronium?

A

2-3 minutes

52
Q

What is the DOA of Vecuronium?

53
Q

What is the e 1/2 t of Vec?

A

50-110 min

54
Q

What is the onset of Pancuronium?

55
Q

What is the DOA of Pancuronium?

56
Q

What is the e 1/2 t of Pancuronium?

57
Q

What is the onset of Doxacurium?

A

6 min (2.5-13)

58
Q

What is the e 1/2 t of Doxacurium?

59
Q

What is the onset of Pipecuronium?

60
Q

What is the DOA of Pipecuronium?

A

75 min (35 -175)

61
Q

What is the onset of Tubocurarine?

62
Q

What is the DOA of tubocurarine?

63
Q

What is the DOA of cisatracurium?

64
Q

What is the e 1/2t of atracurium?

65
Q

What is the onset of atracurium?

A

2.5-5 min (1-3 from drug card)

66
Q

What is the DOA of atracurium?

67
Q

What is a contraindication to giving Cisatracurium and Atracurium?

A

Seizures
Asthmatics
increased sensitivty to MG or eaton-lambert

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