test 2 review Flashcards
(108 cards)
1
Q
You can block Ach with neuromuscular blocker?
A
Depolarizer
Sux
Non- depolarizer
Rocuronium
Vecuronium
Pancuroium
Cisatracurium
2
Q
What makes a NMB competitive?
A
They can be reversed
3
Q
What is Hoffman Elimination dependent on?
A
pH and Temp
4
Q
What is Cisatracurium better for?
A
Renal Failure patients
5
Q
Which neuromuscular blockers are steroidal?
A
Pancuronium
Vecuronium
Rocuronium
6
Q
Which neuromuscular blocker is vagolytic?
A
Pancoronium
7
Q
Which neuromuscular blocker is good for children?
A
Pancuronium
8
Q
Which neuromuscualar blocker would you give to children only under dire circumstances?
A
Sux
9
Q
Sux cannot be?
A
Reversed
10
Q
Neuromuscular drugs are chosen based off of?
A
Desired onset
Duration of action
Recovery rate
11
Q
What decreases the action of plasma cholinesterase?
A
Pancuronium
12
Q
Vercuronium is metabolized where?
A
Hepatic metabolism
13
Q
Which neuromuscular blocking drug has primary elimination on metabolism?
A
Sux
Mivacurium
14
Q
Which an NMBD drug has primary elimination on renal elimination?
A
D-tubocuraine
Pancuronium
15
Q
Which NMBD drug has primary Biliary elimination?
A
Vecuronium
Rocoronium
16
Q
Which drugs doesn’t cross the blood brain barrier?
A
Glycopyrrolate
17
Q
Giving 10% of the neuromuscular blocking dose is?
A
Priming
18
Q
What risk increases when priming a patient with NMBD?
A
Aspiration
19
Q
Muscarinic man was?
A
Juicy and bradycardic
20
Q
How many molecules to open up an acetylcholine receptor?
A
2
21
Q
Patients with poor plasma cholinesterase has what kind of block?
A
Phase 2 block
22
Q
Fetal nicotinic acetylcholine receptors contain what subunit instead of an epsilon?
A
Gamma
23
Q
11 clinical signs of malignant hypothermia?
A
Tachycardia, acidosis, hypercarbia, muscle rigidity, hypoxemia, hypothermia, increased CO2, arrhythmia, hyperkalemia,
24
Q
Early signs of malignant hypothermia?
A
Increase entitled
25
Identify anesthetic agents in patients with malignant hypothermia?
Sux and Halothane
26
Which drug class treats M. Graves?
AntiCholine Inhibitors
27
M. Graves patients have?
Have antibodies to receptors. Receptors are down regulated
28
M. Graves are sensitive to?
Nondepolarizers
29
A patient with M Graves takes too much of a drug has which syndrome?
Cholinergic crisis from too much acetylcholine
30
An M. Graves patient is is given a relaxants why do we care?
Duration of action they don't have enough receptors. May not be able to extubate the patient
31
How to make sure patients are strong enough for extubation?
TO4
32
Sux mimics what?
Acetylcholine
Looks similar to acetylcholine
Is Parasymptomatic
33
True cholinesterase is?
Acetylcholinesterase
34
Succinylcholine can make a patients?
Heart rate slow down or stop beating
35
Another two names for plasma cholinesterase?
Butyrl and Pseudo cholinesterase
36
Complications of succinylcholine?
Malignant hypothermia, anaphylaxis, hyperkalemia, increased gastric pressure, increase cranial pressure
37
Succinylcholine cannot be used in which type of patient?
Eyes surgery Patients
38
Succinylcholine in patience in contraindicated?
Up regulation
| Spinal cord injury, burn victims, paraplegics, skeletal muscle trauma, muscular dystrophy, Parkinson
39
What doesn't it trigger malignant hypothermia?
Nitrous oxide
40
How do you treat laryngospasm?
With succinylcholine
41
You Give dose of succinylcholine for rapid sequence you failed to intubate you get more succinylcholine?
No patient can become resistant to atropine
42
Which receptors are easiest block?
First receptors
43
The goal of priming?
To speed on set and give less drugs in the end
44
What makes nondepolarizing start working if you don't reverse?
Redistribution
45
Atracurium releases?
Histamines and CV effect a rapid injections or high doses
46
Antibiotics act?
Postsynaptically
47
Lithium increases?
Non depolarizers and the polarizers action
48
Hypermagnesium
Increases block
49
Respiratory acidosis
Increases block
50
Hypothermia
Increases block
51
Anticonvulsant
Decreases block
52
Hyperglycemia
Have no effect
53
What causes increased gastric pressure and succinylcholine?
Fasciculations
give defasciculation does (non depolarizing small dose)
Increase risk of aspiration preoperatively
54
Organic phosphate is related to what class of drugs?
Anti-cholinesterase
55
Anticholinergic drugs?
Scopolamine, atropine, Glycopyrrolate
56
Up regulation can develop in how many days?
3 to 5 day
57
Anti- cholinergic receptors
are muscarinic
58
Five side effects of anticholinergic drugs?
Bronco dilation, increased heart rate, decreased secretions
59
Which anticholinergic drug increases the heart rate the most?
Atropine
60
Anti-muscarinic drugs affect sweating
By decreasing sweating
61
Etropinum is given with which drug?
Atropine
62
Symptoms of anti-cholinergic syndrome are?
Dilated pupils, blind as a bat, red is a beet, dry mouth, can't sweat, can't pee, confusion
Caused by atropine and scopolamine poisoning
63
Cholinergic drug Neostigme
Muscarinic Man
64
Patient has M. Graves she is?
Cholinergic Crisis
65
Anti-cholinergic treatment?
Physostigmine
| it crosses the BBB
66
Dibucaine # value?
```
>70 = 70% of enzymes is inhibited by Dibucanine: normal
50= 50% of the enzymes inhibited: heterozygous normal
```
67
Etomidate metabolism?
Hepatic microsomal enzymes and plasmaesterases
68
Nitrous Oxide can prevent what?
Vitamin B12 from acting as a cofactor for methionine synthetase.
69
Dibucaine # 20 what kind of plasma cholinesterase do you have?
Homozygous atypical
70
Dibucaine 20 and given Sux how long will patient be intubated?
Very long time
71
How many twitches to reverse? At what point to reverse none depolarizing muscle relaxants?
2 to 3 twitches
| 15 to 30 minutes
72
Treatment for cholinergic syndrome
Atropine
73
Three places for neuromuscular monitoring?
Facial nerve
thumb
foot
74
How many twitches with 70%?
Four out of four
75
What are ions go to skeletal muscle?
Sodium and potassium
76
Bad plasma cholinesterase what would you check?
Phase II block
77
What causes histamine release?
Benzoquiroline (?)
78
Succinylcholine is metabolized by what enzyme?
Plasma cholinesterase
79
What happens when the channel of the motor end place opens?
Sodium ions and calcium Ion diffuse to the cells
Potassium diffuses out
80
Succinylcholine duration of action
Very short
81
Mivacurium DOA
Short
82
Atracurium DOA
Intermediate
83
Cisatracurium DOA
Intermediate
84
Vecuronium DOA
Intermediate
85
Rocuronium DOA
Intermediate
86
d- tubocurarine DOA
Long
87
Pancuronium DOA
Long
88
Atracurium is eliminated by?
ester hydrolysis and hofmann elimination
89
Cistracurium is eliminated by?
Hofman Elimination
90
Mivacurium is eliminated by?
Plasma Cholinesterase
91
What is used to treat malignant hypothermia?
Dolanthane
92
Principal Pharmacologic Effect of intravenous anesthetic s
Anterograde Amnesia
93
Chemical Structure of Benzodiazepine
2 diazephine rings
94
Benzo GABA Recptor
Made up of 5 subunits
2 GABA molecules attached to an alpha subunite
95
Versed in physiologic PH becomes what?
I'm protonated add highly lipid soluble
96
Versed pharmacokinetics?
Possesses a slow effects sites equilibration time
Rapid redistribution from brain to inactive tissue site and rapid hepatic clearance
97
Versed Metabolism?
Hepatic and small intestine cytochrome P-450 enzyme (CYP3a4)
98
Versed doses
Pre op- .25- 1 mg/
Iv: 1 - 2.5 mg
Induction of Anesthesia IV dosing: 0.1- 2mg
99
Diazepam (valium)
Lorazepam (Ativan)
Dia: Dissolved in organic solvent , must be diluted with water
100
Flumazenil
Benzo Antagonist
101
Barb, Propofol, and Etomidate mechanism of action?
GABA receptor interaction
102
Barbituates
Depress Reticular activation system
lipid soluble- most important
103
Ketamine
Weak action on GABA
noncompetitive attachement on NMDA receptos
104
Propofol
50 % bound to erythrocytes
crosses placenta
Induction: 1.5-2.5 mg/kg
iv sedation: 25-100 mpg/kg/ min
Maintenance of anesthesia 100-300mcg/ kg
No M. Hypothermia trigger
105
Etomidate
Rapid Brain Penetration
Hepatic Microsomal Enzyme and plasmaesterase
Adrenocortical Suppression
Dosing
Induction: 0.2-0.4 mg/kg
Onset: 30-60 sec
106
Ketamine
Rapid Onset= high lipid solubility
short Duration of action: 5-15 min
Metabolism: hepatic microsomal enzymes
Produces dissociative anesthesia
Cataleptic state= eyes open with slow nystagmus gaze
107
Side effects of Interenous and benzo
emergence delirium
108
Scopolamine
Crosses BBB
| Binds to muscarinic receptors
