Exam 1

Question 1

what is the best clinical indicator of if you need to re-dose

Answer 1

twitch monitor

Question 2

increased RESISTANCE of NMBs*
block is ______ dense
patient will recover _________
must give _________ dose
there is a __________ duration*

Answer 2

block is LESS dense
patient will recover FASTER
must give BIGGER dose
there is a SHORTER duration of the drug*

Question 3

what 4 pharmacologic drugs cause increased RESISTANCE to NMBs

Answer 3

phenytoin (seizures)
corticosteroids (CHRONIC doses)
aminophylline/theophylline (bronchodilators)
lasix (LARGE doses)

Question 4

inhibition of phosphodiesterase leads to __________ cAMP which ____________ Ach

Answer 4

Inhibition of phosphodiesterase leads to INCREASED cAMP which leads to INCREASED Ach

Question 5

nondepolarizers are more _______ to chronic hyperkalemia patients*

depolarizers are more __________ to chronic hyperkalemic patients*

Answer 5

nondepolarizers = RESISTANT
depolarizers (Sch) = SENSITIVE

this is because the resting membrane potential is closer to depolarization

Question 6

increased SENSITIVITY of NMBs*
block is ___________
patient will recover _________
give __________ dose

Answer 6

block is denser/POTENTIATED
patient will recover SLOWER
give SMALLER dose

Question 7

retardation of anticholinesterase leads to _____ circulating Ach = ______ sensitivity to nondepolarizers*

Answer 7

retardation/decrease of anticholinesterase = LESS Ach =MORE sensitivity to nondepolarizers

sch is the opposite!

Question 8

what drugs lead to increased SENSITIVITY to non-depolarizers

Answer 8

volatile anesthetics
aminoglycosides
lithium
lasix (NORMAL doses)
Sch
NMBs + NMBs
calcium channel blockers
anti HTN
local anesthetics

Question 9

example of aminoglycosides*

Answer 9

gentamicin, neomycin, streptomycin, kanamycin, amikacin, tobramycin

NOT erythromycin

Question 10

Oat cell carcinoma of the lung (be suspicious of biopsy lung cases/thoracostomy/cancer)

Answer 10

Myasthenic syndrome (eaton lambert)

causes increased SENSITIVITY

Question 11

peds = _______ Vd = _______ recovery

Answer 11

large Vd (“water babies”), faster recovery

Question 12

elderly = _______ Vd = _______ recovery = _________ dose*

Answer 12

small Vd (“dried up”), slower recovery, give SMALLER dose

Question 13

what is the only drug to dose based on TOTAL body weight*

Answer 13

Sch (plasma cholinesterase is greater)

Question 14

ANTIcholinesterases ____________ depolarization and contraction of the muscle

Answer 14

ANTIcholinesterases FACILITATE contraction

Question 15

ACETYLcholinesterases _____________ contraction

Answer 15

DECREASE contraction

Question 16

REVERSIBLE anticholinesterase

Answer 16

edrophonium
neostigmine
pyridostigmine
physostigmine

Question 17

only anticholinesterase that is lipid soluble/tertiary amine*

Answer 17

physostigmine

Question 18

IRreversible complex anticholinestrase

Answer 18

insecticides (dog dipper)
echothiophate (eye drops)
nerve gases

Question 19

carbamylation of AChE

Answer 19

________stigmine group

Question 20

electrostatic binding

Answer 20

edrophonium

Question 21

anticholinesterases (4)

Answer 21

neostigmine
pyridostigmine
edroponium
physostigmine

Question 22

once acetylcholinesterase is max inhibited, giving more ANTIcholinesterase will ____ reverse a block

Answer 22

NOT reverse the block
ceiling effect

Question 23

if giving Sch after laryngospasm and nondepolarizer, block will be _______________*

Answer 23

PROLONGED
you must wait for block to end! only time!

Question 24

reversal of NMB is prolonged by (6)*

Answer 24

o Antibiotics
o Hypothermia
o Respiratory acidosis (PaCO2>50 mm Hg)
o Patients with increased volatile agents
o Metabolic acidosis
o Hypokalemia

Question 25

anticholinesterase overdose (

Answer 25

Nicotinic o weakness ranging to paralysis Muscarinic o MIOSIS, inability to focus vision, copious salivation, bronchoconstriction, bradycardia, abdominal cramps, loss of control of bowel and bladder CNS o Confusion, ataxia, seizures, coma, resp depression

Question 26

treatment for anticholinesterase overdose*

Answer 26

pralidoxime (must give within minutes)

Question 27

anticholinergics treat against __________________

Answer 27

anticholinesterases (take away the nasty side effects)

Question 28

anticholinergics compete with Ach for ____________ receptors

Answer 28

muscarinic receptors

Question 29

examples of anticholinergics (3)

Answer 29

robinul atropine scopolamine

Question 30

treatment for antiCHOLINERGIC overdose (restlessness, hallucinations, somnolence, unconsciousness)

Answer 30

physostigmine

Question 31

Encapsulates the STEROID class NMB and forms a stable complex, prevents the NMB to have action on the NMJ

Answer 31

sugammadex

Question 32

Reduces effects of progesterone; can bind to birth control drug up to 1 week similar allergic reaction as stabilizers in food, increased bleeding be careful with ESRD incompatible with zofran, verapamil, ranitidine

Answer 32

sugammadex

Question 33

if giving Roc and Vec 5 MINUTES AFTER suggamadex, _________ dose*

Answer 33

increase the dose

Question 34

When do you pair atropine with neostigmine?

Answer 34

infant

Question 35

what affects calcium channels

Answer 35

cAMP

Question 36

Hypercalcemia=Hypomagnesium=_________Ach=greater ____________ to nondepolarizing NMBs

Answer 36

increased Ach greater RESISTANCE

Question 37

Hypocalcemia=Hypermagnesium=_________Ach=greater _____________ to nondepolarizing NMBs

Answer 37

decreased Ach greater sensitivity

Question 38

what drug for a patient who is an aspiration risk

Answer 38

Roc or Sch

Question 39

if giving Sch first, ___________ dose of non-depolarizer

Answer 39

DECREASE the dose of the nondepolarizer!

Question 40

drug for difficult airway (broken jaw)

Answer 40

Sch

Question 41

organ failure (but NO cardiac/pulm issues)

Answer 41

atracurium

Question 42

short case, how do you know how long til reversal?

Answer 42

Post tetanic twitch

Question 43

patient 7 days post burn with risk of aspiration

Answer 43

roc

Question 44

if giving non-depolarizer FIRST (defasiculating dose), _________ the Sch dose

Answer 44

increase the dose of Sch!

Question 45

what inhibits plasma cholinesterase*

Answer 45

neostigmine cyclophosphamide metoclopramide (reglan)

Question 46

what drug for a longer case (30 minutes)*

Answer 46

atracurium (NOT Sch)