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20 Cards in this Set
- Front
- Back
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What nerves to you twitch and what muscles do they innervate? |
Ulnar Nerve-Adductor Muscle of the thumb Facial Nerve-Orbicularis Oculi Muscle of the eye |
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What is the order in which the Muscles blockade with NMBA? "Vocal Cords Die Out After Adding Muscle Paralysis Externally" |
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Graph demonstrating the difference between Phase one and Phase two depicted by fade. |
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How is a TOF Ratio calculated and what is a safe ratio for extubation? |
TOF Ratio= Magnitude of 3rd twitch/Magnitude of 1st twitch TOF Ratio of at least 0.9 is safe to extubate TOF Ratio=.7/.75=.933 |
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How is acetylcholine synthesized and degradated? |
Synthesized by Choline Acetyltransferase from Choline and AcetylCoA in the Pre-Synaptic Nerve Terminal. Degradated in the synaptic cleft by Acetylcholinesterase (true Cholinesterase) into Acetic Acid and Choline (gets reabsorbed) |
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Nicotinic Receptors, what type of receptor is it, what binds to it, what blocks it, and what electrolyte is involved? |
Ligand Gated Ion Channel Acetylcholine, Nicotine, Succinlcholine Blocked by NDMRs Na+ enters into the cell K+ leaves the cell |
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How many of the five sites on a Nicotinic receptor needs to be occupied to activate? |
Two |
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How is the action of Succinylcholine ended? How is Succinylcholine broken down? |
Ended by diffusion off the receptor by gradient. After 3-5 minutes due to hydrolysis by plasma cholinesterase (not true cholinesterase) enzymes. |
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What percentage of Succinylcholine reaches the neuromuscular junction (after metabolism) |
Only 10% |
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What are the other two names for plasma cholinesterase? |
Pseudocholinesterase and Butyrocholinesterase |
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What causes a prolonged effect from Succinylcholine lasting 1-3 hours instead of 3-5 minutes? |
Atypical plasma cholinesterase. Can be caused by low quantity or poor quality |
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What are causes of Low plasma cholinesterase (synthesized in the liver)? |
Liver disease Advanced age Malnutrition Pregnancy Burns Oral Contraceptives MOA Inhibitors Cytotoxic Drugs Anticholinesterase Drugs |
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What is the blood test for atypical plasma cholinesterase? |
Dibucaine Number (inhibits normal pseudocholinesterase activity by 80% and atypical activity by 20%) 40-60% Prolongs Succ by 100% (20-30 min) 20 and Below prolongs Succs by 4-8 hours |
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What are the adverse side effects of Succinylcholine? |
Bradycardia Hyperkalemia (increases by5-10meq/dL in burn, trauma, or Head injury patients) Myalgia (muscle pain) |
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What are factors that increase the action of Succinylcholine? |
Antibiotics Local Anesthetics Anticholinesterase Agents Increased extra cellular Mg++ Inherited pseudocholinesterase defecit Lithium |
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How do non-depolarizing neuromuscular blocking agents work? |
Combine with the acetylcholine receptors on the nicotinic receptor at the motor end-plate. |
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What are the two chemical classes of NDMRs? |
Steroidal (oniums)-Pancuronium, Vecuronium, Rocuronium Benzylisoquinolinium (urium) Atricurium, cisatricurium, Mivacurium |
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Factors that increase Potency of NDMRs? |
Aminoglycoside Antibiotics Local Anesthetics (large doses) Haloginated inhalation agents Hypothermia Magnesium Sulfate Hypokalemia Lithium Loop diuretics Antiarrhythic agents (Propranolol, Procainamide) |
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Factors that decrease Potency of NDMRs? |
Chronic Anticonvulsant therapy Hyperparathyroidism and Hypercalcemia Hyperkalemia and Hypermagnesemia |
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How do Myasthenia Gravis and Muscle Denervation Injuries(MDI) affect the response to muscle relaxants? |
Myasthenia Gravis has fewer Ach receptor (down regulates) results in increased sensitivity to NDMR and decreased sensitivity to succs MDI chronic decrease in Ach release with upregulated receptors resulting in resistance to NDMR and increased response to Succs |
