Neuromuscular Blockers

Question 1

✓ Treat spasticity and muscle spasms
✓ Not recommended as a first line

Answer 1

Diazepam ( Valium)

Question 2

Adverse effects of diazepam are

Answer 2

✓ Sedation
✓ Dependence
✓ Abuse

Question 3

Is an analogue of GABA that bind into GABA b presynaptic and postsynaptic.

Answer 3

Baclofen

Question 4

Has an analgesic effect by inhibition releasing of substance P .

Answer 4

Baclofen

Question 5

Adverse effect of baclofen are

Answer 5

Sedation
Drowsiness
Confusion
Depression
Gastrointestinal disturbances
Hyperactivity and seizures

Question 6

Is an alpha 2-adrenoreceptor agonist

Answer 6

Tizanidine

Question 7

Inhibit presynaptic release of excitatory neurotransmitter leading to reduce the excitability of postsynaptic alpha - motor neurons

Answer 7

Tizanidine

Question 8

Adverse effects of Tizanidine

Answer 8

Dry mouth
Hypotension
Drowsiness
Fatigue
Dizziness

Question 9

Has only 10% of the antihypertensive activity of the alpha 2 adrenoceptor agonist clonidine

Answer 9

Tizanidine

Question 10

Uses of centrally acting skeletal muscle relaxant

Answer 10

Spasticity
Hemiplegia
Amyotrophic lateral sclerosis and MS

Question 11

Metabolized by plasma hydrolysis by nonspecific esterase’s

Answer 11

Atracurium and cisatracurium

Question 12

Metabolized in liver

Answer 12

Vecuronium

Question 13

Like suxamethonium is metabolized by Cholinesterase

Answer 13

Mivacurium

Question 14

Prolong action of ACh and rapidly reverse competitive neuromuscular junction blockade

Answer 14

Neostigmine

Question 15

Specific antagonist for the rocuronium and vecuronium by chelating them in the core and reducing their plasma concentration. The complex is then eliminated by the kidneys

Answer 15

Sugammadex

Question 16

Adverse effects of non depolarizing NMBs

Answer 16

✓ Histamine release leading to hypotension and bronchospasm
✓ Respiratory paralysis in high doses

Question 17

Contraindications of non depolarizing NMBs

Answer 17

✓ Bronchial asthma
✓ Myasthenia gravis
✓ With Amino glycosides or quinidine ( they can aggravate Ms paralysis.

Question 18

It is ester of ACh

Answer 18

Suxamethonium (succinylcholine)

Question 19

Metabolized by plasma pseudo ChE enzyme

Answer 19

Succinylcholine

Question 20

Reversal block of succinylcholine by

Answer 20

Neostigmine block in phase 2
Fresh blood transfusion

Question 21

Adverse effects of succinylcholine are

Answer 21

Bradycardia
Acute hyperkalemia
Sudden arise of IOP
Postoperative muscle pain
Prolonged respiratory paralysis
Malignant hyperthermia

Question 22

Contraindications f using succinylcholine

Answer 22

Glaucoma or recent eye surgery
Congenital deficiency of PsChE enzyme

Question 23

Therapeutic uses of neuromuscular blockers

Answer 23

Endotracheal intubation
To induce skeletal muscle relaxation
To control convulsions during ECT

Question 24

Inhibitors of acetylcholine release

Answer 24

Botulinum toxin

Question 25

Therapeutic uses of botulinum toxin

Answer 25

✓Injected locally ✓Treat involuntary movements such as blepharospasm ✓To relieve focal spasticity ✓To temporarily remove wrinkles ✓ Facial muscles for the prophylaxis of migraine ✓ Intravesical injection to treat overactive bladder syndrome

Question 26

It is an antagonist at the ryanodine receptor that inhibits the release of Ca from the sarcoplasmic reticulum of the skeletal muscle.

Answer 26

Dantrolene

Question 27

Therapeutic uses of dentrolene

Answer 27

✓ Treatment of malignant hyperthermia and neuroleptic malignant syndrome ✓Management of spasticity from disorders

Question 28

Adverse effects of dentrolene

Answer 28

✓ Sk Ms weakness, dyspnea, dysphasia, somnolence ✓ dose dependent diarrhea, abdominal pain ✓ dose related risk of hepatitis