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NMBD/R Flashcards

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1
Q

What is a clinically acceptable Tidal volume for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • > or equal to 5mL/kg
  • 80% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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2
Q

What is a clinically acceptable TOF result for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • No discernable fade
  • 70-75% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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3
Q

What is a clinically acceptable Head lift for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • Hold head off bed unassisted for 5 sec
  • 50% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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4
Q

What is a clinically acceptable Hand grip for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • Qualitatively = preinduction strength
  • 50% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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5
Q

What is a clinically acceptable sustained bite for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • Sustained jaw clench on tongue blade
  • 50% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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6
Q

What is a clinically acceptable inspiratory force for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • At least -40cmH2O
  • 50% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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7
Q

What is a clinically acceptable vital capacity for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • 20mL/kg
  • 70% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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8
Q

What is a clinically acceptable Double-burst for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • No palpable/discernable fade
  • 60-70% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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9
Q

What is a clinically acceptable Single-twitch for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • Qualitatively same as preinduction
  • 75-80% occupied

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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10
Q

What is a clinically acceptable Sustained Tetanus (50Hz) for extubation & what % of receptors may be occupied by a NMB at this endpoint?

A
  • No Fade
  • 70% occupied

NH says at least 20mL/kg but that ain’t make no damn sense.

Nagelhout 7th ed. Ch. 12, pg. 157, Table 12.3

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11
Q

_______ is where the pre-synaptic motor nerve endings meet the post-synaptic membranes of the skeletal muscle.

A

Neuromuscular Junction (NMJ)

Stoelting’s, Ch. 11, pg. 315

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12
Q

What does the pre-synaptic nerve terminal contain?

A

Synaptic vesicles filled with Ach
* at active zones

Stoelting’s, Ch. 11, pg. 315

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13
Q

What are the post-synaptic folds filled with?

A

Nicotinic Ach receptors (nAChRs)
…. seriously

Stoelting’s, Ch. 11, pg. 315

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14
Q

How/where is Ach broken down?

A
  • Acetylcholinesterase (AchE) by hydrolysis
  • located around nAChRs

Stoelting’s, Ch. 11, pg. 315

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15
Q

How many Ach molecules are in a quantum?

A

5,000 - 10,000 per synaptic vesicle

Stoelting’s, Ch. 11, pg. 316

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16
Q

What is a quantum?

A

Amount of Ach within a synaptic vesicle

Stoelting’s, Ch. 11, pg. 316

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17
Q

How/where is Ach synthesized?

A
  • Acetyl coenzyme A + choline by choline acetyltransferase = Ach
  • Cytoplasm of the nerve terminal

Stoelting’s, Ch. 11, pg. 316

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18
Q

nAChRs are pentameric complexes composed of what five things?

A
  • two a subunits
  • one b subunit
  • one d subunit
  • one eipsilon subunit
    Should = 5 idk

Stoelting’s, Ch. 11, pg. 318

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19
Q

What nAChRs subunits does Ach occupy?

A

Two alphas

cuz two

Stoelting’s, Ch. 11, pg. 316

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20
Q

What nAChRs subunits does Succinylcholine occupy?

A

Two alphas

Stoelting’s, Ch. 11, pg. 316

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21
Q

Fetal nAChRs are resistant to what kind of NMBs?

A

Nondepolarizing NMBs

idk man stoelting’s is confusing, I found it on his PPT

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22
Q

Fetal nAChRs are sensitive to what kind of NMBs?

A

Succinylcholine

idk man stoelting’s is confusing, I found it on his PPT

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23
Q

Since active transport calcium pumps move Ca2+ back into the Sarcoplasmic reticulum… what happens if they don’t?

A
  • Sustained contraction
  • Malignant Hyperthermia bruh

Stoelting’s, Ch. 11, pg. 320

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24
Q

What is the most common method for peri-operative monitoring of neuromuscular blockade?

A

Qualitative monitoring
(Peripheral nerve stimulator)

Nagelhout 7th ed. Ch 12, pg. 152

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25
Which muscle/nerve is preferred for monitoring of **depth** of blockade?
Adductor pollicis via ulnar n. ## Footnote Nagelhout 7th ed. Ch 12, pg. 152
26
Which muscle/nerve is preferred for monitoring **onset** of blockade?
Orbicularis oculi/corrugator supercili via Facial n. ## Footnote Nagelhout 7th ed. Ch 12, pg. 152
27
In what order are muscles blocked? | by level of sensitivity?
1. Eye muscle 2. Extremities/Trunk muscles 3. Abdominal muscles 4. Diaphragm ## Footnote Nagelhout 7th ed. Ch 12, pg. 153
28
In what order do muscles recover after NMB?
1. Diaphragm 2. Abdominal muscles 3. Extremities/Trunk muscles 4. Eye muscle ## Footnote Nagelhout 7th ed. Ch 12, pg. 153
29
What are the five clinical tests with a PNS for monitoring NMB?
1. Single twitch **2. Train-of-Four (TOF)** **3. Double-burst stimulation (DBS)** **4. Tetanus** 5. Post-tetanic count (PTC) ## Footnote Nagelhout 7th ed. Ch 12, pg. 153
30
What is the definition and cause of fade?
* Inability to sustain a response * Non-depolarizers antagonizing the positive feedback loop of Ach release ## Footnote Nagelhout 7th ed. Ch 12, pg. 153
31
What PNS test is this? Definition?
**Single Twitch** A single supramaximal electrical stimulus ranging from 0.1–1.0 Hz ## Footnote Nagelhout 7th ed. Ch 12, pg. 154, Table 12.2
32
What PNS test is this? Definition?
**Train of Four** Four twitches at 2 Hz separated by 0.5 sec (Total of 2 sec) ## Footnote Nagelhout 7th ed. Ch 12, pg. 154, Table 12.2
33
What PNS test is this? Definition?
**Double-Burst Stimulation** Two short bursts of 50 Hz Separated by 0.75 sec ## Footnote Nagelhout 7th ed. Ch 12, pg. 154, Table 12.2
34
What PNS test is this? Definition?
**Tetany** Rapidly delivery of 30, 50, or 100 Hz stimulus for 5 sec. | seems rude ## Footnote Nagelhout 7th ed. Ch 12, pg. 154, Table 12.2
35
What PNS test is this? Definition?
**Post-Tetanic count** Single 50 Hz tetanus for 5 sec followed by single twiches at 1 Hz ## Footnote Nagelhout 7th ed. Ch 12, pg. 154, Table 12.2
36
What is the percent blockade with 3 twitches (TOF)?
75-80% receptor blockade ## Footnote Nagelhout 7th ed. Ch 12, pg. 154
37
What is the percent blockade with 2 twitches (TOF)?
80-85% receptor blockade ## Footnote Nagelhout 7th ed. Ch 12, pg. 154
38
What is the percent blockade with 1 twitch (TOF)?
90-95% receptor blockade ## Footnote Nagelhout 7th ed. Ch 12, pg. 154
39
What is the ideal level of NMB with TOF?
85-95% blockade 1 or 2 twitches ## Footnote Nagelhout 7th ed. Ch 12, pg. 154
40
What does fade with DBS indicate?
Significant paralysis Like a TOF ratio <0.6 | you monster ## Footnote Nagelhout 7th ed. Ch 12, pg. 154
41
What does fade/no fade mean with Tetany with the PNS?
No fade = significant paralysis unlikely Fade = significant paralysis likely | Fade = bro, chill with the NMB ## Footnote Nagelhout 7th ed. Ch 12, pg. 154
42
The type of NMB and number of receptors occupied determine the type of response to PNS on presynaptic nerves is the definition for __________ ?
Incomplete (partial) neuromuscular block ## Footnote His ppt, I'm too lazy to look
43
Stimulation of the presynaptic nerve that doesn't produce a skeletal muscle response is called ___________ ?
Complete (full) neuromuscular block ## Footnote Again... too lazy
44
What are three characteristics of a Non-depolarizing NMB?
* Decrease in twitch tension * Fade w/ repeat stimulation * Post-tetanic potentiation ## Footnote Stoelting's Ch. 12, pg 324
45
What are four characteristics of a Depolarizing NMB?
* Fasiculations during onset * Decrease in twitch tension * No fade * NO post-tetanic potentiation ## Footnote Stoelting's Ch. 12, pg 324
46
Neostigmine Mechanism of Action?
Inhibits AchE, increases Ach concentration @ nAChRs around NMJ | Anticholinesterase or Cholinesterase inhibitor ## Footnote Nagelhout 7th ed. Ch 12, pg. 215
47
Anticholinergics are given to attenuate what kind of side effects with AchE inhibitors?
Parasympathomimetic side-effects * Brady/dysrhythmias * HoTN * Bronchconstriction * Hyper-salivation * N/V/D ## Footnote Nagelhout 7th ed. Ch 12, pg. 216-217
48
Which anticholinergic is given with each AChE inhibitor?
* Atropine & Edrophonium * Glycopyrrolate & Neostigmine ## Footnote Nagelhout 7th ed. Ch 12, pg. 217
49
All NMB are ______ ______?
Quarternary ammoniums (Similar to Ach) | Except tubocurarine ## Footnote Stoelting's Ch. 12. pg. 323
50
Simply, what is the chemical structure of Succinylcholine?
Two Ach molecules linked via acetate-methyl groups ## Footnote Stoelting's Ch. 12, pg 325
51
What is the ED95 of Succinylcholine?
0.3mg/kg ## Footnote Stoelting's Ch. 12, pg 325
52
What is the intubating dose of Succinylcholine?
1-1.5mg/kg ## Footnote Stoelting's Ch. 12, pg 325
53
Succinylcholine is metabolized via _______?
Butyrylcholinesterase or Pseudocholinesterase or Plasmacholinesterase | Whatever you wanna call it ## Footnote Stoelting's Ch. 12, pg 325
54
CV side effects of Succinylcholine?
* Sinus Tachycardia * Brady w/ repeat dosing @ muscarinic receptors ## Footnote Stoelting's Ch. 12, pg 327 + Nagelhout Ch. 12, pg. 201
55
Other side effects of succinylcholine? | 7
* Hyperkalema * Increase ICP * Increase IOP * Increased IGastricP * Myoglobinuria * Myalgias * Masseter spasm ## Footnote Stoelting's Ch. 12, pg 327
56
Which drugs are Benzylisoquiniums?
-curium * **Atra-curium** * **Miva-curium** * **Cistra-curium** * Except tubocurarine ## Footnote Stoelting's Ch. 12, pg 328-330
57
Which drugs are Aminosteroidals?
-curonium * **Pan-curonium** * **Ve-curonium** * **Ro-curonium** ## Footnote Stoelting's Ch. 12, pg 331
58
Which aminosteroidal(s) are long acting? >50 min
Pancuronium ## Footnote Stoelting's Ch. 12, pg 328, table 12-1
59
Which aminosteroidal(s) are medium acting? 20-50 min
Vecuronium Rocuronium ## Footnote Stoelting's Ch. 12, pg 328, table 12-1
60
Which Benzylisoquinium(s) are long acting? >50min
* Tubocurarine ## Footnote Stoelting's Ch. 12, pg 328, table 12-1
61
Which Benzylisoquinium(s) are medium acting? 20-50min
* Atracurium * Cistracurium ## Footnote Stoelting's Ch. 12, pg 328, table 12-1
62
Which Benzylisoquinium(s) are short acting? 10-20min
Mivacurium ## Footnote Stoelting's Ch. 12, pg 328, table 12-1
63
Which NMBs release histamine?
Atracurium & Mivacurium ## Footnote Nagelhout 7th ed, Ch. 12, Box 12.8 & 9
64
What is the ED95/Intubating dose of Cistracurium
* 0.05mg/kg ED95 * 0.1mg/kg Intubation ## Footnote Nagelhout 7th ed, Ch. 12, pg 168
65
What is the ED95/Intubating dose of Mivacurium
* 0.08mg/kg ED95 * 0.25mg/kg Intubation ## Footnote Nagelhout 7th ed, Ch. 12, pg 168 & 158 table 12.4
66
What is the ED95/Intubating dose of Atracurium
* 0.15mg/kg ED95 * 0.5mg/kg Intubation ## Footnote Nagelhout 7th ed, Ch. 12, pg. 158 table 12.4
67
What is the ED95/Intubating dose of Rocuronium
* 0.3 mg/kg ED95 * 0.6 - 1mg/kg Intubation ## Footnote Nagelhout 7th ed, Ch. 12, pg. 158 table 12.4
68
What is the ED95/Intubating dose of Vecuronium
* 0.05 mg/kg ED95 * 0.1mg/kg Intubation ## Footnote Nagelhout 7th ed, Ch. 12, pg. 158 table 12.4
69
Which drugs undergo Hofmann elimination?
* Atracurium * Cistracurium ## Footnote Nagelhout 7th ed, Ch. 12, pg 169, Table 12.10
70
Which drugs undergo metabolism by Pseudo/Butyl/Plasmacholinesterase?
* Succinylcholine * Mivacurium ## Footnote Nagelhout 7th ed, Ch. 12, pg 168-169, Table 12.10
71
Which drugs undergo metabolism by Hepatic/renal means?
* Rocuronium * Vecuronium ## Footnote Nagelhout 7th ed, Ch. 12, pg 169, Table 12.10
72
Which drug class does Sugammadex reverse?
Aminosteroids * rocuronium > vecuronium>>pancuronium ## Footnote Nagelhout 7th ed, Ch. 12, pg. 175
73
What dose of Sugammadex should you give with a TOF of 2? | You gave roc/vec
2mg/kg ## Footnote Nagelhout 7th ed, Ch. 12, pg. 218
74
What dose of Sugammadex should you give with a TOF of 0 & PTC of 1 to 2? | You gave roc/vec
4 mg/kg ## Footnote Nagelhout 7th ed, Ch. 12, pg. 218
75
You JUST gave 1.2mg/kg Roc and the surgeon is like.... all done here then zips them up. What dose of sugammadex would you give?
16 mg/kg and a piece of your mind ## Footnote Nagelhout 7th ed, Ch. 12, pg. 218
76
What are a couple of conditions that would prolong NMB?
* Acidosis (metabolic or hypercarbia) * Bunch of hypos * hypomagnesemia/phosphatemia/kalemia/calcemia/Thermia * Trauma * Literally a bunch ## Footnote Nagelhout 7th ed, Ch. 12, pg. 175, Box 12.14
77
Hofmann elimination is based on?
pH & temperature Body's "alkalosis" & inc. temp initiate Hofmann elim. ## Footnote Nagelhout 7th ed, Ch. 12, pg. 168
78
What does a dibucaine number of 70 or higher represent?
* Normal butyl/psuedocholinesterase quality * Homozygous typical trait ## Footnote Stoelting's pg. 326
79
What does a dibucaine number of 40-60 represent?
Heterozygous atypical variant ## Footnote Stoelting's pg. 326
80
What does a dibucaine number of less than 30 represent?
Homozygous atypical variant ## Footnote Stoelting's pg. 326
81
You have a patient you want to give Succinylcholine/Mivacurium, and you get a Dibucaine number of 26, what are you concerned for?
Prolonged NMB (4-8 hours) ## Footnote Stoelting's pg. 326
82
Your patient has liver/kidney problems, which NMBs would you consider NOT giving?
* Rocuronium > Vecuronium Roc eliminated by bile/kidneys Vec by bile > kidneys ## Footnote Nagelhout 7th ed., Ch. 12, pg. 159, Table 12.5
83
You give Neostigmine to reverse your deeply paralyzed patient, what is your concern?
Incomplete reversal/Residual NMB Neostigmine does not reverse deep NMB ## Footnote Nagelhout 7th ed., Ch. 12, pg. 173
84
What patient population should be counseled prior Sugammadex administration?
Women of child-bearing years who take oral contraceptives | Use alternatives for 1 week after exposure ## Footnote Nagelhout 7th ed., Ch. 12, pg. 176
85
What does Sugammadex do to oral contraceptives?
Like aminosteroids, it binds to the oral contraceptive, rendering them inactive ## Footnote Nagelhout 7th ed., Ch. 12, pg. 176
86
You give neostigmine/edrophonium to reverse NMB, the patient is Bradycardic... why?
Because you should have also given glycopyrrolate/atropine to block the parasympathomimetic effects of the AchEs Atropine > glyco ## Footnote Nagelhout 7th ed., Ch. 12, pg. 174, table 12.11
87
Why do we use the adductor pollicis to assess diaphragm recovery?
* Muscles of the hand are more sensative to NMB than the diaphragm. * Recovery with the AP = recovery at the diaphragm/upper airway muscles ## Footnote Nagelhout 7th ed., Ch. 12, pg. 153
88
Which subjective measures (including PNS) after NMB indicate the best recovery?
* Double-burst (60-70%) * Inspiratory force -40cmH2O (50%) * Head lift (Fitty) * Hand grip (Fitty) * Sustained bite (Fitty) ## Footnote Nagelhout 7th ed., Ch. 12, pg. 157, table 12.3
89
How do you determine a ToF ratio?
* Compare T4 with T1 * Very subjective * Sensitive between 70-100% blockade ## Footnote Nagelhout 7th ed., Ch. 12, pg. 154
90
Where do you place the electrodes for an adductor policis PNS?
* Proximal flexor crease of wrist * Over/parallel carpi ulnaris tendon ## Footnote Nagelhout 7th ed., Ch. 12, pg. 152-3 Fig. 12.3
91
Which antibiotics have been associated with prolonged NMB?
Aminoglycosides * Gentamicin * Clindamycin * Neomycin ## Footnote Nagelhout 7th ed., Ch. 55, pg. 1278
92
Which drugs are markedly potentiated in Preeclamptic women?
NDNMBs in women receiving Mag Sulfate ## Footnote Nagelhout 7th ed., Ch. 51, pg. 1202
93
What concerns would you have with a pt undergoing parathyroidectomy and receiving a NMB?
Hypocalcemia potentiates **NDNMB** ## Footnote Nagelhout 7th ed., Ch. 37, pg. 865
94
______ and ______ have an inverse relationship
Onset and Potency ## Footnote Nagelhout 7th ed., Ch. 12, pg. 156
95
In order to make a drug with a low potency work you need to _______ ?
give a larger dose achieve a muscle gradient thus, faster onset ## Footnote Nagelhout 7th ed., Ch. 12, pg 156
96
You give Miva/atracurium, your patient becomes flush, hypotensive, and tachycardic, why?
Modest Histamine release ## Footnote Nagelhout 7th ed., Ch. 12, pg. 168-169 table 12.10
97
You give Succinylcholine/Rocuronium, your patient becomes flush, hypotensive, and tachycardic, why? What do you give?
IgE-mediated Anaphylaxis * O2, Fluids, epinephrine ## Footnote Nagelhout 7th ed., Ch. 12, pg. pg. 171
98
You give your patient cis/atracurium and they seize, why?
* Broken down by Hofmann elimination and have Laudanosine as a metabolite * Crosses blood brain barrier, causing CNS excitability * Potential for seizure, but unlikely ## Footnote Stoeltings, pg. 343
99
Why would you use a PNS on the facial n. prior to intubation?
Relaxation of facial muscles mirrors relaxation in the larynx/diaphragm ## Footnote Nagelhout 7th ed., Ch. 12, pg. 153
100
How much can Succinylcholine increase serum K+?
Intubating dose can increase it 0.5-1 mEq/L ## Footnote Nagelhout 7th ed., Ch. 12, pg. 158
101
Succinylcholine dose required for a Phase II block?
6-8 mg/kg ## Footnote Nagelhout 7th ed., Ch. 12, pg. 163

Nurs 575 Anesthesia Pharmacology (18 decks)

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