Misc CNS - NMB + muscle relaxer Flashcards
centrally acting muscle relaxants
drugs
1 benzodiazepines 2 baclofen 3 cyclobenzaprine (no more than 3 wks) 4 tizanidine 5 carisoprodol (no more than 3 wks)
peripherally acting muscle relaxant
drug
dantrolene
*baclofen
Tx
- muscle spasm
- spinal injury
- muscle spasticity r/t cerebral palsy, spincal cord injury, + multiple sclerosis
*baclofen
AE
VERY SLEEPY CNS DEPRESS dissy weak seizure
*baclofen
RN/teaching
no ETOH
don’t drive!!! (CNS DEPRESS + SLEEEEPY)
*cyclobenzaprine
AE
shouldn’t use more than 3 weeks
-no evidence that it works beyond that
liver toxicity
anti ACH
photosensitivity
muscarinic agonist aka
“i cant pee… help me!”
urinary retention
muscarinic agonist
drug
BETHANECHOL
*-chol like cholinergic
pilocarpine
acetylcholine
muscarinic agonist
MOA
incr bladder pressure + contraction of detrusor muscle
-helps w excretion of urine
muscarinic agonist
AE
sludge, dumbbells, ACH crisis
muscarinic agonist
CI
asthma + hyperthyroidism
muscarinic agonist
RN
admin 1 hr before or 2hr after meals
muscarinic antagonist aka
im peeing toooo much
- incontinence
- ANTI CHOLINERGIC
*muscarinic antagonist
drugs (3)
OXYBUTIN
darifenacin
solifenacin
muscarinic antagonist
AE
- mydriasis
- delirium
- flushing
- hyperthermia
- decr secretions
- dry mouth
- dry eyes
- anhidrosis
- photophobia
- constipation
- tachycardia
NMB
Neuromuscular Blockers
2 types of NMB
1 Depolarizing
2 Non-Depolarizing
Depolarizing NMB
drugs
Succinylcholine
-RSI Intubation
Non-Depolarizing NMB
drugs (5)
1 atracurium 2 cisatracurium 3 rocuronium (RSI Intubation) 4 vecuronium 5 pancuronium
*Succinylcholine
AE
- hyper-K
- MALIGNANT HYPERTHERMIA
- muscle pains
*Malignant Hyperthermia
s/s
- muscle rigidity
- incr in temp
-if intubated also rise in ETCO2is first
*Malignant Hyperthermia
Tx
- Dantrolene
- ice packs all over
- chilled IV soln
- room temp down
- bair hugger off
*Succinylcholine
CI
can cause hyper-K
—so contraindicated in crush injuries, poly-trauma, burns, K>5.5, MG patients
NMBs + CNS
safety equipments
- crash cart aka emergency resuscitative equipt
- BVM ambubag
- O2 w connection ““X-mas tree”
- suction set-up w yankauer suction tip catheter
- bedside hrt monitor
- constant SpO2
- train of 4
- reversal meds
*NMBs + CNS
reversal medications
old skool: NEOSTIGMINE, Panc, Atra
new skool: SUGAMMADEX, Roc, Vec
**must be on EKG, SpO2, BIS (in OR)
why is lidocaine often used in intubation?
shown to decr ICP + cough reflex
*why is fentanyl often used in intubation?
- decr BP secondary to catecholamine release
- for PAIN + SEDATION
- patient doesn’t lose consciousness, can still feel everything!
succs is a paralytic, if ____ occurs then _____ is happening
muscle rigidity
malignant hyperthermia
if you paralyze the patient, what drug would you want in the room?
SUGAMMADEX is used to reverse paralysis
what drug class is fentanyl?
opioid
anticholinergics/antimuscucarinic
drugs
DICYCLOMINE,
atropine
benztropine
trihexyphenidyl
ipratropium
oxybutynin
glycopyrrolate
which anticholinergics/antimuscucarinic
drug can cross BBB
DICYCLOMINE
anticholinergics/antimuscucarinic
CNS effects
confusion, hallucination, insomnia
anticholinergics/antimuscucarinic
CI
- glaucoma
- myasthenia gravis
- BPH
- GI/GU obstruction
- antihistamines
- 1st gen TCA
- antipsychotic
