LESSON 10: Neuromuscular Blocking Drugs

Question 1

Drugs that completely paralyze skeletal muscles (from normal tone to zero) by interfering with acetylcholine at neuromuscular junction

Answer 1

NEUROMUSCULAR BLOCKERS

Question 2

Drugs that used to relieve skeletal muscle spasm & bring them from hypertonic state to normal muscle tone. (Ex. Dantrolene)

Answer 2

SPASMOLYTICS

Question 3

These drugs interfere with transmission at the neuromuscular end plate and lack central nervous system activity

Answer 3

NEUROMUSCULAR BLOCKING DRUG

Question 4

All of the available neuromuscular blocking drugs bear a structural resemblance to _________________.

Answer 4

acetylcholine

Question 5

All of the neuromuscular blocking drugs are ___________________ and inactive orally and must be administered parenterally.

Answer 5

highly
polar (water soluble)

Question 6

Non-competitive, agonist;
Act on the acetylcholine receptor (agonist drug)

Answer 6

DEPOLARIZING

Question 7

Competitive, antagonist;
Attacks/goes against the acetylcholine receptor;

Answer 7

NON-DEPOLARIZING

Question 8

NON-DEPOLARIZING EXAMPLE

Answer 8

Tubocurarine

Question 9

DEPOLARIZING EXAMPLE

Answer 9

Succinylcholine (Anectine)
Decamethonium bromide (Syncurine®)

Question 10

Ultra Short-Acting

Answer 10

Succinylcholine

Question 11

Short-Acting

Answer 11

Mivacurium

Question 12

Intermediate Acting

Answer 12

Vecuronium
● Atracurium
● Rocuronium
● Cis-atracurium

Question 13

Long-Acting

Answer 13

Pancuronium

Question 14

Resembles two acetylcholine molecules linked end to end, it has two quaternary ammonium cations which interact with the anionic sites on the muscle end plate receptors.

Answer 14

DEPOLARIZING

Question 15

used to produce complete muscle relaxation for various surgical procedures

Answer 15

succinylcholine (anectine)

Question 16

used as a
muscle relaxant for relatively short surgical procedures

Answer 16

Decamethonium bromide (Syncurine®)

Question 17

another name for Decamethonium bromide (Syncurine®)

Answer 17

Suxamethonium

Question 18

SUCCINYLCHOLINE: MAJOR SIDE EFFECTS

Answer 18

Hyperkalemia
Arrhythmia
Myalgia
Increased intraocular pressure
Increased intracranial pressu re (ICP)
Skeletal muscle contractions
Myoglobinuria
Increased intragastric pressure

Question 19

succinylcholine side effects may be reduced by prior administration of non-paralyzing doses of____________________________

Answer 19

non-depolarizing neuromuscular-blocking agents.

Question 20

These agents also contain a “double-acetylcholine” form; however this form is hidden by ring systems

Answer 20

NON-DEPOLARIZING

Question 21

Contains 1-2 quaternary nitrogens which result in limited lipid-solubility

Answer 21

NON-DEPOLARIZING

Question 22

pancuronium brand name

Answer 22

Pavulon®

Question 23

NON-DEPOLARIZING drugs combine with________________ and
prevent binding of acetylcholine so prevent depolarization of the muscle cell membrane so inhibiting _______________.

Answer 23

nicotinic receptors; muscle contraction

Question 24

NON-DEPOLARIZING drugs competitively block the receptors; this means that you can overcome their action by ____________ (increasing/decreasing) Ach concentration by giving Ach esterase inhibitors such as ____________________

Answer 24

increasing; pyridostigmine or neostigmine.

Question 25

2 MAJOR CLASSES OF NON-DEPOLARIZING BLOCKERS

Answer 25

Isoquinoline derivatives, Steroid derivatives

Question 26

Isoquinoline derivatives

Answer 26

● Tubocurarine ● Atracurium (Tracrium) ● Doxacurium(Nuromax) ● Mivacurium(Mivacron)

Question 27

Steroid derivatives

Answer 27

● Pancuronium (Pavulon) ● Vecuronium (Norcuron) ● Pipecuronium (Arduan) ● Rocuronium (Zemuron)

Question 28

Motor weakness, followed by skeletal muscle flaccidity inexcitability to electrical stimulation

Answer 28

NON-DEPOLARIZING

Question 29

Muscle fasciculations (very evident) especially over the chest and abdomen followed by complete paralysis

Answer 29

DEPOLARIZING

Question 30

Order of Muscle Movement for NON-DEPOLARIZING

Answer 30

● 1 - smaller muscles (eg. facial, foot, hand) ● 2 - larger muscles (eg. abdominal, trunk) ● 3 - diaphragm

Question 31

Order of Muscle Movement for DEPOLARIZING

Answer 31

● 1 - arm, neck, and leg muscles ● 2- facial and pharyngeal muscles ● 3 - muscle follows respiratory weakness rapidly, usually within 60 seconds

Question 32

Recovery for NON-DEPOLARIZING

Answer 32

In reverse order, with the diaphragm regaining function first

Question 33

Recovery for DEPOLARIZING

Answer 33

In reverse order

Question 34

CONSIDERATION FOR CHOOSING A MUSCLE RELAXANT

Answer 34

Duration of action required Route of excretion endency to release histamine Cardiopulmonary side effects The ability to reverse the blockage Contraindication to any specific muscle relaxant. Cost