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oral boards j > NMBs > Flashcards

NMBs Flashcards

1
Q

Rocuronium Class

A

Steroidal nondepolarizing muscle blocking agent

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2
Q

Rocuronium Clinical Use

A

Standard and rapid sequence induction, reduce damage to vocal cords

maintenance of neuromuscular blockade

Improve surgical working conditions, immobility

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3
Q

Rocuronium MOA

A

Competitively blocks nicotinic receptors in the NMJ preventing ACh from binding → channel remains closed and post synaptic membrane remains polarized

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4
Q

Rocuronium Dose

A

Induction dosing: 0.6 – 1.2 mg/kg

RSI dose: 1.2 mg/kg

Maintenance 1/5th

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5
Q

Rocuronium Pharmacokinetics

A

Onset = 1 - 3 min

DOA = 30 - 60 min

Metabolism = hepatic and renal

Excretion = Liver 20% and kidney 80%

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6
Q

Rocuronium Contraindications

A

hypersensitivity - Neuromuscular blocking agents and antibiotics are the most common drugs involved in intraoperative allergic reactions

Depend on hepatic and renal elimination, caution in patients with impaired function

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7
Q

Rocuronium Considerations

A
  • No hypnosis or analgesia
  • Quaternary ammonium does NOT cross BBB
  • sedated prior to admin and adequate ventilation
  • Reverse with sugammadex
  • Hepatic and renal system
    • The steroidal relaxants rocuronium & vecuronium depend to varying degrees on renal and hepatic elimination
  • Hypothermia prolongs duration of action.
  • Drug interactions:
  • Prolonged by:
    • Volatiles
    • Hypothermia
    • Magnesium
    • Lithium
    • IV local anesthetic
  • Shortened by:
  • Long term anti-epileptics, resistant to NMB
  • Steroids antagonize NMB
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8
Q

Vecuronium Class

A

Steroidal nondepolarizing muscle blocking agent

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9
Q

Vecuronium Use

A
  • Standard induction and maintenance of neuromuscular blockade
  • Improve surgical working conditions, immobility
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10
Q

Vecuronium MOA

A

Competitively blocks nicotinic receptors in the NMJ preventing ACh from binding → channel remains closed and post synaptic membrane remains polarized

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11
Q

Vecuronium Dose

A

Induction = 0.1 mg/kg

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12
Q

Vecuronium Pharmacokinetics

A
  • Onset = 2 - 4 min
  • DOA = 30 - 60 min
  • Metabolism = hepatic and renal
  • Excretion = Liver 50% and kidney 50%
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13
Q

Vecuronium Contraindications

A
  • hypersensitivity - Neuromuscular blocking agents and antibiotics are the most common drugs involved in intraoperative allergic reactions
  • Depend on hepatic and renal elimination, caution in patients with impaired function
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14
Q

Vecuronium Considerations

A
  • No hypnosis or analgesia
  • Quaternary ammonium does NOT cross BBB
  • Must be reconstituted
  • Reverse with sugammadex
  • Hepatic and renal system
    • The steroidal relaxants rocuronium & vecuronium depend to varying degrees on renal and hepatic elimination
  • Hypothermia prolongs duration of action
  • Drug interactions:

Prolonged by:

  • Volatiles
  • Hypothermia
  • Magnesium
  • Lithium
  • IV local anesthetic
  • Shortened by:
  • Long term anti-epileptics, resistant to NMB
  • Steroids antagonize NMB
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15
Q

Cisatracurium Class

A

Benzylisoquinolinium nondepolarizing muscle blocking agent

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16
Q

Cisatracurium Use

A
  • Standard induction and maintenance of neuromuscular blockade
  • Improve surgical working conditions, immobility
17
Q

Cisatracurium MOA

A

Competitively blocks nicotinic receptors in the NMJ preventing ACh from binding → channel remains closed and post synaptic membrane remains polarized

18
Q

Cisatracurium Dose

A

Induction 0.1 mg/kg

19
Q

Cisatracurium Pharmacokinetcs

A
  • Onset = 2 - 4 min
  • DOA = 30 - 60 min
  • Metabolism = Hoffman elimination (75%) and nonspecific esterase hydrolysis (25%)
    • Laudanosine metabolite (CNS stimulant)
  • Excretion = Kidney
20
Q

Cisatracurium Contraindications

A

hypersensitivity - Neuromuscular blocking agents and antibiotics are the most common drugs involved in intraoperative allergic reactions

21
Q

Cisatracurium Considerations

A
  • No hypnosis or analgesia
  • Quaternary ammonium does NOT cross BBB
  • Hofmann elimination is a temperature- and pH-dependent break- down of the drug molecule.
  • CANNOT! reverse with sugammadex
  • Best agent for patients with kidney or liver failure
  • Hypothermia prolongs duration of action
  • Drug interactions:

Prolonged by:

  • Volatiles
  • Hypothermia
  • Magnesium
  • Lithium
  • IV local anesthetic
  • Shortened by:
  • Long term anti-epileptics, resistant to NMB
  • Steroids antagonize NMB
22
Q

Succinylcholine Class

A

Depolarizing muscle blocking agent

23
Q

Succinylcholine Clinical Use

A

rapid sequence induction, laryngospasm, ECT

24
Q

Succinylcholine MOA

A

Attaches to one or both alpha subunits of the nicotinic acteylcholine receptors and mimics ACh, thus depolarizing the postjunctional membrane

25
Q

Succinylcholine Dose

A
  • Induction dosing: 1 – 1.5 mg/kg
  • IM induction: 4 mg/kg
  • Laryngospasm: 20 - 40 mg
26
Q

Succinylcholine Pharmacokinetics

A
  • Onset = 30 - 60 sec
  • DOA 5 - 15 min
  • Metabolism = plasma cholinesterases (pseudocholinesterases/butyrocholinesterase) which are made in the liver. Prolonged metabolism with plasma cholinesterase deficiency
  • Excretion = kidneys
27
Q

Succinylcholine Contraindications

A
  • HyperKalemia
  • Burn patients with injuries of over 35% total Body surface area (TBSA),third-degree burn
  • Severe muscle trauma
  • Neurologic injury (e.g., paraplegia, quadriplegia)
  • Severe sepsis (e.g., abdominal)
  • Muscle wasting, prolonged immobilization, extensive muscle denervation
  • Malignant hyperthermia or family history
  • Duchenne muscular dystrophy
  • Children <8 yo (Should only be used in children under 8 years old only in emergency situations; not for routine intubation)
  • Genetic variants of pseudocholinesterase defect (dibucaine test, 80% inhibition is normal)
  • Allergy
28
Q

Succinylcholine Considerations

A
  • Bradycardia due to direct stimulation of muscarinic receptors of the SA node
    • F/U w/ atropine
  • Risk of hyperkalemia, worse with burn/trauma/head injury patients
  • Increases ICP, IOP and gastric pressures
  • Fasciculations and post op muscle pain can occur
  • Rhadbomyolysis can lead to hyperkalemia and cardiac arrest
  • Quaternary ammonium does NOT cross BBB

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