Nagelhout-Pharm 2-Exam 1 |121
Questions & Answers
Ultra short acting neuromuscular blocker
(Length of duration) - -Succinylcholine
(5 - 15 minutes)
- Depolarizing NMB - -Succinylcholine
- Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - -Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
- Long Acting Nondepolarizing NMB
(Length of duration) - -Pancuronium
60-90 minutes
- Short Acting Nondepolarizing NMBs
(Length of duration) - -None
(20-30 minutes)
- NMB Reversal Agents (3) - -Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
- NMBs work at ____ receptors - -Nicotinic Cholinergic (sub-m)
- Neurotransmitter of the NM junction - -acetylcholine
- Breaks down acetylcholine at the NM synapse/junction - -
acetylcholinesterase
- Non-depolarizing agents are: agonists or antagonists - -Antagonist
- Depolarizing agents act as: agonist or antagonist?? - -Agonist then
antagonist
- Onset time definition - -time from drug administration to maximum effect
- Clinical duration definition - -time from drug administration to 25%
recovery of twitch response
, - Total duration of action definition - -time from drug administration to 90%
recovery of twitch response (point at which pt is recovered)
- Recovery index definition - -time from 25% to 75% recovery of twitch
response (how fast?)
- Train of Four Index - -4th twitch of TOF/1st twitch of TOF
- Muscle stimulated by ulnar nerve in TOF - -Adductor pollicis
- Best nerve/muscle to measure onset of NMB - -Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
- Best nerve/muscle to measure emersion from NMB - -Ulnar Nerve
Adductor Pollicis
- Single Twitch Test - -1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
- Train of Four Test - -4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
- Double Burst Simulation (DBS) Test - -2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
- Tetanus Test - -100 Hz twitch for 5 seconds
Painful
- Posttetanic Count Test - -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 - -1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
- Muscles not affected by NMBs (4) - -1. Cardiac muscle
Smooth muscle:
Questions & Answers
Ultra short acting neuromuscular blocker
(Length of duration) - -Succinylcholine
(5 - 15 minutes)
- Depolarizing NMB - -Succinylcholine
- Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - -Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
- Long Acting Nondepolarizing NMB
(Length of duration) - -Pancuronium
60-90 minutes
- Short Acting Nondepolarizing NMBs
(Length of duration) - -None
(20-30 minutes)
- NMB Reversal Agents (3) - -Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
- NMBs work at ____ receptors - -Nicotinic Cholinergic (sub-m)
- Neurotransmitter of the NM junction - -acetylcholine
- Breaks down acetylcholine at the NM synapse/junction - -
acetylcholinesterase
- Non-depolarizing agents are: agonists or antagonists - -Antagonist
- Depolarizing agents act as: agonist or antagonist?? - -Agonist then
antagonist
- Onset time definition - -time from drug administration to maximum effect
- Clinical duration definition - -time from drug administration to 25%
recovery of twitch response
, - Total duration of action definition - -time from drug administration to 90%
recovery of twitch response (point at which pt is recovered)
- Recovery index definition - -time from 25% to 75% recovery of twitch
response (how fast?)
- Train of Four Index - -4th twitch of TOF/1st twitch of TOF
- Muscle stimulated by ulnar nerve in TOF - -Adductor pollicis
- Best nerve/muscle to measure onset of NMB - -Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
- Best nerve/muscle to measure emersion from NMB - -Ulnar Nerve
Adductor Pollicis
- Single Twitch Test - -1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
- Train of Four Test - -4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
- Double Burst Simulation (DBS) Test - -2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
- Tetanus Test - -100 Hz twitch for 5 seconds
Painful
- Posttetanic Count Test - -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 - -1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
- Muscles not affected by NMBs (4) - -1. Cardiac muscle
Smooth muscle:
