Nm Blockers - Goldstein

Front 1

Succinylcholine is 2 ____ put together

Back 1

ACh

Front 2

NM blocking agents interfere with the transmission of ____ impulses b/w somatic motor neurons and skeletal muscle fibers

Back 2

Cholinergic

Front 3

Specificity for the _______ occurs only with therapeutic doses of NM blockers
(in higher amts --> extends to addtl sites and causes ADRs)

Back 3

NM jx

Front 4

NM do not effectively penetrate the _____ at therapeutic levels

Back 4

BBB
(so minimal CNS effects)

Front 5

Most NM blocking agents (older) cause the release of ______ from intracellular stores

Back 5

Histamine

Front 6

NM release of histamine causes (5)

Back 6

- Bronchospasm
- Inc salivary and mucosal secretions
- Hypotension
- Tachycardia
- Urticaria

Front 7

Affected by low dose NM blocking agents (3)

Back 7

Rapid contracting small muscles
- Eyes and eyelids
- Speech and swallowing
- Fingers

Front 8

Anesthesiologist monitors NM blocking with ____

Back 8

Stimulator on finger (1st thing NM affects)

Front 9

Affected by medium dose NM blockers (3)

Back 9

- Limbs
- Neck
- Trunk

Front 10

Affected by high dose NM blockers (2)

Back 10

Respiration
- Intercostal muscles
- Diaphragm

Front 11

NM blockers have ____ margin b/w effective and toxic dose

Back 11

small

Front 12

2 types of NM blocking agents

Back 12

- Depolarizing
- Nondepolarizing

Front 13

Depolarizing NM blockers MOA

Back 13

- Depolarizes receptors initially --> muscle stimulation
- Persistant occupation delays repolarization and blocks recovery

Front 14

Nondepolarizing NM blockers MOA

Back 14

Competively antagonizes ACh at R site
--> prevents depolarization
- Produces flaccid paralysis

Front 15

NM blocking agent uses (4)

Back 15

- Adjuncts to GA
- Facilitates intubation
- Improves breathing on ventilator (pt can't fight)
- Decs injury in shock therapy

Front 16

Drugs that cause additive effects with NM blocking agents (6)

Back 16

- Abx
- Inhalation GAs
- Ketamine
- LAs
- Lithium
- Quinidine

Front 17

Meds that dec effects of NM blocking agents (4)

Back 17

- Cholinergic drugs
- Corticosteroids
- Ranitidine
- Theophylline

Front 18

Abx that have additive effects with NM blocking agents (3)

Back 18

- Aminoglycosides
- Lincosamides
- Polymixins

Front 19

Addtl meds needed for pain control with NM blockers, b/c they do not (2)

Back 19

- Reduce conscious
- Provide analgesia

(need to pinch skin and pay attn to HR)

Front 20

Depolarizing NM blockers have a _____ action

Back 20

Biphasic

Front 21

Biphasic action of depolarizing NM blockers

Back 21

- Depolarization of motor end plate initially
- Persistant ocupation of R site

Front 22

Initial depolarizing of motor end plate in depolarizing NM blockers causes

Back 22

Brief muscle ctxs (fasciculations)

Front 23

Secondary persistant occupation of R sites in depolarizing NM blockers causes

Back 23

- Desensitization of R site to ACh (may last beyond drug action --> possible conformation change)
- Prevents repolarization
- Paralysis

Front 24

Secondary persistant occupation of R sites with depolarizing NM blockers lasts

Back 24

10-30 mins

Front 25

Prototype Depolarizing NM blocker

Back 25

Succinylcholine

Front 26

Succinylcholine is rapidly hydrolyzed by plasma cholinesterase to _______

Back 26

Succinylmonocholine

Front 27

Succinylcholine is rapidly hydrolyzed to Succinylmonocholine by

Back 27

Plasma cholinesterase

Front 28

Succinylmonocholine is a _____ metabolite of Succinylcholine

Back 28

Active

Front 29

- Weaker than parent drug
- Slowly hydrolyzed
- Accumulates with prolonged/lg doses
- May result in lengthy paralysis

Back 29

Succinylmonocholine

Front 30

Muscle paralysis from succinylcholine lasts _____

Back 30

8-10mins

Front 31

Onset of succinylcholine occurs after ____ with IV

Back 31

1 min

Front 32

Max effects of succinylcholine occur in

Back 32

2-4 mins

Front 33

ADRs:
- Muscle twitch/pain
- Tachycardia
- HTN
- Arrhythmia
- Resp depression
- Apnea
- Excessive salivation
- Inc IOP
- Malig Hyperthermia

Back 33

Succinylcholine

Front 34

3 main ADRs of succinylcholine

Back 34

- Muscle twitch
- Muscle pain
- Malignant hyperthermia

Front 35

Early signs of malignant hypertheramia (4)

Back 35

- Muscle rigidity
- Tachycardia
- Metabolic acidosis
- Hyperthermia

Front 36

Need to monitor body temp when administer succinylcholine to prevent

Back 36

Malignant Hyperthermia

Front 37

Inc change of this ADR for succinylcholine if given with GA

Back 37

Malignant Hyperthermia

Front 38

Succinylcholine contraindications (4)

Back 38

- Hx of malignant hyperthermia
- Narrow angle glaucoma (further inc pressure --> crush optic nerve = blind)
- Genetic deficiency of plasma pseudocholinesterase
- Pts on digitalis or quinidine --> may cause arrhythmias

Front 39

If use succinylcholine in patient with ____, may cause blindness

Back 39

narrow angle glaucoma

Front 40

If use succinylcholine in pt with __________ , pt won't be able to metabolize and may inc length of time of drug

Back 40

Deficiency of plasma pseudocholinesterase
(don't test for, just are ready to deal with it if it occurs)

Front 41

Succinylcholine may cause arrhythmias in pts on (2)

Back 41

Digitalis
Quinidine

Front 42

Nondepolarizing agents are antagonists --> have enough affinity for ____

Back 42

R area but doesn't activate it

Front 43

aka antidepolarizing, stabilizing or curariform drugs

Back 43

Nondepolarizing NM blockers

Front 44

Nondepolarizing NM blockers also called curariform drugs b.c used to be used in ___________ collectively called curare

Back 44

South America arrow poisonings

Front 45

All nondepolarizing agents have quaternary nitrogen like ________-

Back 45

d-tubocurarine

Front 46

Nondepolarizing agents are _____ antagonists of ACh at postsynaptic NM cholinergic (nicotininc 2) R sites

Back 46

Reversible

Front 47

Isoquinolone derivative Nondepolarizing NM blocking agent used to dx myasthenia gravis --> if have it, will inc muscle weakness with even a small dose

Back 47

Tubocurarine

Front 48

Isoquinolone derivative nondepolarizing NM blocking agents (4)

Back 48

- Tubocurarine
- Atracurarine
- Doxacurium
- Metocurine
- Mivacurium

Front 49

Isoquinolone derivative that causes histamine release

Back 49

Tubocurarine

Front 50

Use of this with diazepam may inc risk of malignant hyperthermia

Back 50

Tubocurarine

Front 51

Isoquinolone derivative that is less likely to cause histamine release
- Hypotensive effect minimal at recommended dose
- Metabolized quickly

Back 51

Atracurium

Front 52

If administer this under isoflurane or enflurane, have to decrease the dose by 1/3

Back 52

Atracurium

Front 53

Atracurium onset is ____ after IV injection

Back 53

2-5 mins

Front 54

- Rapidly inactivated in plasma
- Recovery occurs within 20-30 mins --> is complete in 1 hr

Back 54

Atracurium

Front 55

Atracurium repeated doses have no cumulative effects on duration of NM block if recommended _______

Back 55

Dosage intervals are followed

Front 56

Atracurium ADRs (3)

Back 56

- Flushing
- Mild hypotension
- At inc dose, have histamine ADRs

Front 57

Isoquinolone with little to no release of histamine

Back 57

Doxacurium

Front 58

Max effect and duration of action of Doxacurium

Back 58

Max = 2-3mins
Duration: 20-30 mins

Front 59

- May accumulate in body with repeated dose
- Excreted largely unchanged in urine

Back 59

Doxacurium

Front 60

Effects of may be increased in presence of:
- Hypokalemia
- Dec renal clearance

Back 60

Doxacurium

Front 61

2 Isoquinolones that have no other notes except that they cause histamine release

Back 61

- Metocurine
- Mivacurium

Front 62

Nodepolarizing NM blockers that are steroid derivatives (3)
--> all have minimal histamine release

Back 62

- Pancuronium
- Pipecuronium
- Vecuronium

Front 63

OD of nondepolarizing NM blockers treated by (3)

Back 63

- Artificial respiration with O2
- Vasopressors
- Cholinesterase inhibitors

Front 64

Vasopressors = aka

Back 64

Vasoconstrictors

Front 65

Things used to tx OD of nondepolazing agents are contraindicated for depolarizing agents b/c (2)

Back 65

- Will further stimulate cholinergic R's
- Can intensify muscle paralysis

Front 66

Direct acting skeletal muscle relaxants differ from NM blocking agents because

Back 66

No interference with transmission of impulse b/w motor neurons and muscle

Front 67

Direct Skeletal Muscle relaxants MOA

Back 67

- Dec Ca2+ release from SR --> Dec ctx of muscle

Front 68

Direct acting skeletal muscle relaxants affect ____ > _____

Back 68

Fast twitch (reflex) > Slow (voluntary)

Front 69

Prototype direct acting skeletal muscle relaxant

Back 69

Dantrolene

Front 70

Dantrolene used in oral form to tx muscle spasticity from ______-

Back 70

Chronic neuro disorders
(CP, MS, Spinal injury, stroke)

Front 71

t1/2 of Dantrolene

Back 71

9 hrs

Front 72

Therpeutic effects of Dantrolene may not occur until _____

Back 72

1-2 wks after initiation

Front 73

Given IV for emergency management of malignant hyperthermia

Back 73

Dantrolene

Front 74

Dantrolene used to tx malignant hyperthermia MOA (3)

Back 74

- Dec Ca2+ from SR
- Impairs catabolism in muscle cells
- Decs potential lethal elevation in body temp

Front 75

Major Dantrolene ADR --> esp with high doses or long term tx

Back 75

Hepatotoxicity
(have to monitor LFTs!)

Front 76

Risk of Hepatic injury with Dantrolene is highest in

Back 76

F - 35 yrs+

Front 77

Discontinue Dantrolene if no benefit seen within ____ days

Back 77

45

Front 78

CNS ADRs of Dantrolene (3)

Back 78

Dizziness
Drowsiness
Weakness

Front 79

Dantrolene ADRs in addition to hepatic and CNS effects (3)

Back 79

- GI probs - Constipation & Diarrhea
- Dysphagia
- Photosensitization