Day 3

Question 1

pancuronium

Answer 1

nondepolarizing NMJ blocker

i: required/desired muscle paralysis
ta: occupy muscle cholinergic receptor - prevent ACH attachment - not activated - flaccid paralysis = depolarization can’t occur
ci: MG, hep/renal dz, preg
c: malignant hyperthermia hx, f/e imbalance, pulmonary/cardiac dysfx, resp dz, lact
ae: r/t paralysis (GI, apnea, skin, wheezing, bronchospasm), hyperkalemia, histamine release, arrhy, hypoT
di: volatile liquid, aminoglycoside abx, CCBs inc paralysis; cholinesterase inhibitor dec; xanthine reverse, barbiturate precipitate, herb (melatonin, mirenia?) slow recovery
ni: contd card/resp/skin/eye monitor, TOF monitor twitch

Question 2

succinylcholine

Answer 2

depolarizing NMJ blocker

i: required/desired muscle paralysis
ta: attach to ACH receptor - prolong depolarization of muscle - muscle stimulation/contraction - flaccid paralysis; rapid onset/short duration
ci: low plasma cholinesterase lv dz (cirrhosis, burn, dehydration, cancer) prolong effect
c: fracture, eye (narrow glaucoma, penetrating eye injury) inc pressure, paraplegia, SCI
ae: same as NonNMJ, malignant hyperthermia, muscle pain, hyperkalemia
di: same as NonNMJ, cholinesterase inhibitor inc
ni: only drug in class