Muscle relaxant clinical use

Question 2

what can potentiate depolarizers (sux)?

Answer 2

cholinesterase inhibitors (Neostigmine)Aminoglycosides (mycins)Local anesthestheticsVolatile anesthticsMagnesiumlithiuim

Question 3

Uses for Sux?

Answer 3

facilitate intubation (RSI)short duration relaxant (bolus/gtt)exact timing of relaxationoverall ease of paralysis, recovery, and re-paralysis

Question 4

side effects of sux?

Answer 4

-allergy-FASICULATIONS-MUSCLE PAIN (MYALGIA)-bradycardia, brady arrythmias, asytole-HYPERKALEMIA (increases 1 mEq/L-Increased IOP-Increased intragastric pressure-Increased ICP-unmasked cholinesterase deficiences-sustained muscle contractions-MH RISK (masseter muscle spasm)

Question 5

how can you lessen the cardiac arrythmias, myalgia, and elevations of IOP, and intragastric pressure with SUX?

Answer 5

pretreat with Non-Depolarizer(will not affect K+ release)

Question 6

Which patients are at the highest risk of getting hyperkalemic with SUX?

Answer 6

up regulated pt’s (denervation injury)

Question 7

Contraindications for SUX?

Answer 7

-denervation after 24-28 hours-immobilization after 3 days-burns after 2 days-MH risk’-Homozygous atypical plasma cholinesterase deficiency-serum K+ >5.5

Question 8

down and dirty how do depolarizers work

Answer 8

bind to and activates sustained depolarization of nicotinic receptor

Question 9

down and dirty how do Non-depolarizers work

Answer 9

Bind to post synaptic nicotinic ACh receptors and competitively inhibit action of ACh

Question 10

with Non-depolarizing greater than what % of ACh receptors must be blocked to inpair motor nerve conduction?

Answer 10

75%

Question 11

what potentiates Non-depolarizing drugs?

Answer 11

-aminoglycerides (mycins)-local anesthetics-volatile anesthetics-Dantrolene (crazy b/c this is the reversal for MMH)-Magnesium-CCB

Question 12

Reasons to use Pancuronium (pavulon)?

Answer 12

-long paralysis-cardiac sx

Question 13

what Non-depolarizing drug would be good to use to balance out the narcotic induced bradycaria in patients?

Answer 13

pancuronium (pavulon) b/c it increases the HR

Question 14

Side effets of Pancuronium (pavulon)?

Answer 14

-increased HR r/t vagolysis at post ganglionic nerve terminal, muscarinic blockade, and catecholamine release-inhibits plasma cholinesterase

Question 15

Reasons to use for Vecuronium (Norcuron)?

Answer 15

-intermediate duration-CV stable-suitiable for ischemic heart disease-suitable for ambulatory surgeries-low incidence of residual muscle paralysis

Question 16

Side effects of Vecuronium (Norcuron)?

Answer 16

minimal to none

Question 17

Reasons to use Rocuronium (Zemuron)?

Answer 17

-1.7th potency of Vecuronium-NON-DEPOLARIZING RSI ABILITY-rapid onset (60 sec) with 1.5 mg/kg dose-can replace SUXs for RSI-CV stabe

Question 18

Side effects of Rocuronium (Zemuron)?

Answer 18

-minimal to none why the fuck not just use this!!!!!

Question 19

perfect test question**what is the main benefit of Cis-Atricurium (Nimbex)? and why?

Answer 19

organ independent metabolism–you don’t need organ function to metabolize b/c of Hofman elimination 2/3 (and 1/3 ester hydrolysis)

Question 20

what is Hofman elimination (associated with Cis-atricurium)

Answer 20

the drug is metabolized and removed independent of organs.

Question 21

what 2 factors can prolong Hofmann elimination?

Answer 21

hypothermiaacidosis