Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
43 Cards in this Set
- Front
- Back
|
PHASE II BLOCK
|
-post junctional membrane repolarizes but does not respond normally to ACh
-usually doses > 3-5 mg/kg IV -resembles non depolarizing block |
|
|
ATYPICAL PLASMA CHOLINESTERASE
|
-gene, unable to hydrolyze the ester bonds in drugs like Sux, mivacurium
-usually don't know until given Sux and block time prolonged -test with dibucaine |
|
|
2 CHEMICAL CLASSIFICATIONS OF NON DEPOLARIZERS
|
STEROID DERIVATIVES-Pan, Roc, Vec, Pipercuronium *vagolytic usually (increase HR)
BENZYLLISOQUINOLINES-d-tubo, atracurium, mivacurium* tend to release histamine |
|
|
DIBUCAINE TEST
|
-local anesthetic that will inhibit normal plasma cholinesterase by 80% (normal is 80)
-40-60 heterozygous atypical prolonged block (20-40) -20-40 Block >60 min homozygous atypical |
|
|
LONG ACTING NON DEPOLARIZERS
|
Pancuronium longest, Doxacurium,pipe, d-tubo, metocurine and gallamine
|
|
|
SIDE EFFECTS OF SUX
|
-can also stimulate muscarinic receptors causing bradycardia
-Fasiculations can cause myalgia -prevent fasiculations by giving subparalyzing dose 3-5% of ED95 non depolarizing drug -hyperkalemia from sustained opening of channels and K out -don't use in burns, upper motor neuron lesions, musc. dystrophy |
|
|
MORE SIDE EFFECTS OF SUX
|
myoglobinuria from fasiculations, Increase IOP, increase ICP, increase IGP, Trismus in children -jaw doesn't relax, may be a sign of suseptibility to MH,
-trigger for MH |
|
|
INTERMEDIATE NON DEPOLARIZER
|
Vec, atracurium, cisatracurium, Roc
|
|
|
SHORT ACTING NON DEPOLARIZER
|
mivacurium
|
|
|
PAVULON (PANCURONIUM)
|
LONG ACTING
-DOSE intub. .08-.12 mg/kg main. .01 mg/kg ONSET 3-5 min DURATION 60-90 min EXCRETION primarily renal (only one) ***can stimulate and block vagus -> increase HR, CAD caution |
|
|
NUROMAX (Doxacurium)
|
LONG ACTING
DOSE intub. .05 mg/kg main. .005 mg/kg ONSET 4-6 min |
|
|
ARDUAN (Pipercuronium)
|
LONG ACTING
DOSE intub. .06-.1 mg/kg **hypotension, bradycardia |
|
|
EDROPHONIUM
|
ANTICHOLINESTERASE
onset like atropine trade names TENSILON, ENLON, REVERSOL DOSE 0.5-1 mg/kg give with atropine 0.014 mg per mg of edrophonium |
|
|
PROSTIGMIN, VAGOSTIGMIN (Neostigmine)
|
ANTICHOLINESTERASE
DOSE .037-0.07 MG/KG give with glycopyrrolate 0.2 mg per mg of neostigmine |
|
|
PHYSOSTIGMINE
|
ANTICHOLINESTERASE
-tertiary amine crosses BBB -used to tx anticholinergic toxicity NOT USED FOR REVERSAL ***too much anticholinesterase will cause weakness and blockade due to excessive ACh in NMJ -this drug will prolong/potentiate the block of Sux |
|
|
TRACURIUM (Atracurium)
|
INTERMEDIATE
-DOSE intub. .5 mg/kg over 30-60 sec main .1mg/kg infusion 5-10 mcg/kg/min EXCRETION hoffman elimination, spontaneous non enzymatic degredation (at normal temp and pH), 2nd non specific tissue esterases. -can cause seizures -good for renal pts -Laudanosine product of metab. CNS stimulant -if push too fast histamine release |
|
|
CHOLINERGIC SYNDROME (CRISIS)
|
-excessive use of cholinesterase inhibitors or organic insecticides
-excessive ACh peripherally or centrally -s/s miosis, salivation, brochoconstriction, bradycardia, abd. cramping -weakness CNS dysphoria, confusion, seizures, coma (inhibits parasympathetic, CNS excitatory) |
|
|
NIMBEX (cisatracurium)
|
INTERMEDIATE ACTING
-stereoisomer of atracurium -slower onset less histamine DOSE intub. .1-.15 mg/kg infusion 1-2 mcg/kg/min EXCRETION Hoffman elimination Laudanosine but less than atracurium |
|
|
ANTICHOLINERGIC SYNDROME
|
-develops in response to increased doses of atropine and scopolamine
s/s CNS restless, shiver, mania, hallucinations, delerium, drowsiness, agitation disorientation -peripheral - blurred vision, dry mouth, Increase HR, dry flushed skin, hypoTN, rash on face, neck and upper chest |
|
|
TREATMENT FOR CHOLINERGIC SYNDROME
|
Atropine 35-70 mcg/kg
Pralidoxime 15 mg/kg IV Q 20min (reactivates acetylcholinesterase) ****then treat s/s |
|
|
ZEMURON (Rocuronium)
|
INTERMEDIATE ACTING
-low s/e profile, alternate for Sux for RSI DOSE intub. .6 mg/kg RSI double the intub dose- will make onset more rapid and longer duration EXCRETION little metab. largely excreted unchanged in the urine |
|
|
MIVACRON (Mivacurium)
|
SHORT ACTING
DOSE intub. .15-.2 mg/kg infusion 4-10 mcg/kg/min EXCRETION hydrolysis via plasma cholinesterase * so if atypical plasma cholinesterase increases block time -histamine release- push slowly -spontaneous recovery need for reversal controversial |
|
|
REVERSAL AGENTS
ANTICHOLINESTERASES |
-inhibit the enzyme that breaks down ACh (acetylcholinesterase)
-Therefore INDIRECTLY increase the amoung of ACh available to compete with the non depolarizing agent which will therefore reestablish neuromuscular transmission |
|
|
PHASE I BLOCK
|
-depolarizing NMB
-"fasiculations" |
|
|
DTc d-tubocurarine
|
not used for NMB but pre tx for sux to prevent fasiculations
DOSE 3 mg IV 3-5 min before sux ***causes histamine release |
|
|
TREATMENT FOR ANTICHOLINERGIC SYNDROME
|
Physostigmine 15-60mcg/kg
crosses the BBB |
|
|
ANTICHOLINESTERASES SIDE EFFECTS
|
-increase in ACh affects more than nicotinic receptors of skeletal muscle
CV Brady, RESP bronchospasm GI N/V so give with anticholinergic agents |
|
|
NORCURON (Vecuronium)
|
INTERMEDIATE ACTING
DOSE intub. .08-.12 mg/kg main. .01 mg/kg infusion 1-2 mcg/kg/min ONSET 3-5 min DURATION 20-60 min under an hour EXCRETION prim biliary, 2nd renal (25%) |
|
|
ULNAR NERVE
|
adductor pollicis, adduction of thumb,
ASSESS FOR READY TO EXTUBATE comes back last |
|
|
MANDIBULAR NERVE
|
masseter muscle, electrode in front of and below zygomatic arch and forehead
|
|
|
POST TIBIAL NERVE
|
plantar flexion of big toe
|
|
|
FACIAL NERVE
|
ASSESS FOR READY TO INTUBATE
-first to go down first to come back -orbicularis oculi -has similar sensitivity to NMB as diaphragm and laryngeal -recover sooner than adductor pollicis, orbicularis, diaphragm, rectus abdominus, and laryngeal |
|
|
POST TETANIC FACILITATION
|
-response to TOF following tetanus is increased yet still fades as before
-typical of non dep block usually means you can start reversal |
|
|
DOUBLE BURST
|
-3 short high frequency bursts 50 Hz separated by 0.2 msec followed by another 3 or 2 750 msec later
-considered gold standard easier to assess -depolar 2 twitches diminished no fade -non depolar 2 twitches with fade |
|
|
TETANY
|
-sustained 5 sec 50-100 Hz
-sustained without fade indicates adequate recovery from block |
|
|
TOF
|
-4 stimuli at 2 Hz delivered Q 0.5 sec
|
|
|
SINGLE TWITCH
|
-frequency 1 Hz
-used as control twitch |
|
|
RECEPTOR BLOCKADE
|
-100%- flaccid no response
-95%- no twitches but diaphragm may move -90%- 1 twitch adequate for abd. surg. -70%- 75%- 4 twitches TOF, VC and TV can be normal -50%- can pass inspriatory pressure test (NIF) -30%- head lift and hand grasp sustained |
|
|
MIOSIS
|
CONSTRICT
|
|
|
MYDRIASIS
|
DILATE
|
|
|
CHOLINERGIC CRISIS
|
-too much anticholinesterases
AKA muscarinic crisis s/s abd pain, n/v, blurred vision, bronchial hypersecretion TX PRALIDOXIME 15 MG/KG Q 20 min (reactivates acetylcholinesterase ATROPINE 35-70 MCG/KG |
|
|
ANTICHOLINERGIC SYNDROME
|
-opposite of cholinergic syndrome ( TOO MUCH ANTIMUSCARINICS, atropine, glycopyrolate, pralidoxime)
s/s Increase of SNS efffects Increase HR, blurred vision, rash neck, face, and chest TX PHYSOSTIGMINE 15-60 MCG/KG CROSSES BBB |
|
|
PYRIDOSTIGMINE
|
ANTICHOLINESTERASE
DOSE 0.15- 0.35 mg/kg give with glycopyrrolate 0.05 mg per pyridostigmine |
