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Flashcards in NMB Deck (39)
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1

List the depolarizing NMB agent

Succinylocholine

2

List the two non-depolarizing NMB agents

1. Isoquinoline
2. Steroid derivative

3

List the non-depolarizing steroid derivatives

1. Pancronium
2. Rocuronium
3. Vecuronium

4

List the main non-depolarizing Isoquinoline derivatives

Tubocurarine

5

Does renal elimination or hepatic elimination have longer half lives?

Renal elimination= >35 minutes = longer duration of action

6

List the effects of Succinylcholine

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

7

What is the main indication for Succinylcholine

Rapid endotracheal intubation

8

What is the norma duration of Succinylcholine

Rapid=5 minutes

9

Succinylcholine ADE's

Arrhythmias

10

Tubocurarine MOA

Non-Depolarizing Agent
Competitive ANTAGONIST @ nACh receptors

11

What is the effect of Tubocurarine

Prevents depolarization by ACh=Flaccid Paralysis

12

When do we use Tubocurarine and Panuronium

1. Prolonged relaxation for surgical procedures
2. Facilitate intubation and maintain skeletal muscle relaxation during surgery

13

How can you overcome the effects of Tubocurarine and Panuronium?

Increase amount of ACh in synaptic cleft:
1. Cholinesterase inhibitors: Neostigmine, Pyridostigmine
2. Muscarinic receptor antagonist: atropine (voids bradydysrhthmias)

14

What drugs enhance the neuromuscular blocking effects?

1. Aminiglycosides
2. Calcium Channel Blockers (verapamil)

15

Tubocurarine and Panuronium Toxicities

1. Histamine release
2. Hypotension
3. Prolonged apnea

16

Define Minimum alveolar anesthetic concentration (MAC)

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

17

Define analgesia

state of decreased awareness of pain
sometimes with amnesia

18

Define general anesthesia

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

19

List the 4 stages of Anesthesia

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

List the 5 Primary Effects produced by general anesthesia

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

21

List the main inhaled anesthetics

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

22

inhaled anesthetic MOA

1. Facilitate GABA-mediated inhibition
2. Block brain NMDA and ACh-N receptors

23

Effects of inhaled anesthetic

Increase cerebral blood flow, vasodilation
Decrease respiratory function

24

What are potential SE's of Nitric Oxide?

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