•Name the acetylcholine receptors
Ach receptors
•Nicotinic
•Muscarinic
•How are muscle relaxant classified?
•Depolarizing
•Non-depolarizing
Non-depolarizing muscle relaxant are competitive antagonist for Ach receptors
•True
•False
TRUE
•Two common side-effects of pancurium on CVS and its causes
HTN and Bradycardia
•Vagolytic effects and sympathetic stimulation
•What is the structure of the acetylcholine receptor?
•Five glycoprotein subunits: two α subunits; and single β, δ, and ε subunits
•These are arranged in a cylindric fashion; the center of the cylinder is an ion channel. ACh binds to the a-subunits.
what is the onset and duration time of suxamethonium?
•30-60s
•5-10min
What is the defasciculating dose of rocuronium?
0.1mg/kg
•Name 3 clinical conditions potentiate the action of muscle relaxants
•Respiratory acidosis
• Metabolic alkalosis
•Hypothermia
• Hypokalemia
• Hypercalcemia
• Hypermagnesemia potentiate blockade.
Hepatic or renal dysfunction
•How is Acetylcholine metabolized?
•Acetylcholine is metabolized by acetylcholinesterase/ specific cholinesterase or true cholinesterase into acetate and choline.
what is the indication of suxa in anesthesia practice?
RSII
•Rocuronium (at a dose of 0.9–1.2 mg/kg) has an onset of action that approaches succinylcholine of 60–90 s)
True or false
TRUE
Which mode of nerve stimulation is most commonly used to assess degree of blockade?
TOF
•Explain in brief the physiology of neuromuscular junction
•As a nerve’s action potential depolarizes its terminal, an influx of calcium ions through voltage-gated calcium channels into the nerve cytoplasm allows storage vesicles to fuse with the terminal plasma membrane and release acetylcholine and the later binds to nicotinic receptors and trigger an end-plate action potential.
•Succinylcholine-induced depolarization hyperkalemia increase potassium by
a.0.5 mmol/l
b.1.0 mmol/l
a
Define Hofman elimination and name the drug eliminated by that process
•Hofman elimination: spontaneous breakdown at physiologic temperature and PH
•Atracurium
•For surgical purposes, based on nerve stimulation, what is adequate muscular relaxation?
•Adequate relaxation is generally present when one to two twitches of the TOF response are present, correlating with 80% depression of single-twitch height.
by which process acetylcholine is released through the presynaptic cell membrane?
exocytosis
•A marked increase in masseter muscle tone preventing laryngoscopy is abnormal and can be a premonitory sign of malignant hyperthermia.
a.True
b,False
a
What is the precurarization dose of vecuronium for a 70Kg old man?
0.7mg
1/10 of the total dose
what is SUGAMADEX?
•A modified cyclodextrin that forms extremely tight water-soluble complexes with relaxants having steroidal nuclei (rocuronium > vecuronium >> pancuronium) and terminate their action at the NMJ.