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Apex Review > Neuromuscular blockers 3 > Flashcards

Neuromuscular blockers 3 Flashcards

1
Q

Identify the patient at the HIGHEST risk for developing postoperative myalgia following succinylcholine.
a. 6-year-old boy for strabismus correction
b. 24-year-old female for umbilical hernia repair
c. 35-year-old pregnant patient for appendectomy
d. 86-year-old-male for total hip arthroplasty

A

b. 24 year old female for umbilical hernia repair

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2
Q

Succinylcholine is a well-recognized cause of _______________ that may persist up to 24-48 hours.

A

postoperative myalgia

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3
Q

Patients with the highest risk of myalgia following succinylcholine include

A

young adults undergoing ambulatory surgery (women>men) and those that do not routinely engage in strenuous activity

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4
Q

When using a defasciculating dose of a nondepolarizer, the dose of succinylcholine should be increased to

A

1.5-2.0 mg/kg

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5
Q

Methods of reducing the incidence of myalgia include

A

pretreatment with a nondepolarizing neuromuscular blocker
NSAIDs
lidocaine
using a higher dose rather than a lower dose of succinylcholine

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6
Q

Patients that should probably not receive a defasciculation dose of a nondepolarizer include

A

those with pre-existing skeletal muscle weakness such as those with myasthenia gravis

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7
Q

Myalgia manifests as

A

soreness in the neck, shoulders, subcostal region, upper abdominal muscles, and trunk muscles

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8
Q

Patients who have the lowest risk of succinylcholine induced myalgias include

A

children
the elderly
pregnant patients

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9
Q

How early should a nondepolarizer be administered prior to giving succinylcholine?

A

3-5 minutes

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10
Q

What doses of nondepolarizers can be used to prevent fasciculations?

A

rocuronium 2 mg
1.5 mg atracurium
0.3 mg vecuronium

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11
Q

Why does the dose of succinylcholine need to be increased if using a nondepolarizer drug?

A

the nondepolarizer will competitively antagonize the nicotinic receptor so more succinylcholine must be given to overwhelm the nondepolarizer’s effect

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12
Q

Which diseases are associated with hyperkalemia following succinylcholine administration? (select 3)
a. hyperkalemic periodic paralysis
b. multiple sclerosis
c. hypokalemic periodic paralysis
d. myotonic dystrophy
e. Huntington chorea
f. Guillain-barre

A

a. hyperkalemic periodic paralysis
b. multiple sclerosis
f. Guillain-Barre

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13
Q

Select conditions that increase the risk of succinylcholine-induced hyperkalemia include:

A

Guillain-Barre
Hyperkalemic periodic paralysis
Malignant hyperthermia
multiple sclerosis
Up-regulation of acetylcholine receptors

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14
Q

Select conditions that increase sensitivity to nondepolarizing neuromuscular blockers include

A

Guillain-Barre
Huntington chorea
multiple sclerosis
myasthenia gravis

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15
Q

What is Duchenne’s muscular dystrophy response to succinylcholine?

A

hyperkalemia + rhabdomyolysis

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16
Q

What is Duchenne’s muscular dystrophy response to nondepolarizing drugs?

A

sensitive

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17
Q

What is Guillain-Barre’s response to succinylcholine?

A

hyperkalemia

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18
Q

What is Guillain-Barre’s response to non-depolarizer drugs?

A

sensitive

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19
Q

What is MS’s response to succinylcholine

A

hyperkalemia

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20
Q

What is MS’s response to nondepolarizer drugs?

A

sensitive

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21
Q

What is ALS’ response to succinylcholine?

A

hyperkalemia

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22
Q

What is ALS’ response to nondepolarizer drugs?

A

sensitive

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23
Q

What is upregulation of AChRs response to succinylcholine?

A

hyperkalemia

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24
Q

What is upregulation of AChRs response to nondepolarizers?

A

resistant or normal- depends on timing of injury

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25
Q

What is Charcot-Marie-Tooth response to succinylcholine?

A

hyperkalemia

26
Q

What is Charcot-Marie Tooth response to nondepolarizers?

A

normal

27
Q

What is hyperkalemic periodic paralysis response to succinylcholine?

A

hyperkalemia

28
Q

What is hyperkalemic periodic paralysis response to non-depolarizers?

A

normal

29
Q

What is hypokalemic periodic paralysis response to succinylcholine?

A

MH???

30
Q

What is hypokalemic periodic paralysis response to nondepolarizers?

A

normal

31
Q

What is malignant hyperthermias response to succinylcholine?

A

MH

32
Q

What is MH’s response to nondepolarizer drugs?

A

normal

33
Q

What is myotonic dystrophy’s response to succinylcholine?

A

muscle contractures- potential problem with airway management

34
Q

What is myotonic dystrophy’s response to nondepolarizers?

A

normal or sensitive

35
Q

What is Huntington’s response to succinylcholine?

A

sensitive

36
Q

What is Huntington’s response to nondepolarizers?

A

sensitive

37
Q

What is myasthenia gravis’ response to succinylcholine?

A

resistant

38
Q

What is myasthenia gravis’ response to nondepolarizers?

A

sensitive

39
Q

Rank the nondepolarizing neuromuscular blockers in terms of potency (most to least):

A

cisatracurium, pancuronium, atracurium, rocuronium

40
Q

In the context of neuromuscular blockers, the ED95 is the dose at which there’s

A

a 95% decrease in twitch hheight

41
Q

The dose required to provide optimal conditions for tracheal intubation is

A

~2-3 times the ED95

42
Q

The higher the ED95, the __________ the potency, and the ______________ the onset

A

lower; faster

43
Q

What is the intubating dose of mivacurium?

A

0.15 mg/kg

44
Q

What is the onset of mivacurium?

A

3.3 minutes

45
Q

What is the duration of mivacurium?

A

17 minutes

46
Q

What is the intubating dose of cisatracurium?

A

0.1 mg/kg

47
Q

What is the onset of cisatracurium?

A

5.2 minutes

48
Q

What is the duration of cisatracurium?

A

45 minutes

49
Q

What is the intubating dose of vecuronium?

A

0.1mg/kg

50
Q

What is the onset of vecuronium?

A

2.4 minutes

51
Q

What is the duration of vecuronium?

A

45 minutes

52
Q

What is the intubating dose of atracurium?

A

0.5 mg/kg

53
Q

What is the onset of atracurium?

A

3.2 minutes

54
Q

What is the duration of atracurium?

A

45 minutes

55
Q

What is the dose of rocuronium?

A

0.6 mg/kg

56
Q

What is the onset of rocuronium?

A

1.7 minutes

57
Q

What is the duration of rocuronium?

A

35 minutes

58
Q

What is the dose of pancuronium?

A

0.08 mg/kg

59
Q

What is the onset of pancuronium?

A

2.9 minutes

60
Q

What is the duration of pancuronium?

A

85 minutes

Apex Review (224 decks)

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