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5230 > Muscle Relaxants > Flashcards

Muscle Relaxants Flashcards

(70 cards)

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1
Q

Muscle Relaxants - Ultra Short Acting

A

succinylcholine

5-15 minutes

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2
Q

Muscle Relaxants - Short Acting

A

mivacurium

20-40 minutes

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3
Q

Muscle Relaxants - Intermediate Acting

A

atracurium
cisatracurium
vecuronium
rocuronium

30-60 minutes

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4
Q

Muscle Relaxants - Long Acting

A

pancuronium

60-90 minutes

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5
Q

Muscle Relaxants - onset time

A

time from administration to maximal effect

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6
Q

Muscle Relaxants - clinical duration

A

time from administration to 25% recovery of the twitch response

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7
Q

Muscle Relaxants - total duration of action

A

time from administration to 90% recovery of the twitch response

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8
Q

Muscle Relaxants - recovery index

A

time from 25% to 75% recovery of twitch response

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9
Q

Train of 4 Ratio

A

compares the 4th twitch with the 1st twitch; recovery is indicated with the ratio is 90%

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10
Q

neuromuscular blockage tests that reflect diaphragm paralysis

A

orbicularis oculi of facial nerve

upper airway muscle are more sensitive than peripheral muscles

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11
Q

neuromuscular blockage - best site to measure recovery

A

ulnar nerve

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12
Q

neuromuscular blockage - best site to measure onset

A

facial nerve - orbicularis oculi or corrugator supercilii*

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13
Q

sequence of loss of muscle function

A
  1. eye lids
  2. extremities
  3. chest - intercostals
  4. abdominal muscles
  5. diaphragm
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14
Q

blockade responses

A 
4 responses, no fade = <70%
4 responses, fade = 70-75%
3 responses = 75-80%
2 responses = 80-85%
1 response = 90-95%
**want surgery here
0 responses = 100%
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15
Q

twitches with depolarizing drug

A

no fade or post-tetanic count

sustained response to tetany

muscle fasciculation

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16
Q

Post Tetanic Count

A
  1. 50 Nz for 5 seconds
  2. Wait 3 seconds
  3. Single twitches every second for up to 20 seconds

number of twitches inversely proportional with recovery time, 1 twitch 15-30 minutes

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17
Q

TOF ratio when fade is no longer detected, which leads to

A

0.4-0.9

“blind paralysis”

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18
Q

Esterase Enzymes

A

cholinesterase: acetyl and pseudo (plasma)

non-specific: RBC, paraoxonase, albumin

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19
Q

metabolism - succinylcholine

A

pseudocholinesterase

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20
Q

metabolism - mivacurium

A

pseudocholinesterase

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21
Q

metabolism - atracurium

A

Hoffman elimination and non-specific esterase

elimination - 10-40% renal

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22
Q

metabolism - cisatracurium

A

Hoffman elimination and non-specific esterase

elimination - 15% renal

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23
Q

test for determining cholinesterase variants

A

dibucaine - inhibits typical but not atypical and measure activity

low number - indicates atypical enzymes
low activity - indicates low levels of enzyme

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24
Q

succinylcholine side effects

A 
hyperkalemia
dysrhythmias: tachycardia, bradycardia in repeat doses
myalgia
elevated intragastric pressure
elevated ICP
elevated intraocular pressure
myoglobinemia
massester spasm
malignant hyperthermia
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25
atracurium cisatracurium mivacurium
benzylisoquinoline relaxants
26
pancuronium vecuronium rocuronium
steroidal relaxants
27
metabolism - vecuronium
liver (40%) - removed by kidneys and liver
28
metabolism - rocuronium
not metabolized - removed by liver (70%) and kidney (25%)
29
metabolism - pancuronium
liver (20%) - removed by kidneys (85%)
30
which relaxant releases histamine
atracurium > mivacurium small amount released with succinylcholine
31
factors prolonging paralysis
``` hypothermia aminoglycoside toxicity penicillin toxicity steroid myopathy clindamycin tetracycline volatile anesthetics dantrolene magnesium lithium ```
32
intubating dose - succinylcholine
1-1.5 mg/kg
33
intubating dose - mivacurium
0.2 mg/kg
34
intubating dose - atracurium
0.5 mg/kg
35
intubating dose - cisatracurium
0.1 mg/kg
36
intubating dose - rocuronium
0.6-1 mg/kg
37
intubating dose - vecuronium
0.1 mg/kg
38
intubating dose - pancuronium
0.08-0.18 mg/kg
39
time to onset - succinylcholine
30-60 sec
40
time to onset - mivacurium
3 min
41
time to onset - atracurium
2-4 min
42
time to onset - cisatracurium
2-4 min
43
time to onset - rocuronium
1-1.5 min
44
time to onset - vecuronium
2-4 min
45
time to onset - pancuronium
2-4 min
46
sugammadex reversal doses
2 mg/kg if >2 twitches 4 mg/kg if 1 twitch 16 mg/kg after intubation dose
47
dose - neostigmine
0.03-0.07 mg/kg
48
dose - edrophonium
0.5-1 mg/kg
49
dose - atropine
0.01 mg/kg
50
dose - glycopyrrolate
0.01 mg/kg
51
max dose - neostigmine
5 mg
52
max dose - edrophonium
1 mg/kg
53
time to onset - neostigmine
7-10 min
54
time to onset - edrophonium
5-10 min
55
time to onset - atropine
1-1.5 min
56
time to onset - glycopyrrolate
2 min
57
time to onset - sugammadex
1-1.5 min
58
duration - neostigmine
55-75 min
59
duration - edrophonium
15-60 min
60
duration - atropine
15-30 min
61
duration - glycopyrrolate
1-2 hours
62
why does fade occur?
the presynaptic receptors are being blocked
63
sugammadex adverse drug reactions
``` dry mouth dysgeusia n/v coughing hypotension abnormal levels of N-acetylglucosaminidase in urine chills inactivate birth control ```
64
relaxants - response when 80% of receptors are occupied
tidal volume of 5 ml/kg | single twitch is as strong as baseline
65
relaxants - response when 70% of receptors are occupied
TOF and sustained tetanus for 5 seconds - no fade | vital capacity of 20 ml/kg
66
relaxants - response when 60% of receptors are occupied
double burst no fade
67
relaxants - response when 50% of receptors are occupied
``` hand grip head lift sustained bite sustained tetanus @ 100 htz inspiratory force at least -40 cm H2O ```
68
characteristics of neuromuscular blockade - phase 1 vs phase 2
- phase 1 = depolarizing | - phase 2 = non-depolarizing
69
anti-cholinesterase drugs ______ phase 1 drugs and _____ phase 2 drugs
- potentiate | - reverse
70
medications that inhibit cholinesterase
``` donepezil rivastigmine galantamine tacrine physostigmine phospholine iodide (anticholinesterase eye drops) ```

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