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pharm1 S.Horvath > NMB > Flashcards

NMB Flashcards

(84 cards)

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1
Q

fade during TOF is caused by

A

antagonism of pre-synaptic nicotinic receptors

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2
Q

acetylcholine - autonomic nervous system - which branch?

A

both! SNS and PNS but mostly Parasympathetic

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3
Q

how do depolarizing NMB’s work

A

depolarize the muscle fiber leaving it constantly stimulated and unable to be affected by Ach

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4
Q

how do non-depolarizers work

A

competitively block Ach from binding to receptors post-synaptically

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5
Q

non-depolarizers participate in ___ antagonism

A

competitive

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6
Q

ED95

A

dose of NMB necessary to produce 95% suppression of the single twitch response

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7
Q

ED95 when volatile anesthetic is used in conjunction with NMB

A

greatly reduced

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8
Q

use ___times the ED95 dose for tracheal intubation

A

2

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9
Q

which muscles are blocked first

A

small rapidly moving muscles - eyes and fingers

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10
Q

which muscle is blocked last

A

abdomen (diaphragm)

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11
Q

which muscle is a good predictor of laryngeal relaxation?

A

orbicularis

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12
Q

which muscles recover first?

A

larger muscles because they have more blood flow. (recovery in reverse order than paralysis)

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13
Q

ach channels are

A

ligand gated ion channels.

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14
Q

___% suppression of single twitch response is adequate for surgery

A

90

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15
Q

which non-dolparizers have a higher incidence of histamine release

A

benzylisoquinolinium

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16
Q

quaternary ammonium are ionized or lipophilic?

A

highly ionized.

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17
Q

quaternary cns effects?

A

none

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18
Q

quaternary binds to alpha sub unit ___ synaptically

A

post

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19
Q

quaternary are not completely specific, meaning they bind to

A

cardiac muscarinic and autonomic ganglia nicotinic

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20
Q

are quaternary’s highly protein bound?

A

no

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21
Q

which non-depol are long acting

A

panc, dox, and pipe

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22
Q

which non-depol are intermediate acting

A

atra, vec, roc, cis

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23
Q

which non-depol are short acting

A

miv

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24
Q

onset of succs

A

30-60s

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25
duration of succs
3-5min
26
succs MOA
binds to one or both alpha subunits at nicotinic receptor. mimics Ach
27
does succs have a shorter or longer duration than ach
longer
28
succs increases K by
.5meq/L
29
tof ratio for succs
>0.7
30
which recovers first.. diaphragm or peripheral muscles?
diaphragm
31
succs is broken down by
plasma cholinesterase in the blood
32
what things reduce the amt of plasma cholinesterase
severe liver dz, neostigmine, high estrogen levels. reglan
33
obese patients and cholinesterases
they have increased levels - so break down succs faster - need more
34
what kind of cardiac side effects does succs cause
arrhythmias - sinus brady, junctional rhythm, sinus arrest.... some people get tachycardia and inc BP due to ganglia stimulation (some people get sympathetic boost)
35
what should you give to treat the bradycardia with succs?
epi. not atropine
36
if something is anti-muscarinic, it is also
anticholinergic
37
succs causes increased pressure where
intragastric, intraocular, intracrmail.
38
which drug causes an increase in mortality for brain injured patients in the ED
succes
39
what is the TOF ratio for non-depol
<0.7
40
which ND's cause histamine release
atra and miv
41
panc CV effects
increased HR, MAP, CO. blocks vagal/muscarinic.. so anti-parasympathetic, SNS activation
42
panc CV don't give
digoxin
43
critical myopathy is common with which class
aminosteroids , higher risk with corticosteroids
44
critical myopathy what happens to pt's
long term paralysis for mech vent >6 days
45
NMB's are enhanced by
volatile anesthetics, aminoglycosides, LA's, antiarrhymics, diuretics, Mg, Li
46
how do anticonvulsants affect NMB
affect cyp enzymes
47
how does cyclosporine affect NMB
prolonged blockade
48
how do corticosteroids affect NMB
compounded muscle weakness
49
how do sympathomimetics affect NMB
increased onset d/t changes in blood flow. argument on whether it leads to shorter or longer duration.
50
hypothermia ___ duration of NMB
prolongs
51
how does HYPOkalemia affect NMB
resistance to succs and increases sensitivity to NDNMB
52
how does HYPERkalemia affect NMB
increases succs effects and opposes NDNMB
53
how does paresis or hemiplegia affect NMB
have extra junctional receptors so need more, mega doses
54
are men or women more sensitive to NMB?
women
55
long acting panc and pipe NDNMB's have ___ positive nitrogens
2
56
which long acting is a benzyl
dox
57
panc structure
bisquaternary aminosteriod
58
panc and renal failure
80% excreted unchanged in urine, renal failure reduces clearance up to 50%
59
panc metabolite
3-desacetylpancuronium (half as potent as panc)
60
how does liver disfunction effect panc
longer half life
61
which NMB is enhanced by resp acidosis
panc
62
ronium's are
aminosteriods
63
curium's are
benzyl's
64
which NMB has an increased potency and shorter duration in infants
pipe
65
which NDNMB have only 1 positive nitrogen and what does that do
vec and roc - lipophiilc.. hepatic/renal clearance.
66
priming principle for roc
1. small dose binds spare receptors, 4 min later deliver the rest.
67
which NDNMB is 82% protein bound
atra
68
which NDNMB's undergo hoffman elimination
atra and cis
69
hoffman elimination is accelerated by ___ and slowed by ____
alkalosis, acidosis
70
which drugs have laudanosine as a metabolite
atra and cis. mostly atra - inactive at NMJ but may be CNS stimulant and increase MAC
71
laudanosine causes peripheral ____ and ___ MAC of volatile anesthetics
vasodilation, increases
72
atra CV
at 3x ED95 increase HR, decrease MAP. histamine release
73
H1 and H2's help with
histamine release with atra
74
long term h2 blocker use may do what to CV effects of atra
exacerbate CV effects d/t histamine
75
atra infant dose
half dose of older children
76
cis main difference
no histamine release
77
how is vec eliminated
both hepatic and renal. lipid soluble!
78
vec and biliary excretion
40% unchanged in bile, exaggerated response with hepatic cirrhosis
79
vec and urinary elmin
30% unchanged in urine, half life prolonged in renal failure
80
cumulative effects of vec panc and atra
panc> vec> atra
81
which has a slight vagolytic effect... vec or roc?
roc
82
vec has a ___ onset in infants
rapid
83
vec and elderly
decreased clearance, longer recovery
84
onset of roc
1-2min

pharm1 S.Horvath (18 decks)

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