Pharm NMJ part I Flashcards Preview

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Flashcards in Pharm NMJ part I Deck (50)
1

What are the nondepolarizing NMJ blocking drugs

cisatracurium
tubocurarine
pancuronium
rocuronium
vecuronium

2

which nondepolarizing blocking drugs are steroid derivatives

pancuronium
rocuronium
vecuronium

3

what is the depolarizing NMJ blocking drug

succinylcholine

4

what drugs do we have that are muscle relaxants aka spasmolytics

dantrolene
botulinum toxin

5

What are the AChEI

echothiophate
edrophonium
neostigmine
physostigmine
pyridostigmine

6

what are the antimuscarinic agents

atropine

7

what are the cholinesterase reactivators

pralidoxime

8

what are the 2 main therapeutic groups of drugs that affect skel mm function

NMJ blockers
spasmolytics

9

how do nondepolarizing NMJ blockers work

antagonists of nAChR

10

how do depolarizing NMJ blockers work

excess depolarizing agonist, so AchR taken up

11

What makes NMJ blockers hard to enter CNS

one or 2 quaternary nitrogens,, poorly lipid soluble

12

how are NMJ blockers administered

parenterally because highly polar and inactive orally

13

what muscles are more R to NMJ blockades

trunk, paraspinals and diaphragm

14

what is the last muscle to be paralyzed and quickest to recover from a NMJ blockade

diaphragm

15

what is the least potent nondepolarizing NMJ blocker

rocuronium

16

how do you reverse a NMJ blockade

Ach or succinylcholine

17

what cholinesterase inhibitors can antagonize nondepolarizing blockers blockade

neostigmine and pyridostigmine because increase ACh availability and increase release of NT from motor nerve terminal

18

why is edrophonium less effective in reversing the effects of nondepolarizing blockers

no effect on NT release

19

what is given to minimize adverse effects of cholinesterase inhbitors

anticholinergic agents like atropine

20

what are the adverse effects of cholinesterase inhibitors

bradycardia, bronchoconstriction, salivation, nausea, vomiting

21

adverse effects nondepolarizing NMJ blockers

histamine release which can cause wheal reaction, bronchospasm, hypotension and bronchial and salicary secretion

22

at large doses tubocurarine and metocurine can cause what

ACh blockade at autonomin ganglia in adrenal medulla causing a dec in BP and tachycardia

23

why is d tubocurarine not used anymore

long duration and caused significant histamine release

24

what drugs can potentiate the NMJ blockade from nondepolarizing afents

inhaled anesthetics
aminoglycosides

25

be careful with NMJ blockers in what population subtype

elderly because longer duration from decreased hepatic and renal clearance

26

what patients are resistant to nondepolarizing muscle relaxants

patients with severe burns and with UMN disease

27

which nondepolarizing NMJ blocker has very little to no CV effects

cisatracurium

28

which nodepolarizing relaxant has the shortest duration of action

mivacurium

29

inermediate acting steroid muscle relaxants are excreted how

biliary excretion or hepatic metabolism

30

what metabolizes steroid mm relaxants

3- 17- or 3,17 hydroxy derivatives

31

which muscle relaxant is least likely to cause histamine release

steroidal NMJ blockers

32

agent of choice for patients with normal renal and hepatic function requireing paralysis for more than one hour

pancuronium

33

adverse effects pancuronium

tachy
HTN
increased CO from vagal blockade

34

most rapid time onset steroidaly relaxant

rocuronium

35

common use rocuronium

used to facilitate a difficult tracheal intubation because rapid acting
basically no CV effects

36

alternative to rocuronium for intubation

vecoronium

37

PK of succinylcholine

short duration because rapid hydrolysis and inactivation by butyrylcholinesterase

38

What is the phase I block for succinylcholine

depolarizes motor end plate and spreads to adjacent membranes. remain depolarized (block)

39

what augments the phase I depolarizing block ofd succinylcholine

cholinesterase inhibitors

40

what is the phase II desensitizing block of succinylcholine

continued exposure causes intiial depolarization to decrease and membrane repolarized. R has to be desensitized until it can depolarize again

41

what reverses the phase II block by succinylcholine

AChE inhibitors

42

what occurs with standad dose IV succinylcholine

fasciculations within 30 sec then paralysis withing 90 sec
initiall arm and neck, leg muscles then respiratory muscles

43

when is succinylcholine used

EM surgery when need to secure airway rapidly

44

what degrades succinylcholine

plasma cholinesterases

45

CV effects of succinylcholine

cardiac arrhythmias when administered with halothane anesthesia
negative inotropic and chronotropic effects
large doses cause positive inotropic and chronotropic effects

46

What acid base status does succinylcholine cause

hyperkalemia

47

adverse effects succinylcholine

increased intraocular P
increased intragastric P
muscle pain
slight histamine release

48

CI to succinylcholine

personal or familial Hx of malignant hyperthermia
myopathies with elevated CPK values
acute phase injury following major burns
multiple trauma
extensive denervation of skel mm or UMN injury

49

black block warning on succinylcholine

acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death if administered to child with undiagnosed skel mm myopathy

50

what drug if used with succinulcholine can induce malignant hypertermia

volatile anesthetics