Name that drug
Long-acting non-depolarizing muscule relaxant
Pancuronium
A spontaneous nonenzymatic chemical breakdown occurs at physiological pH and temperature.
Hofmann elimination
Compared to adults, pediatric patients require a _____ dose of succinylcholine for reliable and safe conditions for intubation.
Higher
The increased dose requirement in younger patients is attributed to its rapid distribution into an enlarged volume of extracellular fluid
What are some triggers of malignant hyperthermia?
Consists of two joined ACh molecules
Succinylcholine
What mediates the termination of the neuromuscular blockade induced by succinylcholine?
Diffusion away from the neuromuscular endplate, which is driven by concentration gradients created by rapid hydrolysis of succinylcholine in the plasma by butyrylcholinesterase
What might happen if you give a calcium channel blocker to a naïve patient who is also receiving a NMB agent?
Mild potentiation of both depolarizing and non-depolarizing NMB agent
Volatile agent that most significantly prolongs neuromuscular blocking agents
Desflurane
An anticholinergic that does NOT cross the placenta
Glycopyrrolate
How much does serum potassium increase after succinylcholine-induced depolarization in normal muscle?
0.5 mEQ/L
Myasthenia gravis results in a resistance to ______ and hypersensitivity to _______.
Resistance to depolarizing NMBs and hypersensitivity to non-depolarizing NMBs.
Adequate recovery of neuromuscular blockade is defined as a train-of-four ratio (TOFR) _____ as measured at the _____ muscle
Adequate recovery of neuromuscular blockade is defined as a train-of-four ratio (TOFR) ≥ 0.9 as measured at the adductor pollicis muscle
Triggers a dose-dependent histamine release that becomes significant at doses above 0.5 mg/kg. Its stereoisomer is more frequently used since it does not cause this.
Atracurium
How does hypercalcemia affect the effects of non-depolarizing NMB agents?
Antagonizes by facilitating increased acetylcholine release at the motor end plate
Medical conditions that cause susceptibility to succinylcholine-induced hyperkalemia (name 3)
Burn injury, massive trauma, severe intraabdominal infection,, spinal cord injury, encephalitis, stroke, Guillain-Barre syndrome, severe Parkinson disease, tetanus, prolonged total body immobilization, ruptured cerebral aneurysm, polyneuropathy, closed head injury, hemorrhagic shock with metabolic acidosis, myopathies (eg Duchenne dystrophy)
What is considered to be MOST effective at decreasing incidence of myalgia following succinylcholine administration?
Pre-treatment with NSAIDs
Hepatically cleared neuromuscular blockade agents (3)
pancuronium, vecuronium, and rocuronium
What happens when an action potential arrives at the axon terminal boutons at the neuromuscular junction?
Voltage-gated calcium channels open to allow calcium influx, which triggers exocytosis of acetylcholine into the NMJ.
Myotonia congenita
A breakdown product of atracurium's Hofmann elimination that has been associated with central nervous system excitation, resulting in elevation of the minimum alveolar concentration and precipitation of seizures.
Laudanosine