Lesson 5: NMBA's and CNS Affecting Drugs

Question 1

What are the two types of NMBAs

Answer 1

Nondepolarizing and depolarizing

Question 2

What do NMBAs do

Answer 2

Cause skeletal muscle weakness or paralysis

Question 3

What is another name for NMBAs

Answer 3

Paralytics or muscle relaxants

Question 4

CNS and PNS consist of what

Answer 4

CNS: brain, spinal cord
PNS: Somatic nervous system - voluntary control
Autonomic nervous system- involuntary
control

Question 5

Parts of a neuron include

Answer 5

Cell body
Axons
Dendrites

Question 6

What is the synapse

Answer 6

Area between nerve and muscle

Question 7

NM junction is

Answer 7

Area between axon and skeletal muscle fiber

Question 8

What is the action of nondepolarizing agents

Answer 8

Binding and blocking of the Ach receptors without depolarization

Question 9

What is the action of depolarizing agents

Answer 9

Sustained depolarization of the NM junction

Question 10

How do nondepolarizing agents work

Answer 10

Paralyze skeletal muscle by simple competitive inhibition of Ach at muscle receptor sites, agents block the depolarizing effects of Ach and prevent muscle contraction.

Question 11

What are the nondepolarizing meds

Answer 11

Atracurium
Cisatracurium
Mivacurium
Pancuronium
Rocuronium
Vecuronium

Question 12

What nondepolarizing agent has the shortest duration

Answer 12

Mivacurium

Question 13

What depolarizing agent has the longest duration

Answer 13

Pancuronium

Question 14

What are adverse effects of nondepolar. agents

Answer 14

May cause vagolytic effect: tachycardia
Histamine release: all NMBAs cause histamine
release from mast cells
Inadequate ventilation: paralysis of diaphragm

Question 15

How are nondepolar. agents reversed?

Answer 15

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

Question 16

What are the nondepolar. reveral agents

Answer 16

Neostigmine
Edrophonium (Tensilon test)
Pyridostigmine

Question 17

What is another types of nondepolar reversal agent, not mentioned before, and what two nondepolar agents can it only reverse

Answer 17

Sugammadex (Bridion)

Can only reverse Rocuronium and Vecuronium

Question 18

What drug is used as a treatment for Myasthenia Gravis

Answer 18

Pyridostigmine (Nondepolar. reversal agent)

Question 19

What is the only depolarizing agent, what is the duration

Answer 19

Succinycholine, shorter acting than nondepolar agents.

Question 20

What patients is succinycholine ideal for

Answer 20

Patients req. intubation

Question 21

What is the reversal agent for succinycholine

Answer 21

None available

Question 22

What is phase 1 of a depolarizing agent

Answer 22

Succinylchoine remains on receptor, causing prolonged depolarizing and paralysis. Doesnt allow membrane to repolarize resulting in paralysis

Question 23

What does the depolarizing agent bind to, to active it

Answer 23

Ach

Question 24

What is succinycholine metabolized by

Answer 24

plasma cholinesterase (pseudocholinesterase)

Question 25

What disease processes do NMBAs work well in mech vent with

Answer 25

ARDS
Status asthmaticus
Status epilepticus
NM toxins
Tetanus

Question 26

What do we use in conjunction with the NMBA

Answer 26

Analgesics or Amnestic sedatives

Question 27

What is the Train of Four method

Answer 27

Measures amount of eyelid twitches while on NMBAs

0 twitch = 100% block
1 twitch = 95% block
2 twitch = 90% block
etc

Question 28

Two types of psychiatric meds (anxiolytics)

Answer 28

Benzons and Barbiturates

Question 29

Benzos include

Answer 29

-Pams
Xanax
Valium
Ativan
Versed

Question 30

What is the reversal agent for benzos

Answer 30

Flumazenil

Question 31

What is used for consiois sedation

Answer 31

Versed