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Apex > 4 nmb > Flashcards

4 nmb Flashcards

1
Q

When a phase 2 block with sux occurs

A

> 7-10 mg/kg. 30-60 min iv infusion

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2
Q

Best place to measure onset of blockade

A

Orbicularis oculi or corrugated supercilii, facial nerve

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3
Q

Best places to measure recovery from blockade

A

Adductor pollicis (thumb adduction) or flexor hallucis. Ulnar or pt nerve

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4
Q

NMB recovery= TOF

A

<0.9

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5
Q

TV: acceptable endpoint, max % receptors occupied

A

> 5ml/kg, 80

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6
Q

TOF: acceptable endpoint, max % receptors occupied

A

No fade, 70

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7
Q

VC: acceptable endpoint, max % receptors occupied

A

> 20 ml/kg, 70

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8
Q

Sustained tetanus, DBS: acceptable endpoint, max % receptors occupied

A

No fade, 60

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9
Q

Insp force: acceptable endpoint, max % receptors occupied

A

Better than -40 (more neg the better), 50

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10
Q

Head lift >5 sec, hand grip: endpoint, % receptors

A

Sustained 5 seconds, 50

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11
Q

Holding tongue blade: %occipied

A

50

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12
Q

How sux causes bradycardia, when to give atropine

A

M2 receptor on sa node, 2nd dose increases risk. Due to metabolite of sux. Atropine should be given to kids before 2nd dose of sux

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13
Q

How sux affects intragastric pressure, esoph tone, and barrier pressure at GE junction

A

Inc, raises lower esoph tone, and unchanged pressure at ge junction

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14
Q

Things attenuated by a defasciculating dose

A

Little to no benefit with IOP. Inc Intragastric pressure, ICP

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15
Q

Enzymes that metabolize acetylcholine 5

A

Type 1 cholinesterase, acetylcholinesterase, true cholinesterase, specific cholinesterase, genuine cholinesterase

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16
Q

Metab sux, miva, and ester LAs 5

A

Type 2 cholinesterase, butyrlcholinesterase, false cholinesterase, plasma cholinesterase, pseudocholinesterase

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17
Q

Pseudocholinesterase: made by what, when NM symptoms appear/when Serious

A

Liver. 60%, 20%

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18
Q

Drugs that reduce pseudocholinesterase activity

A

Reglan, esmolol, neostigmine, echothiophate, BC/estrogen, cyclophosphamide, MAOIs, nitrogen mustard

19
Q

Co existing conditions that reduce pseudocholinesterase activity

A

Atypical pche, severe liver disease, chronic renal disease, organophosphate poisoning, burns, cancer, older, malnutrition, late state pregnancy

20
Q

What dibucaine is

A

Amide LA that inhibits normal plasma cholinesterase but has no effect on atypical pche

21
Q

What a nml v abnormal dibucaine test looks like

A

Normal= 80, dibucaine inhib 80% of pseudocholinesterase and a nml enzyme is present. Abn= 20, dibucaine didn’t inhib the pts pche and an atypical variant is present

22
Q

Pche variant/dibucaine number/sux duration: typical homozygous, heterozygous, atypical heterozygous

A

70-80/5-10 min. 50-60/20-30 min. 20-30 4-8 hours

23
Q

What will restore plasma pseudocholinesterase levels in a pt with an atypical variant

A

Ffp, whole blood, or purified human cholinesterase

24
Q

In hyperkalemia: how to tx with stabilizing the myocardium

A

Ca cl 20 mg/kg or ca gluconate 60 mg/kg

25
Q

Tx hyperkalemia by shifting k into cells

A

Glucose 0.3-0.5g/kg 10% sol, insulin 1u/5g glucose, na bicarb 1-2mmol/kg, hypervent, albuterol neb

26
Q

How to enhance k elim

A

Lasix 1 mg/kg, volume resusc, HD

27
Q

Who is at highest risk of myalgia with sux. Lowest rates of myalgia in who

A

Women > men, young adults, those who dont routinely work out. Lowest: elderly, preg, kids

28
Q

Meds that dec the risk of myalgia w sux

A

Defasciculating dose, nsaids, lido 1.5, higher dose of sux. Not decreased by opioids

29
Q

Conditions that lead to hyperkalemia w sux

A

ALS, Charcot Marie, duchenne’s (and rhabdo), GB, hyperkalemic periodic paralysis, MS, up reg of achrs (injury)

30
Q

Conditions that are sensitive or resistant to sux

A

Sensitive: Huntington chorea. Resistant: MG

31
Q

Conditions that are sensitive to NDMR

A

ALS, duchennes, GB, Huntington chorea, MS, MG, sometimes myotonic dystrophy

32
Q

The dose to intubate is usually ______ the ed 95

A

3-4x

33
Q

ETT dose, onset, duration: miva, cis, vec, atra

A

Miva 0.15 mg/kg 3.3 min 17 min. Cis 0.1/5min/45 min. Vec 0.1/2 min/45 min. Atra 0.5/3min/45 min

34
Q

ETT dose/onset/duration: roc, panc

A

0.6/1.7 min/35 min. 0.08/3 min/85 min

35
Q

How atracurium, cis, and miva are metabolized

A

Atra= 33% Hoffman and 66% plasma esterases. Cis= Hoffman. Miva= pseudocholinesterase

36
Q

How Hoffman elim affected by ph and temp

A

Elim faster w alkalosis and hyperthermia. Elim slower with acidosis and hypothermia

37
Q

Drugs that potentiate NMB

A

VA (des>sevo>iso>n2o), abx (aminoglyc, polymyx, clinda, tetra), antidysrhythmics (verap, amlodip, lido, quin), LAs, lasix, dantrolene, cyclosporine, tamoxifin

38
Q

How lytes effect NMB

A

INC by: lithium and mag. Dec by calcium and K

39
Q

NMB that cause histamine release

A

Atra, miva, sux

40
Q

What ppl are allergic to that is in nmb

A

Quaternary ammonium groups

41
Q

Highest to lowest likelihood of anaphylaxis

A

Sux > atra > cis > roc > vec

42
Q

Test to see is anaphylaxis has occured w nmb

A

Tryptase

43
Q

TOF ratio assoc with aspiration

A

<0.9

Apex (21 decks)

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