Nagelhout-Pharm 2-Exam 1
Usual Pseudocholinesterase Activity (Heterozygote):
1. Genetic makeup
2. Frequency of the population
3. Enzyme activity
4. Duration of Succ.
5. Dibucaine number - ANSWER-1. Heterozygote (Eu, Ea) u= usual, a=abnormal
2. 3%
3. Decreased activity
4. Slightly prolonged; 50% increased duration
5. 50-69
Atypical Pseudocholinesterase Activity
1. Genetic makeup
2. Frequency of the population
3. Enzyme activity
4. Duration of Succ.
5. Dibucaine number - ANSWER-1. Ea, Ea
2. 0.3%
3. Decreased by ≥70%
4. Significantly prolonged; 4-24 hours
5. 16-30
Esterases found in red blood cells (2) - ANSWER-1. RBC esterase
2. Acetylcholinesterase
Acetylcholinesterase
1. Other names
2. Location - ANSWER-1. True, specific, genuine, Type 1
2. Erythrocytes, nerve endings, lungs, spleen, grey matter of brain
Neurotransmitter of the NM junction - ANSWER-acetylcholine
Breaks down acetylcholine at the NM synapse/junction - ANSWER-acetylcholinesterase
Non-depolarizing agents are: agonists or antagonists - ANSWER-Antagonist
Depolarizing agents act as: agonist or antagonist?? - ANSWER-Agonist then antagonist
Onset time definition - ANSWER-time from drug administration to maximum effect
, Clinical duration definition - ANSWER-time from drug administration to 25% recovery of
twitch response
Total duration of action definition - ANSWER-time from drug administration to 90%
recovery of twitch response (point at which pt is recovered)
Recovery index definition - ANSWER-time from 25% to 75% recovery of twitch
response (how fast?)
Train of Four Index - ANSWER-4th twitch of TOF/1st twitch of TOF
Muscle stimulated by ulnar nerve in TOF - ANSWER-Adductor pollicis
Best nerve/muscle to measure onset of NMB - ANSWER-Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
Best nerve/muscle to measure emersion from NMB - ANSWER-Ulnar Nerve
Adductor Pollicis
Single Twitch Test - ANSWER-1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - ANSWER-4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Double Burst Simulation (DBS) Test - ANSWER-2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - ANSWER-100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - ANSWER-50 Hz stimulus for 5 sec → 3 sec pause → 1 Hz
single twitch every second
Only used when patient is 100% paralyzed
More post-tetanic twitches = closer to recovery
Sequence of muscle paralysis - ANSWER-1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
Usual Pseudocholinesterase Activity (Heterozygote):
1. Genetic makeup
2. Frequency of the population
3. Enzyme activity
4. Duration of Succ.
5. Dibucaine number - ANSWER-1. Heterozygote (Eu, Ea) u= usual, a=abnormal
2. 3%
3. Decreased activity
4. Slightly prolonged; 50% increased duration
5. 50-69
Atypical Pseudocholinesterase Activity
1. Genetic makeup
2. Frequency of the population
3. Enzyme activity
4. Duration of Succ.
5. Dibucaine number - ANSWER-1. Ea, Ea
2. 0.3%
3. Decreased by ≥70%
4. Significantly prolonged; 4-24 hours
5. 16-30
Esterases found in red blood cells (2) - ANSWER-1. RBC esterase
2. Acetylcholinesterase
Acetylcholinesterase
1. Other names
2. Location - ANSWER-1. True, specific, genuine, Type 1
2. Erythrocytes, nerve endings, lungs, spleen, grey matter of brain
Neurotransmitter of the NM junction - ANSWER-acetylcholine
Breaks down acetylcholine at the NM synapse/junction - ANSWER-acetylcholinesterase
Non-depolarizing agents are: agonists or antagonists - ANSWER-Antagonist
Depolarizing agents act as: agonist or antagonist?? - ANSWER-Agonist then antagonist
Onset time definition - ANSWER-time from drug administration to maximum effect
, Clinical duration definition - ANSWER-time from drug administration to 25% recovery of
twitch response
Total duration of action definition - ANSWER-time from drug administration to 90%
recovery of twitch response (point at which pt is recovered)
Recovery index definition - ANSWER-time from 25% to 75% recovery of twitch
response (how fast?)
Train of Four Index - ANSWER-4th twitch of TOF/1st twitch of TOF
Muscle stimulated by ulnar nerve in TOF - ANSWER-Adductor pollicis
Best nerve/muscle to measure onset of NMB - ANSWER-Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
Best nerve/muscle to measure emersion from NMB - ANSWER-Ulnar Nerve
Adductor Pollicis
Single Twitch Test - ANSWER-1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - ANSWER-4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Double Burst Simulation (DBS) Test - ANSWER-2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - ANSWER-100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - ANSWER-50 Hz stimulus for 5 sec → 3 sec pause → 1 Hz
single twitch every second
Only used when patient is 100% paralyzed
More post-tetanic twitches = closer to recovery
Sequence of muscle paralysis - ANSWER-1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
