Lesson 5: NMBA's and CNS Affecting Drugs Flashcards
What are the two types of NMBAs
Nondepolarizing and depolarizing
What do NMBAs do
Cause skeletal muscle weakness or paralysis
What is another name for NMBAs
Paralytics or muscle relaxants
CNS and PNS consist of what
CNS: brain, spinal cord
PNS: Somatic nervous system - voluntary control
Autonomic nervous system- involuntary
control
Parts of a neuron include
Cell body
Axons
Dendrites
What is the synapse
Area between nerve and muscle
NM junction is
Area between axon and skeletal muscle fiber
What is the action of nondepolarizing agents
Binding and blocking of the Ach receptors without depolarization
What is the action of depolarizing agents
Sustained depolarization of the NM junction
How do nondepolarizing agents work
Paralyze skeletal muscle by simple competitive inhibition of Ach at muscle receptor sites, agents block the depolarizing effects of Ach and prevent muscle contraction.
What are the nondepolarizing meds
Atracurium
Cisatracurium
Mivacurium
Pancuronium
Rocuronium
Vecuronium
What nondepolarizing agent has the shortest duration
Mivacurium
What depolarizing agent has the longest duration
Pancuronium
What are adverse effects of nondepolar. agents
May cause vagolytic effect: tachycardia
Histamine release: all NMBAs cause histamine
release from mast cells
Inadequate ventilation: paralysis of diaphragm
How are nondepolar. agents reversed?
Neuromuscular blockade are reversed with cholinesterase inhibitors. It breaks down Ach, blocking cholinesterase would allow more Ach at NMJ to displace the the blocking agents
What are the nondepolar. reveral agents
Neostigmine
Edrophonium (Tensilon test)
Pyridostigmine
What is another types of nondepolar reversal agent, not mentioned before, and what two nondepolar agents can it only reverse
Sugammadex (Bridion)
Can only reverse Rocuronium and Vecuronium
What drug is used as a treatment for Myasthenia Gravis
Pyridostigmine (Nondepolar. reversal agent)
What is the only depolarizing agent, what is the duration
Succinycholine, shorter acting than nondepolar agents.
What patients is succinycholine ideal for
Patients req. intubation
What is the reversal agent for succinycholine
None available
What is phase 1 of a depolarizing agent
Succinylchoine remains on receptor, causing prolonged depolarizing and paralysis. Doesnt allow membrane to repolarize resulting in paralysis
What does the depolarizing agent bind to, to active it
Ach
What is succinycholine metabolized by
plasma cholinesterase (pseudocholinesterase)
What disease processes do NMBAs work well in mech vent with
ARDS
Status asthmaticus
Status epilepticus
NM toxins
Tetanus
What do we use in conjunction with the NMBA
Analgesics or Amnestic sedatives
What is the Train of Four method
Measures amount of eyelid twitches while on NMBAs
0 twitch = 100% block
1 twitch = 95% block
2 twitch = 90% block
etc
Two types of psychiatric meds (anxiolytics)
Benzons and Barbiturates
Benzos include
-Pams
Xanax
Valium
Ativan
Versed
What is the reversal agent for benzos
Flumazenil
What is used for consiois sedation
Versed
