Pharm Chapter 18 NMBA quiz

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Questions and Answers

What are NMBAs termed as?

  • Paralytics or muscle relaxants (correct)
  • Bronchodilators
  • Anti-inflammatory
  • Parasympathetic agent

What does NMBA cause?

  • Vasodilation
  • Increases fatigue
  • Skeletal muscle weakness or paralysis (correct)
  • Tachycardia / increase BP

Mode of action of NMBA? Select all that apply

  • Inhibits cell wall synthesis and is bactericidal
  • Produces effect at neuromuscular junction by interfering with action of Acetylcholine. (correct)
  • Binds with Alpha and beta receptors to activate adrenegic effect that causes bronchodilator, vasodilation.
  • Depolarizes the presynaptic and postsynaptic membrane or compete with Ach for binding at the receptors or make the receptors more sensitive for Ach. (correct)

Clinical uses of NMBA?

<p>Inducing Skeletal muscle paralysis in several clinical situations such as Intubation, surgery, facilitation of ventilation (A)</p>
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What are the 2 groups of NMBA? Select all that apply

<p>Depolarizing (A), Non-Depolarizing (C)</p>
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What does Depolarizing agent(s) do?

<p>Binds to AcH receptors and causes the postsynaptic ending become more refractory and unexcitable resulting in flaccid muscles. (B)</p>
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Agent(s) that belong to depolarizing NMBA?

1 Albuterol, Levalbuterol 2 Mucomyst 3 Atrovent, tiotropium bromide 4 Succinylcholine 5 Omalizumab 6 Accolate, Montelukast

<p>4 only (A)</p>
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What does Non depolarizing NMBA do?

<p>Produces paralysis and muscle weakness by competing with AcH for binding at the AcH receptors. Preventing muscle contraction (A)</p>
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What is the clinical use of NMBA in the operating room?

<p>Anesthesia induction (A)</p>
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What is the clinical use of NMBA in the ICU unit?

<p>Management of Mechanical ventilation (A)</p>
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What are the Clinical uses of NMBAs?

1 To facilitate endotracheal intubation 2 To obtain muscle relaxation 3 To reduce asthma attack 4 To reduce ICP in intubated patients 5 To reduce mucus production 6 To terminate convulsive status epilepticus and tetanus refractory to other therapies

<p>1, 2 4 and 6 only (A)</p>
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What are the common examples of ventilated patients who require muscle relaxation? (Select all the apply)

<p>With severe asthma attack (B), With ARDS (Acute Respiratory Distress Syndrome) (A), Patients who requires “uncomfortable” modes of ventilation such as pressured-controlled inverse ratio ventilation. (C)</p>
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What does the CNS consist of? 1 Peripheral nerves 2 Somatic motor Neurons 3 Brain 4 Autonomic motor neurons 5 Spinal cord 6 Sensory afferent neurons

<p>3 and 5 only (D)</p>
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What does the PNS consist of?

1 Brain 2 Sensory afferent neurons 3 Autonomic motor neurons 4 Spinal cord 5 Somatic motor neurons 6 the heart

<p>2, 3, and 5 only (B)</p>
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What is the correct process of AcH binding to receptors and what can it cause?

<p>AcH is released from the presynaptic membrane then goes to a tiny gap between the nerve and muscle fiber where it diffuses and interact with AcH receptors resulting nerve action potential or nerve impulse. AcH is then broken down by and enzyme called acetylcholinesterase AchE, allowing the muscle to return to its normal state (A)</p>
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What is an enzyme that breaks down AcH?

<p>Acetylcholinesterase (AchE) (C)</p>
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What does the neuron consist of? select all the apply

<p>Cell body (A), Axons (B), Dendrites (C)</p>
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What are the two ways muscle contraction can be blocked? Define them.

<p>Competitive Inhibition, where the AcH receptors are blocked without depolarizing muscle fiber, this is an effect of non-depolarizing agents. Another way is called Prolonged binding of AcH receptors, where AcH receptors are held in place for a long time, causing the muscle fiber to become more and more depolarized. This is an effect of depolarizing agents.</p>
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What is the mechanism of action of Non-depolarizing agents?

1 Blocks the channel of postsynaptic cholinergic receptors by occupying channel pore 2 Affects the receptors from the internal side and reducing the channel opening 3 Open sodium channels and depolarize postsynaptic muscle membrane 5 Has a resistant to AchE, allowing persistent and longer duration of action 6 Competes with endogenous AcH for receptor occupancy.

<p>1, 2 and 6 only (A)</p>
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Is the effect of Non-depolarizing agents dose related? Meaning that with large doses, it overcomes the effects of AcH more and blocks more receptors?

<p>True (A)</p>
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Can Non-depolarizing agents be reversed? Why or why not?

<p>Yes, it can. Utilizing inhibitors of AchE which breaks down AcH can be used. An example would be Neostigmine. (B)</p>
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What is the pharmacokinetic of Non-depolarizing agents?

<p>It’s poorly lipophilic (A), Doesn’t penetrate well into fat tissues or across the blood brain barrier (B), Poorly absorbed from GI tract, must be given via IV (C)</p>
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Match the Non-depolarizing agents (which is which)

<h1>=</h1> <p>=</p>
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Non-depolarizing agents has a short duration of action compared with depolarizing agent, succinylcholine.

<p>False (B)</p>
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What are the factors that are dose related for Rocuronium? Select all that apply

<p>Magnitude of effect (A), Rate of onset of maximum blockade (B), Duration of action (D)</p>
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When normal conduction returns __ of AcH receptors may still be occupied by a blocker.

<p>75%</p>
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Metabolism, which is which?

<h1>=</h1> <h1>=</h1>
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What is the difference between Atracurium and Cisatracurium?

<p>Atracurium has a breakdown product of Hofmann degradation called Laudanosine, while Cisatracurium does not. (D)</p>
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What is the breakdown product of Hoffmann degradation called?

<p>Laudanosine (A)</p>
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What are the adverse effects of Non-depolarizing agents in the following categories, match.

<h1>=</h1> <p>=</p>
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What are the agents that can reverse the action of Non-depolarizing agents?

<p>Neostigmine (A), Edrophonium (D), Pyridogstigmine (@)</p>
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Match the following Cholinesterase inhibitors/non-depolaring revere agents to its definition

<h1>=</h1> <p>=</p>
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Depolarizing agent(s) short acting and no agents can reverse the blockade

<p>True (A)</p>
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What is the dosage, delivery method and duration for succinylcholine?

<p>The dosage would be 1-1.5 mg/kg via IV with duration of 10-15 mins. (A)</p>
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What patients are ideal for use of succinylcholine?

<p>Those that require intubation (A)</p>
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How many seconds does succinylcholine cause total paralysis to the body?

<p>60-90 seconds (D)</p>
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What are the mechanism of action of succinylcholine?

1 Opens sodium channel and depolarizes’ postsynaptic muscle membrane 2 Competes with AcH to occupy AcH receptors that causes its blockage 3 Resistant to effects of AchE 4 Reduced the opening of receptors 5 Last longer at the receptor sites resulting flaccid muscles 6 Depolarization occurs and is maintained until succinylcholine leaves the body

<p>1, 3, 5 and 6 only (A)</p>
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What are the 2 phases of Succinylcholine effect in the body? Select all that applies.

<p>Phase 1: Prolonged depolarization and flaccid muscles paralysis (C), Phase 2: Resembles non-depolarizing block, dose related. (D)</p>
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What are the adverse effects of Succinylcholine? Select all that applies

<p>Sympathomimetic response (A), Vagal response (in repeat doses) (B), Muscle pain/soreness (C), Malignant hyperthermia (D), Histamine release and Hyperkalemia (@), Increased Intracranial, intraoptic and intragastric pressure (@)</p>
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What kind of patients will have sensitivity to Succinylcholine — which will not metabolize it effectively?

<p>Patients with abnormal or deficient pseudocholinesterase (A)</p>
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NMBA is beneficial in?

<p>HFOV (B), ARDS (D), Status Asthmaticus (C), Neuromuscular Toxins (A), Tetanus (@)</p>
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List the risks and precautions when using NMBAs

<p>Proper eye care, Suctioning, Proper sedation and analgesia, Risk of prolonged skeletal muscle weakness, Decubitus ulcers, DVT</p>
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NMBA causes muscle paralysis and loss of consciousness .

<p>False (B)</p>
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What should we monitor when patient is put under sedation and analgesia?

<p>Tachycardia (A), Hypertension (C), Diaphoresis (@), Lacrimation (@)</p>
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Choose the medications that belong to: Analgesics

<p>Fentanyl (A), Hydromorphine (B), Morphine (C)</p>
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Choose the medications that belong to: Amenestic

<p>Lorazepam (B), Midazolam (C), Propofol (D)</p>
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What agent works well (can be additive, antagonistic, synergistic) with NMBAs?

<p>Aminoglycoside (A)</p>
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What agents antagonizes’ NMBA?

<p>Azathioprine (B), Theophylline (C), Phenytoin (A)</p>
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What clinical factors can potentiate neuromuscular blockade?

<p>Hyponatremia (C), Acidosis (D), Hypokalemia (A), Hypocalcemia (@), Hypermagnesemia (@)</p>
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