Neuromuscular Drugs/muscle Relaxants

Front 1

What does Acetylcholine breakdown to when it binds in the post synaptic groove? What was is it broken down by

Back 1

Acetyl Acid and Choline. Broken Down by acetylcholinesterase.

Front 2

What are the three major conformations or states of the skeletal muscle nicotinic acetylcholine receptor?

Back 2

resting, open and desensitized.

Front 3

Nicotinic agonists stabilize which 2 states of the receptor?

Back 3

the open and desensitized states

Front 4

Competitive antagonists stabilize what what state of the receptor

Back 4

Resting state

Front 5

What are the 2 clinical uses of neuromuscular drugs

Back 5

provide muscle relaxation for surgery, 2) Anticholinesterases are used for dx and tx of myasthenia gravis

Front 6

What is the name of the prototype NON depolarizing muscle relaxants (nicotinic receptor antagonist)

Back 6

Vecuronium. This drug sits on receptor and doesn't allow it to respond to ACH

Front 7

How does neostigmine work?

Back 7

It blocks Acetylcholinesterase. Neostigmine binds to the anionic site of cholinesterase. The drug blocks the active site of acetylcholinesterase so the enzyme can no longer break down the acetylcholine molecules before they reach the postsynaptic membrane receptors. This allows for the threshold to be reached so a new impulse can be triggered in the next neuron. In myasthenia gravis there are too few acetylcholine receptors so with the acetylcholinesterase blocked, acetylcholine can bind to the few receptors and trigger a muscular contraction.

Front 8

What is the adverse effects of non depolarizing muscle relaxants?

Back 8

Hypotension

Front 9

How does your body get rid of vecuronium?

Back 9

Biliary secretion. Polar drugs are usually secreted in bile, it takes long for its effects and is eliminated slowly.

Front 10

How does your body get rid of Atracurium?

Back 10

Breaks down at physiological pH. This drug is non polar and works faster. It is chemically unstable. its spontaneously cleaved. doesn't have to be excreted, it breaks down by itself.

Front 11

This drug is used for tracheal intubation

Back 11

Succinylcholine

Front 12

What is the ion channel state with the nicotinic receptor and sodium channel receptors during Tracheal Intubation?

Back 12

nicotinic is open, sodium channel is closed (refractory)

Front 13

what is the ion channel state with nicotinic and sodium channel receptors during Desensitization (pg 361?)

Back 13

Nicotinic receptor is closed and sodium channel is open.

Front 14

Is succinylcholine fast or slow acting and how many minutes does it stay. what then chews it up?

Back 14

fast acting, stays 2-5 minutes. Plasma cholinesterase chews it up.

Front 15

What are 4 disadvantages of depolarizing blockers?

Back 15

1) Muscle soreness of succinylcholine-induced muscle relaxation
2) Inability to reverse stage 1 block with anti ChEs. 3) Potassium release may be life threatening in burn patients displaying skeletal muscle denervation hypersensitivity.4) Succinylcholine biotransformation is abnormally slow in certain people.

Front 16

With the muscle relaxants Nicotinic agonists, there is continuous depolarization/fasiculations. Spontaneous contractions. Thin later with Anti-ChE further relaxation is taking place

Back 16

True

Front 17

True or False: Depolarization muscle relaxation meds can not be reversed by Anti CHE

Back 17

True

Front 18

This drug blocks the release of calcium from internal stores

Back 18

Dantrolene

Front 19

This drug is used for malignant hyperthermia and spasticity disorders

Back 19

Dantrolene.

Front 20

This drug relaxes muscle in a unique way, by inhibiting Ca+ ion release from skeletal muscle sarcoplasmic reticulum

Back 20

Dantrolene

Front 21

The Molecular Basis of this disease is the autoimmune loss of muscle nicotinic ACh receptors

Back 21

Myasthenia Gravis. Antibodies that bind to nicotinic receptors which degrades them and disappears, and makes the muscles weak.

Front 22

These 3 drugs are given for myasthenia gravis

Back 22

neostigmine, pyridostigmine, edrophonium

Front 23

These 2 myasthenia Gravis drugs are administered orally and display intermediate durations of action

Back 23

neostigmine and pyridostigmine (anti-cholinesterases)

Front 24

This myasthenia gravis drug is used for diagnosis of MG and for adjustment of AntiChE dose regime

Back 24

Edrophonium (anti-cholinesterases)

Front 25

True or False: With increasing Anti-ChE, you can start with Maysthemic weakness, then began to have optimal contractility, but then have cholinergic crisis.

Back 25

True. You have cholinergic crisis due to decreased contractility because of desensitization (Resembling the 2nd stage of SuCC) Patient over medicates with esterase inhibitor and needs to decrease dosage or decrease frequency..(Myasthenic weakness occurs when the patient is undermedicated with a long duration cholinesterase inhibitor, where as cholinergic crisis occurs when the patient is over medicated.

Front 26

True or False. A Major advantage of using a non depolarizing muscle relaxant acting upon the neuromuscular nicotonic receptor is because of the rapid reversibility with an acetylcholinesterase agonist.

Back 26

False. A Major advantage of using a non depolarizing muscle relaxant acting upon the neuromuscular nicotonic receptor is because of the rapid reversibility with an acetylcholinesterase INHIBITOR

Front 27

You do not use this drug if a surgical patient has suffered extensive skeletal muscle trauma several days to weeks earlier

Back 27

Succinylcholine (depolarizing muscle relaxant/nicotinic agonist)

Front 28

When a patient with myasthenia gravis is under medicated with an anticholinesterase, injection of a small dose of edrophonium will cause:

Back 28

transient increase in muscle contractility.

Front 29

With this drug: There is possible systolic arrest in post trauma patients with denervation hypersensitivity, clearance rate varies. This drug also can't be reversed by anti-ChE

Back 29

Succinylcholine