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Anesthesia Basics > Pharm: NMBD drugs > Flashcards

Pharm: NMBD drugs Flashcards

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

A

benzylisoquinolinium

22
Q

Atracurium (Tracrium) concentration

A

10mg/mL

23
Q

Atracurium (Tracrium) induction dose

A

0.5mg/kg

24
Q

Atracurium (Tracrium) onset and duration

A

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

25
Q

Atracurium (Tracrium) elimination

A

90% Hoffman
10% renal

26
Q

Hoffman elimination

A

Hoffman
elimination is
dependent on
normal body temp
and pH (acidosis
and hypothermia
decrease)

27
Q

Cisatracurium (Nimbex) drug class

A

benzylisoquinolinium

28
Q

Cisatracurium (Nimbex) concentration

A

2mg/mL

29
Q

Cisatracurium (Nimbex) induction dose

A

0.1mg/kg -0.2mg/kg (4x ED95)

30
Q

Cisatracurium (Nimbex) onset and duration

A

Onset: 2.5 min
Duration: 40-60 sec

31
Q

Cisatracurium (Nimbex) elimination

A

Hoffman elimination

32
Q

Cisatracurium (Nimbex) potency and histamine response

A

3x more potent than atracurium w/ decreased release of histamine

33
Q

Mivacurium (Mivacron) drug class

A

benzylisoquinolinium

34
Q

Mivacurium (Mivacron) concentration

A

2mg/mL

35
Q

Mivacurium (Mivacron) induction dose

A

0.15mg/kg over 30-60 seconds

36
Q

Mivacurium (Mivacron) onset and duration

A

onset 3-5min
duration 20 min

37
Q

Mivacurium (Mivacron) metabolism

A

metabolized by plasma cholinesterase

38
Q

Non-depolarizing NMBD

A

compete with ACh for active binding sites; competitive antagonist

39
Q

Depolarizing NMBD

A

similar structure to ACh, acts as partial agonist at postsynaptic Nm junction causing prolonged depolarization

40
Q

Factors influencing choice of NMBDs

A
  • 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
Q

Impact of low potency

A

require high dosing for diffusion gradient (i.e. Rocuronium)

42
Q

Defasciculating dose goal and administration procedure

A

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
Q

Aminosteriod Compouds

A
  • Rocuronium (Zemuron)
  • Vecuronium (Nocuron)
  • Pancuronium (Pavulon)
44
Q

Benzylisoquinolinium compound

A
  • Atracurium (Tracrium)
  • Cisatracurium (Nimbex)
  • Mivacurium (Mivacron)
    **more likely to release histamines
45
Q

short acting NMBD

A

Mivacurium
10-20m

46
Q

Intermediate NMBD

A

(20-50 m)
- Rocuronium
- Vecuronium
- Atracurium
- Cistracurium

47
Q

Long acting NMBD

A

> 50min Pancuronium

48
Q

Effect of NMBD: increased potency

A
  • inhalation agents
  • des> sevo> iso> halo
  • antibiotics (aminoglycosides)
  • hypothermia
  • antiarrhythmic (quinidine)
  • magnesium sulfate
  • large dose of LA
49
Q

Effects of NMBD: decrease potency

A
  • chronic anticonvulsant
  • hypercalcemia
  • up-regulation of receptors (burns, atrophy, denervation)
50
Q

Adverse outcomes of residual blockade

A

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
Q

Clinical signs of recovery

A
  • 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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