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Pharmacology: NA > test 2 review > Flashcards

test 2 review Flashcards

1
Q

You can block Ach with neuromuscular blocker?

A

Depolarizer
Sux

Non- depolarizer
         Rocuronium
          Vecuronium
          Pancuroium
         Cisatracurium
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2
Q

What makes a NMB competitive?

A

They can be reversed

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3
Q

What is Hoffman Elimination dependent on?

A

pH and Temp

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4
Q

What is Cisatracurium better for?

A

Renal Failure patients

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5
Q

Which neuromuscular blockers are steroidal?

A

Pancuronium
Vecuronium
Rocuronium

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6
Q

Which neuromuscular blocker is vagolytic?

A

Pancoronium

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7
Q

Which neuromuscular blocker is good for children?

A

Pancuronium

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8
Q

Which neuromuscualar blocker would you give to children only under dire circumstances?

A

Sux

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9
Q

Sux cannot be?

A

Reversed

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10
Q

Neuromuscular drugs are chosen based off of?

A

Desired onset
Duration of action
Recovery rate

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11
Q

What decreases the action of plasma cholinesterase?

A

Pancuronium

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12
Q

Vercuronium is metabolized where?

A

Hepatic metabolism

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13
Q

Which neuromuscular blocking drug has primary elimination on metabolism?

A

Sux

Mivacurium

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14
Q

Which an NMBD drug has primary elimination on renal elimination?

A

D-tubocuraine

Pancuronium

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15
Q

Which NMBD drug has primary Biliary elimination?

A

Vecuronium

Rocoronium

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16
Q

Which drugs doesn’t cross the blood brain barrier?

A

Glycopyrrolate

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17
Q

Giving 10% of the neuromuscular blocking dose is?

A

Priming

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18
Q

What risk increases when priming a patient with NMBD?

A

Aspiration

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19
Q

Muscarinic man was?

A

Juicy and bradycardic

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20
Q

How many molecules to open up an acetylcholine receptor?

A

2

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21
Q

Patients with poor plasma cholinesterase has what kind of block?

A

Phase 2 block

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22
Q

Fetal nicotinic acetylcholine receptors contain what subunit instead of an epsilon?

A

Gamma

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23
Q

11 clinical signs of malignant hypothermia?

A

Tachycardia, acidosis, hypercarbia, muscle rigidity, hypoxemia, hypothermia, increased CO2, arrhythmia, hyperkalemia,

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24
Q

Early signs of malignant hypothermia?

A

Increase entitled

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25
Q

Identify anesthetic agents in patients with malignant hypothermia?

A

Sux and Halothane

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26
Q

Which drug class treats M. Graves?

A

AntiCholine Inhibitors

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27
Q

M. Graves patients have?

A

Have antibodies to receptors. Receptors are down regulated

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28
Q

M. Graves are sensitive to?

A

Nondepolarizers

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29
Q

A patient with M Graves takes too much of a drug has which syndrome?

A

Cholinergic crisis from too much acetylcholine

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30
Q

An M. Graves patient is is given a relaxants why do we care?

A

Duration of action they don’t have enough receptors. May not be able to extubate the patient

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31
Q

How to make sure patients are strong enough for extubation?

A

TO4

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32
Q

Sux mimics what?

A

Acetylcholine
Looks similar to acetylcholine
Is Parasymptomatic

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33
Q

True cholinesterase is?

A

Acetylcholinesterase

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34
Q

Succinylcholine can make a patients?

A

Heart rate slow down or stop beating

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35
Q

Another two names for plasma cholinesterase?

A

Butyrl and Pseudo cholinesterase

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36
Q

Complications of succinylcholine?

A

Malignant hypothermia, anaphylaxis, hyperkalemia, increased gastric pressure, increase cranial pressure

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37
Q

Succinylcholine cannot be used in which type of patient?

A

Eyes surgery Patients

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38
Q

Succinylcholine in patience in contraindicated?

A

Up regulation

Spinal cord injury, burn victims, paraplegics, skeletal muscle trauma, muscular dystrophy, Parkinson

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39
Q

What doesn’t it trigger malignant hypothermia?

A

Nitrous oxide

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40
Q

How do you treat laryngospasm?

A

With succinylcholine

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41
Q

You Give dose of succinylcholine for rapid sequence you failed to intubate you get more succinylcholine?

A

No patient can become resistant to atropine

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42
Q

Which receptors are easiest block?

A

First receptors

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43
Q

The goal of priming?

A

To speed on set and give less drugs in the end

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44
Q

What makes nondepolarizing start working if you don’t reverse?

A

Redistribution

45
Q

Atracurium releases?

A

Histamines and CV effect a rapid injections or high doses

46
Q

Antibiotics act?

A

Postsynaptically

47
Q

Lithium increases?

A

Non depolarizers and the polarizers action

48
Q

Hypermagnesium

A

Increases block

49
Q

Respiratory acidosis

A

Increases block

50
Q

Hypothermia

A

Increases block

51
Q

Anticonvulsant

A

Decreases block

52
Q

Hyperglycemia

A

Have no effect

53
Q

What causes increased gastric pressure and succinylcholine?

A

Fasciculations

give defasciculation does (non depolarizing small dose)

Increase risk of aspiration preoperatively

54
Q

Organic phosphate is related to what class of drugs?

A

Anti-cholinesterase

55
Q

Anticholinergic drugs?

A

Scopolamine, atropine, Glycopyrrolate

56
Q

Up regulation can develop in how many days?

A

3 to 5 day

57
Q

Anti- cholinergic receptors

A

are muscarinic

58
Q

Five side effects of anticholinergic drugs?

A

Bronco dilation, increased heart rate, decreased secretions

59
Q

Which anticholinergic drug increases the heart rate the most?

A

Atropine

60
Q

Anti-muscarinic drugs affect sweating

A

By decreasing sweating

61
Q

Etropinum is given with which drug?

A

Atropine

62
Q

Symptoms of anti-cholinergic syndrome are?

A

Dilated pupils, blind as a bat, red is a beet, dry mouth, can’t sweat, can’t pee, confusion

Caused by atropine and scopolamine poisoning

63
Q

Cholinergic drug Neostigme

A

Muscarinic Man

64
Q

Patient has M. Graves she is?

A

Cholinergic Crisis

65
Q

Anti-cholinergic treatment?

A

Physostigmine

it crosses the BBB

66
Q

Dibucaine # value?

A 
>70 = 70% of enzymes is inhibited by Dibucanine: normal
50= 50% of the enzymes inhibited: heterozygous normal
67
Q

Etomidate metabolism?

A

Hepatic microsomal enzymes and plasmaesterases

68
Q

Nitrous Oxide can prevent what?

A

Vitamin B12 from acting as a cofactor for methionine synthetase.

69
Q

Dibucaine # 20 what kind of plasma cholinesterase do you have?

A

Homozygous atypical

70
Q

Dibucaine 20 and given Sux how long will patient be intubated?

A

Very long time

71
Q

How many twitches to reverse? At what point to reverse none depolarizing muscle relaxants?

A

2 to 3 twitches

15 to 30 minutes

72
Q

Treatment for cholinergic syndrome

A

Atropine

73
Q

Three places for neuromuscular monitoring?

A

Facial nerve
thumb
foot

74
Q

How many twitches with 70%?

A

Four out of four

75
Q

What are ions go to skeletal muscle?

A

Sodium and potassium

76
Q

Bad plasma cholinesterase what would you check?

A

Phase II block

77
Q

What causes histamine release?

A

Benzoquiroline (?)

78
Q

Succinylcholine is metabolized by what enzyme?

A

Plasma cholinesterase

79
Q

What happens when the channel of the motor end place opens?

A

Sodium ions and calcium Ion diffuse to the cells

Potassium diffuses out

80
Q

Succinylcholine duration of action

A

Very short

81
Q

Mivacurium DOA

A

Short

82
Q

Atracurium DOA

A

Intermediate

83
Q

Cisatracurium DOA

A

Intermediate

84
Q

Vecuronium DOA

A

Intermediate

85
Q

Rocuronium DOA

A

Intermediate

86
Q

d- tubocurarine DOA

A

Long

87
Q

Pancuronium DOA

A

Long

88
Q

Atracurium is eliminated by?

A

ester hydrolysis and hofmann elimination

89
Q

Cistracurium is eliminated by?

A

Hofman Elimination

90
Q

Mivacurium is eliminated by?

A

Plasma Cholinesterase

91
Q

What is used to treat malignant hypothermia?

A

Dolanthane

92
Q

Principal Pharmacologic Effect of intravenous anesthetic s

A

Anterograde Amnesia

93
Q

Chemical Structure of Benzodiazepine

A

2 diazephine rings

94
Q

Benzo GABA Recptor

A

Made up of 5 subunits

2 GABA molecules attached to an alpha subunite

95
Q

Versed in physiologic PH becomes what?

A

I’m protonated add highly lipid soluble

96
Q

Versed pharmacokinetics?

A

Possesses a slow effects sites equilibration time

Rapid redistribution from brain to inactive tissue site and rapid hepatic clearance

97
Q

Versed Metabolism?

A

Hepatic and small intestine cytochrome P-450 enzyme (CYP3a4)

98
Q

Versed doses

A

Pre op- .25- 1 mg/

Iv: 1 - 2.5 mg

Induction of Anesthesia IV dosing: 0.1- 2mg

99
Q

Diazepam (valium)

Lorazepam (Ativan)

A

Dia: Dissolved in organic solvent , must be diluted with water

100
Q

Flumazenil

A

Benzo Antagonist

101
Q

Barb, Propofol, and Etomidate mechanism of action?

A

GABA receptor interaction

102
Q

Barbituates

A

Depress Reticular activation system

lipid soluble- most important

103
Q

Ketamine

A

Weak action on GABA

noncompetitive attachement on NMDA receptos

104
Q

Propofol

A

50 % bound to erythrocytes
crosses placenta

Induction: 1.5-2.5 mg/kg

iv sedation: 25-100 mpg/kg/ min

Maintenance of anesthesia 100-300mcg/ kg

No M. Hypothermia trigger

105
Q

Etomidate

A

Rapid Brain Penetration
Hepatic Microsomal Enzyme and plasmaesterase

Adrenocortical Suppression

Dosing
Induction: 0.2-0.4 mg/kg
Onset: 30-60 sec

106
Q

Ketamine

A

Rapid Onset= high lipid solubility
short Duration of action: 5-15 min

Metabolism: hepatic microsomal enzymes

Produces dissociative anesthesia

Cataleptic state= eyes open with slow nystagmus gaze

107
Q

Side effects of Interenous and benzo

A

emergence delirium

108
Q

Scopolamine

A

Crosses BBB

Binds to muscarinic receptors

Pharmacology: NA (4 decks)

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