Nagelhout videos: NMB's

Question 1

Pt can start breathing when _____% of their nicotinic cholinergic receptors are still blocked

Answer 1

80%

-only need 20% return of function to breathe

Question 2

Smooth muscle isn’t affected by NMB… what kind of things are smooth muscle

Answer 2

• Bronchi
• Uterus
• Bowel

Question 3

T/F- GI sphincters are affected by NMB

Answer 3

True but the smooth muscle itself is not

Question 4

if smooth muscle in the abdomen aren’t affected by NMB, why do we need to give relaxant to belly cases?

Answer 4

Think of it as a tube and toothpaste ; the way we keep the toothpaste from squeezing out of the tube, is by relaxing the tube (all the abdominal muscles surrounding the guts)

Question 5

which way is the electric current flowing between the red and black leads on twitch monitor

Answer 5

electricity flows from positive to negative

Question 6

What muscles are the easiest muscles to paralyze?

Answer 6

the eyelid muscles

Question 7

Hardest muscle in the body to paralyze?

Answer 7

Diaphragm- makes sense, you need to breathe to live

Question 8

Why shouldn’t you put the electrodes for TOF like around the eye like you sometimes might do lol

Answer 8

bc you can directly stimulate the muscle even if its 100% paralyzed- youre sending the electricity directly into the muscle- the muscle is going to contract;

& paralytics don’t paralyze the muscle, they paralyze nerve-to-muscle transmission

Question 9

Why would you give SUX for an RSI? And don’t say bc it’s fast onset of action, what’s the real deal

Answer 9

Bc propofol makes people lose their airway reflexes, and during that time they are vulnerable to aspiration; the ability to give sux lessens the time they are a-reflexic and vulnerable to aspirating bc you can get the tube in quicker to secure the airway; whereas with roc/vec you would have to wait a much longer time for it to work

want prop to tube time to be as short as possible

Question 10

What is a modified RSI

Answer 10

instead of not ventilating at all while waiting for relaxant to work, you gently ventilate

Question 11

Recovery time with neostigmine based on
1 twitch:
2-3 twitches:
4 twitches:

Answer 11

1 = up to 30 minues
2-3 twitches = 4-15 mins
4 twitches = 5-10 mins

Question 12

How is TOF ratio measured?

Answer 12

Comparing the first twitch to the 4th twitch

Question 13

What percent is blocked with each line

Answer 13

4 twitches = 70% blocked

3 twitches = 75% blocked

2 twitches = 80% blocked

1 twitch = 90% blocked

0 twitch = 100% blocked

Question 14

4 twitches without fade = ___% blocked, ___% recovered, TOFR:

4 twitches with fade = ____% blocked, ___% recovered, TOFR:

Answer 14

• no fade = <70% blocked, >30% recovered; TOF > 0.9 or 90%
  
  • fade = 70-75% blocked, 25-30% recovered; TOF < 0.9 or 90%

Question 15

someone asks you what the TOF ratio is on someone with 2 twitches

Answer 15

n/a - it’s a TOfour , need 4 twitches to get a TOF ratio

Question 16

Single twitch = ____hz

TOF twitchs = _____hz

DBS = _____hz

Tetany = _______hz

Answer 16

single = 1 hz

TOF = 2 hz

DBS = 50hz

Tetanus = 50-100hz

Question 17

DBS is 2 twitches at ___ hz with what time lapse in between

Answer 17

50hz, 3/4 of a second

Question 18

Explain why post-tetanic potentiation is a shitty way to claim someone has twitches

Answer 18

okay so you give a tetanus over 5 seconds

• this mobilizes acetylcholine down the presynaptic nerve and floods the synapse but pt is 100% blocked and you don’t see any reaction from that ACH right away
• After you flood the synapse with ACH and do a TOF, there hasn’t’ been enough time that lapsed for AchE to metabolize it, so it can breifly overpower the blocked receptors
• However, that NMB is going to hop right back onto that receptor as ACH becomes more and more metabolzied by AchE.
• So you’re only kidding yourself if you think the patient is any bit kind of recovered

Question 19

T/F- dibucaine SHOULD inhibit psedudocholinesterase

Answer 19

True

Question 20

T/F- dibucaine should NOT inhibit pseudocholinesterase

Answer 20

false - it should

if it doesn’t inhbit PchE, the patient is atypical

Question 21

T/F- the dibucaine number reflects the amount of pseudocholinesterase that was inhibited in the test tube

Answer 21

true- if it’s 80, means 80% was inhibited and 80% is normal

Question 22

1 culprit of MH

Answer 22

Sux

Question 23

2 drugs that increase IOP

Answer 23

Sux and Ketamine

Question 24

What percentage of burn injury shouldn’t you give sux to after 24 hrs?

Answer 24

>35% burned

Question 25

What should you think when you see these in a chemical structure? What are they?

Answer 25

They are ester links and it means they can be hydrolyzed by plasma esterases; since this is atracurium and cist - it would be non-specific esterases

Question 26

What should influence your decision of what muscle relaxant to use?

Answer 26

How it will be eliminated

Question 27

Stimulation of which histamine receptor results in increased capiliary permeability -> inflammation/swelling/bronchoconstriction

Answer 27

Histamine 1

Question 28

Which histamine receptor results in a great increase in gastric acid production?

Answer 28

H2 - hence why we give H2 blockers, decreases amount of gastric acid secretion

Question 29

Which histamine receptor causes systemic and cerebral vasodilation?

Answer 29

H2

Question 30

T/F- the degree of histamine release is directly propotional to how much and how fast you push a histamine-releasing drug

Answer 30

True!

-push them slow!

Question 31

If you are going to give a known histamie-releasing drug, would you pre-treat with a H1 or H2 blocker?

Answer 31

Both

H1 = benadryl

H2 = pepcid

Question 32

How does benadryl work?

Question 33

muscle relaxants intubating dose is ___x the maintenance dose (ED95)

ex. Roc

Answer 33

3x

ED 95 = 0.3mg/kg

intubating dose = 0.9mg/kg (1mg/kg)

Question 34

acetylcholinesterase inhibitors work by indirectly increasing the amount of acetylcholine in the synaptic cleft in excess of the blocker; this is the law of _________

Answer 34

mass action

Question 35

purpose of giving glyco with neostigmine

Answer 35

bc the acess of ACH that builds up in the synaptic cleft, also builds up around the cholinergic receptors in the PNS; so in order to block that from binding to those receptors too, an antimuscarinic is given that will work in the PNS but not block the nicotnic NMJ receptors

Question 36

max dose of edrophonium

Answer 36

1mg

Question 37

The potency is (directly/inversely) propotional to the speed of onset.

Answer 37

inversely

• more potent = slower onset (less molecules)
• less potent (more molecules needed) = faster onset

Question 38

anticholinesterase eyedrops

Answer 38

echothipate

Phospholine Iodide (Wyeth-Ayerst)

Question 39

T/f - echothiapate would increase the DOA of sux

Answer 39

true bc they are anticholinesterase eyed drops