Quiz 4 Flashcards
Post operative delirium is associated with ? because it is a ?
atropine; tertiary amine (crosses BBB)
What NMBs are reliant on Hoffman elimination?
cisatracurium and atracurium
What is Hoffman elimination sensitive to?
temperature and pH
What do cholinesterase inhibitors do?
increase amount of ACh in the NMJ by inhibiting cholinesterase (which breaks down ACh)
What are other names for pseudocholinesterase?
nonspecific cholinesterase, plasma cholinesterase, butyrylcholinesterase
How are nondepolarizers reversed?
redistribution, metabolism excretion, or administration of reversal agents (cholinesterase inhibitors)
What can happen with high doses of cholinesterase inhibitors?
may potentiate NMB- causes ACh channel blockade
What conditions can prolong the DoA of cholinesterase inhibitors?
hepatic and renal disease
What are side effects of cholinesterase inhibitors?
muscarinic stimulation by ACh- bradycardia, asystole, AV blocks, bronchospasm, salivation, bladder spasm, GI hypermotility, N/V, stool incontinence, CNS excitation/sz
Dose of neostigmine?
0.025-0.075 mg/kg (max 5 mg)
What is the matched anticholinergic for neostigmine?
glyco
What has neostigmine been reported to do?
crossed placenta resulting in fetal bradycardia (consider Atropine when reversing pregnant patient)
What is the dose of edrophonium?
0.5-1 mg/kg
What is the matched anticholinergic for edrophonium?
atropine
Which NMB reversal agent has less pronounced muscarinic effects so it requires less anticholinergic?
edrophonium
What is the dose of pyridostigmine?
0.1-0.3 mg/kg (max 20 mg)
What is the matched anticholinergic agent for pyridostigmine?
glyco
What is the dose of physostigmine?
0.01-0.03 mg/kg
What is the only tertiary amine that crosses the BBB?
physostigmine
Which agent is not useful for NMB reversal but is often used for central anticholinergic toxicity?
physostigmine
What can physostigmine be used for?
reverse CNS depression from benzos, post op shivering, morphine induced respiratory depression
Is an anticholinergic usually needed for physostigmine?
no
What is the dose of glyco per mg of neostigmine?
0.2 mg
What is the dose of glyco per mg of pyridostigmine?
0.05 mg
What is the dose of atropine per mg of edrophonium?
0.014 mg
What is the MoA of anticholinergics (antimuscarinics)?
bind reversibly with muscarinic ACh receptor to competitively inhibit activation by ACh
What are the cardiovascular effects of antimuscarinics?
tachycardia, shorten PR, junctional rhythms, reduce AV blocks
What are the respiratory effects of antimuscarinics?
inhibits secretions, smooth muscle relaxation, increased anatomical dead space
What are the CNS effects of antimuscarinics?
either depression or stimulation, depending on whether or not they cross BBB
What are the GI effects of antimuscarinics?
reduced secretions and motility, LES tone reduced
What are the opthalmic effects of antimuscarinics?
mydriasis, cycloplegia (inability to accommodate near vision)
What are the GU effects of antimuscarinics?
decreased bladder tone, urinary retention
What are the thermoregulatory effects of antimuscarinics?
inhibition of sweat glands may lead to rise in body temp (atropine fever)
What is atropine and does it cross the BBB?
tertiary amine- yes
What is the dose of atropine?
0.02 mg/kg (peds)
0.04 mg/kg (adults)
2 mg IVP for severe vagal blockade
What population should you use caution with when using atropine?
narrow angle glaucoma
What is scopolamine and does it cross the BBB?
tertiary amine- yes
What is the dose of scopolamine?
1.5 mg transdermal
Describe how to use scopolamine for PONV
patch 4 hrs pre-op and maintain for 72 hours
What can scopolamine be used for in a trauma patient?
amnesia
What is glyco?
quaternary ammonium
What is the dose of glyco?
0.005-0.01 mg/kg IV
Rate the antimuscarinics from most to least in terms of causing tachycardia
atropine>glyco>scopolamine
Rate the antimuscarinics from most to least in terms of causing bronchodilation
atropine & glyco> scopolamine
Rate the antimuscarinics from most to least in terms of causing sedation
scopolamine> atropine> glyco (none)
Rate the antimuscarinics from most to least in terms of its antisalagogue effects
glyco & scopolamine > atropine
What is the primary NT of the somatic nervous system and what are its effector organs?
ACh; skeletal muscle
Where is ACh in the ANS?
Preganglionic in the SNS; pre and postganglionic in the PNS
What are the effector organs of the ANS?
smooth muscle, glands, cardiac muscle
Where is NE and epi in the ANS?
postganglionic in the SNS (epi specifically released from medulla)
Where are nicotinic receptors found?
somatic nervous system on skeletal muscles, preganglionic SNS & PNS, adrenal medulla
Where are muscarinic receptors found?
sweat glands, heart (nodes, Purkinje, AV), muscles of the eye, salivary glands, GI tract (sphincters, secretions, gallbladder and ducts), urinary detrusor and sphincter
Which NMB is the #1 cause of intraop allergic reactions?
rocuronium (succs is also common)
Which NMBs release histamine?
benzylisoquinoines (-curium)
