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Anes. Pharm I Test 1

Succinylcholine

QuestionAnswer
What is the ED 95 of Succinylcholine (Anectine)? 0.3 mg/kg
What is the intubating dose of Succinylcholine (Anectine)? 1 - 1.5 mg/kg IV and 4 - 5 mg/kg IM
What is Succinylcholine's (Anectine) onset? 45 - 90 seconds (whether given IV or IM)
What is Succinylcholine's (Anectine) duration? 5 - 10 minutes (8 minutes)
How is Succinylcholine (Anectine) metabolized? hydrolyzed by plasma cholinesterase
What is Succinylcholine's method of action? Binds to both alpha subunits of the postsynaptic nicotinic receptors & mimics acetylcholine by causing the cell to depolarize.
What action allows the cells at the NMJ to repolarize after succinylcholine has been given? the hydrolization of succinylcholine by plasma cholinesterase
What is the chemical structure of Succinylcholine (Anectine)? 2 acetylecholine molecules linked by acetate methyl groups
True or False: Succinylcholine (Anectine) can also affect Acetylcholine receptors elsewhere in the body besides the NMJ.... True
Why will you most certainly see bradycardia with any re-dosing of Succinylcholine (Anectine)? because succinyl monocholine (a metabolite of SCh) also has affinity for muscarinic receptors in the SA node
If Succinylcholine (Anectine) binds with muscarinic receptors in the SA node or affects parasympathetic receptors what side effect will you see? bradycardia
If Succinylcholine (Anectine) affects sympathetic ganglia what possible side effects of the drug will you see? tachycardia and hypertension
What are the indications for use of Succinylcholine (Anectine)? aspiration risk (short onset), difficult airways (short duration)
What occurs in a phase I block with Succinylcholine (Anectine)? Depolarization with initial contractions, and then paralysis because cell can't repolarize.
In a phase I block will anticholinesterase (reversal agent) reverse the block or enhance it? enhance it
What is a phase II block? a NMB caused by the depolarizer Succinylcholine that mimics a non depolarizing blockade
What kinds of situations predispose a phase II block? NMJ is repeatedly exposed through subsequent doses or a continuous drip of Succinylcholine, causing tachyphylaxis
What drug will reverse a phase II block? an anticholinesterase drug, like edrophonium
What drug and dosage would you give to determine if a patient has gone into a phase II block? edrophonium 0.1 - 0.2 mg/kg IV
If you give edrophonium to a patient who was on a drip of Succinylcholine and the block is attenuated (lessened), what would you assume? Assume the patient has moved into a phase II block and give the remainder of the full dose of edrophonium to antagonize the block
If you give edrophonium to a patient who received multiple doses of Succinylcholine and the block is accentuated, what would you assume? Assume the patient is in a phase I block and do not give any more anticholinesterase drugs.
Why do you use edrophonium with a phase II block? Because edrophonium has no effect on plasma cholinesterase, and plasma cholinesterase is what breaks down succinylcholine
What controls the amount of succinylcholine that makes it to the receptor? plasma cholinesterase
Recovery of neuromuscular function after the administration of Succinylcholine is prolonged by decreased concentration of what? plasma cholinesterase
What are some causes of plasma cholinesterase deficiency? severe liver disease (<20% function), pregnancy, malignancies, hypothermia, malnutrition, collagen vascular disease, hypothyroidism, genetic predisposition
What does the dibucaine number test for? the genetic component of plasma cholinesterase, does not speak to the quantity, only the quality
What is a normal dibucaine number? 80
What dibucaine number would a person with heterozygous atypical plasma cholinesterase have? How long would SCh last in these people? dibucaine number 40 - 60; SCh would last 30 minutes
What dibucaine number would a person with homozygous atypical plasma cholinesterase have? How long would SCh last in these people? dibucaine number 20; SCh would last 3+ hours
What is the fluoride resistant gene? a rare gene that causes inability to metabolize SCh
Any inhibition of plasma cholinesterase, no matter what is causing it, will lead to what? prolonged duration of Sch
Can you give atropine as a pretreatment to prevent the bradycardic effect that Succinylcholine (Anectine) can cause? No. It will not prevent bradycardia, it can only be used to treat it after it occurs.
Succinylcholine (Anectine) is a triggering agent for what medical emergency? Malignant Hyperthermia
A ________ ________ is a sign of Malignant Hyperthermia, but could also be a normal response to the onset of Succinylcholine (Anectine)? masseter spasm
How much does a patient's serum potassium typically increase with the administration of Succinylcholine (Anectine)? 0.5 - 1 mEq/L
What conditions could lead to a potentially fatal increase in potassium related to the use of Succinylcholine (Anectine)? damaged & diseased muscle membranes, burns/massive tissue trauma, neurologic injuries/trauma, neuromuscular disorders (ALS, MS, etc...)
What timeframe after a burn injury is it still safe to administer Succinylcholine (Anectine)? within 48 hour window after burn injury; after 48 hours, proliferation of extra junctional receptors, which can last 6 months - 2 years
Why would the administration of Succinylcholine (Anectine) to a patient who had recent eye surgery or who has an open eye injury be of concern? Succinylcholine can cause increased intraocular pressure
What potential side effect of Succinylcholine (Anectine) would be important to consider for a patient undergoing a craniotomy? Increased ICP
Although Succinylcholine is commonly used for aspiration risk patients, what potential side effect of the drug could actually contribute to aspiration? Increased Intragastric Pressure. The findings are inconsistent, but could cause GE sphincter to spontaneously open.
Which side effect of Succinylcholine is a patient satisfaction issue and is of concern in younger patients, who are typically ambulatory after surgery? Mylagia
What is the pretreatment for myalgia caused by Succinylcholine? NSAIDs, de-fasiculating dose of non depolarizing NMB (10% of intubating dose), and Na channel blockers (lidocaine)
Which potential side effect of Succinylcholine occurs mostly in pediatric patients rather than adults? Rhabdomyelosis (myoglobinuria)
Why do we pretreat with a small dose of a non depolarizing NMB before the administration of Succinylcholine? to prevent the fasiculations that occur with the onset of SCh due to widespread depolarization
What is a risk of pretreatment with non depolarizing NMB? Even this small dose (10% of intubating dose) could cause paralysis in a patient with undiagnosed myasthenia gravis
How does pretreatment with non depolarizing NMB affect the dose of Succinylcholine given? pretreatment requires increased dose of SCh (1.5 mg/kg)
What side effects can potentially be prevented or lessened by pretreatment with a non depolarizing NMB? cardiac dysrhthymias, myalgia, increased ICP, increased intragastric pressure, increased intraocular pressure
Pretreatment with non depolarizing NMB has NO effect on which potentially fatal side effect of Succinylcholine? hyperkalemia
The de-fasiculating dose of a non depolarizing NMB given prior to the administration of Succinylcholine is usually _____ of the intubating dose 1/10th of the intubating dose
Created by: Mary Beth