Neuromuscular and ganglionic blockers Flashcards Preview

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Flashcards in Neuromuscular and ganglionic blockers Deck (58):
1

Ganglionic blockers block which reflexes? (2)

Baroreceptor
Pupillary

2

What are ganglionic blockers?

Nicotinic receptor antagonists

3

What is Trimethaphan used for?

Hypotension for surgery

4

What is Mecamylamine used for? (3)

Tourette's
Smoking Cessation
Severe hypertension

5

Majority of vascular smooth muscle tone is what?

SANS more than PANS

6

Majority in rest of ANS is what system?

PANS more than SANS

7

What is Train of Four impulse?

Response of 4th twitch relative to first

8

What does Train of Four ratio of 0.25 mean?

75% of receptors blocked, but still near full muscle responses.

9

What ratio is needed before extubation?

Greater than 0.7

10

What ratio is classified as full clinical recovery?

0.9

11

At what point is the patient properly sedated?

When only 1-2 twitches are seen during a neuromuscular blockage

12

Sequence of muscle paralysis by curare/neuromuscular blocker OD?

Eye -> Speech -> Fingers -> Toes -> Limbs -> Intercostals -> Diaphragm

13

What disease is similar to curare paralysis?

Guillain-Barre Syndrome

14

Characteristics of Succinylcholine? (2)

Short duration 5-10 minutes
Fast onset

15

What metabolizes Succinylcholine?

Butyrylcholinesterase

16

What do you use Succinylcholine for? (3)

Trauma care
Intubation
Electro-convulsant therapy

17

When do you want to avoid Succinylcholine?

Hyperkalemia, due to risk of cardiac arrest

18

How does the depolarizing neuromuscular blocker Succinylcholine work?

It is an agonist which means it bind and depolarizes which due to persistence makes the muscle fiber resistant to further stimulation by Ach.

19

How does the non-depolarizing (curare-like) neuromuscular blocker work?

It is a nicotinic acetylcholine receptor antagonist

20

Benefits of Pancuronium? (3)

Long duration (greater than 180 minutes)
Easily reversible
Widely used

21

What is neostigmine?

Reversible acetylcholinesterase inhibitor

22

Where is acetylcholinesterase located?

In the synapses

23

Where is Plasmacholinesterase located?

In plasma

24

What is a carbamate?

Acetylcholinesterase inhibitor

25

Characterisitics of Carbamates? (4)

Quaternary or tertiary amine group
Temporary covalent modification to AChE
Reversible
Dissociates in 0.5-0.8 hours

26

Main difference between physostigmine and neo/pyridostygmine?

Physostigmine enters CNS while Neo/Pyridostygmine is peripherally restricted

27

Pyrido word root means?

Orally available, so Pyrido can be taken orally for fewer side effects and longer duration

28

Organophosphates irreversible or reversible acetylcholinesterase inhibitors?

Irreversible

29

How long do Organophosphates last?

Longer than a week

30

What are organophosphates used to treat on occasion?

Glaucoma

31

What else irreversibly binds to acetylcholinesterase? (2)

Nerve Gas
Insecticides

32

What is antidote for Acetylcholinesterase inhibitor poisoning?

Pralidoxime Chloride (2-PAM)

33

When is Pralidoxime Chloride antidote most effective?

Within a few hours of exposure

34

What do you give for symptoms of Acetylcholinesterase inhibitor poisoning?

Atropine due to fast acting nature

35

Effect of Pralidoxime Chloride on organophosphate?

Organophosphate bond to AchE is broken and Acetylcholinesterase is regenerated

36

Mnemonic for symptoms of Acetylcholinesterase inhibitor poisoning?

DUMBBELSS
D: Diarrhea
U: Urination
M: Miosis
B: Branchospasms
B: Bradycardia
E: Excitation of skeletal muscle and CNS
L: Lacrimation
S: Sweating
S: Salivation

37

Who is Acetylcholinesterase inhibitor poisoning most common in?

Farmers

38

What quaternary ammonium alcohol is used for diagnosis of myasthenia gravis?

Edrophonium (Tensilon)

39

What happens in Myasthenia Gravis?

Antibodies block Nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction

40

What does Myasthenia Gravis cause?

Muscle weakness

41

What does Edrophonium test differentiate between?

Myasthenia Gravis and Lambert Eaton

42

How does the Edrophonium differ between the two?

In MG exercise worsens muscle strength and Edro improves muscle strength while in Lambert Eaton exercise improves muscle strength while Edro has no effect on muscle strength

43

How do you treat MG?

Neostigmine/pyridostigmine

44

Effect of Edrophonium between cholinergic crisis and myasthenia crisis?

In CC Edro has no effect, maybe small muscle decrease
In MG Edro improves muscle strength

45

When do you want to avoid the use of parasympathomimetic drugs? (5)

Asthma/COPD
Coronary deficiency
Peptic Ulcer
Obstruction of urinary or GI tract
Epilepsy

46

Cholinergic centers in the CNS? (2)

Nucleus Basalis of Meynert/medial septal nuclei (basal forebrain)
Mesopontine tegmentum (brain stem)

47

Adrenergic centers in brain (1)?

Locus Coeruleus

48

What does Locus Coeruleus produce?

Norepinephrine

49

Alzheimer's disease is due to deficits in what?

Cholinergic

50

Most common cause of dementia after age 50?

Alzheimers

51

What brain changes are there in Alzheimer's?

Widening of sulk and thinning of gyri

52

What malfunction causes alzheimer's?

Improper processing of b-amyloid precursor protein (b-APP) leads to toxic form (b-A42) that promotes apoptosis

53

What pathologies will you see in Alzheimer's? (2)

B-amyloid plaques
Neurofibrillary tangles

54

What do you treat alzheimer's with?

ACHE inhibitors

55

What specific drugs can you give for Alzheimer's?

Donepezil
Rivastigmine
Galanthamine

56

What is Donepezil?

ACHE inhibitor
Reversible
Enhances cognitive ability
Doesn't slow disease

57

What is Rivastigmine?

Reversible
carbamate ACHE inhibitor
Loses effectiveness as disease progresses
Replaced by Eptastigmine

58

What is Galanthamine?

Reversible competitive ACHE inhibitor
Nicotinic receptor agonist
use with Inhibitors of P450 enzymes (increases bioavailability)