Nondepolarizing NMB

Question 1

what is NMB structurally similar to?

Answer 1

Ach

Question 2

NMB have one or two quaternary ________

Answer 2

nitrogens

Question 3

are NMB polar? ionized?

Answer 3

YES

they are also water-soluble

Question 4

d-Tubocurarine (Curare)

Answer 4

Benzylisoquinoline Class

Question 5

______curonium, what class?

Answer 5

Steroidal Class

Question 6

______curium, what class?

Answer 6

Benzylisoquinoline Class

Question 7

mechanism of action of NMB nondepolarizers:

C______e with Ach to bind with the alpha subunits on the postjunctional AChR and, thus, p_______t the ion channel from opening and p_______t the muscle cell membrane from depolarizing.

Answer 7

Compete, prevent, prevent

Question 8

does nondepolarizing NMB have decreased twitch response to a single stimulus

Answer 8

yes

Question 9

does nondepolarizing NMB have fade with tetanus, TOF

Answer 9

yes

Question 10

does nondepolarizing NMB have posttetanic potentiation (increase in strength)

Answer 10

yes

Question 11

is nondepolarizing NMB enhanced by other nondepolarizing NMBs

Answer 11

yes

example: roc for rapid sequence, then nimbex for a drip

Question 12

nondepolarizing NMB are antagonized by ______cholinesterase drugs

Answer 12

ANTIcholinesterases

Question 13

is decreased strength correlated with decreased release of Ach

Answer 13

yes

Question 14

what type of drug is neostigmine

Answer 14

anticholinesterase

Question 15

determinants of NMB selection

Answer 15

agent/drug related, patient related, cost, clinical site, pharmacists

Question 16

The less potent the drug (the ______ the ED95), the more ______ the onset.**

Answer 16

The less potent the drug
the higher/greater number the ED95
the more rapid the onset

more molecules/drug must be given per dose, resulting in more molecules reaching the NMJ to cause more rapid creation of the blockade

Question 17

determined by measuring the dose needed to produce 95% suppression of the single-twitch response

Answer 17

ED95

Question 18

what has the fastest onset time

Answer 18

succs (depolarizer though!)

rocuronium

Question 19

what has the slowest onset time

Answer 19

cisatracurium

Question 20

what is least potent

Answer 20

rocuronium

Question 21

when is the priming principle utilized

Answer 21

To facilitate rapid intubating conditions

Question 22

how small of a dose is given in the priming principle

Answer 22

1/10th the intubating dose
OR
1/3 the ED95

Question 23

To facilitate rapid intubating conditions with nondepolarizing agents, a small dose (1/10th the intubating dose or 1/3 the ED95) of the NMB is given prior to the induction to allow some receptors to be occupied and minimize the time required for the remaining receptors to be blocked by remainder of the intubating dose

Answer 23

priming principle

Question 24

Example: Pancuronium
Priming dose: 0.01 mg/kg (0.7 mg/70 kg) +
Usual intubating dose: 0.1 mg/kg (7 mg/70 kg)
Remaining dose 6.3 mg/70 kg

Answer 24

priming principle

does NOT work for Sch

Question 25

what is the disadvantage to simply increasing the dose of the NMB to speed onset?

Answer 25

increases side effects AND prolongs duration

Question 26

when is it a good idea to use an increased dose of NMB?

Answer 26

long cases (such as 5 hrs)

Question 27

what is the short-acting NMB

Answer 27

mivacurium (mivacrap haha)

Question 28

what are the 4 intermediate acting NMBs

Answer 28

Cisatracurium (Nimbex) Atracurium (Tracrium) Rocuronium (Zemuron) Vecuronium (Norcuron) "CARV"

Question 29

what are the 3 long-acting NMBs

Answer 29

Pancuronium (Pavulon) Pipecuronium (Arduan) Doxacurium (Nuromax) d-Tubocurarine (Curare) "PPDD"

Question 30

when a drug diffuses away from a receptor but it is NOT eliminated yet*

Answer 30

Termination of action

Question 31

what type of clearance/metabolism has the longest duration (>60 min)

Answer 31

kidneys/nephro these drugs are typically longer-acting

Question 32

what type of clearance/metabolism has the shortest duration

Answer 32

liver/hepatic these drugs are typically shorter-acting

Question 33

what family is usually metabolized by the liver

Answer 33

steroid family

Question 34

what NMB is hofmann elimination + plasma esterases laudanosine (metabolite that causes seizures in animals) histamine

Answer 34

atracurium

Question 35

what NMB is eliminated by plasma CHOLINesterase

Answer 35

mivacurium

Question 36

what NMB is by MOSTLY Hofmann elimination

Answer 36

Cistacurium

Question 37

what drug: Amazon jungle MASSIVE histamine release

Answer 37

d-Tubocurarine (Curare)

Question 38

what drug: is the most commonly used long-acting NMB

Answer 38

Pancuronium (Pavulon)

Question 39

Long acting, neurosurgery is target?

Answer 39

Doxacurium (Neuromax)

Question 40

what does histamine release do?

Answer 40

think WORST case scenario, decrease SVR, decrease BP, increase HR, bronchoconstriction

Question 41

________________ metabolizes acetylcholinesterase

Answer 41

ANTIcholinesterases (this leads to increased Ach)

Question 42

ACETYLcholinesterase leads to ___________ Ach

Answer 42

decreased Ach

Question 43

less potent the drug = the more _______ the onset

Answer 43

more rapid! less potent!

Question 44

fastest to slowest onset for NMBs

Answer 44

(SCh) > Rocuronium > Atracurium, Vecuronium, Mivacurium > Nimbex

Question 45

causes anaphylacTOID (similar to histamine)

Answer 45

rocuronium

Question 46

what drug is NOT used for difficult airway but IS used for RSI

Answer 46

rocuronium

Question 47

histamine NMBs (3)

Answer 47

mivacrap atracurium curare

Question 48

what drug to be careful with atypical plasma cholinesterase patients

Answer 48

mivacrap

Question 49

what drug is good for organ dysfunction patients

Answer 49

nimbex

Question 50

inhibits histamine-N-methyl transferase (similar to histamine) powder form

Answer 50

vecuronium

Question 51

what drug causes a release of norepi and prevents its uptake back into nerve ending*

Answer 51

pancuronium