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Apex Review > Neuromuscular blockers 2 > Flashcards

Neuromuscular blockers 2 Flashcards

1
Q

Identify the statement that demonstrates the MOST accurate understanding of succinylcholine (select 2.):
a. hypertension is a normal side effect
b. it’s an absolute contraindication with an open globe injury
c. severe sepsis increases the risk of hyperkalemia
d. masseter spasm warrants cancellation of the planned procedure

A

a. hypertension is normal side effect
c. severe sepsis increases the risk of hyperkalemia

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2
Q

Succinylcholine can produce a wide variety of side effects including:

A

bradycardia
tachycardia
increased serum K+
increased intraocular pressure
increased intracranial pressure
increased intragastric pressure
malignant hyperthermia

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3
Q

__________ are more susceptible to bradycardia with succinylcholine because of

A

children; because of a higher baseline vagal tone

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4
Q

If a child requires a second dose of succinylcholine, you should administer _________ before administering the second dose of succinlycholine

A

atropine

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5
Q

Succinylcholine is safe in patients with

A

renal failure and a normal serum potassium level

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6
Q

Succinylcholine can cause

A

masseter spasm

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7
Q

If masseter spasm occurs with succinylcholine,

A

it does not warrant cancellation of the planned surgical procedure; this finding in the absence of other s/sx of MH is normal

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8
Q

How does succinylcholine cause bradycardia or asystole?

A

stimulating the M2 receptor in the SA node

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9
Q

How can succinylcholine cause tachycardia and hypertension?

A

by mimicking the action of Ach at the sympathetic ganglia

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10
Q

Succinylcholine transiently intraocular pressure by

A

5-15 mmHg for up to 10 minutes

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11
Q

How can a temporary increase in ICP be prevented when giving succinylcholine?

A

giving a defasciculating dose

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12
Q

Is the risk of aspiration increased with succinylcholine?

A

No because contraction of the abdominal muscle increase intragastric pressure but succinylcholine also raises lower esophageal sphincter tone and they cancel each other out

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13
Q

Which enzymes hydrolyze succinylcholine? Select 3
a. butyrylcholinesterase
b. type 1 cholinesterase
c. true cholinesterase
d. pseudocholinesterase
e. plasma cholinesterase
f. acetylcholinesterase

A

a. butyrylcholinesterase
d. pseudocholinesterase
e. plasma cholinesterase

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14
Q

Acetylcholinesterase is found in

A

the neuromuscular junction

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15
Q

Acetylcholinesterase metabolizes

A

acetylcholine

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16
Q

Pseudocholinesterase is found in the

A

plasma

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17
Q

Pseudocholinesterase metabolizes

A

succinylcholine
mivacurium
ester local anesthetics

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18
Q

Other names for acetylcholinesterase include

A

genuine cholinesterase
type 1 cholinesterase
true cholinesterase
specific cholinesterase

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19
Q

Other names for pseudocholinesterase include

A

butyrylcholinesterase
type 2 cholinesterase
false cholinesterase
plasma cholinesterase

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20
Q

Pseudocholinesterase is produced in the

A

liver and serves as an indicator of hepatic synthetic function

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21
Q

In the plasma, pseudocholinesterase has a reference concentration range of

A

2900-7100 units/L

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22
Q

Pseudocholinesterase is also located in

A

smooth muscles
intestines
white matter of the brain
heart
pancreas
NOT located in the CSF

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23
Q

With pseudocholinesterase, neuromuscular symptoms begin at __ of normal and become serious at ____ of normal

A

60%; 20%

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24
Q

Which factors prolong the duration of succinylcholine? (select 3).
a. metoclopramide
bb. edrophonium
c. obesity
d. late-stage pregnancy
e. myasthenia gravis
f. esmolol

A

a. metoclopramide
d. late-stage pregnancy
f. esmolol

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25
Key drugs that reduce pseudocholinesterase activity include
metoclopramide esmolol neostigmine
26
Key conditions that reduce pseudocholinesterase activity include:
atypical PChe severe liver disease burns neoplasm pregnancy (late-stage)
27
All co-existing diseases that reduce pseudocholinesterase activity include
atypical PChe severe liver disease chronic renal disease organophosphate poisoning burns neoplasm advanced age malnutrition pregnancy (late stage)
28
All drugs that prolong the duration of succinylcholine include
metoclopramide esmolol neostigmine (not edrophonium) echothiphate oral contraceptives/estrogen cyclophosphamide monoamine oxidase inhibitors nitrogen mustard
29
A patient with a dibucaine number of 20 received succinylcholine. This patient: a. is heterozygous for pseudocholinesterase b. fails to produce pseudocholinesterase in sufficient quantity c. should receive fresh frozen plasma d. will be paralyzed for eight hours
d. will be paralyzed for eight hours
30
______________ is an amide local anesthetic that is used to diagnose atypical PChE
Dibucaine
31
Dibucaine inhibits __________, but has no effect on ______________.
normal PChE, no effect on atypical PChe
32
_________________ determines the type of pseudocholinesterase she produces (typical or atypical)
A patient's genetic makeup
33
What does a dibucaine number of 20-30 indicate
atypical homozygous
34
What does a dibucaine number of 70-80 indicate?
typical homozygous (normal)
35
What does a dibucaine number of 50-60 indicate?
heterozygous variant
36
The best treatment for a patient with atypical PChE who has received succinylcholine is
mechanical ventilation sedation tincture of time
37
Atypical PChE variants cannot _______________ so the duration of succinylcholine will be ________________
hydrolyze succinylcholine; prolonged
38
A normal dibucaine number is
80
39
A normal dibucaine number of 80 indicates that
dibucaine has inhibited 80% of the pseudocholinesterase in the sample
40
A tentative bedside diagnosis of pseduocholinesterase deficiency can be made if
the response to train-of-four stimulation is absent for longer than expected
41
With a dibucaine number of 50-60, succinylcholine duration is prolonged by
20-30 minutes
42
With a dibucaine number of 20-30, succinylcholine duration is prolonged by
4-8 hours
43
Atypical plasma cholinesterase is a
qualitative defect; pseudocholinesterase in produced in sufficient quantity however the enzyme that is produced is not functional
44
_______, _______, or ________________ will restore plasma pseudocholinesterase levels in a patient with an atypical variant but it is not necessarily the treatment of choice.
whole blood, FFP, or purified human cholinesterase
45
The routine administration of succinylcholine is contraindicated in young children because of the possibility of: a. malignant hyperthermia b. hyperkalemic rhabdomyolysis c. trismus d. bradycardia
b. hyperkalemic rhabdomyolysis
46
Succinylcholine sports a black box warning that details the risk of
cardiac arrest and sudden death secondary to hyperkalemia in children with undiagnosed skeletal muscle myopathy
47
The most common cause of skeletal muscle myopathy is
Duchenne muscular dystrophy
48
Succinylcholine-induced hyperkalemia typically presents with
peaked T waves and sudden cardiac arrest
49
Succinylcholine-induced hyperkalemia most commonly affects
males under 8 years old
50
Succinylcholine is generally avoided in
children under 8 years of age
51
If a health infant or small child develops cardiac arrest following succinylcholine, treatment should include
stabilizing the myocardium shifting potassium into cells enhancing potassium elimination
52
What should be given in a succinylcholine induced cardiac arrest to stabilize the myocardium?
IV calcium
53
What should be given in a succinylcholine induced cardiac arrest to shift potassium into cells
glucose+insulin sodium bicarbonate hyperventilation albuterol
54
What should be given in a succinylcholine induced cardiac arrest to enhance potassium elimination?
furosemide volume resuscitation hemodialysis hemofiltration
55
Other forms of skeletal muscle myopathy that can lead to succinylcholine induced cardiac arrest include
Becker Emery-Dreifuss facioscapuloumeral limb-girdle muscular dystrophy
56
What is the dose of calcium chloride?
20 mg/kg
57
What is the dose of calcium gluconate?
60 mg/kg
58
What is the dose of sodium bicarbonate?
1-2 mmol/kg
59
What is the dose of furosemide?
1mg/kg
60
What is the dose of glucose + insulin?
0.3-0.5 g/kg as 10% glucose solution + 1 unit insulin per 4-5 g IV glucose

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