pharmacology part 2 Flashcards
(122 cards)
1
Q
What is a depolarizing agent?
A
succinylcholine
2
Q
Succinylcholine is also called what?
A
anectine
3
Q
What is succinylcholine (anectine) primarily used for?
A
induction to facilitate tracheal intubation
4
Q
What is acetylcholine? what 2 things is it for?
A
a neurotransmiter for your parasympathetic nervous system and muscle contraction
5
Q
what is the MOA?
A
motor neuron throws acetylcholine down. Acetylcholine gets in receptors on motor end plate, which stimulates depolarization (sodium potassium exchange). Sodium potassium exchange creates a voltage or charge across that cell membrane or an action potential, which causes muscle contraction.
6
Q
What is succinylcholine really doing physiologically?
A
it is acting like acetylcholine (which is what our body produces), so it can interact with acetylcholine receptors. which causes muscle contractions.
7
Q
During an action potential, sodium and potassium do what?
A
sodium moves into the cell and potassium moves out of the cell
8
Q
How can you tell the succinylcholine has hit the motor end plate?
A
fasiculations
9
Q
What is the onset of succinylcholine?
A
1 minute
10
Q
What is the duration of succinylcholine?
A
5-10 minutes
11
Q
Succinylcholine is metabolized by what? which is a what?
A
pseudocholinesterase, which is an enzyme from liver
12
Q
Succinylcholine causes what? how?
A
paralysis, because it holds the depolarization before pseudocholinesterase comes through
13
Q
What is an adverse reactions of succinylcholine?
A
- bradycardia - rest and digest
- increases intraocular pressure - caused by fasiculations
- hyperkalemia - sodium moves in and potassium moves out. PVCs are normal
- oxygen depletion -
14
Q
What are 2 contraindications of succinylcholine?
A
- malignant hyperthermia family history
- degenerative neuromuscular disorders
15
Q
What are 2 meds that are contraindicated in glaucoma patients?
A
- succinylcholine - increase intraocular pressure
- anticholinergics (atropine, robinol) - causes pupil to dilate which further constricts the ocular drainage system
16
Q
What is the treatment med for glaucoma?
A
Pilocarpine
17
Q
Pilocarpine is the reversal agent for what group of meds?
A
anticholinergics
18
Q
So if glaucoma patients are given atropine and are taking pilocarpine, what happens?
A
atropine doesn’t work because pilocarpine is the reversal agent
19
Q
Is there a reversal agent for succinylcholine?
A
no
20
Q
effects of succinylcholine are reversed how?
A
effects reversed quickly by metabolism from pseudocholinesterase only
21
Q
There is a rare deficiency of what that can be an issue with succinylcholine?
A
pseudocholinesterase
22
Q
What does pseudocholinesterase deficiency look like?
A
you go to wake them up and monitor is going nuts but they can’t move anything including their own diaphragm, but they are awake.
23
Q
What is a non-depolarizing muscle relaxant? how does it work?
A
blocking agent. they block the motor end plate, form a film over top of motor end plate so the acetylcholine just bounces off resulting in no depolarization
24
Q
what are non-depolarizing muscle relaxants also called?
A
acetylcholine competitive antagonists
25
Acetylcholine does not interact with what with non-depolarizing muscle relaxants?
with receptor
26
Non-depolarizing muscle relaxants work slower than what?
succinylcholine
27
large doses of what med come close to succinylcholine?
rocuronium comes close
28
Rocuronium and vecuronium only lasts about how long?
15 minutes
29
Vecoronium likes the what muscle?
heart muscle
30
vecuronium decreases the what demand on the heart?
oxygen demand on the heart
31
what are NDMR reversal agents?
anticholinesterases
32
How do anticholinesterases work?
block acetylcholinesterase
33
How do anticholinesterases work?
1. increases acetylcholine concentration in the neuromusclar junction
2. displaces the muscle relaxant from the acetylcholine receptor
34
When would they give anticholinesterases?
when patient starts to move a little big, that's how you know the film at the motor end plate is peeling back so it's safe to give it.
35
What are the 4 unwanted side effects with anticholinesterases?
1. bradycardia
2. bronchospasm
3. enhanced GI peristalsis
4. enhanced oral secretions
36
Anticholinesterases, because of their side efffects, are usually combined with what?
typically combined with a muscarinic antagonist (anticholinergic)
37
What are 2 anticholinergics?
1. glycopyrrolate
2. atropine
38
What are 2 anticholinesterases?
1. edrophonium
2. neostigmine
39
neostigmine is always mixed with what anticholinergic?
glycopyrrolate
40
Who's effects come first atropine or neostigmine?
atropine effects occur before neostigmine
41
What anticholinergic is mixed with edrophonium or enlon plus?
atropine
42
What is sugammadex?
it is an NDMR reversal agent
43
What is the difference between edrophonium and neostigmine with sugammadex?
sugammadex is an active reversal agent
44
Suggammadex selectively does what?
Sugammadex selectively binds rocuronium or vecuronium
45
How does sugammadex work?
It does 1:1 binding of rocuronium or vecuronium, so it engulfs these things so your body just thinks it's sugammadex. It sucks up these meds too
46
Due to sugammadex 1:1 binding it is able to do what?
reverse any depth of neuromuscular block
47
sugammadex is NOT a what?
not an anticholinesterase
48
What is the strongest inhalation gas?
halothane
49
What can halothane cause in conjuction with epi?
cause arrhythmias
50
Do we use halothane anymore?
no
51
What is the gas that is most often related to MH?
halothane
52
What is Isoflurane also known as?
forane
53
What is isoflurane most used for?
neuro procedures
54
What are 2 huge negatives of isoflurane?
1. you can't give it to patients with a pneumatic tourniquet. When you exsanguinate, the blood engorges surrounding organs. The blood brain barrier protects cerebral vascular system from this, but because isoflurane brings down the blood brain barrier it increases intracranial pressure
2. smells terrible
55
What do we have with isoflurane?
rapid recovery
56
Isoflurane makes people lucid in how much time?
(lucid in 15-30 minutes)
57
What is the benefit of sevoflurane?
rapid onset and offset
58
Sevoflurane is the chosen drug for what?
inhaled induction in children
59
Does sevo have issues with pneumatic tourniquet?
no
60
What is ethrane contraindicated in?
in people with seizures, because it lowers the seizure threshold
61
What gas has the fastest onset and offset?
desflurane
62
Who do we not give desflurane to?
neuro patients because coughing is common
63
Desflurane is terrible for what?
bad for the environment
64
where do we mostly use desflurane?
in ambulatory surgery
65
What is common with desflurane?
coughing
66
What are 2 characteristics of nitrous oxide?
it is a gas and it is odorless. It is different from the rest of the inhaled anesthetics
67
What is something unique about nitrous oxide?
it is the only thing that is not an opioid that is also going to interact with opioid receptors - has some analgesic properties
68
Is nitrous oxide a good anesthetic
NO it is a weak anesthetic, not very good at being a sedative and suppressing consciousness around painful stimuli
69
Nitrous oxide can support what?
combustion like oxygen
70
Why is nitrous oxide different from halothane, isoflurane, sevoflurane, ethrane, and desflurane?
the -anes are all volatile agents, meaning they are liquids under pressure
71
Because nitrous oxide is an oxidizer it can cause what?
diffusion hypoxia
72
What will anesthesia providers commonly do with nitrous oxide?
combine it with another inhaled anesthetic because it has analgesic properties
73
All of the inhaled anesthetics are all exhaled in a what?
unchanged form
74
When nitrous oxide is exhaled it can cause what?
leaving blood into the alveoli it can displace oxygen out of the alveoli
75
What is a nursing intervention for nitrous oxide?
patient needs to have nasal cannula postoperatively until they are done off gassing the nitrous oxide
76
Inhalation gases are exhaled in what kind of form?
in an unchanged form
77
What are neuro effects of inhalation gases?
headaches, irritability, cognitive changes
78
What are hormonal changes that can happen with inhalation gases?
miscarriage, birth defects, female and male sterility
79
what are systemic things that inhalation gases can cause?
renal and hepatic disease, cancer
80
Safety data sheet includes info on what?
chemical hazards, special handling and exposure
81
Where is a lot of our exposure from anesthesia gases coming from?
1. leaking anesthesia circuits
2. when someone is extubated
82
What can nitrous oxide effect?
DNA synthesis
83
MH is what kind of syndrome?
inherited
84
MH is autosomal what?
dominant
85
MH has no racial boundaries, but, at least in america, who are most commonly affected?
caucasian
86
MH happens more frequently in who?
older children and young adults
87
How can we test for MH?
1. blood test - but if you get negative test doesn't mean you don't really have it
2. string muscle biopsy - oxygenated solution, throw halothane, give MH outside of the body
88
MH is consistently more frequent in men or women?
men
89
We do what more specifically with MH?
pre-op family history
90
How does a normal muscle contraction work?
DHP receptor acts as the foot that kicks open the door to calcium channel. The calcium channel is also known as the ryanidid receptor. When door opens the calcium comes out of the sarcoplasmic reticulum and causes muscle contraction
91
What is really the ryanidid receptor?
the MAMA, it tell the calcium to come back in
92
What is the issue with MH as far as mechanism of action for a muscle contraction?
the triggering agents (succinylcholine and halothane) act as a door stop in the ryanidid receptor. Door can't close or open, so it causes calcium so stay out causing CONTRACTION CONTRACTION CONTRACTION ENERGY ENERGY ENERGY which is an MH crisis
93
To trigger an episode of MH what kind of patient do you have to have?
genetically susceptible patient
94
What is the most common triggers of MH?
succinylcholine, especially when used in conjunction with an inhaled anesthetic such as desflurane, isoflurane, and halothane
95
An MH susceptible patient should never receive what?
never receive succinylcholine or one of these anesthestics
96
Early signs of MH cause what?
trismus or jaw tightening
97
Is trismus or jaw tightening consistent indicator of MH?
NO
98
What is a consistent early indicator of MH?
a rapid rise in end tidal CO2 and metabolic acidosis
99
Why is rise in exhaled in CO2 and metabolic acidoses a consistent early sign?
because the muscle cell is sucking in oxygen and throwing out co2 and heat, so it is going to throw out tons of CO2
100
MH causes intense what?
muscle rigidity - xtreme rictus
101
MH increases what 2 hemodynamic things?
HR and BP
102
People in MH burn what faster than you can what?
burn oxygen faster than you can push it into their lungs
103
What are late signs of MH?
1. rapidly rising body temp
2. change in color of soda lime
3. hyperkalemia - bc of the depolarization, potassium is thrown out of their cells
4. hypoxia - metabolic acidosis
5. myoglobinuria - muscle cells fly apart
6. cardiac arrest
104
It is not uncommon for patients who have MH to go on what afterwards?
dialysis, because muscle tissue is toxic to the kidneys
105
What 3 things can cause cardiac arrest?
1. hyperkalemia
2. hypoxia
3. acidosis
106
What are the steps for intervening with MH?
1. immediately discontinue all triggering agents -
2. switch over to nitrous oxide
3. hyperventilate the patient with 100% oxygen
4. call MHAUS 1-899-MH-HYPER
5. Dontrolene 2-3 mg/kg
6. sodium bicarb IV for metabolic acidosis
7. treat hyperkalemia with calcium, insulin, glucose
8. treat myoglobinuria with diuretics, bicarb, fluids
107
What is 1 dose of dantrolene?
2.5 mg/kg
108
In an adult you would get a 2.5 mg/kg out of how many vials?
9 vials is one dose
109
Dantrolene has to be mixed with what?not what?
PF sterile water, not saline
110
You have to have how many doses of dantrolene on your cart?
4 doses
111
How many vials do you need on your MH cart?
36 vials
112
What is ryanedex?
powdered dantrolene
113
Do you have to mix ryanadex?
yes with pf sterile water
114
How many mL's in a dantrolene vial?
60 mL's, so you need a liter bag of sterile water to reconstitute (with 60 mL syringe to pull out sterile water, and put it in the dantrolene vials 9 times, and then do redraw it and put it back into the sterile water bag).
115
What is the issue with ryanodex?
it is 3 times more costly than all 9 vials of dantrolene
116
No what type of meds for MH?
no calcium channel blockers - prolongs MH crisis
117
Verapimil (calcium channel blocker) has a very bad lethal drug interaction with what med?
dantrolene; causes severe hyperkalemia
118
How can we cool MH patients down?
ice packs and hypothermia blanket
119
Give what kind of fluids? not what?
iced NSS - avoid ringers (has potassium and lactate)S
120
Send what and correct what during MH?
send labs and correct electrolyte imbalances
121
Monitor what and correct what during MH?
monitor ECG and correct arrhythmias
122
Where will the patient be transferred post MH crisis
transfer patient to ICU when stable and monitor for 36 hours for recurrence and complications
