Succinylcholine Flashcards

1
Q

What is the drug class of Succ?

A

the only depolarizing neuromuscular blocker that is used clinically

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2
Q

What is the MOA of Succ?

A

attaches to one or both of the alpha subunits of the nicotinic, Ach receptors, and mimics the action of Ach (partial agonist). It depolarizes the post-junctional membrane causing a brief pd of excitation (fasciculations in muscle cells), followed by flaccid paralysis. The paralysis occurs b/c the open cholinergic channels maintain the cell membrane in a depolarized state effecting the inactivation of VG-Na channels so that they cannot open to support further action potentials

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3
Q

How is succ metabolized and eliminated?

A

-metabolized rapidly by hydrolysis via plasma cholinesterases (pseudo-cholinesterases), an enzyme synthesized by the liver. It is not present in significant amounts at the NMJ

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4
Q

How are the effects of Succ terminated?

A

by diffusion away from the NMJ (redistribution) and into the ECF

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5
Q

What is the Vd of Succ?

A

similar to ECF 200ml/Kg

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6
Q

What are the side effects of Succ?

A
  • Cardiac Dysrhythmias (sinus BRADY, junctional, sinus arrest) due to mimicking of Ach at cardiac muscarinic receptors and hyperkalemia
  • Hyperkalemia!!! avg increase of 0.5-1 meq/L (increased risk with burns, trauma, NM disease, Muscular dystrophy, prolonged immobility)
  • Masseter spasms
  • Increased IOP, ICP, IGP
  • Malignant Hyperthermia!!!
  • Histamine release
  • Myalgia
  • Myoglobinuria
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7
Q

What are the contraindications to the use of Succ?

A
  • Hyperkalemia
  • 3rd degree burns
  • Severe muscular disorders
  • Stroke (CVA)
  • Neurologic injury (quads/paraplegic)
  • muscle wasting
  • MH
  • Children under 8
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8
Q

What are the common drug interactions with Succ?

A
  • anticholinesterases increase relaxation and prolong effects of succ
  • anticonvulsants may increase hyperkalemia and prolong Succ
  • Lithium prolongs succ
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9
Q

What is the intubating dose of Succ?

A

1-1.5 mg/kg IV

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10
Q

What is the onset of succ?

A

30-60 secs

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11
Q

What is the E 1/2 t of succ?

A

2-4 minutes

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12
Q

What is the DOA of succ?

A

4-8 mins (8-15 min)

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13
Q

What is the Laryngospasm dose of succ?

A

20-40 mg IV

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14
Q

What is the cont. infusion dose of succ?

A

2-4mg/min (dilute 1-2mg/ml)

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15
Q

Who do you want to avoid giving succ to? Why?

A

Peds:

  • contraindicated in routine managemnt due to SE
  • must give with Atropine 0.02mg/kg
  • MH trigger
  • may result in malignant ventricular arrhythmias and cardiac arrest 2dary to acute rhabdomyolysis with hyperkalemia
  • can result in profound bradycardia and asystole!!!!
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