Muscle relaxant clinical use (11)

Question 1

what can potentiate depolarizers (sux)?

Answer 1

cholinesterase inhibitors (Neostigmine)
Aminoglycosides (mycins)
Local anesthesthetics
Volatile anesthtics
Magnesium
lithiuim

Question 2

Uses for Sux?

Answer 2

facilitate intubation (RSI)
short duration relaxant (bolus/gtt)
exact timing of relaxation
overall ease of paralysis, recovery, and re-paralysis

Question 3

side effects of sux?

Answer 3

• allergy
• FASICULATIONS
• MUSCLE PAIN (MYALGIA)
• bradycardia, brady arrythmias, asytole
• HYPERKALEMIA (increases 1 mEq/L
• Increased IOP
• Increased intragastric pressure
• Increased ICP
• unmasked cholinesterase deficiences
• sustained muscle contractions
• MH RISK (masseter muscle spasm)

Question 4

how can you lessen the cardiac arrythmias, myalgia, and elevations of IOP, and intragastric pressure with SUX?

Answer 4

pretreat with Non-Depolarizer

will not affect K+ release

Question 5

Which patients are at the highest risk of getting hyperkalemic with SUX?

Answer 5

up regulated pt’s (denervation injury)

Question 6

Contraindications for SUX?

Answer 6

• denervation after 24-28 hours
• immobilization after 3 days
• burns after 2 days
• MH risk’
• Homozygous atypical plasma cholinesterase deficiency
• serum K+ >5.5

Question 7

down and dirty how do depolarizers work

Answer 7

bind to and activates sustained depolarization of nicotinic receptor

Question 8

down and dirty how do Non-depolarizers work

Answer 8

Bind to post synaptic nicotinic ACh receptors and competitively inhibit action of ACh

Question 9

with Non-depolarizing greater than what % of ACh receptors must be blocked to inpair motor nerve conduction?

Answer 9

75%

Question 10

what potentiates Non-depolarizing drugs?

Answer 10

• aminoglycerides (mycins)
• local anesthetics
• volatile anesthetics
• Dantrolene (crazy b/c this is the reversal for MMH)
• Magnesium
• CCB

Question 11

Reasons to use Pancuronium (pavulon)?

Answer 11

• long paralysis

- cardiac sx

Question 12

what Non-depolarizing drug would be good to use to balance out the narcotic induced bradycaria in patients?

Answer 12

pancuronium (pavulon) b/c it increases the HR

Question 13

Side effets of Pancuronium (pavulon)?

Answer 13

• increased HR r/t vagolysis at post ganglionic nerve terminal, muscarinic blockade, and catecholamine release
• inhibits plasma cholinesterase

Question 14

Reasons to use for Vecuronium (Norcuron)?

Answer 14

• intermediate duration
• CV stable
• suitiable for ischemic heart disease
• suitable for ambulatory surgeries
• low incidence of residual muscle paralysis

Question 15

Side effects of Vecuronium (Norcuron)?

Answer 15

minimal to none

Question 16

Reasons to use Rocuronium (Zemuron)?

Answer 16

• 1.7th potency of Vecuronium
• NON-DEPOLARIZING RSI ABILITY
• rapid onset (60 sec) with 1.5 mg/kg dose
• can replace SUXs for RSI
• CV stabe

Question 17

Side effects of Rocuronium (Zemuron)?

Answer 17

-minimal to none

why the fuck not just use this!!!!!

Question 18

perfect test question**

what is the main benefit of Cis-Atricurium (Nimbex)? and why?

Answer 18

• *organ independent metabolism
• -you don’t need organ function to metabolize

** b/c of Hofman elimination 2/3 (and 1/3 ester hydrolysis)

Question 19

what is Hofman elimination (associated with Cis-atricurium)

Answer 19

the drug is metabolized and removed independent of organs.

Question 20

what 2 factors can prolong Hofmann elimination?

Answer 20

hypothermia

acidosis