5 NMB/reversals

Question 1

What happens when both alphas occupied on nmj

Answer 1

Na and ca in, k out

Question 2

Structure of extrajunctional receptors

Answer 2

Gamma instead of an epsilon or all alpha

Question 3

When sux contraindicated in denervation injury

Answer 3

24-48 hrs after and for one year after

Question 4

How pts w upregulation of extrajunctional receptors react to NDMR

Answer 4

Resistant to them, reduced potency

Question 5

How nmdrs cause fade

Answer 5

Antag presynaptic nn receptor

Question 6

How fade is prevented

Answer 6

Agonism of presynaptic nicotinic receptor

Question 7

Pseudocholinesterase is inhib by what, implication for sux

Answer 7

Neostigmine and pyridostigmine. If they’re given before sux, sux doa will be prolonged

Question 8

Ways ache is inhibited

Answer 8

Electrostatic inhib (edrophonium), carbamyl esters (neo/pyrido/physo), phosphorylation (non competitive, organophosphate and echothiophate)

Question 9

Reversal agent that needs atropine

Answer 9

Edrophonium

Question 10

How age effects speed of neostigmine antagonism

Answer 10

Faster in infants and children than adults

Question 11

Quat vs tertiary, which cross bbb

Answer 11

Physo= tertiary, crosses bbb. All others quaternary

Question 12

Intrathecal neostigmine fx and se

Answer 12

Analgesia. NV, pruritis, prolonged block

Question 13

Physostigmine alternative use

Answer 13

Prevents shivering

Question 14

Cholinergic se and pneumonic

Answer 14

Dumbbells. Diarrhea, urine, miosis, bradycardia, bronchoconstriction, emessi, lacrimation, laxation, salivation

Question 15

Fx of scop that are stronger than atropine and glyco

Answer 15

Sedation, antisialogogue, mydriasis, prevents nausea

Question 16

Effects of suggamadex on nmb most to least

Answer 16

Roc, vec, panc

Question 17

Reversal doses w suggamadex.

Answer 17

2/4 TOF or better 2 mg/kg. 4 mg/kg if 0 twitches but 2 ptc. 16 mg/kg 3 min after roc 1.2 mg/kg

Question 18

Suggamadex metabolism

Answer 18

Excreted unchanged by kidneys

Question 19

What to do if you have to re paralyze after suggamadex

Answer 19

Use a diff category of nmb, roc 1.2 works if b/w 5 min-4 hrs of sugg. If >4 hrs 0.6 will work

Question 20

Agent to reverse central anticholinergic syndrome

Answer 20

Physostigmine

Question 21

PO drug for mg pt

Answer 21

Physostigmine

Question 22

What s ugg binds

Answer 22

Aminosteroids