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38 Cards in this Set
- Front
- Back
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List a couple of non-depolarizing NMBs
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Atracurium, Rocuronium, Rapacuronium, Pipecuronium, Mivacurium
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What receptor do non-depolarizing NMBs work on
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nicotinic AChR
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Name the only FDA apporoved depoloarizing NMB
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Succinylcholine
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how do depolarizing NMBs work?
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phase I - binds to open Na/K channels. membrane depolorizes. Ca2+ that is released from the SR on stimulation is reabsorbed into the SR. (Fasiculation then flaccid paralysis)
phase II - channel becomes desensitized to succinylcholine and the membrane can repolarize but the Na/K channels remain in a closed state, reponse is to repteat ACh action. |
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what drugs prolong Phase II of succinylcholine action?
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ButyrylChE inh. (plasma choline esterase)
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what 2 drugs depend on blood choline esterases for breakdown?
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mivacurium, succinylcholine
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what is the mode of administration for NMBs? why?
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IV, inactivation
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Which NMBs produce active metabolites?
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the steroid derived NMBs produce 3-hyrdoxy metabolites. these are: Pancuronium, Pipcuronium and Rocuronium.
Atracurium/Cisatracurium produces laudanosine - crosses BBB, induces seizures |
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laudanosine is a by-poduct of?
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Atracurium or Cisatracurium -- causes CNS exictation and seizures
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3-hydroxy metabolites are produced by which NMBs?
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Pancuronium, Pipecuronium, Rocuronium (steroid based)
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which 2 NMBs are ok for pts. w/ liver & kidney failure?
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Succinylcholine and mivacurium
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what are the long acting NMBs?
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ones metabolized by kideny: Pancuronium. Vecuronium and Pipcuronium have both hepatic and renal metabolism.
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Name a couple of Acetyl-cholinesterase inhibitors
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neostigmine and pyridostigmine
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What is the action of pyridostigmine?
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AChE inh. allows more ACh to compete with NMBs reversing their action.
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What two ndNMBs cause histamine release?
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tubocurarine and atracurium
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What ndNMB causes increased cardiac output and tachycardia
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pancuronium
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what NMB causes cardiac arrhythmias and bradycardia?
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succinylcholine
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what drug can be used to reduces the bradycardia of succinycholine
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atropine
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What NMBs do not have cardiovascular effects? (and no histamine relase)
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vecuronium, pipecuronium, rocuronium
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What Dz increases responsiveness to NMBs
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MG
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What is the effect of age on NMB blockade
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prolongs duration
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What reduces the efficacy of NMBs
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burns and UMN injury
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Hyperkalemia is caused by what NMB and in what situation?
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Succinylcholine w/ burns or nerve damage. can cause cardiac arrest.
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What are the sideffects of succinylcholine?
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increased intraoccular and intragastric pressure and myalgia especially in muscular pts.
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What are the drug interactions of NMBs?
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Inhaled Anesthetics - augment block. Isoflurane, desflurane and svoflurane augment more than halothane. decrease vascular resistance. CNS depressant. Decreased membrane sensetivity to depolarization
Aminoglycosides - decrease release of ACh Local anesthetics/antiarrythmics - enhanced NMB non-depolarizing NMBs and succinylcholine are antagonistic in phase I block. |
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What are the common BDZs?
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Diazepam, Lorazepam, Clonazepam
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What is the mechanism of action for BDZs
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GABAa agonists
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Mechanism of action of Baclofen
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GABAb agonist. increased K+ conductance.
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Side-effects of baclofen
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incresed seizures in epileptics, increased drowsiness/sedation.
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What drug is given for spasticity associated with spinal cord injury?
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baclofen
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What are two gabanergic drugs used as spasmolytics?
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progabide and gabapentin
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What is the mechanism of action of glycine?
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agonist at glycine receptor. an inhibitory receptor
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What is the mechanism of action of riluzole?
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inhibitor of exitatory glutaminergic pathway
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What is the mechanism of action of tizandidine
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like clonidine ... a2 agonist, w/ hypotension. drymouth and drowsiness [Zanaflex]
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what is the mechanism of action of cyclobenzaprine
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animuscarinic; acts on spinal cord/brain, sedation and halucination. avoid w/ MAOIs and EtOH [Flexeril]
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What is the mechanism of action of chlorzoxazone and orphenadrine?
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antimuscarinics
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What is the mechanism of action of Carisporodol?
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BZD metabolite meprobamate is sedative and hypnotic. [Soma]
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What is the mechanism of action of Dantrolene?
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reduces release of Ca2+ from SR. Used to treat malignant hypothermia.
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