Muscle Relaxants Flashcards

1
Q

What is the primary use of Neuromuscular Blockers?

A

adjunct to general anesthesia to relax muscles without cardiorespiratory depression
Lack CNS activity

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2
Q

Spasmolytic indications

A

Chronic Back Pain
Fibromyalgia
Muscle Spasms
“Central Acting” muscle relaxants

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3
Q

2 categories of Neuromuscular blockers

A
  1. Nondepolarizing agents

2. Depolarizing agents

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4
Q

Nondepolarizing agent mechanism

A

Competitive antagonist at the nAChR that blocks depolarization

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5
Q

Depolarizing agent mechanism

A

causes excess depolarization with no repolarization. Leads to flaccid paralysis

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6
Q

What duration of action is most preferred for the neuromuscular blocking agents?

A

Intermediate- 20-60m

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7
Q

Adverse effects of Neuromuscular blockers

A
Effects lasting too long
Hypotension with Tachy
Histamine release (bronchoconstriction, salivary secretion)
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8
Q

What is used to reverse NMJ blockage

A

AChE inhibitors

Anticholingeric co-administered to minimize mAChR overactivation

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9
Q

What is the most clinically relevant depolarizing agent?

A

Succinylcholine

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10
Q

Phase 1 Block of Succinylcholine

A

Depolarizes membrane and prevents repolarization

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11
Q

Phase 2 Block of Succinylcholine

A

membrane repolarizes but is desensitized and doesn’t depolarize, similar to nondepolarizing block. Reversed by AChE inhibitor

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12
Q

4 uses for NMBDs

A
  1. Surgical relaxation
  2. Tracheal Intubation
  3. Control of Ventilation
  4. Treatment of Convulsions
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13
Q

Drugs used for rapid intubation

A

Succinylcholine
Rocuronium
Vecuronium

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14
Q

Drugs used as adjuncts to anesthesia

A

Pancuronium
Atracurium
Cisatracurium

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15
Q

Spasmolytic Agents

A

relax spastic muscle seen in cerebral palsy, MS, and stroke. Can be centrally acting or non-centrally acting

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16
Q

Centrally acting spasmolytic agents

A

Baclofen (GABAb agonist)
Carisoprodol (unknown MOA)
Cyclobenzaprine aka Flexeril (unknown MOA)
Diazepam (Benzo)

17
Q

Non-centrally acting spasmolytic agents

A

Dantrolene- Ryanodine receptor antagonist that inhibits Ca release from SR

Botox- inhibits ACh release

18
Q

Agents for MS

A

Glucocorticoids (in acute attack)
Interferons- interferes with T-cell adhesion
Glatiramer Acetate- activates Tregs to save MBP
Mitoxantrone- DNA intercalating agent

19
Q

Adverse effects of non depolarizing agents

A

Histamine release–> wheals, bronchospasm, hypotension, bronchial/salivary secretion

20
Q

Drug-Drug interactions with Non-depolarizing NMBD

A

Aminoglycosides and some other classes of ABX

21
Q

How do burn patients or those with UMN diseases react to non depolarizing NMBD?

A

They are resistant

22
Q

How can you recognize a non depolarizing NMBD

A

-cur- in the name (Atracurium, Cisatracurium, Doxacurium, etc)

23
Q

What are the steroid derivative muscle relaxants and why are they good?

A

Less Histamine release.
Vecuronium, Rocuronium, Pancuronium, Pipecuronium,

With steroids, you are Very Red & your Penis is Poppin’

24
Q

What drug can be given as an alternative to Succinylcholine?

A

Rocuronium

25
Black box warning of Succinylcholine
Rhabdomyolysis with Hyperkalemia
26
How do you treat malignant hyperthermia?
Dantrolene
27
Baclofen
GABAb agonist that hyper polarizes and inhibits neurotransmitter release
28
Tizanidine
a2-agonist that decreases input to alpha motor neurons
29
Dantrolene
RyR inhibitor that stops efflux of Ca from SR in muscle | Cardiac and SM not affected