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Apex Review > Musculoskeletal diseases 2 > Flashcards

Musculoskeletal diseases 2 Flashcards

(55 cards)

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1
Q

Which agents are safe to administer to the patient with hypokalemic periodic paralysis?
a. rocuronium
b. terbutaline
c. D5LR
d. acetazolamide

A

a. rocuronium
d. acetazolamide

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2
Q

Familial periodic paralysis is characterized by

A

acute episodes of skeletal muscle weakness accompanied by serum potassium concentration changes
two variants of the disease- hypokalemic & hyperkalemic

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3
Q

Hypokalemic periodic paralysis is presnt if

A

skeletal muscle weakness follows a glucose-insulin infusion

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4
Q

With hypokalemic periodic paralysis, the patient becomes weak when the serum K+

A

decreases

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5
Q

Hyperkalemic periodic paralysis is present if skeletal muscle weakness follows

A

oral potassium administration

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6
Q

The patient with hyperkalemic periodic paralysis becomes weak when

A

serum K+ increases

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7
Q

_______ is the treatment for both forms of familial periodic paralysis

A

Acetazolamide

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8
Q

For patients with familial periodic paralysis, _______ should be avoided at all costs.

A

Hypothermia

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9
Q

For patients with hyperkalemic familial periodic paralysis, __________ is contraindicated.

A

succinylcholine

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10
Q

For patients with hypokalemic familial periodic paralysis ________________ should be avoided because _______

A

succinylcholine because this condition might be associated with MH

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11
Q

_______ should be monitored for patients with familial periodic paralysis.

A

Serum potassium levels

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12
Q

Familial periodic paralysis is a disorder of ____________ and not a disease of ____________

A

the skeletal muscle membrane (reduced excitability) and not a disease of the neuromuscular junction

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13
Q

Hypokalemic periodic paralysis is associated with a _______ channelopathy

A

calcium

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14
Q

Hyperkalemic periodic paralysis is associated with a _________ channelopathy

A

sodium

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15
Q

Why is acetazolamide the treatment of choice for both forms of familial periodic paralysis?

A

it creates a non-anion acidosis which protects against hypokalemia and it also facilitates renal potassium excretion which guards against hyperkalemia

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16
Q

For patients with hypokalemic periodic paralysis, we should avoid these drugs:

A

glucose containing solutions
potassium wasting diuretics
beta-2 agonists
succinylcholine

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17
Q

For patients with hyperkalemic periodic paralysis, we should avoid these drugs:

A

succinylcholine
potassium containing solutions (LR)

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18
Q

Malignant hyperthermia is primarily associated with the genetic mutation of the:
a. SERCA2 pump
b. ryanodine receptor
c. dihydropyridine receptor
d. actin myofilament

A

b. ryanodine receptor

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19
Q

List three co-existing diseases that are definitely associated with MH:

A

King-Denborough syndrome
Central core disease
multiminicore disease

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20
Q

What two classes of drugs are known to trigger MH?

A

halogenated anesthetics
depolarizing neuromuscular blockers

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21
Q

MH is an

A

inherited disease of skeletal muscle that is characterized by disorder calcium homeostasis

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22
Q

Describe the pathophysiology of MH.

A

a defective ryanodine receptor contributes to excessive Ca2+ release from the endoplasmic reticulum and this leads to sustained skeletal muscle contraction, a hypermetabolic state, and increased oxygen consumption

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23
Q

MH is not associated with the following conditions:

Study These Flashcards
A

Duchenne muscular dystrophy
Becker muscular dystrophy
neuroleptic malignant syndrome
myotonia congenita
myotonic dystrophy
osteogenesis imperfecta

24
Q

Consequences of increased intracellular calcium in the myocyte include

Study These Flashcards
A

rigidity from sustained contraction
accelerated metabolic rate and rapid depletion of ATP
increased oxygen consumption
increased CO2 and heat production
mixed respiratory and lactic acidosis
sarcolemma breaks down
potassium and myoglobin leak into the systemic circulation

25
Factors that increase the risk of MH include
Male sex youth geography- families from Wisconsin, Nebraska, West Virginia, and Michigan appear to be at higher risk
26
The earliest signs of malignant hyperthermia include (choose 3): a. tachycardia b. hyperthermia c. cola-colored urine d. increased EtCo2 e. masseter spasm f. DIC
a. tachycardia d. increased EtCo2 e. masseter spasm
27
The most sensitive indicator of MH is
EtCO2 that rises out of proportion to minute ventilation
28
MH can occur as late as ______ hours after exposure to a triggering agent
6 hours
29
____________ is typically a late sign of MH.
hyperthermia
30
Conditions to consider in your differential diagnosis of MH includes
thyroid storm pheochromocytoma sepsis heatstroke
31
_____ & _______ are two entities that exist on a continuum with MH.
Trismus and masseter muscle rigidity
32
_____ describes a tight jaw that can still be opened and is a normal response to __________
trismus; succinylcholine
33
_____________ muscle rigidity describes a tight jaw that cannot be opened. ____________ will not relax the jaw.
Masseter muscle rigidity; a neuromuscular blocker
34
Anyone who has experienced MH or masseter spasm should be referred for
a halothane contracture test for diagnosis
35
Early signs of MH include
tachycardia tachypnea masseter spasm warm soda lime irregular heart rhythm
36
Intermediate signs of MH include
cyanosis irregular heart rhythm patient warm to touch
37
Late signs of MH include
muscle rigidity cola-colored urine coagulopathy irregular heart rhythm overt hyperthermia
38
What drug is contraindicated in the management of malignant hyperthermia? a. verapamil b. mannitol c. calcium chloride d. insulin
a. verapamil CCB can result in life-threatening hyperkalemia
39
Considerations for preventing MH include:
flushing the anesthesia machine with high flow oxygen for up to 100 minutes the vaporizers must be physically removed from the machine external parts should be removed and replaced (CO2 absorbent, circuit, and breathing bag) dantrolene prophylaxis is unwarranted
40
The four steps to treat MH include.
Discontinue the triggering agents. Convert to an IV technique. call for help and notify the surgeon to terminate the procedure hyperventilate with 100% O2 at a minimum FGF of 10L/min apply charcoal filters to the inspiratory and expiratory port and then apply a new breathing circuit and bag
41
The last 4 steps of treating MH include
administer dantrolene or Ryanodex 2.5 mg/kg IV q5-10 mint cool the patient treat acidosis and electrolyte disturbances maintain UO above 2mL/kg/hr
42
If the patient with MH doesn't present with s/sx of MH within the first _________ of the procedure, then it is very unlikely that it will occur later.
hour
43
As an alternative to the purging guidelines (10L FGF at 100% O2 for min 20-100 min.), you can use
a charcoal filter such as the Vapor-clean flush with high FGF for 90 seconds prior to using the machine on the patient
44
After the patient is stabilized, they should be
observed in the ICU as MH can reoccur up to 36 hours
45
What are the MOAs of dantrolene?
it reduces Ca2+ release from the RyR1 receptor in the skeletal myocyte it prevents Ca2+ entry into the myocyte which reduces the stimulus for calcium-induced calcium release
46
What should dantrolene be reconstituted with?
60 mL of preservative free water NS introduces additional solute and prolongs the time required for dantrolene to dissolve
47
Most common side effects of dantrolene are
weakness venous irritation
48
What is the continuous infusion rate of dantrolene?
1 mg/kg q6 hr. or 0.1-0.3 mg/kg/hr for 48-72 hours
49
If the patient requires more than ___________, reconsider the diagnosis of MH
20 mg/kg
50
Patients with MH should be cooled until
their temperature drops below 38 degrees C
51
Ways to cool the patient include
Cold IVF cold fluid lavage of stomach and bladder ice packs
52
What can be given to correct lactic acidosis?
sodium bicarbonate 1-2 mEq/kg IV titrated to ABG and base deficit
53
What can be done to treat hyperkalemia?
CaCl 5-10 mg/kg IV insulin 0.15 units/kg + D50 1 mL/kg Hyperventilation
54
What can be given to protect against dysrhythmias for the patient with MH?
procainamide 15 mg/kg IV lidocaine 2 mg/kg IV co-administration of a CCB with dantrolene can precipitate life-threatening hyperkalemia
55
For patients with MH, urine output can be maintained with
IV hydration mannitol 0.25 g/kg IV furosemide 1 mg/kg IV

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