Muscle Relaxants Flashcards
What are the 2 types of skeletal muscle relaxants and how are they used?
- Neuromuscular blocker: used during surigal procedures and in ICUs to cause paralysis; Antagonist and Agonist
- Spasmolytics: used to reduce spasticity in a variety of neurologic conditions; Chronic and Acute
Whata re the non-depolarizing blockers Benzylisoquinolines and Ammonio Steroids?
Benzylisoquinolines
- Tubocuraine, Atracurium, Cisatracurium, Mivacurium
Ammonio Steroids
- Pancuronium, Rocuronium, Vecuronium
Nondepolarizing blockers MOA?
MOA: competitive antagonist of ACh receptors > motor weakness > totally flaccid and inexcitable to stimulation
Depolarizing blockers MOA?
MOA: Succinylcholine (not metabolized effectively by AChE) activates the nicotinic receptors and depolarizes the junction > fasciculations > membrane remain depolarized/unresponsive to additional impulses > flaccid paralysis; onset is rapid in less than a minute
What are the short, intermediate, and long-acting non-depolarizing blockers?
Short:
- Mivacurium
Intermediate:
- Atracurium, Cisatracurium, Rocuronium, Vecuronium
Long:
Tubocurarine, Pancuronium
- Atricurium is inactivated by hydrolysis by __________ and by spontaneous reaction with one of it metabolites being _______ which causes _______ and ________
- Cisatracurium is stereoisomer that forms less _________
- Atricurium is inactivated by hydrolysis by non-specific plasma esterases and by spontaneous reaction with one of it metabolites being Laudanosine which causes hypotension and seizures
- Cisatracurium is stereoisomer that forms less Laudanosine
- Mivacurium is the only nondepolarizing blocker classified as short acting and is hydrolyzed in the plasma by _______?
- _____ has the most rapid onset among nondepolarizing blockers?
- Mivacurium is the only nondepolarizing blocker classified as short acting and is hydrolyzed in the plasma by Butyrylcholinesterase?
- Rocuronium has the most rapid onset among nondepolarizing blockers?
- Succinylcholine (DB) has sort duration of 5-10 minutes due to hydrolysis by _________?
- Abnormal variant of _________ can cause prolonged blockade when using Succinylcholine or Mivacurium but can tx with ______ until muscle function returns
- Succinylcholine (DB) has sort duration of 5-10 minutes due to hydrolysis by butyrylcholinesterase
- Abnormal variant of butyrylcholinesterase can cause prolonged blockade when using Succinylcholine or Mivacurium but can tx with mechanical ventilation until muscle function returns
- _______ may cause hypotension due to ______ and ganglionic blockade with _____ and _____ to a lesser extent
- ________ causes moderate tachycardia due to blockade of cardiac M2 receptors
- Tubocurarine may cause hypotension due to histamine release and ganglionic blockade with Mivacurium and Atracurium to a lesser extent
- Pancuronium causes moderate tachycardia due to blockade of cardiac M2 receptors
Succinylcholine AE
- Bradycardia
- Histamine release
- Muscle pain
- Hyperkalemia
- Increased intraocular pressure
- Increased intragastric pressure
- Malignant hyperthemia
Muscle relaxants for DI with….
- drugs that enchance neuromuscluar blockade
- Inhaled anesthetics
- Aminoglycosides
- Tetracyclines
Depolarizing blockers CI?
- Hx of malignant hyperthermia
- Hx of skeletal muscle myopathies
- Major burns
- Mutliple trauma
- Denervation of skeletal muscle
- UMN injury
Uses of neuromuscluar blockers?
- Adjuvants in surgical anesthesia
- Succinylcholine used to facilitate endotracheal intubation
What should be used to reverse nondepolarizing neuromuscluar blockade?
- Neostigmine or Edrophonium for competitive blockade
- Atropine or Glycopyrrolate uses concomitantly to prevent bradycardia
