Quiz 4

Question 1

Post operative delirium is associated with ? because it is a ?

Answer 1

atropine; tertiary amine (crosses BBB)

Question 2

What NMBs are reliant on Hoffman elimination?

Answer 2

cisatracurium and atracurium

Question 3

What is Hoffman elimination sensitive to?

Answer 3

temperature and pH

Question 4

What do cholinesterase inhibitors do?

Answer 4

increase amount of ACh in the NMJ by inhibiting cholinesterase (which breaks down ACh)

Question 5

What are other names for pseudocholinesterase?

Answer 5

nonspecific cholinesterase, plasma cholinesterase, butyrylcholinesterase

Question 6

How are nondepolarizers reversed?

Answer 6

redistribution, metabolism excretion, or administration of reversal agents (cholinesterase inhibitors)

Question 7

What can happen with high doses of cholinesterase inhibitors?

Answer 7

may potentiate NMB- causes ACh channel blockade

Question 8

What conditions can prolong the DoA of cholinesterase inhibitors?

Answer 8

hepatic and renal disease

Question 9

What are side effects of cholinesterase inhibitors?

Answer 9

muscarinic stimulation by ACh- bradycardia, asystole, AV blocks, bronchospasm, salivation, bladder spasm, GI hypermotility, N/V, stool incontinence, CNS excitation/sz

Question 10

Dose of neostigmine?

Answer 10

0.025-0.075 mg/kg (max 5 mg)

Question 11

What is the matched anticholinergic for neostigmine?

Answer 11

glyco

Question 12

What has neostigmine been reported to do?

Answer 12

crossed placenta resulting in fetal bradycardia (consider Atropine when reversing pregnant patient)

Question 13

What is the dose of edrophonium?

Answer 13

0.5-1 mg/kg

Question 14

What is the matched anticholinergic for edrophonium?

Answer 14

atropine

Question 15

Which NMB reversal agent has less pronounced muscarinic effects so it requires less anticholinergic?

Answer 15

edrophonium

Question 16

What is the dose of pyridostigmine?

Answer 16

0.1-0.3 mg/kg (max 20 mg)

Question 17

What is the matched anticholinergic agent for pyridostigmine?

Answer 17

glyco

Question 18

What is the dose of physostigmine?

Answer 18

0.01-0.03 mg/kg

Question 19

What is the only tertiary amine that crosses the BBB?

Answer 19

physostigmine

Question 20

Which agent is not useful for NMB reversal but is often used for central anticholinergic toxicity?

Answer 20

physostigmine

Question 21

What can physostigmine be used for?

Answer 21

reverse CNS depression from benzos, post op shivering, morphine induced respiratory depression

Question 22

Is an anticholinergic usually needed for physostigmine?

Answer 22

no

Question 23

What is the dose of glyco per mg of neostigmine?

Answer 23

0.2 mg

Question 24

What is the dose of glyco per mg of pyridostigmine?

Answer 24

0.05 mg

Question 25

What is the dose of atropine per mg of edrophonium?

Answer 25

0.014 mg

Question 26

What is the MoA of anticholinergics (antimuscarinics)?

Answer 26

bind reversibly with muscarinic ACh receptor to competitively inhibit activation by ACh

Question 27

What are the cardiovascular effects of antimuscarinics?

Answer 27

tachycardia, shorten PR, junctional rhythms, reduce AV blocks

Question 28

What are the respiratory effects of antimuscarinics?

Answer 28

inhibits secretions, smooth muscle relaxation, increased anatomical dead space

Question 29

What are the CNS effects of antimuscarinics?

Answer 29

either depression or stimulation, depending on whether or not they cross BBB

Question 30

What are the GI effects of antimuscarinics?

Answer 30

reduced secretions and motility, LES tone reduced

Question 31

What are the opthalmic effects of antimuscarinics?

Answer 31

mydriasis, cycloplegia (inability to accommodate near vision)

Question 32

What are the GU effects of antimuscarinics?

Answer 32

decreased bladder tone, urinary retention

Question 33

What are the thermoregulatory effects of antimuscarinics?

Answer 33

inhibition of sweat glands may lead to rise in body temp (atropine fever)

Question 34

What is atropine and does it cross the BBB?

Answer 34

tertiary amine- yes

Question 35

What is the dose of atropine?

Answer 35

0.02 mg/kg (peds) 0.04 mg/kg (adults) 2 mg IVP for severe vagal blockade

Question 36

What population should you use caution with when using atropine?

Answer 36

narrow angle glaucoma

Question 37

What is scopolamine and does it cross the BBB?

Answer 37

tertiary amine- yes

Question 38

What is the dose of scopolamine?

Answer 38

1.5 mg transdermal

Question 39

Describe how to use scopolamine for PONV

Answer 39

patch 4 hrs pre-op and maintain for 72 hours

Question 40

What can scopolamine be used for in a trauma patient?

Answer 40

amnesia

Question 41

What is glyco?

Answer 41

quaternary ammonium

Question 42

What is the dose of glyco?

Answer 42

0.005-0.01 mg/kg IV

Question 43

Rate the antimuscarinics from most to least in terms of causing tachycardia

Answer 43

atropine>glyco>scopolamine

Question 44

Rate the antimuscarinics from most to least in terms of causing bronchodilation

Answer 44

atropine & glyco> scopolamine

Question 45

Rate the antimuscarinics from most to least in terms of causing sedation

Answer 45

scopolamine> atropine> glyco (none)

Question 46

Rate the antimuscarinics from most to least in terms of its antisalagogue effects

Answer 46

glyco & scopolamine > atropine

Question 47

What is the primary NT of the somatic nervous system and what are its effector organs?

Answer 47

ACh; skeletal muscle

Question 48

Where is ACh in the ANS?

Answer 48

Preganglionic in the SNS; pre and postganglionic in the PNS

Question 49

What are the effector organs of the ANS?

Answer 49

smooth muscle, glands, cardiac muscle

Question 50

Where is NE and epi in the ANS?

Answer 50

postganglionic in the SNS (epi specifically released from medulla)

Question 51

Where are nicotinic receptors found?

Answer 51

somatic nervous system on skeletal muscles, preganglionic SNS & PNS, adrenal medulla

Question 52

Where are muscarinic receptors found?

Answer 52

sweat glands, heart (nodes, Purkinje, AV), muscles of the eye, salivary glands, GI tract (sphincters, secretions, gallbladder and ducts), urinary detrusor and sphincter

Question 53

Which NMB is the #1 cause of intraop allergic reactions?

Answer 53

rocuronium (succs is also common)

Question 54

Which NMBs release histamine?

Answer 54

benzylisoquinoines (-curium)