Muscle Relaxants Flashcards
What are the cardiovascular side effects of Succinylcholine? (Depolarizing)
1) Low doses: Negative chronotropic/inotropic effects
2) High doses: Higher heart rate, contractility, and circulating catecholamine
3) Children: Bradycardia
What are the side effects of Succinylcholine? (Depolarizing)
1) Fasciculations
2) Muscle pains
3) Hyperkalemia
4) Malignant hyperthermia
5) Increased ICP
6) Increased intragastric pressure
7) Increased intraocular pressure
What are some conditions that cause succinylcholine-induced hyperkalemia?
1) Burns
2) Trauma
3) Neurological conditions
4) Pre-existing hyperkalemia
How is Atracurium metabolized?
Hoffman elimination (independent of renal and biliary routes)
What are the side effects of Atracurium?
1) Hypotension
2) Reflex tachycardia
3) Cutaneous flush
4) Laudanosine toxicity
Which drug is a stereoisomer of Atracurium?
Cisatracurium
Cisatracurium is how many times more potent than Atracurium?
4 times
How is Cisatracurium metabolized?
Hoffman elimination
Which drug produces dose-dependent increase in histamine:
Atracurium or Cisatracurium?
Atracurium
How is Mivacurium metabolized?
Pseudocholinesterase
Mivacurium can be markedly prolonged by:
Prior admission of pancuronium
How is Doxacurium metabolized?
Renally
What is the onset for Doxacurium?
4-6 minutes
What is the duration of Doxacurium?
60-90 minutes
What are the cardiac and histamine-release side effects of Doxacurium?
There are none
Which drugs have a benzylisoquinolone base?
1) Atracurium
2) Cisatracurium
3) Mivacurium
4) Doxacurium
Which drugs have a steroidal base?
1) Pancuronium
2) Pipercuronium
3) Vecuronium
4) Rocuronium
How is Pancuronium metabolized?
Renally (major) and biliary (minor)
If a patient with cirrhosis is given Pancuronium, do we give a higher or a lower dose?
Higher
What are the side effects of Pancuronium?
1) Hypertension
2) Tachycardia
3) Arrhythmias
4) Allergic reactions (bromide)
How is Pipercuronium metabolized?
Renally
What are the cardiovascular side effects of Pipercuronium?
None
How is Vecuronium metabolized?
Renally and Biliary
What are the side effects of Vecuronium?
1) Potentiation of opioid-induced bradycardia
2) Long term administration = buildup of active
3-hydroxy metabolite = elongates drug clearance
= polyneuropathy
Rocuronium is an analogue of ___ designed for:
Vecuronium; rapid onset
Why is Rocuronium better long-term?
Because there are no active metabolites
How is Rocuronium metabolized?
Hepatic and renal
