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Anesthesia Basics > Pharm: NMBD drugs > Flashcards

Pharm: NMBD drugs Flashcards

(51 cards)

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1
Q

Rocuronium (Zemuron) drug class

A

Aminosteriod

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2
Q

Rocuronium (Zemuron) concentrations

A

10mg/mL

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3
Q

Rocuronium (Zemuron) standard induction dose

A

0.6mg/kg

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4
Q

Rocuronium (Zemuron) RSI dose

A

1.2mg/kg

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5
Q

Rocuronium (Zemuron) maintenance dose

A

5-10mg (frequently 10mg)

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6
Q

Rocuronium (Zemuron) onset and duration for standard and RSI doses

A

standard:
Onset: 1.5-3 m
Duration: 15-30 m

RSI
Onset: 30-45 sec
Duration: 45-150 m

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7
Q

Rocuronium (Zemuron) elimination

A

10-25% renal
10-20% hepatic
50-70% biliary

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8
Q

Vecuronium (Norcuron) drug class

A

Aminosteriod

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9
Q

Vecuronium (Norcuron) concentration

A

1mg/mL

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10
Q

Vecuronium (Norcuron) induction dose

A

0.1mg/kg

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11
Q

Vecuronium (Norcuron) maintenance dose

A

1-2mg

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12
Q

Vecuronium (Norcuron) onset and duration

A

onset: 3-5m
duration 25-40m

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13
Q

Vecuronium (Norcuron) elimination

A

15-25% renal
20-30% hepatic
40-75% biliary

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14
Q

Pancuronium (Pavulon) drug class

A

aminosteriod

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15
Q

Pancuronium (Pavulon) concentration

A

1mg/mL

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16
Q

Pancuronium (Pavulon) induction dose

A

0.1mg/kg

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17
Q

Pancuronium (Pavulon) infusion dose

A

1-15mcg/kg/min

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18
Q

Pancuronium (Pavulon) onset and duration

A

Onset: 4 m
Duration: 100 m

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19
Q

Pancuronium (Pavulon) elimination

A

80% renal
10% hepatic
10% biliary
(prolong duration
with disease)

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20
Q

Pancuronium (Pavulon) PSNS effects

A

blocks M2 receptors causing increased HR, MAP, CO

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21
Q

Atracurium (Tracrium) drug class

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A

benzylisoquinolinium

22
Q

Atracurium (Tracrium) concentration

23
Q

Atracurium (Tracrium) induction dose

24
Q

Atracurium (Tracrium) onset and duration

Study These Flashcards
A

Onset: 2-2.5 m
Duration: 20-35 m

25
Atracurium (Tracrium) elimination
90% Hoffman 10% renal
26
Hoffman elimination
Hoffman elimination is dependent on normal body temp and pH (acidosis and hypothermia decrease)
27
Cisatracurium (Nimbex) drug class
benzylisoquinolinium
28
Cisatracurium (Nimbex) concentration
2mg/mL
29
Cisatracurium (Nimbex) induction dose
0.1mg/kg -0.2mg/kg (4x ED95)
30
Cisatracurium (Nimbex) onset and duration
Onset: 2.5 min Duration: 40-60 sec
31
Cisatracurium (Nimbex) elimination
Hoffman elimination
32
Cisatracurium (Nimbex) potency and histamine response
3x more potent than atracurium w/ decreased release of histamine
33
Mivacurium (Mivacron) drug class
benzylisoquinolinium
34
Mivacurium (Mivacron) concentration
2mg/mL
35
Mivacurium (Mivacron) induction dose
0.15mg/kg over 30-60 seconds
36
Mivacurium (Mivacron) onset and duration
onset 3-5min duration 20 min
37
Mivacurium (Mivacron) metabolism
metabolized by plasma cholinesterase
38
Non-depolarizing NMBD
compete with ACh for active binding sites; competitive antagonist
39
Depolarizing NMBD
similar structure to ACh, acts as partial agonist at postsynaptic Nm junction causing prolonged depolarization
40
Factors influencing choice of NMBDs
- potency, dose-response relationship (inversely related to onset of block) - onset time, relationship b/t twitch depression and dose (ED 95 causes 95% suppression, 2 x ED 95 used for intubating) -increasing dose will increase onset of block -duration of action = administration time to 90% recovery of twitch response -lipophilicity, drugs ability to move toward the neuromuscular junction
41
Impact of low potency
require high dosing for diffusion gradient (i.e. Rocuronium)
42
Defasciculating dose goal and administration procedure
Goal: decrease intensity of fasciculations and myalgia Admin 1/10 of non-depolarizing blockade 3-4 minutes prior to succ. Admin 50-70% more succ (1.5 mg/kg)
43
Aminosteriod Compouds
- Rocuronium (Zemuron) - Vecuronium (Nocuron) - Pancuronium (Pavulon)
44
Benzylisoquinolinium compound
- Atracurium (Tracrium) - Cisatracurium (Nimbex) - Mivacurium (Mivacron) **more likely to release histamines
45
short acting NMBD
Mivacurium 10-20m
46
Intermediate NMBD
(20-50 m) - Rocuronium - Vecuronium - Atracurium - Cistracurium
47
Long acting NMBD
>50min Pancuronium
48
Effect of NMBD: increased potency
- inhalation agents - des> sevo> iso> halo - antibiotics (aminoglycosides) - hypothermia - antiarrhythmic (quinidine) - magnesium sulfate - large dose of LA
49
Effects of NMBD: decrease potency
- chronic anticonvulsant - hypercalcemia - up-regulation of receptors (burns, atrophy, denervation)
50
Adverse outcomes of residual blockade
1.Increased risk of aspiration -Impairment of pharyngeal coordination and force of contraction -Swallowing dysfunction/delayed initiation of swallowing reflex -Reductions in upper esophageal sphincter tone 2.Upper airway obstruction -Reduction in airway volumes and inspiratory flow -Impairment of upper airway dilator muscle function -Impaired hypoxic ventilatory drive 3.Symptoms of muscle weakness (visual disturbances, severe facial weakness, difficulty speaking) 4.Increased risk of postop hypoxemia 5.Interop awareness
51
Clinical signs of recovery
- Adequate tidal volume and respiratory rate - Respirations smooth and unlabored - Effective swallowing and sustained bite - Effective cough - Sustain head or leg lift for at least 5 sec - Strong, constant hand grip -TOF >0.9, no fade - Sustained tetanic response to 50Hz for 5 sec

Anesthesia Basics (7 decks)

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