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PHARMACOLOGY STUDY GUIDE FOR LESSON 3 QUIZ. #2
NOTE: THE TABLES and INFORMATION IN THE MANDATORY READING
ON "MEDICATIONS USED IN TRACHEAL INTUBATION" and "RAPID
SEQUENCE INTUBATION" ARE VERY IMPORTANT FOR THE QUIZ THIS
WEEK!! Note: some of the numbers below are information and definitions
THE REVERSAL AGENT STUDY GUIDE WILL BE USED FOR A SHORT
BONUS QUIZ!
1) Know the reason why preoxygenation is important for patients undergoing RSI
anesthesia
2) Know what causes a pressor response.
3) Know the names of the drugs that decrease (attenuate) the pressor response:
4) What is lidocaine?
5) What is fentanyl?
6) Know the order of rapid onset/short duration for the following opioid drugs from
fastest to slowest: Alfentanil (=fastest), Sufentanil, Fentanyl(=slowest)
7) In neuro cases the following formula and information is very important:
Cerebral oxygenation (oxygenation of the brain) is determined by:
Cerebral Perfusion Pressure (CPP), which is defined as
CPP = MAP (mean arterial pressure) - ICP (intracranial pressure).
Normal CPP is 80-100 mm Hg and must be maintained above 50 mm Hg to maintain
normal cerebral autoregulatory functions. Normal ICP is less than 10 mm Hg.
MAP is a term used to describe an average arterial blood pressure during a single cardiac
cycle (from the beginning of one heartbeat to the beginning of the next) in an individual.
In patients with brain injuries: coughing, gagging, pressor responses, and stimulation due
to endotracheal suction and laryngeal manipulation (intubation) can increase the ICP.
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Any significant increase in ICP or decrease in MAP may result in a critical decrease in
CPP---which means further injury and damage to the brain of the neuro patient!!!
8) Know the advantages of atropine.
9) Know the advantages of Norcuron.
10) Know the advantages of Zemuron.
11) Know examples of pretreatment (before induction) medications.
12) When are pretreatment medications given or administered?
13) Know the 2 classes of neuromuscular blocking agents:
14) What is the action of depolarizing agents?
15) What is the action of nondepolarizing agents?
16) Know the following definitions:
Agonist- a drug that can combine with a receptor on a cell to produce a physiological
reaction
Antagonist- a drug that neutralizes or counteracts the effects of another drug
17) What is the paralytic of choice in almost all cases of rapid sequence induction (RSI)
in adults?
18) What type of agent is succinylcholine?
19) What is the rare disorder associated with succinylcholine use?
20) What is the electrolyte imbalance that succinylcholine can cause?
21) Know the following information (from wisegeek.com):
Electrolyte: In human health, electrolytes aid in a number of vital bodily processes. Many
heart and nerve functions, muscle control and coordination, and the body's ability to
absorb fluids all depend on a healthy balance of electrolytes. The most common
electrolytes found in the human body are sodium (Na+), potassium (k+), magnesium
(Mg++), chloride (Cl-) and calcium (2+). LR (lactated ringers) have lots of electrolytes in
them.
Various hormones in the body help regulate intake of these electrolytes, and the kidneys
filter electrolytes which reach excessive levels. Unhealthy levels of consumption of any
or all of the body's necessary electrolytes can cause serious health issues. The most
common imbalances are: hyper- and hypo-natremia (Na+), or excessive and insufficient
levels of sodium, and hyper- and hypo-kalemia (k+), or excessive and insufficient levels
of potassium.
Many sports drinks contain added potassium and sodium to help restore the body's proper
electrolyte balance after intense physical exertion. After exercising heavily, it can be
dangerous to ingest large quantities of water, as it may dilute existing electrolyte levels
and cause physical problems. Additionally, a number of electrolyte enhanced drinks exist
specifically for children and may be helpful for regular use, particularly to restore
electrolyte balance after sickness which has included vomiting or diarrhea.
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Electrolytes conducts electricity. This is why sterile water instead of LR is used in many
Cystoscopy procedures, especially if the use of a bovie is needed during the procedure;
the proper amount and distribution of electrolytes in the body is essential for health;
examples: calcium and sodium and potassium; An electrolyte solution is full of ions,
which are atoms that have some sort of net electric charge, either positive or negative. A
dilute electrolyte solution has a relatively small amount of ions for its volume, while a
concentrated electrolyte solution has a high amount of ions.
22) What is the safe alternative to succinylcholine?
23) What other nondepolarizing agent is rocuronium similar to?
24) Know the following: Atracurium and Mivacurium are also nondepolarizing
neuromuscular blocking agents.
25) From the Rapid Sequence Intubation article,
Know the following:
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Pretreatment medications are typically administered 2-3 minutes prior to
induction and paralysis. These medications can be remembered by using the
mnemonic LOAD (ie, Lidocaine, Opioid analgesic, Atropine, Defasciculating
agents).