Elimination Mechanisms
Factors that affect Hoffman elimination?
pH and Temp
What is the difference between anaphylaxis and anaphylactoid reactions?
Anaphylaxis= IgE mediated, antibodies fixed to mast cells
Anaphylactoid= NOT immune-mediated
NMBDs are ______ to ACh at the ____ subunit of the ____ receptor
NMBDs are competitive antagonist to ACh at the alpha subunit of the nACh receptor
Entry of _____ will cause the release of ACh into the synaptic cleft?
Calcium
What two reactants is Acetylcholine made from?
Choline and acetyl CoA
What is the metabolite of Atricurium that builds up during liver disease?
Laudanosine
What does Atricurium release that Cisatracurium does not?
Histamine
What are two classes of nondepolarizers?
Aminosteroids and Benzlisoquinliniums
What is the specialized secretory organelle in the presynaptic region?
Synaptic vesicles
____ is known as the “true” cholinesterase?
AChE
What organ states prolong Rocuronium?
Hepatic and renal disease
Which steroidal compound is the most vagolytic?
Pancuronium
Butyrylcholinesterase is also known as ____ or ____?
Pseudocholinesterase or plasmacholinesterase
Simultaneous binding of two Ach molecules to the Nach receptor causes what ion shifts?
A channel opens allowing sodium and calcium ions to move into muscle while K leaves
What medications does sugammadex interact with?
Oral steroidal hormone contraceptive and Toremifene
Which NMBA are broken down by Hoffman elimination?
Atracurium and Cisatricurium
Histamine by benzylisoquinoline compounds have what autonomic side effects?
Hypotension, tachycardia and bronchospasm
____% of SCh makes it to the NMJ due to the rapid hydrolysis by ______
10% of SCh makes it to the NMJ due to the rapid hydrolysis by butyrylcholinesterase
How big is the synaptic cleft
20-50 nm wide
Describe the structure of SCh.
Two molecules of ACh linked together through acetate methyl linkage
What are 5 factors (there are more than 5) that interfere with butyrylcholinesterase?
Advanced liver disease, advanced age, malnutrition/starvation, pregnancy, burns, oral contraceptives, MOAIs, Echothiophate, Cytototoxc drugs, Neoplastic disease, anticholinesterase drugs, Reglan, Esmolol, following HD,
***obesity increases it!
How to treat an anaphylaxis reaction
FIO2 100%, early tracheal intubation, fluids, NE/sympathomimetic drugs, dysrhythmias should be treated (antihistamines/steroids controversial)
Give 5 disadvantages/side effects (there are more) of SCh.
Cardiac dysrhythmias, hyperkalemia, myalgias, myoglobinuria, increased IOP, increased ICP, increased intragastric pressure, anaphylaxis, masseter muscle spasm, phase II block.
Calcium binds to ______, which moves ______ off the ______ binding site on the _____filmments which allows myosin to bind to these sites.
Calcium binds to troponin, which moves tropomyosin off the myosin binding site on the actin filaments which allows myosin to bind to these sites.
What is the structure of Zemuron?
Monoquarternary aminosteroid