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1. Top Drawer Meds > Succinylcholine > Flashcards

Succinylcholine Flashcards

1
Q

What is the brand/trade name for succinylcholine?

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2
Q

BONUS

Structurally, succinylcholine is composed of two ___________ molecules joined together

A
  • Acetylcholine

All neuromuscular blockers are structurally related to acetylcholine

Nagelhout (7th ed.), p. 156
Stoelting’s Pharmacology (5th ed.), pp. 323, 325
UpToDate - Succinylcholine (suxamethonium): Drug Information

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3
Q

What is the pharmacologic category/class of succinylcholine?

A
  • Neuromuscular blocking agent, depolarizing

Nagelhout (7th ed.), p. 156
UpToDate - Succinylcholine (suxamethonium): Drug Information

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4
Q

What is the mechanism of action of succinylcholine?

A
  • Initial activation of nicotinic acetylcholine receptors at neuromuscular junction, followed by desensitization/antagonism

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Stoelting’s Pharmacology (5th ed.), p. 325
Nagelhout (7th ed.), p. 156

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5
Q

What is the ED95 dose of succinylcholine?

A
  • 0.3 mg/kg

Dose that causes, on average, 95% supression of twitch height

Stoelting’s Pharmacology (5th ed.), p. 325
Nagelhout (7th ed.), p. 156

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6
Q

What is the typical dosing range of succinylcholine to rapidly achieve good intubating conditions?

A
  • 1-1.5 mg/kg IV

Different texts list ranges as wide as 0.5-2 mg/kg, with larger doses more conducive to RSI

Intubating doses of NMBA are usually 2-3x the ED95

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Nagelhout (7th ed.), pp. 156-157, 158 - Table 12.4, 169 - Table 12.10
Stoelting’s Pharmacology (5th ed.), p. 325
UpToDate - Succinylcholine (suxamethonium): Drug Information

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7
Q

What is the onset of action for succinylcholine?

A
  • 30-60 seconds or less

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Nagelhout (7th ed.), pp. 156-157, 158 - Table 12.4, 169 - Table 12.10
Stoelting’s Pharmacology (5th ed.), p. 325
UpToDate - Succinylcholine (suxamethonium): Drug Information

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8
Q

What is the duration of action for succinylcholine?

A
  • 5-15 minutes — ultrashort acting

Twitch recovery at ~5 mins, 90-95% twitch recovery in ~8 mins

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Nagelhout (7th ed.), pp. 157, 158 - Table 12.4, 169 - Table 12.10
Stoelting’s Pharmacology (5th ed.), p. 325
UpToDate - Succinylcholine (suxamethonium): Drug Information

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9
Q

What is the pediatric dosing of propofol for induction?

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10
Q

What organ(s) are responsible for propofol’s clearance (metabolism/elimination)?

A
  • Metabolism: Liver (P450), with extrahepatic metabolism in lungs likely
  • Elimination: Kidneys

Half-life: ~0.5-1.5 hours

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 1. Propofol: Part 1

UpToDate - Propofol: Drug Information

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11
Q

True or False

Egg allergy is an absolute contraindication to propofol use

A

False

  • while propofol formulations include lecithin derived from egg yolks, there is no good evidence that it should be avoided in patients allergic to egg (or soy/peanut)

In fact, Europe does not even include this in manufacturing information!

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 2. Propofol: Part 2

UpToDate - Propofol: Drug Information

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12
Q

Because propofol is emulsified in soy and/or egg fats, bacterial growth is possible - spiked vials, and prepared syringes must be discarded within what time frame?

A
  • 6 hours if the drug has been removed from the vial
  • 12 hours if the drug remains in the vial (after rubber stopper has been punctured - i.e. during infusion)

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 2. Propofol: Part 2

UpToDate - Propofol: Drug Information

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13
Q

Cardiovascular effects of propofol include:

A
  • Decreased SVR & BP (due to ↓ SNS tone, vasodilation)
  • Decreased venous tone → decreased preload
  • Decreased CO (due to myocardial depression/↓ myocardial contractility)

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 1. Propofol: Part 1

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14
Q

What are the respiratory effects of propofol?

A
  • Dose dependent depression of ventilation
    (shifting of the CO2 response curve)
  • Apnea following initial administration/induction
  • Inhibits hypoxic ventilatory drive
  • Bronchodilation

Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 1. Propofol: Part 1

Nagelhout (7th ed.), p. 104

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15
Q

What effect does propofol have on the CNS (e.g. CMRO2, cerebral blood flow, ICP)

A
  • ↓ CMRO2, ↓ CBF (maintains coupling)
  • ↓ ICP

Some say myoclonus is possible, but much less common than etomidate

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 1. Propofol: Part 1

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16
Q

BONUS

Propofol infusions can change the color of the urine

  • green urine = _________ excretion
  • _______ urine = increased uric acid excretion (does not suggest renal impairment or infection)
A
  • phenol
  • cloudy

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 1. Propofol: Part 1

17
Q

The following preservatives may be used in different generic formulations of propofol - which patient populations should they warrant precaution in?

  1. Benzyl alcohol
  2. Sodium metabisulfite
A
  1. Avoid in infants (neurotoxicity)
  2. Use with caution in patients with allergies and asthma (may cause bronchospasm)

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 2. Propofol: Part 2

Benzyl Alcohol

Nagelhout (7th ed.), p. 102 - Table 9.1

18
Q

Propofol may cause pain or burning on injection - how can this be eliminated or minimized?

A
  • Use of a larger and more proximal vein
  • Giving an opioid or lidocaine prior to administration

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 2. Propofol: Part 2

19
Q

Propofol has antipruritic effects and can reduce itching caused by spinal opioids and cholestasis - what is the appropriate dose for this indication?

A
  • 10 mg IV

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 2. Propofol: Part 2

20
Q

Propofol has antiemetic effects and can be used to treat PONV - what is the appropriate dose for this indication?

A
  • 10-20 mg IV
  • Infusion of 10 mcg/kg/min can also be used

Apex Unit 4: Pharmacology 1; Intravenous Anesthetics; Lesson 2. Propofol: Part 2

21
Q

What is the concentration (mg/mL) of propofol vials?

A
  • 10 mg/mL

Vials are often 10 mL, 20 mL, 50 mL, or 100 mL

UpToDate - Propofol: Drug Information

22
Q

laryngospasm dose

23
Q

MH triggering agent

24
Q

IM dose

1. Top Drawer Meds (39 decks)

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