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Anesthesia Pharm > Exam 2 part II > Flashcards

Exam 2 part II Flashcards

1
Q

when succinylcholine is metabolized by _________________________, it produces the active metabolite _______________________.

A

pseudocholinesterase; succinylmonocholine

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2
Q

DOA of succinylcholine

A

10 minutes; with full recovery within 12-15 min (normal Tv breathing)

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3
Q

ED95 of succinylcholine

A

0.3 - 0.5 mg/kg

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4
Q

ED95 of muscle relaxants refers to what ?

A

a decrease in 95% of twitch height comparing twitch one to twitch four

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5
Q

adult dose of succinylcholine (IV)

A

0.5-1.5 mg/kg

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6
Q

pediatric IV dose of succinylcholine

A

2.0 - 2.5 mg/kg

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7
Q

pediatric IM dose of succinylcholine

A

4-5 mg/kg

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8
Q

when would you typically give succinylcholine to pediatric patients IM?

A

if they are experiencing a laryngospasm

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9
Q

succinylcholine will typcially not cause fasciulations in children under age _____________, or in __________________

A

10; elderly

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10
Q

CNS effects succinylcholine

A
  1. fasiculations 2. myalgias 3. increased IOP and ICP
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11
Q

why do pts experience myalgia 2/2 to succinylcholine?

A

prolonged depolarization of muscle cell causes lactic acid release

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12
Q

respiratory effects of succinylcholine

A
  1. apnea 2. vocal cord paralysis 3. relaxation of airway musculature
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13
Q

CV effects of succinylcholine

A
  1. increase or decrease in HR 2. profound bradycardia in children 3. adult bradycardia with 2nd dose 4. dysrhythmias 5. hyperkalemia
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14
Q

what is the only muscle relaxant medication that has a ultra rapid onset and ultra short duration of action

A

succinylcholine

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15
Q

neuromuscular blockade effect of succinylcholine is terminated by its diffusion __________________ from the NMJ

A

away

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16
Q

GI effects of succinylcholine

A
  1. increases intragastric pressure 2. increases lower esophageal tone
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17
Q

T/F: succinylcholine only causes masseter rigidity if malignant hyperthermia is occuring

A

false; masseter rigidity is a s/e of succinylcholine

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18
Q

if you give a second dose of succinylcholine for an adult, what would expect to happen?

A

bradycardia

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19
Q

________________ decreases the hydrolysis of succinylcholine via pseudocholinesterase 2/2 decreased metabolism

A

hypothermia

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20
Q

what drugs decrease pseudocholinesterase (thus would increase the duration of action of succinylcholine)

A
  1. echothiophate 2. neostigmine 3. pyridostigmine 4. phenelzine 5. cyclophosphamide 6. metoclopramide 7. esmolol 8. pancuronium 9. oral contraceptives
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21
Q

conditions that decrease pseudocholinesterase levels

A
  1. pregnancy 2. severe liver disease 3. acute infections* 4. PE 5. muscular dystrophy* 6. active MI 7. renal failures/uremia 8. elderly males 9. burns * 10. plasmapheresis 11. certain drugs * ones that are most likely to be seen
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22
Q

conditions that increase pseudocholinesterase levels (thus may decrease effects of succ)

A
  1. nepritic syndrome 2. thyrotoxicosis* 3. hemochromatosis 4. obese pts with DM* 5. anxiety d/o* *ones most likely to see
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23
Q

pregnancy (at term) decreases pseudocholinesterase levels by ___________% and is d/t ______________

A

40; increase in pts blood volume (i.e. it gets diluted out)

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24
Q

what is “atypical pseudocholinesterase”

A

having 1 or 2 abnormal pseudocholinesterase genese

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25
Q

heterozygous atypical pseudocholinesterase

A

having one normal and one abnormal pseudocholinesterase gene

26
Q

if your pt has a heterozygous pseudocholinesterase, you would expect your neuromuscular block to be prolonged by _______________

A

20-30 min

27
Q

Homozygous atypical pseudocholinesterase

A

two abnormal pseudocholinesterase genes

28
Q

if someone has homozygous atypical pseudocholinesterase, you would expect the neuromuscular block to be prolonged by ____________

A

3-8 hours; would require extended mechanical ventilation

29
Q

_________________ is a blood tests that determines the presence of normal pseudocholinesterase (i.e. determines how well its working)

A

dibucaine number

30
Q

T/F: dibucaine number determines the number of pseudocholinesterase enzymes

A

false; determines the presence of normal P-AchE, NOT the number

31
Q

___________________ is a local anesthetic (you will never see clinically) that inhibits normal pseudocholinesterase

A

dibucaine

32
Q

Normal pseudocholinesterase will have __________% inhibition by dibucaine

A

80

33
Q

heterozygous (atypical) pseudocholinesterase will have _____________ inhibition by dibucaine

A

40-60%

34
Q

homozygous (atypical) pseudocholinesterase will have ___________% inhbition by dibucaine

A

20

35
Q

Adverse effects of succinylcholine

A
  1. dysrhythmias/Bradycardia 2. fasiculations 3. hyperkalemia 4. muscle pain/myalgia 5. increased intragastric pressure & increased lower esophageal sphincter tone 6. increased IOP 7. increased ICP 8. masseter muscle rigidity 9. histamine release 10. MH
36
Q

which adverse effects of succinylcholine can be diminished with “pretreatment” dose of NDMR

A
  1. fasiculations 2. muscle pain/myalgia 3. increased intragastric pressure/increased lower esophageal sphincter tone 4. increased ICP
37
Q

low doses of succinylcholine typically causes what CV effects?

A

low HR/BP

38
Q

high doses of succinylcholine typically causes what CV effects

A

higher HR/BP & catecholamines

39
Q

__________________ may experience profound bradycardia with succinylcholine. Pretreat with IV atropine to prevent

A

children (peds)

40
Q

if you are going to give succinylcholine to a pediatric pt you would pretreat with __________mg/kg of atropine

A

0.02

41
Q

T/F: adults typically do not experience bradycardia with succinylcholine, unless subsequent dose is given

A

TRUE

42
Q

dysrhythmias that may be seen with succinylcholine administration

A
  1. sinus arrest 2. PVCs 3. AV nodal blockade with jx’al rhythm 4. peaked T waves (d/t hyperK - tx with CaCl)
43
Q

fasiculations with succinylcholine administration is produced by the _______________ receptors

A

presynaptic

44
Q

___________________ are disorganized muscle activity resulting from depolarization of the nerve terminal after succinylcholine administration

A

fasiculations

45
Q

fasiculations with succinylcholine are not typically observed in whom?

A
  1. children < 10 2. elderly
46
Q

fasiculations 2/2 succinylcholine administration may cause _______________ in pts with osteoporosis and may worsen pre-existing ____________

A

pathologic fractures; fractures

47
Q

what is a “self-taming” dose of succinylcholine

A

giving a small dose of succinylcholine 1 min prior to the intubating dose to prevent fasiculations (ineffective, no longer used)

48
Q

succinylcholine will increase potassium levels by _______________mEq/L within __________ min of admin, and will last less than ____________ min

A

0.5-1.0; 3; 10-15

49
Q

T/F: administration of succinylcholine is not threatening to potassium levels, if the pts potassium is normal

A

TRUE

50
Q

conditions that cause susceptibility to succinylcholine induced hperkalemia

A
  1. burn injury 2. severe intra-abdominal infection 3. encephalitis 4. GullianBarre syndrome 5. prolonged immobilization 6. polyneuropathy 7. hemorrhagic shock with metabolic acidosis 8. massive trauma/peripheral denervation 9. SCI/transection 10. stroke 11. tetanus 12. ruptured cerebral aneurysm 13. closed head injury 14. myopathies
51
Q

myalgias and muscle pains 2/2 succinylcholine are most common in what patients

A

female and inactive

52
Q

where is the myalgia and muscle pain 2/2 succinylcholine administration typically located

A

“neck to hips” 1. subcostal region 2. trunk 3. neck 4. upper abs 5. shoulders

53
Q

how can you prevent/decrease myalgias/muscle pain 2/2 succinylcholine administration

A
  1. NDMR pre-tx 2. NSAIDs
54
Q

myalgia and muscle pain 2/2 succinylcholine typically presents __________ hours after administration, but can last ____________

A

24-48; 2-7 days

55
Q

T/F: decreased fasciculations with succinylcholine = decreased myalgias

A

TRUE

56
Q

what is the theory behind myalgias and muscle pain 2/2 succinylcholine administration

A

initial unsynchronized contractions increase myoglobin levels and creatinine kinase (indicates muscle damage/muscle injury)

57
Q

_____________________ is a rare complication after extensive fasciculation or in malignant hyperthermia

A

myoglobinemia

58
Q

why is there an increase in intragastric pressure and LES with the administration of succinylcholine

A

2/2 the abdominal wall fasiculations

59
Q

lower esophageal sphcinter may open spontaneously at intragrastric pressure of > ______________ cmH20

A

28

60
Q

what can cause increase in IOP and ICP with anesthesia?

A
  1. inadequate anesthesia 2. inadequate relaxation (muscle relaxants) 3. stimulation from intubation 4. administration of succinylcholine

Anesthesia Pharm (18 decks)

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