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97 Cards in this Set

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  • Back
how do neuromuscular blockers work?
block the cholinergic transmission between somatic motor nerve endings and the nicotninc receptors on the end plate of skeletal muscle
what is the most important application of neuromuscular blockers?
surgical relaxation, especially for intra-abdominal and intrathoracic procedures
what use do neuromuscular blockers have in terms of ventilation?
eliminate chest wall resistance and ineffective spontaneous ventilation so it can be used for critically ill patients with ventilator failure
when is mechanical ventilation required?
when a full dose of neuromuscular blockers is used
how do neuromuscular blockers treat convulsions?
attenuate or eliminate the peripheral manifestations of convulsions
what will neuromuscular blockers not do?
cross the BBB
what is the MOA of nondepolarizing neuromuscular blockers?
pure competitive agonists that occupy the nicotinic receptor to block Ach from gaining access
how can the effect of nondepolarizing neuromuscular blockers be overcome?
ACE inhibitor to increase the amount of Ach available in the synaptic cleft
how long is the onset of action for nondepolarizing neuromuscular blockers?
short (1-6mins)
which nondepolarizing neuromuscular blockers will have a slightly longer duration of action?
those eliminated by the kidney
what can inhaled anesthetics do?
strongly potentiate and prolong the neuromuscular blockade
what is an example of a neuromuscular anesthetic?
isolurane
what will prolong the relaxation caused by nondepolarizing neuromuscular blockers? (2)
aminoglycoside antibiotics
antiarrhythmic agents
what is atracurium?
a nondepolarizing neuromuscular blockers
what is cistracurium?
a nondepolarizing neuromuscular blockers
what is vecuronium?
a nondepolarizing neuromuscular blockers
what is rocuronium?
a nondepolarizing neuromuscular blockers
what is pancuronium?
a nondepolarizing neuromuscular blockers
what is tubocurarine?
a nondepolarizing neuromuscular blockers
what is mivacurium?
a nondepolarizing neuromuscular blockers
what is the structure of antracurium?
isoquinolone based
how long is the duration of action of antracurium?
medium
how is antracurium metabolized?
hoffman degeneration
what are 3 adverse effects of antracurium?
hypotension
histamine release
broken down into laudanosine which is a toxic metabolite that can cross the BBB and cause seizures with long term use
what will cause more laudanosine built up?
kidney failure
what is the structure of cistracurium?
isoquinolone based
how long is the duration of action of cistracurium?
long
how is cistracurium metabolized?
hoffman degeneration
what are 3 good things about cistracurium?
much less hypotension, histamine release, and formation of laudanosine
what is the structure of vecuronium?
amino steroid based
how long is the duration of action of vecuronium?
medium
how is vecuronium metabolized?
liver metabolism and clearance
renal elimination
what are 3 adverse effects of vecuronium?
generally fewer
may cause prolonged paralysis
may promote muscarinic block
moderate block of cardiac muscarinic receptors
what is the structure of rocuronium?
amino steroid based
how is rocuronium metabolized?
liver metabolism and clearance
what is an adverse effect of rocuronium?
may promote muscarinic block
what is the structure of pancuronium?
amino steroid based
how long is the duration of action of pancuronium?
very long
how is pancuronium metabolized?
liver metabolism and clearance
renal elimination
what are 2 adverse effects of pancuronium?
slight tachycardia
no hypotension
what is the structure of tubocurarine?
isoquinoline based
how long is the duration of action of tubocurarine?
very long
how does tubocurarine work?
it blocks autonomic ganglia (opposite of succinyl choline)
what are 3 adverse effects of tubocurarine?
most likely to cause histamine release
hypotension due to block and release of histamine
bronchoconstriction due to histamine
what is the structure of mivacurium?
isoquinolone based
how long is the duration of action of mivacurium?
short
how is mivacurium metabolized?
hydrolyzed by plasma cholinesterase
what is important about mivacurium?
no longer manufactured
what is phase I of the MOA of depolarizing blockers?
acts as an agonist at nicotinic receptors and initially depolarizes the muscle membrane, relaxes calcium, and causes fasiculationsand then flaccid paralysis
what will worsen phase I of depolarizing blockers?
an ACE inhibitor
what is phase II of the MOA of depolarizing blockers?
upon continued exposure to succinylcholine, the membrane is repolarized but resistant to further activation
what 2 receptors will depolarizing blockers also block?
autonomic ganglia
cardiac muscle receptors
what is succinyl choline?
a depolarizing blocker
how is succinyl choline metabolized?
by pseudocholinesterase (not acetylcholinesterase)
how can the duration of action of succinyl choline be prolonged?
in patients with generic variants of pseudocholinesterase or hepatic damage
what are 4 adverse effects of succinyl choline?
post-op muscle pain due to fasciculations
hyperkalemia
decreased HR and increased IOP at high doses
hyperthermia
what causes malignant hyperthermia?
massive calcium release from the SR of skeletal muscle
how do you treat hyperthermia?
dantrolene
what is the goal of spasmolytic agnets?
reduce excessive skeletal muscle tone caused by neurologic or muscle end plate disease without reducing strength
what are chronic diseases of the CNS associated with?
abnormally high reflex activity, specifically the neuronal pathway that control skeletal muscles, resulting in painful spasms
what is carisoprodol?
an acute spasmolytic agent
what is cyclobenzaprine?
an acute spasmolytic agent
what is metaxalone?
an acute spasmolytic agent
what is methocarbamol?
an acute spasmolytic agent
what are 2 adverse effects of carisoprodol?
drowsiness (increased by alcohol)
CNS effects much more prominent in the elderly
what is the possible MOA with cyclobenaprine?
believed to act at the brain stem, possible interference with polysynaptic reflexes that maintain skeletal muscle tone
may act as a TCA
how is cyclobenaprine administered?
orally
what are 3 adverse effects of cyclobenzaprine?
marked sedation
antimuscarinic action
confusion/hallucinations (increased with co-administration of other drugs)
what is cylobenzaprine not effective for?
chronic muscle spasm
what is metaxalone used for?
indicated in the relief or discomfort associated with acute, painful musculoskeletal conditions
what does metaxalone not have?
a direct effect on skeletal muscle (most therapeutic effect comes from actions on the CNS)
what are 3 adverse effects of metaxalone?
drowsiness
dizziness
irritability
what is methocarbamol used for? (2)
used in the treatment of muscle spasms associated with acute painful musculoskeletal conditions
supportive therapy in tetanus
what are 4 adverse effects of methocarbamol?
drowsiness
dizziness
hypotension
syncope
who is methocarbamol contraindicated in?
renal impairment
how do chronic spasmolytic agents work?
act in the spinal cord to reduce tonic output of primary spinal motor neurons
how are chronic spasmolytic agents usually administered?
orally
what may refractory cases of chronic spasm require?
intrathecal administration of baclofen
what is diazepam?
a chronic spasmolytic agent
what is baclofen?
a chronic spasmolytic agent
what is dantrolene?
a chronic spasmolytic agent
what is tizanidine?
a chronic spasmolytic agent
what is the botulinum toxin?
a chronic spasmolytic agent
what is gabapentin?
a chronic spasmolytic agent
how does diazepam work?
facilitates GABA-mediated inhibition
what is an adverse effect of diazepam?
sedation
how does baclofen work? (3)
acts as a GABA agonist and opens K channels causing hyperpolarization
closes Ca channels
decreased the release of excitatory neurotransmitters, especially substance P
what is an adverse effect of baclofen?
sedation (less than diazepam)
how does dantrolene work?
acts in the skeletal muscle cell to block ryanodine receptors to reduce the release of calcium from the SR
what are 2 adverse effects of dantrolene?
significant muscle weakness
less sedation than bactofen or diazepam
how does tizanidine work?
significant alpha-2 agonist activity that reinforces both pre- and postsynaptic inhibtion at the spinal cord
what is tizanidine closely related to?
clonidine
what are 2 adverse effects of tizanidine?
drowsiness
hypotension
how does the botulinum toxin work?
prevents synaptic fusion and release of Ach
what can the botulinum toxin be used for? (2)
can be injected into selected muscles to reduce pain
can be used in the management of cerebral palsy
how does gabapentin work?
analog of GABA designed to cross the BBB but has no direct GABA-mimetic effects (thought to either interfere with its breakdown or enhance its release)
what is gabapentin used for?
manage spasms in a patient with MS