• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

image

PLAY BUTTON

image

PLAY BUTTON

image

Progress

1/44

Click to flip

Card Range To Study

through

44 Cards in this Set

  • Front
  • Back
Nondepolarizing neuromuscular blocking agents act by binding to the __________ receptors at the motor end plate.
nicotinic
Nondepolarizing NMBs competitively blocks _____________ from binding to its receptor.
acetylcholine
Nondepolarizing NMBs cause __________ channels to stay closed. Does the post synaptic membrane remains polarized or depolarized?
calcium; polarized
After IV administration, nondepolarizing NMB circulates to all tissues, then diffuses from vascular department to _________ ______ of the neuromuscular junction.
synaptic cleft
Review 7 characteristics of nondepolarizing NMB.
1. No muscle fasciculation prior to paralysis.
2. Can be reversed by agents that inhibit true acetylcholinesterase (neostigmine, pyridostigmine, edrophonium).
3. Amplitude of single twitch decreases with increasing block.
4. Decreased twitch response to a single stimulus.
5. Unsustained response (fade) during continuous stimulation.
6. Post-tetanic facilitation (potentiation) is present.
7. TOF (amplitude of fourth beat to first) is less than 70%.
RECOVERY FROM NONDEPOLARIZING BLOCK
How many twitches do you need to reverse a nondepolarizing NMB?
1 twitch, but preferably 3 or 4
Pancuronium is a ______________ aminosteroid with an ED95 = ____ mcg/kg.
bisquaternary; 70
What is the intubating dose of pancuronium?
0.8-0.12 mg/kg = intubation in 2-3 minutes
What is the onset of action for pancuronium?
3-5 minutes
What is the duration of action for pancuronium?
60-90 minutes
Where is pancuronium excreted?
80% excreted unchanged in urine. Clearance decreased 33-50% in renal failure.
Where is pancuronium metabolized?
10-40% liver metabolism. Prolonged elimination in liver failure.
State 3 side effects of pancuronium.
1. Modest increase in HR.
2. Mean arterial blood pressure (10-15%).
3. Selective cardiac vagal blockade (atropine-like effect limited to cardiac muscarinic receptors).
Patients receiving pancuronium can have an allergic reaction if hypersensitive to _________.
bromide
Patients that receive pancuronium are at risk for cardiac arrhythmias if they have been on chronic doses of what drug?
digitalis
Does pancuronium produce histamine release?
NO
Atracurium is a ____________ benzylisoquinolinium (mixture of ten geometric isomers).
bisquarternary
The onset of action for atracurium is ___-___ minutes. The duration of action is ___ - ___ minutes.
3-5; 20-35
Where is the site of action for atracurium?
Pre and post synaptic cholinergic receptors. May block ion channels.
How is atracurium eliminated?
Atracurium is designed to undergo spontaneous degradation (HOFFMANN ELIMINATION) at normal body pH & temperature.
Does atracurium cause histamine release?
YES; causes HR and BP changes
Vecuronium is a _____________ aminosteroid.
monoquaternary

Pancuronium minus a quaternary methyl group. Minor changes in structure beneficially alters side effects without effecting potency.
The ED95 of vecuronium is ___ - ___ mcg/kg.
ED95 = 50-120
What is the onset of action for vecuronium? What is the duration?
Onset = 3-5 minutes
Duration = 20-35 minutes
How is vecuronium prepared?
Vec is unstable in solution; therefore it is dissolved in 10 ml NS or sterile water.
Clearance for vecuronium occurs where?
40% excreted unchanged in bile and 30% in urine within 24 hours. Half-time prolonged in renal failure, but doesn't appear to be with liver disease.
Is vecuronium associated with cardiovascular side effects? If so, what are they?
NO - little if any cardiovascular side effects are associated with vecuronium.

Modest vagolytic effect.
Does vecuronium produce histamine release?
NO
Why does vecuronium produce prolonged effect in obesity?
Increased lipid solubility
Rocuronium is a ___________ steroid analogue of vecuronium designed to provide a rapid onset of action.
monoquaternary
The ED95 of rocuronium is ___ - ___ mg/kg. The intubating dose for rocuronium is ____ - ___ mg/kg.
ED95 = 0.3-0.4 mg/kg
Intubation = 0.45-0.9 mg/kg
What is the onset of action of rocuronium? What is the duration?
Onset = 1-2 minutes
Duration = 20-35 minutes
How is rocuronium excreted?
Largely excreted unchanged in bile (up to 50% in 2 hours).

Renal excretion >30% in 24 hours. Modest prolonged duration in renal failure patients.
Is rocuronium associated with cardiovascular side effects?
NO - Very little if any cardiovascular side effects.

Slight vagolytic effect.
Does rocuronium cause histamine release?
NO - Very little if any histamine release.
Cisatracurium is a __________ - purified form of one of the ten stereoisomers of atracurium.
benzylisoquinolinium
What is the ED95 for cisatracurium?
ED95 = 50 mcg/kg
What is the onset of action for cisatracurium? What is the duration?
Onset = 3-5 minutes
Duration = 20-35 minutes
How is cisatracurium eliminated?
Degradation principally by Hoffmann elimination.
Because cisatracurium is very expensive it is good to use on patients with what co-morbidities?
Hepatic or renal dysfunction.

Can be used in patients with hepatic or renal dysfunction without changing its profile.
Is cisatracurium associated with cardiovascular effects? If so, what are they?
NO - Very little if any cardiovascular effects.
Does cisatracurium produce histamine release?
Dramatically less likely than atracurium.
Chemically, all nondepolarizing NMB are either _____________ or ________ ________.
Benzylisoquinolines - Atracurium; Cisatracurium

Steroidal Compounds - have a steroid nucleus. Vecuronium; Rocuronium; Pancuronium