Nagelhout Pharm 2 Exam 1 |111 Q’s and
A’s |100% Scores
Ultra short acting depolarizer - -Succinylcholine
- Short-Acting non-depolarizer - -NONE
- Intermediate acting non-depolarizer - --Atracurium
-Cisatracurium
-Vecuronium
-Rocuronium
- Long acting non-depolarizer - --Pancuronium
- Agents used to treat alzheimers - --Donepezil (Aricept)
-Rivastigmine (Exelon)
-Galantamine (Razadyne)
-Tacrine (Cognex)
- How do alzheimer's drugs work? - -They are cholinesterase inhibitors.
More acetylcholine availability, patient more alert/aware.
- What is important to know about alzheimer's drugs and anesthetic? - -
Succinylcholine effects may last longer. Inability to appropriately breakdown
excess acetylcholine.
- Single twitch monitoring test - --A single electrical stimulus ranging from
0.1-1.0 Hz.
*Requires baseline before drug administration; generally used as qualitative
rather than quantitative assessment.*
- Train-of-four test? Useful during? Not used with? - -A series of four
twitches at 2Hz. Every half second for two seconds.
*Reflects blockade from 70-100%;
useful during onset, maintenance and emergence.
Administration of Succs
- Double-burst test - -Two short bursts of 50Hz tetanus seperated by 0.75
seconds.
, *Similar to TOF; useful during onset, maintenance, and emergence; may be
easier to detect fade than with TOF; tactile evaluation.*
- Tetanus test - -Generally, consists of rapid delivery of a 30, 50, or 100 Hz
stimulus for 5 seconds.
*Should be used sparingly for deep block assessment, painful.*
- Posttetanic count? Parameters? - -50-Hz. Tetanus for 5 seconds, a 3
second pause, then single twitches of 1Hz.
*Used only when TOF or double burst stimulation response is absent; count
less than eight indicates a deep block, and prolonged recovery is likely.*
- Onset time - -Time from drug administration to maximal effect.
- Clinical duration - -Time from drug administration to 25% recovery of
twitch response
- Total duration of action - -Time from drug administration to 90% recovery
of twitch response
- Recovery Index - -time from 25% to 75% recovery of twitch response
- Where to measure onset of relaxant - -Facial nerve. Orbicularis oculi and
corrugator supercilii (*best site*).
- Where to measure recovery from relaxant - -Ulnar nerve innervation of
adductor pollicis.
- Sequence of onset of muscle relaxant? Recovery? - -1. Eye lids
2. Extremities
3. Chest - intercostals (from strap muscles in the neck downward).
4. Abdominal muscles
5. Diaphragm
Vice Versa
- 4 Characteristics of NM blockade? - -Oribicularis oculi response to facial
nerve stimulation reflects the extent of neuromuscular blockade of the
diaphragm better than does the adductor pollicis.
upper airway muscles are more sensitive than peripheral muscles
no difference in arm and leg muscles
A’s |100% Scores
Ultra short acting depolarizer - -Succinylcholine
- Short-Acting non-depolarizer - -NONE
- Intermediate acting non-depolarizer - --Atracurium
-Cisatracurium
-Vecuronium
-Rocuronium
- Long acting non-depolarizer - --Pancuronium
- Agents used to treat alzheimers - --Donepezil (Aricept)
-Rivastigmine (Exelon)
-Galantamine (Razadyne)
-Tacrine (Cognex)
- How do alzheimer's drugs work? - -They are cholinesterase inhibitors.
More acetylcholine availability, patient more alert/aware.
- What is important to know about alzheimer's drugs and anesthetic? - -
Succinylcholine effects may last longer. Inability to appropriately breakdown
excess acetylcholine.
- Single twitch monitoring test - --A single electrical stimulus ranging from
0.1-1.0 Hz.
*Requires baseline before drug administration; generally used as qualitative
rather than quantitative assessment.*
- Train-of-four test? Useful during? Not used with? - -A series of four
twitches at 2Hz. Every half second for two seconds.
*Reflects blockade from 70-100%;
useful during onset, maintenance and emergence.
Administration of Succs
- Double-burst test - -Two short bursts of 50Hz tetanus seperated by 0.75
seconds.
, *Similar to TOF; useful during onset, maintenance, and emergence; may be
easier to detect fade than with TOF; tactile evaluation.*
- Tetanus test - -Generally, consists of rapid delivery of a 30, 50, or 100 Hz
stimulus for 5 seconds.
*Should be used sparingly for deep block assessment, painful.*
- Posttetanic count? Parameters? - -50-Hz. Tetanus for 5 seconds, a 3
second pause, then single twitches of 1Hz.
*Used only when TOF or double burst stimulation response is absent; count
less than eight indicates a deep block, and prolonged recovery is likely.*
- Onset time - -Time from drug administration to maximal effect.
- Clinical duration - -Time from drug administration to 25% recovery of
twitch response
- Total duration of action - -Time from drug administration to 90% recovery
of twitch response
- Recovery Index - -time from 25% to 75% recovery of twitch response
- Where to measure onset of relaxant - -Facial nerve. Orbicularis oculi and
corrugator supercilii (*best site*).
- Where to measure recovery from relaxant - -Ulnar nerve innervation of
adductor pollicis.
- Sequence of onset of muscle relaxant? Recovery? - -1. Eye lids
2. Extremities
3. Chest - intercostals (from strap muscles in the neck downward).
4. Abdominal muscles
5. Diaphragm
Vice Versa
- 4 Characteristics of NM blockade? - -Oribicularis oculi response to facial
nerve stimulation reflects the extent of neuromuscular blockade of the
diaphragm better than does the adductor pollicis.
upper airway muscles are more sensitive than peripheral muscles
no difference in arm and leg muscles
