Muscle relaxant clinical use Flashcards

2
Q

what can potentiate depolarizers (sux)?

A

cholinesterase inhibitors (Neostigmine)Aminoglycosides (mycins)Local anesthestheticsVolatile anesthticsMagnesiumlithiuim

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3
Q

Uses for Sux?

A

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

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4
Q

side effects of sux?

A

-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)

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5
Q

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

A

pretreat with Non-Depolarizer(will not affect K+ release)

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6
Q

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

A

up regulated pt’s (denervation injury)

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7
Q

Contraindications for SUX?

A

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

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8
Q

down and dirty how do depolarizers work

A

bind to and activates sustained depolarization of nicotinic receptor

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9
Q

down and dirty how do Non-depolarizers work

A

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

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10
Q

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

A

75%

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11
Q

what potentiates Non-depolarizing drugs?

A

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

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12
Q

Reasons to use Pancuronium (pavulon)?

A

-long paralysis-cardiac sx

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13
Q

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

A

pancuronium (pavulon) b/c it increases the HR

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14
Q

Side effets of Pancuronium (pavulon)?

A

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

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15
Q

Reasons to use for Vecuronium (Norcuron)?

A

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

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16
Q

Side effects of Vecuronium (Norcuron)?

A

minimal to none

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17
Q

Reasons to use Rocuronium (Zemuron)?

A

-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

18
Q

Side effects of Rocuronium (Zemuron)?

A

-minimal to none why the fuck not just use this!!!!!

19
Q

perfect test question**what is the main benefit of Cis-Atricurium (Nimbex)? and why?

A

organ independent metabolism–you don’t need organ function to metabolize b/c of Hofman elimination 2/3 (and 1/3 ester hydrolysis)

20
Q

what is Hofman elimination (associated with Cis-atricurium)

A

the drug is metabolized and removed independent of organs.

21
Q

what 2 factors can prolong Hofmann elimination?

A

hypothermiaacidosis