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48 Cards in this Set
- Front
- Back
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Duration of Succinylcholine
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less than 8 minutes
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Mechanism of action of Succinylcholine
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Depolarization
Blockade of muscle nicotinic receptors |
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Elimination of Succinylcholine
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metabolized by plasma cholinesterase
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Why use Succinylcholine
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tracheal intubation or ECT short term paralytic
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Duration of Pancuronium
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30-60 minutes
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Mechanism of action of Pancuronium
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Non-depolarizing
blockade of muscle Nicotinic receptors |
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Elimination of Pancuronium
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Primarily renal
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Why use Pancuronium
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Adjuvant in
surgical anesthesia, sp. Abdominal wall relaxation & orthopedic procedures |
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Duration of D-tubocurarine
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less than 60 minutes
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Mechanism of action of D-tubocurarine
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Non-depolarizing
blockade of muscle nicotinic receptors |
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Elimination of D-tubocurarine
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Mostly cleared by liver also renal elimination
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Why use D-tubocurarine
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Prototype
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Duration of Rocuronium
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about 25 minutes
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Mechanism of action of Rocuronium
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Non-depolarizing
blockade of muscle nicotinic receptors |
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Elimination of Rocuronium
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Liver
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Why use Rocuronium
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Intubation,
muscle relaxation during surgery or ventilation |
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Duration of Mivacuronium
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Duration 15-20 minutes
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Mechanism of action of Mivacuronium
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Non-depolarizing blockade of muscle nicotinic receptors
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Elimination of Mivacuronium
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Plasma Cholinesterase
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Why use Mivacuronium
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Intubation,
muscle relaxation during surgery or ventilation in pts w/ renal failure |
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Duration of action of Vecuronium
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30-45 minutes
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Mechanism of action of Vecuronium
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Non-depolarizing
blockade of muscle nicotinic receptors |
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Elimination of Vecuronium
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Liver metab.
& clearance, renal elimination |
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Why use Vecuronium
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Adjuvant in
surgical anesthesia, sp. Abdominal wall relaxation & orthopedic procedures |
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Mechanism of action of Baclofen
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Inhibits
neurotransmitter release from skeletal muscle sensory afferent |
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Why use Baclofen
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Muscle
spasticity assoc. with multiple sclerosis or spinal cord injury |
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Mechanism of action of Diazepam
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Benzodiazepine
receptor agonist |
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Why use Diazepam
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due to local
injury (inflammation), muscle spasticity due to loss of descending inhibitory input, e.g. cerebral palsy |
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Mechanism of action of Tizanidine
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Centrally acting
α2 agonist |
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Why use Tizanidine
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Muscle
spasticity due to spinal cord injury or multiple sclerosis |
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Mechanism of action of Dantrolene
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Uncoupling of excitation-contraction of skeletal muscle by blocking ryanidine receptor
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Why use Dantrolene
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Muscle spasm,
Malignant hyperthermia |
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Non-depolarizing agents mechanisms
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Competitive antagonism of the Nm receptor
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Non-depolarizing agents
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Pancuronium, Tubocurarine, Vecuronium, Mivacurium, Rocuronium
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How do you overcome Non-depolarizing agents
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Overcome by excess Ach via AChE
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Depolarizing agents
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Succinylcholine
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Why use non-depolarizing NM relaxants
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Adjuvant to anesthesia during surgery
Relaxation of larynx for endotracheal intubation Relaxation of chest during mechanical ventilation |
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Side Effects of non-depolarizing NM relaxants
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Not analgesic (all)
Apnea (all) Histamine release (mivacuronium) Muscarinic blockade: increased HR and CO (pancuronium, rocuronium) |
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Drug interactions with non-depolarizing NM relaxants
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Inhalation anesthetics (enhance effect)
Antibiotics (enhance effect, particularly aminoglycosides) |
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Side effects of Depolarizing NM relaxants
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Not analgesic (all)
Apnea (all) must be ventilated Muscle pain (fasciculations) Intraocular pressure/intragastric pressure Stimulation of ganglionic nicotinic receptors Stimulation of muscarinic receptors, sinoatrial node (arrhythmia and hypertension) Hyperkalemia (K+ release from motor endplate) immediately after burns several days after widespread tissue injury |
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Drug interactions (enhance)
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local anesthetics
cholinesterase inhibitors |
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Antidotes to Depolarizing NM relaxants
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Time to diffuse away from synapse in Phase 1
Phase 2- AchE |
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Contraindications of Depolarizing NM relaxants
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malignant hyperthermia family history
early burns late severe soft tissue injury |
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Toxicity of Baclofen
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Drowsiness or altered mental status
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Toxicity of Diazepam
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Drowsiness
altered mental status |
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Contraindications for Diazepam
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acute narrow angle glaucoma
untreated open angle glaucoma |
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Toxicity of Tizanidine
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Drowsiness and Hypotension
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Toxicity of Dantrolene
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Muscle Weakness
Sedation Hepatitis |
