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Pharm 1 > Nondepolarizing NMB > Flashcards

Nondepolarizing NMB Flashcards

1
Q

what is NMB structurally similar to?

A

Ach

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2
Q

NMB have one or two quaternary ________

A

nitrogens

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3
Q

are NMB polar? ionized?

A

YES

they are also water-soluble

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4
Q

d-Tubocurarine (Curare)

A

Benzylisoquinoline Class

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5
Q

______curonium, what class?

A

Steroidal Class

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6
Q

______curium, what class?

A

Benzylisoquinoline Class

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7
Q

mechanism of action of NMB nondepolarizers:

C______e with Ach to bind with the alpha subunits on the postjunctional AChR and, thus, p_______t the ion channel from opening and p_______t the muscle cell membrane from depolarizing.

A

Compete, prevent, prevent

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8
Q

does nondepolarizing NMB have decreased twitch response to a single stimulus

A

yes

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9
Q

does nondepolarizing NMB have fade with tetanus, TOF

A

yes

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10
Q

does nondepolarizing NMB have posttetanic potentiation (increase in strength)

A

yes

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11
Q

is nondepolarizing NMB enhanced by other nondepolarizing NMBs

A

yes

example: roc for rapid sequence, then nimbex for a drip

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12
Q

nondepolarizing NMB are antagonized by ______cholinesterase drugs

A

ANTIcholinesterases

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13
Q

is decreased strength correlated with decreased release of Ach

A

yes

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14
Q

what type of drug is neostigmine

A

anticholinesterase

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15
Q

determinants of NMB selection

A

agent/drug related, patient related, cost, clinical site, pharmacists

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16
Q

The less potent the drug (the ______ the ED95), the more ______ the onset.**

A

The less potent the drug
the higher/greater number the ED95
the more rapid the onset

more molecules/drug must be given per dose, resulting in more molecules reaching the NMJ to cause more rapid creation of the blockade

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17
Q

determined by measuring the dose needed to produce 95% suppression of the single-twitch response

A

ED95

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18
Q

what has the fastest onset time

A

succs (depolarizer though!)

rocuronium

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19
Q

what has the slowest onset time

A

cisatracurium

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20
Q

what is least potent

A

rocuronium

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21
Q

when is the priming principle utilized

A

To facilitate rapid intubating conditions

22
Q

how small of a dose is given in the priming principle

A

1/10th the intubating dose
OR
1/3 the ED95

23
Q

To facilitate rapid intubating conditions with nondepolarizing agents, a small dose (1/10th the intubating dose or 1/3 the ED95) of the NMB is given prior to the induction to allow some receptors to be occupied and minimize the time required for the remaining receptors to be blocked by remainder of the intubating dose

A

priming principle

24
Q

Example: Pancuronium
Priming dose: 0.01 mg/kg (0.7 mg/70 kg) +
Usual intubating dose: 0.1 mg/kg (7 mg/70 kg)
Remaining dose 6.3 mg/70 kg

A

priming principle

does NOT work for Sch

25
Q

what is the disadvantage to simply increasing the dose of the NMB to speed onset?

A

increases side effects
AND
prolongs duration

26
Q

when is it a good idea to use an increased dose of NMB?

A

long cases (such as 5 hrs)

27
Q

what is the short-acting NMB

A

mivacurium (mivacrap haha)

28
Q

what are the 4 intermediate acting NMBs

A

Cisatracurium (Nimbex)
Atracurium (Tracrium)
Rocuronium (Zemuron)
Vecuronium (Norcuron)

“CARV”

29
Q

what are the 3 long-acting NMBs

A

Pancuronium (Pavulon)
Pipecuronium (Arduan)
Doxacurium (Nuromax)
d-Tubocurarine (Curare)

“PPDD”

30
Q

when a drug diffuses away from a receptor
but it is NOT eliminated yet*

A

Termination of action

31
Q

what type of clearance/metabolism has the longest duration (>60 min)

A

kidneys/nephro

these drugs are typically longer-acting

32
Q

what type of clearance/metabolism has the shortest duration

A

liver/hepatic

these drugs are typically shorter-acting

33
Q

what family is usually metabolized by the liver

A

steroid family

34
Q

what NMB is hofmann elimination + plasma esterases

laudanosine (metabolite that causes seizures in animals)

histamine

A

atracurium

35
Q

what NMB is eliminated by plasma CHOLINesterase

A

mivacurium

36
Q

what NMB is by MOSTLY Hofmann elimination

A

Cistacurium

37
Q

what drug:
Amazon jungle
MASSIVE histamine release

A

d-Tubocurarine (Curare)

38
Q

what drug:
is the most commonly used long-acting NMB

A

Pancuronium (Pavulon)

39
Q

Long acting, neurosurgery is target?

A

Doxacurium (Neuromax)

40
Q

what does histamine release do?

A

think WORST case scenario, decrease SVR, decrease BP, increase HR, bronchoconstriction

41
Q

________________ metabolizes acetylcholinesterase

A

ANTIcholinesterases (this leads to increased Ach)

42
Q

ACETYLcholinesterase leads to ___________ Ach

A

decreased Ach

43
Q

less potent the drug = the more _______ the onset

A

more rapid! less potent!

44
Q

fastest to slowest onset for NMBs

A

(SCh) > Rocuronium > Atracurium, Vecuronium, Mivacurium > Nimbex

45
Q

causes anaphylacTOID (similar to histamine)

A

rocuronium

46
Q

what drug is NOT used for difficult airway
but IS used for RSI

A

rocuronium

47
Q

histamine NMBs (3)

A

mivacrap
atracurium
curare

48
Q

what drug to be careful with atypical plasma cholinesterase patients

A

mivacrap

49
Q

what drug is good for organ dysfunction patients

A

nimbex

50
Q

inhibits histamine-N-methyl transferase (similar to histamine)

powder form

A

vecuronium

51
Q

what drug causes a release of norepi and prevents its uptake back into nerve ending*

A

pancuronium

Pharm 1 (9 decks)

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