NMB Flashcards

(39 cards)

1
Q

List the depolarizing NMB agent

A

Succinylocholine

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2
Q

List the two non-depolarizing NMB agents

A
  1. Isoquinoline

2. Steroid derivative

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3
Q

List the non-depolarizing steroid derivatives

A
  1. Pancronium
  2. Rocuronium
  3. Vecuronium
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4
Q

List the main non-depolarizing Isoquinoline derivatives

A

Tubocurarine

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5
Q

Does renal elimination or hepatic elimination have longer half lives?

A

Renal elimination= >35 minutes = longer duration of action

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6
Q

List the effects of Succinylcholine

A

Initially depolarizes=Transient contractions (fasciculation’s)
Followed by refractory depolarization=Flaccid Paralysis

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7
Q

What is the main indication for Succinylcholine

A

Rapid endotracheal intubation

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8
Q

What is the norma duration of Succinylcholine

A

Rapid=5 minutes

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9
Q

Succinylcholine ADE’s

A

Arrhythmias

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10
Q

Tubocurarine MOA

A

Non-Depolarizing Agent

Competitive ANTAGONIST @ nACh receptors

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11
Q

What is the effect of Tubocurarine

A

Prevents depolarization by ACh=Flaccid Paralysis

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12
Q

When do we use Tubocurarine and Panuronium

A
  1. Prolonged relaxation for surgical procedures

2. Facilitate intubation and maintain skeletal muscle relaxation during surgery

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13
Q

How can you overcome the effects of Tubocurarine and Panuronium?

A

Increase amount of ACh in synaptic cleft:

  1. Cholinesterase inhibitors: Neostigmine, Pyridostigmine
  2. Muscarinic receptor antagonist: atropine (voids bradydysrhthmias)
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14
Q

What drugs enhance the neuromuscular blocking effects?

A
  1. Aminiglycosides

2. Calcium Channel Blockers (verapamil)

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15
Q

Tubocurarine and Panuronium Toxicities

A
  1. Histamine release
  2. Hypotension
  3. Prolonged apnea
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16
Q

Define Minimum alveolar anesthetic concentration (MAC)

A

The alveolar concentration of an inhaled anesthetic that is required to prevent a response to a standardized painful stimulus in 50% of patients

17
Q

Define analgesia

A

state of decreased awareness of pain

sometimes with amnesia

18
Q

Define general anesthesia

A

state of unconsciousness, analgesia, and amnesia with skeletal muscle relaxation and loss of reflexes

19
Q

List the 4 stages of Anesthesia

A
  1. Analgesia: Decreased awareness
  2. Disinhibition: Delirious, excited; Amnesia; irregular respiration; incontinence
  3. Surgical Anesthesia: Unconscious, no pain; regular reparation and BP
  4. Medullary Depression: Severe respiratory & CV depression; mechanical and pharm support
20
Q

List the 5 Primary Effects produced by general anesthesia

A
  1. Unconsciousness
  2. Amnesia
  3. Analgesia
  4. Inhibition of autonomic reflexes
  5. Skeletal muscle relaxation
21
Q

List the main inhaled anesthetics

A
  1. Nitric Oxide
  2. Sevoflurane
  3. Isoflurane
  4. Methoxyflurane
22
Q

inhaled anesthetic MOA

A
  1. Facilitate GABA-mediated inhibition

2. Block brain NMDA and ACh-N receptors

23
Q

Effects of inhaled anesthetic

A

Increase cerebral blood flow, vasodilation

Decrease respiratory function

24
Q

What are potential SE’s of Nitric Oxide?

A

Increase CBF=Increase ICP

Caused by activation of sympathetic nervous system

25
What is the drug of choice in patients with underlying airway problems? Why?
Halothane and Sevoflurane | Bronchodilators
26
What is the preferred method of anesthesia induction in most settings?
IV Anesthetics
27
List the IV Barbituates
1. Thiopental 2. Thioamylal 3. Methohexital
28
IV Barbituates MOA
Facilitate GABA-mediated inhibition @ GABA-A receptors
29
IV Barbituates PK's
High Lipid Solubility=Fast Onset & Short Duration
30
List the IV Benzodiazepine
Midazolam
31
Midazolam PK's
Slower onset, but LONGER duration than barbituarates
32
How can you reverse the postop respiratory depression effects of Midazolam?
Flumazenil
33
What are the effects of Ketamine?
1. Analgesia 2. Amnesia 3. Catatonia 4. NOT unconscious 5. CV Stimulation!
34
Ketamine toxicities?
Increased ICP
35
Is Ketamine long or short acting?
Long acting
36
List the IV opioids used
1. Fentanyl 2. Alfentanil 3. Remifentanil 4. Morphine
37
How do you reverse the respiratory depression effects of opioids?
Naloxone=Narcan
38
List the IV Phenols
1. Propofol | 2. Fospropofol
39
Phenols effects
1. Vasodilation 2. Hypotension 3. Negative Inortopy= CV depression d/t decreased cardiac muscle contraction