NMB

Question 1

List the depolarizing NMB agent

Answer 1

Succinylocholine

Question 2

List the two non-depolarizing NMB agents

Answer 2

1. Isoquinoline

2. Steroid derivative

Question 3

List the non-depolarizing steroid derivatives

Answer 3

1. Pancronium
2. Rocuronium
3. Vecuronium

Question 4

List the main non-depolarizing Isoquinoline derivatives

Answer 4

Tubocurarine

Question 5

Does renal elimination or hepatic elimination have longer half lives?

Answer 5

Renal elimination= >35 minutes = longer duration of action

Question 6

List the effects of Succinylcholine

Answer 6

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

Question 7

What is the main indication for Succinylcholine

Answer 7

Rapid endotracheal intubation

Question 8

What is the norma duration of Succinylcholine

Answer 8

Rapid=5 minutes

Question 9

Succinylcholine ADE’s

Answer 9

Arrhythmias

Question 10

Tubocurarine MOA

Answer 10

Non-Depolarizing Agent

Competitive ANTAGONIST @ nACh receptors

Question 11

What is the effect of Tubocurarine

Answer 11

Prevents depolarization by ACh=Flaccid Paralysis

Question 12

When do we use Tubocurarine and Panuronium

Answer 12

1. Prolonged relaxation for surgical procedures

2. Facilitate intubation and maintain skeletal muscle relaxation during surgery

Question 13

How can you overcome the effects of Tubocurarine and Panuronium?

Answer 13

Increase amount of ACh in synaptic cleft:

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

Question 14

What drugs enhance the neuromuscular blocking effects?

Answer 14

1. Aminiglycosides

2. Calcium Channel Blockers (verapamil)

Question 15

Tubocurarine and Panuronium Toxicities

Answer 15

1. Histamine release
2. Hypotension
3. Prolonged apnea

Question 16

Define Minimum alveolar anesthetic concentration (MAC)

Answer 16

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

Question 17

Define analgesia

Answer 17

state of decreased awareness of pain

sometimes with amnesia

Question 18

Define general anesthesia

Answer 18

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

Question 19

List the 4 stages of Anesthesia

Answer 19

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

Question 20

List the 5 Primary Effects produced by general anesthesia

Answer 20

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

Question 21

List the main inhaled anesthetics

Answer 21

1. Nitric Oxide
2. Sevoflurane
3. Isoflurane
4. Methoxyflurane

Question 22

inhaled anesthetic MOA

Answer 22

1. Facilitate GABA-mediated inhibition

2. Block brain NMDA and ACh-N receptors

Question 23

Effects of inhaled anesthetic

Answer 23

Increase cerebral blood flow, vasodilation

Decrease respiratory function

Question 24

What are potential SE’s of Nitric Oxide?

Answer 24

Increase CBF=Increase ICP

Caused by activation of sympathetic nervous system

Question 25

What is the drug of choice in patients with underlying airway problems? Why?

Answer 25

Halothane and Sevoflurane | Bronchodilators

Question 26

What is the preferred method of anesthesia induction in most settings?

Answer 26

IV Anesthetics

Question 27

List the IV Barbituates

Answer 27

1. Thiopental 2. Thioamylal 3. Methohexital

Question 28

IV Barbituates MOA

Answer 28

Facilitate GABA-mediated inhibition @ GABA-A receptors

Question 29

IV Barbituates PK's

Answer 29

High Lipid Solubility=Fast Onset & Short Duration

Question 30

List the IV Benzodiazepine

Answer 30

Midazolam

Question 31

Midazolam PK's

Answer 31

Slower onset, but LONGER duration than barbituarates

Question 32

How can you reverse the postop respiratory depression effects of Midazolam?

Answer 32

Flumazenil

Question 33

What are the effects of Ketamine?

Answer 33

1. Analgesia 2. Amnesia 3. Catatonia 4. NOT unconscious 5. CV Stimulation!

Question 34

Ketamine toxicities?

Answer 34

Increased ICP

Question 35

Is Ketamine long or short acting?

Answer 35

Long acting

Question 36

List the IV opioids used

Answer 36

1. Fentanyl 2. Alfentanil 3. Remifentanil 4. Morphine

Question 37

How do you reverse the respiratory depression effects of opioids?

Answer 37

Naloxone=Narcan

Question 38

List the IV Phenols

Answer 38

1. Propofol | 2. Fospropofol

Question 39

Phenols effects

Answer 39

1. Vasodilation 2. Hypotension 3. Negative Inortopy= CV depression d/t decreased cardiac muscle contraction