Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology 680 > Nondepolarizing NMB > Flashcards

Nondepolarizing NMB Flashcards

1
Q

Structurally similar to ACh with one or two quaternary nitrogens

  • high polar, highly ionized (H2O soluble)
  • cannot cross lipid barries (no CNS effects, no placental cross, poor oral absorption)
A

chemical characteristics of nondepolarizing NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • d-tubocurarine (curare)
  • astracurium (tracrium)
  • cisatracurium (nimbex)
  • doxacurium (nuromax)
  • mivacurium (mivacron)
A

benzylisoquinoline class NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • pancuronium (pavulon)
  • vecuronium (norcuron)
  • pipecuronium (arduan)
  • rocuronium (zemuron)
  • rapacuronium (raplon)
A

steroidal class NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NMB that end with “urium”

-except for one that ends with urarine

A

benzylisoquinoline class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NMB that end with ronium

A

steroidal class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

competes with ACh to bind with alpha subunits on the postjunctional AChReceptor, which, prevents the ion channel from opening…which prevents depolarization (no muscle movement)

A

MOA of nondepolarizing NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • small, rapidly contracting muscles (eye, fingers, toes)
  • long muscles (adductor pollicis, intercostals)
  • diaphragm *first to recover
A

sequence of relaxation after dose of NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • decreased twitch response to single stimulus
  • fade with tetanus, TOF
  • enhanced by other nondepolarizing NMB
  • antagonized by anticholinesterase drugs
A

characteristics of nondepolarizing NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • onset
  • duration
  • side effects
  • metabolism
A

agent related determinants of NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • co-existing diseases (renal, hepatic, cardiac, neurom)
  • current medical therapy
  • surgical procedure
A

patient related determinants of NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cost

A

determinants of NMB selection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The less potent the drug, the ____ the ED95, and the more ____ onset

A

higher, rapid

more molecules must be given per dose, resulting in more molecules reaching the NMJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What drug is the least potent and has the highest ED95

A

rocuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

facilitates rapid intubating conditions by giving a small dose (1/10 intubating dose or 1/3 ED95) of the NMB prior to induction which allows some receptors to be occupied and minimizes the time required for the remaining receptors to be blocked by intubating dose

A

priming principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What happens when you increase dose of NMB?

A

speed up onset, increase side effects, and prolong duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the one short acting nondepolarizing NMB?

A

mivacurium (mivacron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  • astracurium (tracrium)
  • cisatracurium (nimbex)
  • vecuronium (norcuron)
  • rocuronium (zemeron)
A

intermediate acting nondep NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  • pancuronium (pavulon)
  • doxacurium (nuromax)
  • pipecuronium (arduan)
A

long acting nondep NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

if nondep excreted by kidneys, do they have longer half lives and duration or shorter?

A

longer half lives, longer duration (>60 mins)

20
Q

if nondep NMB excreted by liver, does that mean shorter half lives and duration or longer? and what family is this?

A

shorter half lives, shorter duration and steroid family

21
Q

how is atracurium eliminated

A

primarily by hofmann elimination and a bit hepatic

22
Q

how is mivacurium eliminated?

A

plasma cholinesterase

just like SCh, which is a depolarizing NMB

23
Q
  • naturally occurring benzylisoquinoline obtained from the plant chondodendrum tomentosum
  • horrific histamine release
  • LONG ACTING - eliminated renal and hepatic
A

d-tubocurarine (curare)

24
Q
  • ED95: 0.07 mg/kg (potent)
  • intubating: 0.1 mg/kg
  • onset: 3-5 mins
  • duration: 60-90 mins
  • elimination: renal and liver (10-40%)
A

pancuronium (pavulon)

25
Q
  • cards - vagolytic effect due to vagal blockade at cardiac muscarinic receptors and stimulation of sympathetic nervous system (norepi release)
  • increase HR, CO, BP, MAP (especially when AV conduction is altered, think afib)
A

pancuronium (pavulon) side effects

26
Q
  • ED95: 0.030 mg/kg
  • intubating: 0.05-0.08 mg/kg
  • onset: 4 to 6 mins
  • duration: 60 - 90 mins
  • elimination: mostly kidneys, some liver
A

doxacurium (nuromax)

27
Q
  • decreased renal/hepatic function causes prolonged duration
  • elderly have prolonged effect
  • indicated for long cases where extubation immediately post-op is not necessary, or for ventilated patients in the unit
  • NO CARDS EFFECT
A

doxacurium (nuromax)

28
Q
  • ED95: 0.050 mg/kg
  • intubating: 0.085 mg/kg
  • onset: 3-5 mins
  • duration 60 to 90 mins
  • elimination: renal (unchanged)
A

pipecuronium (arduan)

29
Q
  • no cards effects
  • no histamine release
  • prolonged duration in renal failure
  • used for prolonged ventilation, cards stability, liver patients
A

pipecuronium (arduan)

30
Q

ED95: 0.05 mg/kg

intubating: .1 mg/kg
onset: 2.3 mins
duration: 45 to 60 mins
elimination: hepatic (40% in bile), urine

A

vecuronium (norcuron)

31
Q

metabolizes by deacetylation in the hepatocytes to two metabolites which have less than one-tenth of the NMB properties of drug

A

vecuronium (norcuron)

32
Q
  • more lipid soluble allowing greater passage into hepatocytes for clearance
  • do not give to infants (>duration)
  • rarely histamine release
  • no vagolytic effect
A

vecuronium (norcuron)

33
Q
  • ED95: 0.3 mg/kg
  • intubating: 0.6 mg/kg
  • onset: 1 to 2 mins
  • duration: 20 to 35 mins
  • elimination: unchanged in bile and urine
A

rocuronium (zemuron)

34
Q
  • priming dose no impact
  • > duration in liver/kidney patients
  • no histamine release
  • anaphylactoid reactions
  • rapid sequence
  • NO DIFFICULT AIRWAYS
A

rocuronium (zemuron)

35
Q 
ED95: 0.2 mg/kg (not super potent)
Intubating: 0.5 mg/kg
onset: 2 to 3 mins
duration: 20-35 mins
elimination: hoffman elimination, plasma esterases
A

atracurium (tracrium)

36
Q
  • elimination independent of organ function
  • laudanosine (metabolite) causes seizures
  • histamine release (can be avoided by slow admin, h1/2 blockers)
  • increased HR
  • decreased MAP, SVR, flushing
A

atracurium (tracrium)

37
Q

ED95: 0.05 mg/kg

intubating: 0.2 mg/kg
onset: 2 to 3 mins
duration: 20 - 35 mins
elimination: hofmann elimination, no ester hydrolysis

A

cisatracurium (nimbex)

38
Q
  • elimination independent of organ function
  • good for infusions
  • minimal histamine release
  • minimal CV effects (really none)
  • indicated: organ failure, intermediate length case, the need to avoid histamine release, infusion
A

cisatracurium (nimbex)

39
Q

what two drugs are used for rapid sequence

A

SCh and rocuronium

40
Q

ED95: 0.08 mg/kg

intubating: 0.15 to 0.2 mg/kg
onset: 1.5 to 3 mins
duration: 12 to 20 mins
elimination: plasma cholinesterase (slower than SCh)

A

mivacurium (mivacron)

41
Q
  • good bigger peds pt
  • laryngeal muscles relax and recover quicker than long muscles
  • histamine release, avoid by dividing doses
  • CV effects at 3x ED95
  • neostigmine can slow recovery
  • use edrophonium
A

mivacurium (mivacron)

42
Q
  • will cause prolonged blockade in pts with atypical plasma cholinesterase
  • monitor oo
  • not organ dependent, > duration renal/liver
A

mivacurium (mivacron)

43
Q

vagolytic, tachycardia, htn, dysrhythmias, enhanced av conduction

A

pancuronium (pavulon)

44
Q

histamine release from mast cells causes hypotension and tachycardia

A

mivacurium (mivacron) atracurium (tracurium)

45
Q

doesn’t release histamine, may interfere with catabolism of it causing more to remain active (inhibits histamine-n-methyl-transferase)

A

vercuronium (norcuron)

Pharmacology 680 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions