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Pharm 2 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Post operative delirium is associated with ? because it is a ?

A

atropine; tertiary amine (crosses BBB)

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2
Q

What NMBs are reliant on Hoffman elimination?

A

cisatracurium and atracurium

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3
Q

What is Hoffman elimination sensitive to?

A

temperature and pH

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4
Q

What do cholinesterase inhibitors do?

A

increase amount of ACh in the NMJ by inhibiting cholinesterase (which breaks down ACh)

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5
Q

What are other names for pseudocholinesterase?

A

nonspecific cholinesterase, plasma cholinesterase, butyrylcholinesterase

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6
Q

How are nondepolarizers reversed?

A

redistribution, metabolism excretion, or administration of reversal agents (cholinesterase inhibitors)

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7
Q

What can happen with high doses of cholinesterase inhibitors?

A

may potentiate NMB- causes ACh channel blockade

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8
Q

What conditions can prolong the DoA of cholinesterase inhibitors?

A

hepatic and renal disease

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9
Q

What are side effects of cholinesterase inhibitors?

A

muscarinic stimulation by ACh- bradycardia, asystole, AV blocks, bronchospasm, salivation, bladder spasm, GI hypermotility, N/V, stool incontinence, CNS excitation/sz

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10
Q

Dose of neostigmine?

A

0.025-0.075 mg/kg (max 5 mg)

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11
Q

What is the matched anticholinergic for neostigmine?

A

glyco

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12
Q

What has neostigmine been reported to do?

A

crossed placenta resulting in fetal bradycardia (consider Atropine when reversing pregnant patient)

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13
Q

What is the dose of edrophonium?

A

0.5-1 mg/kg

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14
Q

What is the matched anticholinergic for edrophonium?

A

atropine

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15
Q

Which NMB reversal agent has less pronounced muscarinic effects so it requires less anticholinergic?

A

edrophonium

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16
Q

What is the dose of pyridostigmine?

A

0.1-0.3 mg/kg (max 20 mg)

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17
Q

What is the matched anticholinergic agent for pyridostigmine?

A

glyco

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18
Q

What is the dose of physostigmine?

A

0.01-0.03 mg/kg

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19
Q

What is the only tertiary amine that crosses the BBB?

A

physostigmine

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20
Q

Which agent is not useful for NMB reversal but is often used for central anticholinergic toxicity?

A

physostigmine

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21
Q

What can physostigmine be used for?

A

reverse CNS depression from benzos, post op shivering, morphine induced respiratory depression

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22
Q

Is an anticholinergic usually needed for physostigmine?

A

no

23
Q

What is the dose of glyco per mg of neostigmine?

A

0.2 mg

24
Q

What is the dose of glyco per mg of pyridostigmine?

A

0.05 mg

25
Q

What is the dose of atropine per mg of edrophonium?

A

0.014 mg

26
Q

What is the MoA of anticholinergics (antimuscarinics)?

A

bind reversibly with muscarinic ACh receptor to competitively inhibit activation by ACh

27
Q

What are the cardiovascular effects of antimuscarinics?

A

tachycardia, shorten PR, junctional rhythms, reduce AV blocks

28
Q

What are the respiratory effects of antimuscarinics?

A

inhibits secretions, smooth muscle relaxation, increased anatomical dead space

29
Q

What are the CNS effects of antimuscarinics?

A

either depression or stimulation, depending on whether or not they cross BBB

30
Q

What are the GI effects of antimuscarinics?

A

reduced secretions and motility, LES tone reduced

31
Q

What are the opthalmic effects of antimuscarinics?

A

mydriasis, cycloplegia (inability to accommodate near vision)

32
Q

What are the GU effects of antimuscarinics?

A

decreased bladder tone, urinary retention

33
Q

What are the thermoregulatory effects of antimuscarinics?

A

inhibition of sweat glands may lead to rise in body temp (atropine fever)

34
Q

What is atropine and does it cross the BBB?

A

tertiary amine- yes

35
Q

What is the dose of atropine?

A

0.02 mg/kg (peds)
0.04 mg/kg (adults)
2 mg IVP for severe vagal blockade

36
Q

What population should you use caution with when using atropine?

A

narrow angle glaucoma

37
Q

What is scopolamine and does it cross the BBB?

A

tertiary amine- yes

38
Q

What is the dose of scopolamine?

A

1.5 mg transdermal

39
Q

Describe how to use scopolamine for PONV

A

patch 4 hrs pre-op and maintain for 72 hours

40
Q

What can scopolamine be used for in a trauma patient?

A

amnesia

41
Q

What is glyco?

A

quaternary ammonium

42
Q

What is the dose of glyco?

A

0.005-0.01 mg/kg IV

43
Q

Rate the antimuscarinics from most to least in terms of causing tachycardia

A

atropine>glyco>scopolamine

44
Q

Rate the antimuscarinics from most to least in terms of causing bronchodilation

A

atropine & glyco> scopolamine

45
Q

Rate the antimuscarinics from most to least in terms of causing sedation

A

scopolamine> atropine> glyco (none)

46
Q

Rate the antimuscarinics from most to least in terms of its antisalagogue effects

A

glyco & scopolamine > atropine

47
Q

What is the primary NT of the somatic nervous system and what are its effector organs?

A

ACh; skeletal muscle

48
Q

Where is ACh in the ANS?

A

Preganglionic in the SNS; pre and postganglionic in the PNS

49
Q

What are the effector organs of the ANS?

A

smooth muscle, glands, cardiac muscle

50
Q

Where is NE and epi in the ANS?

A

postganglionic in the SNS (epi specifically released from medulla)

51
Q

Where are nicotinic receptors found?

A

somatic nervous system on skeletal muscles, preganglionic SNS & PNS, adrenal medulla

52
Q

Where are muscarinic receptors found?

A

sweat glands, heart (nodes, Purkinje, AV), muscles of the eye, salivary glands, GI tract (sphincters, secretions, gallbladder and ducts), urinary detrusor and sphincter

53
Q

Which NMB is the #1 cause of intraop allergic reactions?

A

rocuronium (succs is also common)

54
Q

Which NMBs release histamine?

A

benzylisoquinoines (-curium)

Pharm 2 (7 decks)

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