Pharm

Question 1

atracurium

Answer 1

non-depolarizing agent: isoquinolone

AE: histamine release, SEIZURE due to laudanosine

Question 2

cisatracurium

Answer 2

non-depolarizing agent: isoquinolone
fewer AE than atracurium
HOFFMAN elimination: spontaneous breakdown (doesn’t change t1/2 in renal/hepatic problems)

Question 3

D-tubocurarine

Answer 3

non-depolarizing agent: isoquinolone

Question 4

pancuronium

Answer 4

non-depolarizing agent: steroid

AE: cardiac M receptor block

Question 5

rocuronium

Answer 5

non-depolarizing agent: steroid
not as potent as other steroid derivatives
AE: slight cardiac M receptor block, allergic reaction

Question 6

vecuronium

Answer 6

non-depolarizing agent: steroid

Question 7

succinylcholine

Answer 7

depolarizing agent
binds and opens nACh receptor and prevents repolarization after initial depolarization by preventing Na channel closure
SHORT duration
muscle contraction, then flaccid paralysis: twitches
AE: histamine release, stimulate cardiac M receptor, stimulate ganglia, MALIGNANT HYPERTHERMIA, HYPERKALEMIA (in injury), HTN, arrhythmia, brady or tachycardia, ANAPHYLAXIS, muscle pain
broken down by pseudocholinesterase
genetic variants of plasma cholinesterase: increase risk for long duration

Question 8

endophonium

Answer 8

reversal agent
AChE inhibitor
give ATROPINE
shorter onset and duration than other AChE inhibitors

Question 9

pyridostigmine

Answer 9

reversal agent
AChE inhibitor
give GLYCOPYRROLATE
longer onset and action

Question 10

neostigmine

Answer 10

reversal agent
AChE inhibitor
give GLYCOPYRROLATE

Question 11

sugammedex

Answer 11

reversal agent

capsule that prevents STEROIDAL NMB from accessing binding site on Ach nicotinic receptor

Question 12

malignant hyperthermia

Answer 12

SUCCINYLCHONLINE
uncontrolled Ca release from SR
brown urine, rise in body temp, muscle rigidity
Tx: DANTROLENE

Question 13

glycopyrrolate

Answer 13

anticholinergic

give with AChE inhibitor to reduce consequences of off target activation

Question 14

atropine

Answer 14

anticholinergic
non-sedating
give with endrophonium to reduce consequences of off target activation

Question 15

scopolamine

Answer 15

anticholinergic

crosses BBB: sedating

Question 16

duloxetine

Answer 16

serotonin-NE reuptake inhibitor (SER greater)
CYP metabolism; CYP2D6 inhibition
Tx: fibromyalgia
AE: increase HR and BP, SIADH (hyponatremia), suicidal ideation
CI: liver dysfunction, alcoholism, close angle glaucoma, MAOI

Question 17

milnacipran

Answer 17

serotonin-NE reuptake inhibitor (NE greater)
Tx: fibromyalgia
AE: increase HR and BP, SIADH (hyponatremia), suicidal ideation
CI: liver dysfunction, alcoholism, closed angle glaucoma, MAOI,

Question 18

pregabalin

Answer 18

inhibit glutamate presynaptically (inhibit L-type Ca channels)
Tx: fibromyalgia (off label)
CI: reduce in renal dysfunction
AE: rebound, dependence, suicidal thoughts, depression, dizzy, sedation, blurred vision, xerostomia
monitor: serum creatinine

Question 19

amitriptyline

Answer 19

tricyclic antidepressant
Tx: fibromyalgia (off label)
AE: anticholinergic

Question 20

cyclobenzaprine

Answer 20

skeletal muscle relaxer
related to TCA, central action at brain stem
CYP metabolism
Tx: fibromyalgia (off label)
AE: anticholinergic (GI most significant)
CI: anticholinergics, 1st gen antihistamine, tricyclics (prolong QT)

Question 21

fluoxetine

Answer 21

SSRI (SER reuptake inhibitor)

Tx: fibromyalgia

Question 22

skeletal muscle relaxers

Answer 22

AE: sedation

Question 23

dantrolene

Answer 23

ryanodine receptor: block release of Ca from SR
Tx: spasticity, malignant hyperthermia
AE: thrombophlebitis (need slow infusion), liver, floppy child syndrome (C-section), muscle weakness
CI: Ca channel blocker
monitor: LFTs

Question 24

botulinum toxin (botox)

Answer 24

block fusion of vesicles with end of presynaptic terminal

Tx: spasticity

Question 25

baclofen

Answer 25

GABA(B) agonist: inhibitory signals or reduces excitatory glutamate pathways inhibition of substance P: pain relief AE: dependence Tx: spasticity AE: rebound neural activity results in seizure, confusion, hallucinations, increased spasticity (TAPER down), increase blood glucose; drowsy, dizzy, confusion CI: adjust in diabetic agents, CNS toxicity in renal failure

Question 26

tizanidine

Answer 26

``` skeletal muscle relaxer pre-synaptic alpha 2 agonist AE: decreased sympathetic outflow, liver, taper cessation, xerosomia, dizzy, sedation, hypotension monitor: LFTs Tx: spasticity ```

Question 27

methocarbamol

Answer 27

skeletal muscle relaxer sedation, altered pain perception AE: irritable, blurred vision, dizzy CI: hepatic/renal dysfunction increases toxicity

Question 28

non-depolarizing agents

Answer 28

prevents any activation of muscle contraction by preventing opening of channel

Question 29

reversal agents

Answer 29

given post procedure to reverse residual effects of paralytic agents

Question 30

Nm

Answer 30

nicotinic M receptors found on skeletal muscle site of action of paralytics

Question 31

phase I NM blockade by succinylcholine 1. EPP 2. onset 3. dose-dependence 4. recovery 5. TOF 6. AchE inhibition 7. muscle response

Answer 31

``` EPP: -55mV onset: immediate dose-dependence: low recovery: rapid TOF: no fade AchE inhibition: augments muscle response: fasciculations, then flaccid paralysis ```

Question 32

phase II NM blockade by succinylcholine 1. EPP 2. onset 3. dose-dependence 4. recovery 5. TOF 6. AchE inhibition 7. muscle response

Answer 32

``` EPP: -80mV onset: slow dose-dependence: high recovery: long TOF: fade, PTP follows fade AchE inhibition: reverses muscle response: flaccid paralysis ```

Question 33

laudanosine

Answer 33

product of atracurium | causes seizures

Question 34

dibucaine test

Answer 34

enzyme inhibitor identify genetic variants of plasma cholinesterase important in succinylcholine use

Question 35

steroid derivatives

Answer 35

more potent | hepatic and renal elimination

Question 36

isoquinilone derivatives

Answer 36

spontaneous elimination

Question 37

effect of blocking/stimulating cardiac M receptor

Answer 37

block: tachycardia stimulate: bradycardia

Question 38

effect of histamine release

Answer 38

hypotension | edema

Question 39

Off target actions of AchE inhibitors

Answer 39

``` bradycardia bronchospasm increased secretions pupillary constriction increase peristalsis and bladder tone cerebral excitation ```

Question 40

therapeutic use of NMBs

Answer 40

IV adjuvant to surgical anesthesia (no pain relier or amnesia) short orthopedic procedures endotracheal intubation

Question 41

What causes death with NMB overdose?

Answer 41

diaphragm paralysis

Question 42

carisoprodol

Answer 42

skeletal muscle relaxer sedation and altered pain perception by CNS action on reticular activating system and spinal cord CYP2C19 metabolism AE: drowsy, dizzy, CNS, vision loss, mydriasis, orthostatic hypotension CI: renal/hepatic dysfunction increases toxicity