Notes in 11 Neuromuscular Blocking Agents

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Published	12/13/2023	Succinylcholine diffuses away from the neuromuscular junction and is hydrolyzed in the liver by {{c1::pseudocholinesterase}}
Published	12/13/2023	Patients with {{c1::homozygous::homo/heterozygous}} atypical pseudocholinesterase will have a blockade of {{c2::4-8}} hours after succinylcholine admi…
Published	12/13/2023	{{c1::Succinylcholine::paralytic}} is relatively contraindicated in the routine management of children and adolescents due to undiagnosed {{c2::m…
Published	12/13/2023	A child given succinylcholine with a sudden hyperkalemia, rhabdomyolysis, and cardiac arrest is indicative of an {{c1::undiagnosed myopathy}…
Published	12/13/2023	Succinylcholine-induced paralysis can raise the serum {{c2::potassium}} by {{c1::0.5}} mEq/L.
Published	12/13/2023	The nondepolarizing paralytics {{c1::pancuronium}} and {{c1::vecuronium}} have a prolonged action in patients with {{c2::kidney}} failure.
Published	12/13/2023	{{c1::Atracurium}} and {{c1::cisatracurium}} are paralytics that undergo degradation via {{c2::Hofmann elimination}}.
Published	12/13/2023	{{c1::Pancuronium::paralytic}} produces cardiovascular effects via vagal blockade and {{c2::catecholamine}} release from adrenergic nerve endings…
Published	12/13/2023	Pancuronium may cause {{c1::tachy}}-cardia and {{c1::hyper}}-tension.
Published	12/13/2023	{{c1::Vecuronium & pancuronium::paralytics}} infusions may result in prolonged paralysis due to accumulation of the active {{c2::3-hydroxy}} metab…
Published	12/13/2023	{{c1::Rocuronium}} is an alternative to succinylcholine for rapid-sequence inductions.
Published	12/13/2023	The neuromuscular junction is depolarized by {{c1::Ca2+}} influx, causing {{c2::ACh}} to be released into the synaptic cleft.
Published	12/13/2023	Normal neuromuscular transmission occurs when {{c3::ACh}} molecules bind to {{c1::nicotinic cholinergic}} receptors on the {{c2::motor end-plate::spec…
Published	12/13/2023	Only the {{c1::α}} subunits of the ACh receptor are capable of binding acetylcholine.
Published	12/13/2023	For a voltage-gated sodium channel:at rest ({{c1::-70}} mV), the channel is closed.
Published	12/13/2023	During the depolarization stage, when the {{c1::threshold}} voltage is reached, the {{c2::activation/upper}} gate of the {{c3::fast::slow/fast}}&…
Published	12/13/2023	During the repolarization stage, the {{c1::inactivation/lower}} gate of the voltage-gated {{c2::Na+}} channel is {{c3::closed}}.
Published	12/13/2023	{{c3::Ca2+}} release from the sarcoplasmic reticulum causes the contractile proteins {{c2::actin}} and {{c2::myosin}} to interact, resulting…
Published	12/13/2023	{{c1::Eaton–Lambert}} syndrome is the result of decreased release of {{c2::ACh}}
Published	12/13/2023	{{c1::Myasthenia gravis::NMJ pathology}} is characterized by a decreased number of {{c2::acetylcholine}} receptors.
Published	12/13/2023	Acetylcholine is rapidly hydrolyzed into {{c1::acetate}} and {{c1::choline}} by the substrate-specific enzyme {{c2::acetylcholinesterase}}.
Published	12/13/2023	Acetylcholinesterase is found immediately adjacent to the ACh receptors embedded into the {{c1::motor end-plate}} membrane
Published	12/13/2023	{{c1::Succinylcholine}} is a {{c2::short}}-acting {{c3::de::de/nonde-}}polarizing muscle relaxant
Published	12/13/2023	Mivacurium is a {{c2::short}}-acting {{c3::nonde::de/nonde-}}polarizing muscle relaxant
Published	12/13/2023	{{c1::Atracurium}}, {{c1::Cisatracurium}}, {{c1::Vecuronium}}, & {{c1::Rocuronium}} are {{c2::intermediate}}-acting {{c2::nonde::de/nonde-}}polar…
Published	12/13/2023	Depolarizing muscle relaxants very closely resemble ACh but are not metabolized by {{c1::acetylcholinesterase}}
Published	12/13/2023	In a phase {{c1::I}} block, succinylcholine binds to ACh receptors and prevents the motor end-plate from {{c2::repolarizing}}.
Published	12/13/2023	Phase {{c2::II}} of succinylcholine blocks resembles that of {{c1::nonde::de/nonde-}}polarizing muscle relaxants.
Published	12/13/2023	Conditions associated with a chronic decrease in ACh release stimulate expression of the {{c1::immature}} isoform of the ACh receptor
Published	12/13/2023	Conditions associated with a chronic decrease in ACh release cause a resistance to {{c1::non-depolarizing}} muscle relaxants
Published	12/13/2023	Conditions associated with fewer ACh receptors (e.g. myasthenia gravis) demonstrate a resistance to {{c1::depolarizing}} muscle relaxants
Published	12/13/2023	Conditions associated with fewer ACh receptors (e.g. myasthenia gravis) demonstrate a increased sensitivity to {{c1::nondepolarizi…
Published	12/13/2023	{{c1::Mivacurium}} is the ONLY nondepolarizing paralytic metabolized by {{c2::pseudocholinesterase}}
Published	12/13/2023	The {{c3::cyclodextrin::structure}} {{c1::sugammadex}} is a selective relaxant-binding agent which forms tight complexes with {{c2::steroidal nondepol…
Published	12/13/2023	{{c1::Succinylcholine}} is comprised of two joined ACh molecules
Published	12/13/2023	The enzyme {{c1::pseudocholinesterase}} catalyzes the conversion of {{c2::succinylcholine}} → {{c2::succinylmonocholine}}
Published	12/13/2023	{{c1::Echothiophate}} is an organophosphate used for glaucoma known to decrease pseudocholinesterase activity
Published	12/13/2023	What cholinesterase inhibitors decrease pseudocholinesterase activity?{{c1::Neostigmine & Pyridostigmine}}
Published	12/13/2023	Phenelzine is a {{c1::monoamine oxidase inhibitor}} known to decrease pseudocholinesterase activity
Published	12/13/2023	{{c1::Cyclophosphamide}} is an antineoplastic agent known to decrease pseudocholinesterase activity
Published	12/13/2023	{{c1::Metoclopramide}} is an antiemetic/prokinetic agent known to decrease pseudocholinesterase activity
Published	12/13/2023	{{c1::Esmolol}} is a β-blocker known to decrease pseudocholinesterase activity
Published	12/13/2023	{{c1::Oral}} contraceptives are agents known to decrease pseudocholinesterase activity
Published	12/13/2023	Patients with {{c1::heterozygous::homo/heterozygous}} atypical pseudocholinesterase will have a blockade of {{c2::20-30}} minutes after succ…
Published	12/13/2023	Dibucaine inhibits {{c1::normal::normal or abnormal}} pseudocholinesterase more than {{c1::abnormal::normal or abnormal}} pseudocholinesterase.&n…
Published	12/13/2023	The percentage of inhibition of pseudocholinesterase activity is termed the {{c1::dibucaine number}}
Published	12/13/2023	The normal dibucaine number is {{c1::80}}, while a {{c2::homo}}zygote for the most common abnormal allele will have a dibucaine number of < {{…
Published	12/13/2023	Prolonged paralysis from succinylcholine caused by abnormal pseudocholinesterase is treated with continued {{c1::mechanical ventilation}} and {{c1::se…
Published	12/13/2023	Organophosphate pesticides cause an irreversible inhibition of {{c1::acetylcholinesterase and pseudocholinesterase}}.
Published	12/13/2023	Antibiotics {{c1::increase::increase/decrease}} the effect of depolarizing paralytics.
Published	12/13/2023	High doses of local anesthetics {{c1::increase::increase/decrease}} the effect of depolarizing paralytics and {{c2::increase::increase/decrease}} the …
Published	12/13/2023	Dantrolene {{c2::increases::increase/decrease}} the effect of nondepolarizing blockade
Published	12/13/2023	Inhaled anesthethetics {{c1::increase::increase/decrease}} the effect of depolarizing paralytics and {{c2::increase::increase/decrease}} the effect of…
Published	12/13/2023	Anticonvulsants {{c1::decrease::increase/decrease}} the effect of {{c2::nondepolarizing::depolarizing/nondepolarizing}} muscle relaxants.
Published	12/13/2023	Calcium channel blockers and aminoglycosides {{c1::increase::increase/decrease}} the effect of nondepolarizing paralytics by blocking {{c2::presynapti…
Published	12/13/2023	Lithium carbonate {{c1::increases::increase/decrease}} the effect of paralytics by activating {{c2::K+}} channels.
Published	12/13/2023	Magnesium sulfate {{c1::increases::increase/decrease}} the effect of nondepolarizing paralytics by inhibiting {{c2::presynaptic calcium influx}}.&nbsp…
Published	12/13/2023	Pseudocholinesterase levels are {{c1::reduced}} in elderly {{c2::men::men/women}}.
Published	12/13/2023	The intramuscular dose of succinylcholine for pediatrics is {{c1::4}}-{{c1::5}} mg/kg.
Published	12/13/2023	Preganglionic sympathetic fibers to the adrenal medulla secrete {{c1::acetylcholine}}.
Published	12/13/2023	{{c2::High}} doses of succinylcholine stimulate nicotinic receptors in sympathetic ganglia, which commonly causes {{c1::tachy}}cardia and {{c1::hyper}…
Published	12/13/2023	{{c2::Children}} are particularly susceptible to profound {{c1::brady}}cardia following administration of succinylcholine
Published	12/13/2023	{{c1::Repeat}} doses of succinylcholine may cause {{c2::bradycardia}} due to accumulation of {{c3::succinylmonocholine}}.
Published	12/13/2023	What drug is administered prophylactically in pediatric patients undergoing intubation with succinylcholine?{{c1::Atropine 0.02 mg/kg IV::drug + dose}…
Published	12/13/2023	Administration of succinylcholine can cause visible muscle contractions, called {{c1::fasciculations}}.
Published	12/13/2023	The {{c1::immature}} isoform of the ACh receptors are upregulated by denervation injuries (SCI, burns, etc.)
Published	12/13/2023	{{c1::Succinylcholine::paralytic}} is associated with an increased incidence of postoperative myalgia.
Published	12/13/2023	Postoperative myalgia from succinylcholine can be avoided by prior administration of {{c1::rocuronium}}.
Published	12/13/2023	Administration of {{c1::succinylcholine}} may cause abdominal wall muscle fasciculations that increase {{c2::intragastric}} pressure.
Published	12/13/2023	Administration of {{c1::succinylcholine::paralytic}} can cause transient increases in {{c2::intraocular}} pressure due to contraction of extraocular m…
Published	12/13/2023	What paralytic should be avoided in a patient with a family history of malignant hyperthermia?{{c1::Succinylcholine}}
Published	12/13/2023	Administration of {{c1::succinylcholine::paralytic}} may cause light increases in cerebral blood flow and intracranial pressure.
Published	12/13/2023	Succinylcholine can cause a slight increase in ICP, which can be prevented by pretreating with {{c1::nondepolarizing paralytics}} or {{c1::lidocaine}}…
Published	12/13/2023	Elderly patients demonstrate a prolonged distribution and elimination of {{c1::steroidal}} nondepolarizing muscle relaxants.
Published	12/13/2023	What paralytics are associated with histamine release?{{c1::Atracurium}} and {{c1::succinylcholine}} and {{c1::mivacurium}}
Published	12/13/2023	{{c2::Mivacurium}}, {{c2::Atracurium}} and {{c2::Cisatracurium}} are {{c1::benzylisoquinolones::chemical structure}} nondepolarizing muscle …
Published	12/13/2023	{{c2::Pancuronium}}, {{c2::Vecuronium}}, and {{c2::Rocuronium}} are {{c1::aminosteroidal::chemical structure}} nondepolarizing muscle r…
Published	12/13/2023	{{c1::Atra}}curium, {{c1::miva}}curium, and {{c1::ganta}}curium {{c2::increase}} the heart rate and {{c2::decrease}} the blood pressure via …
Published	12/13/2023	The ED95 of succinylcholine is:{{c1::0.5}} mg/kg
Published	12/13/2023	The ED95 of Rocuronium{{c1::0.3}} mg/kg
Published	12/13/2023	The ED95 of Mivacurium{{c1::0.08}} mg/kg
Published	12/13/2023	The ED95 of Atracurium{{c1::0.2}} mg/kg
Published	12/13/2023	The ED95 of cisatracurium{{c1::0.05}} mg/kg
Published	12/13/2023	The ED95 of vecuronium{{c1::0.05}} mg/kg
Published	12/13/2023	The ED95 of pancuronium{{c1::0.07}} mg/kg
Published	12/13/2023	The intubation dose of Rocuronium is{{c1::0.6}} to {{c1::1.2}} mg/kg
Published	12/13/2023	The intubation dose of Mivacurium is {{c1::0.2}} mg/kg
Published	12/13/2023	The intubation dose of Atracurium is{{c1::0.5}} mg/kg
Published	12/13/2023	The intubation dose of cisatracurium is {{c1::0.1}} mg/kg
Published	12/13/2023	The intubation dose of vecuronium is {{c1::0.12}} mg/kg
Published	12/13/2023	The onset of action of Rocuronium for intubating is {{c1::1.5}} minute(s) while the duration is {{c1::35}} to {{c1::75}} minutes.
Published	12/13/2023	The onset of action of Mivacurium for intubating is {{c1::2.5-3}} mins while the duration is {{c1::15-20}} mins
Published	12/13/2023	The onset of action of atracurium for intubating is {{c1::2-3}} mins while the duration is {{c1::30-45}} mins
Published	12/13/2023	The onset of action of Cisatracurium for intubating is {{c1::2-3}} mins while the duration is {{c1::40-75}} mins
Published	12/13/2023	The onset of action of Vecuronium for intubating is {{c1::2-3}} mins while the duration is {{c1::45-90}} mins
Published	12/13/2023	{{c1::Pancuronium::Nondepolarizing agent}} blocks vagal {{c3::muscarinic ACh}} receptors in the sinoatrial node, resulting in {{c2::tachycardia}}.&nbs…
Published	12/13/2023	Massive histamine release from mast cells can result in broncho{{c1::spasm}}, skin {{c1::flushing}}, and {{c1::hypo}}tension.
Published	12/13/2023	Which neuromuscular blockers are significantly metabolized by the liver (> 50%)?{{c1::vecuronium}} and {{c2::rocuronium}}
Published	12/13/2023	Hypothermia prolongs blockade of mivacurium, atracurium, and cisatracurium by decreasing {{c1::metabolism}}
Published	12/13/2023	What electrolyte disorders will increase the effect of nondepolarizing paralytics?{{c1::Hypokalemia}}{{c2::Hypocalcemia}}
Published	12/13/2023	{{c1::Magnesium}} potentiates nondepolarizing blockade because it competes with calcium at the motor endplate.
Published	12/13/2023	Neonates have an increased sensitivity to {{c1::nondepolarizing}} relaxants because of immature neuromuscular junctions
Published	12/13/2023	Patients with liver disease have an {{c1::increased::⇅}} volume of distribution
Published	12/13/2023	Atracurium is metabolized via {{c1::ester hydrolysis::66%}} and {{c2::Hofmann elimination::33%}}
Published	12/13/2023	How does atracurium affect the heart rate?{{c1::Increased (tachycardia)}}
Published	12/13/2023	Atracurium is metabolized to {{c2::laudanosine}}, which is associated with {{c1::seizures}} at high concentrations.
Published	12/13/2023	{{c1::Succinylcholine::paralytic agent}} is contraindicated in patients with amyotrophic lateral sclerosis.
Published	12/13/2023	Familial periodic paralysis has a {{c1::hyperkalemia}} response to succinylcholine.
Published	12/13/2023	Guillain–Barré syndrome has a {{c1::hyperkalemia}} response to depolarizers
Published	12/13/2023	Muscular dystrophy (Duchenne type) has a {{c1::hyperkalemia}} response to depolarizers.
Published	12/13/2023	{{c1::Burn}} injuries or {{c2::muscle wasting}} diseases are absolute contraindications to using succinylcholine because of the risk of {{c3::hyperkal…
Published	12/13/2023	Patients with myotonia can develop {{c1::generalized muscular contractions}} in response to depolarizers.
Published	12/13/2023	Amyotrophic lateral sclerosis has a {{c1::hypersensitive}} response to nondepolarizers
Published	12/13/2023	What paralytics are safe to administer in patients with familial periodic paralysis (hyperkalemic and hypokalemic)?{{c1::Nondepolarizers}}
Published	12/13/2023	Guillain–Barré syndrome has a {{c1::hypersensitive}} response to nondepolarizers
Published	12/13/2023	Muscular denervation (peripheral nerve injury) has a {{c1::normal}} response or {{c1::resistant}} response to nondepolarizers
Published	12/13/2023	Muscular dystrophy (Duchenne type) has a {{c1::hypersensitive}} response to nondepolarizers
Published	12/13/2023	In general, patients with neuromuscular disorders (Duchenne, ALS, Lambert-Eaton, etc.) demonstrate {{c1::increased::increased/decreased}} sensitivity …
Published	12/13/2023	Myotonia has a normal or {{c1::hypersensitive}} response to nondepolarizers
Published	12/13/2023	{{c1::Cisatracurium}} is a stereoisomer of atracurium that is also four times more potent.
Published	12/13/2023	Pancuronium & vecuronium are metabolized by the {{c2::liver}} via {{c1::deacetylation}}.
Published	12/13/2023	{{c1::Pancuronium::steroidal paralytic}} causes tachycardia because it has a {{c2::bis}}quaternary structure.
Published	12/13/2023	What gender is more sensitive to vecuronium?{{c1::women}}
Published	12/13/2023	What is the dose of rocuronium when administered intramuscularly for children < 1 year?{{c1::1 mg/kg }}
Published	12/13/2023	How does rocuronium affect the heart rate?{{c1::slightly increased }}
Published	12/13/2023	{{c2::Plasma cholinesterase}}, an enzyme that metabolizes esters, is produced by the {{c1::liver}}.
Published	12/13/2023	Children are {{c1::more::more/less}} susceptible than adults to the adverse effects associated with succinylcholine
Published	12/13/2023	What is an alternate, rapid route for administration of succinylcholine in pediatric emergencies?{{c1::Intralingual}}
Published	12/13/2023	Phase {{c2::II}} blocks from succinylcholine occurs after {{c1::prolonged}} end-plate depolarization.
Published	12/13/2023	The two primary classes of nondepolarizing muscle relaxants are {{c1::benzylisoquinolines}} and {{c2::steroidals}}.
Published	12/13/2023	A phase {{c1::I}} block of succinylcholine will not have fade or post-tetanic counts on peripheral nerve stimulation.
Published	12/13/2023	Phase {{c1::II}} of succinylcholine blocks present with {{c2::fade}} in respond to {{c2::tetanic}} stimulation.
Published	12/13/2023	The mature isoform of the ACh receptor differs from the immature isoform in that it has a {{c1::ε::mature}} subunit instead of a {{c1::γ::immature}} s…
Published	12/13/2023	Activation of {{c2::fetal acetylcholine}} receptors by succinylcholine produces an exaggerated {{c1::potassium}} efflux.
Published	12/13/2023	In skeletal muscle, action potentials travel along {{c2::T-tubules}} to move {{c1::dihydropyridine}} receptors and open {{c3::ryanodine}} recept…
Published	12/13/2023	Succinylcholine should be dosed on {{c1::total}} body weight.
Published	12/13/2023	What neuromuscular disease does not affect the pharmacokinetics/dynamics of non-depolarizing muscle relaxants?{{c1::Huntington disease}}
Published	12/13/2023	The potency of a nondepolarizing muscle relaxant is {{c1::inversely}} proportional to the onset time.
Published	12/13/2023	{{c2::Succinylcholine::paralytic}} and {{c1::benzylisoquinolines::paralytic class}} directly liberate histamine from {{c3::serosal mast cells}}.
Published	12/13/2023	Laudanosine is eliminated in the {{c1::urine and bile}}.
Published	12/13/2023	Mivacurium causes histamine release with {{c1::rapid}} administration.
Published	12/13/2023	Non-depolarizing muscle relaxants should be dosed on {{c1::ideal}} body weight.
Published	12/13/2023	The dose of edrophonium to reverse neuromuscular blockade is {{c1::0.5}}-{{c1::1}} mg/kg.
Published	12/13/2023	The onset of neostigmine is {{c1::4}}-{{c1::8}} minutes.
Published	12/13/2023	The duration of neostigmine is {{c1::30}}-{{c1::120}} minutes.
Published	12/13/2023	The duration of edrophonium is {{c1::5}}-{{c1::10}} minutes.
Published	12/13/2023	The onset of edrophonium is {{c1::0.5}}-{{c1::1}} minutes.
Published	12/13/2023	{{c1::Edrophonium}} reversibly inhibits acetylcholinesterase by forming a {{c2::electrostatic}} bond.
Published	12/13/2023	A deep block with a post-tetanic count ≥ 1 can be reversed by {{c1::4}} mg/kg of sugammadex.
Published	12/13/2023	A moderate block with a train-of-four count of 1-3 can be reversed by {{c1::2}} mg/kg of sugammadex.
Published	12/13/2023	If a patient needs to be re-paralyzed 5 minutes after reversal with 4 mg/kg sugammadex, {{c1::rocuronium 1.2 mg/kg}} is administered.
Published	12/13/2023	If a patient needs to be re-paralyzed 4 hours after reversal with 4mg/kg sugammadex, {{c1::rocuronium 0.6 mg/kg}} or {{c2::vecuronium 0.1 mg/kg}} is a…
Published	12/13/2023	If a patient needs to be re-paralyzed after reversal with 16 mg/kg sugammadex, {{c1::a nonsteroidal (benzolisoquinoline) paralytic}} is administered.&…
Published	12/13/2023	What neuromuscular disease is it generally safe to administer succinylcholine in?{{c1::Huntington disease}}
Published	12/13/2023	In patients with a denervation injury, succinylcholine should be avoided {{c1::48}} hours after the injury, and for {{c2::1}} year(s) after.
Published	12/13/2023	{{c1::Pseudocholinesterase}} deficiencies result in prolonged blockade with {{c2::succinylcholine}}.
Published	12/13/2023	In patients with {{c1::myasthenia gravis}}, {{c2::neostigmine}} should be administered slowly because it may cause a potential {{c3::cholinergic crisi…
Published	12/13/2023	What drugs should be avoided in patients with hyperkalemic periodic paralysis?{{c1::Neostigmine}} and {{c1::succinylcholine}}
Published	12/13/2023	Plasma cholinesterase is also known as {{c1::pseudocholinesterase}}.
Published	12/13/2023	In the adrenal medulla, {{c3::acetylcholine}} release from preganglionic fibers stimulates {{c1::N2}} nicotinic cholinergic receptors on {{c2::chromaf…
Published	12/13/2023	Antibiotics {{c1::increase::increase/decrease}} the effect of nondepolarizing paralytics.
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