ANS Ganglionic and Neuromuscular Blockers

Question 1

Hexamethonium

Answer 1

ganglionic blocker. synthetic, antihypertensive agent

Question 2

Mecamylamine

Answer 2

ganglionic blocker. synthetic, absorbed via GI, crosses BBB, adjunct with nicotine patch

Question 3

Trimethaphan

Answer 3

ganglionic blocker. synthetic, short acting, IV only, treat hypertensive emergencies, reduce neurosurgery bleeding

Question 4

d-tubocurarine

Answer 4

non-depolarizing NMJ blocker. not absorbed from GI, no BBB cross, duration 45-60 min. muscle relaxant, allows lower dosage of anesthetics

Question 5

Cisatracurium

Answer 5

non-depolarizing NMJ blocker. duration 25-45 min, 1.5X potency of tubocurarine, less likely to cause histamine release, prolonged relaxation, more common. TX: prolonged apnea

Question 6

Vecuronium

Answer 6

non-depolarizing NMJ blocker. duration 20-35 min, eliminated by liver, 6X potency of tubocurarine

Question 7

Mivacurium

Answer 7

non-depolarizing NMJ blocker. rapid onset, short duration 10-20 min, met. by pseudocholinesterase

Question 8

Succinylcholine

Answer 8

depolarizing NMJ blocker. agonist at nAChR, initial fasciculations, rapid onset, short duration, met. by pseudocholinesterase, remains depolarized, flaccid paralysis. augmented by AchE inhibitors. after prolonged exposure repolarizes but desensitized. avoid! Adverse increase IOP, muscle pain, prolonged apnea, hyperthermia