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Skeletal Muscle > Muscle Relaxers PCOL Sharpe > Flashcards

Muscle Relaxers PCOL Sharpe Flashcards

1
Q

The drug Sugammadex will inactivate Non-depolarizing neuromuscular blockers by binding to them and forming an inactive complex. Which of these drugs listed will be inactivated if taken with sugammadex. (Select All)(Hint it only affects Steroid-derivative Non-depolarizing neuromuscular blockers)

A. Rocuronium

B. Atricurium

C. Pancuronium

D. Vecuronium

E. Tubocurarine

A

A, C, D

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2
Q

Diazepam, Tizanidine and Baclofen act ____ and Dantrolene acts ____ at the muscle,

A. Centrally, Peripherally

B. Peripherally, Centrally

A

A

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3
Q

T/F The common side effects of spasmolytics include sedation and muscle weakness

A

T

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4
Q

T/F Medications that are meant to activate the Neuromuscular nicotnic receptors are generally able to pass the BBB

A

F

Medications that are meant to activate the neuromuscular recetpors are only needed in the periphery so they do not need to be able to pass the BBB. If they were designed to do that as well they would also cause more side effects

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5
Q

What is the mechanism of action of Succinylcholine?

A. Hyperpolarizes the motor end plate via nAChR, similar to ACh

B. Depolarizes the motor end plate via nAChR, similar to ACh

C. Antagonizes the motor end plate by blocking the nAChR

D. Inhibits AChE and elevates levels of ACh, causing continued depolarization and leading to paralysis

A

B

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6
Q

Which of these Non-Depolarizing Neuromuscular blockers is a steroid derivative? (Select All)

A. Pancuronium

B. Atracurium

C. Cisatricurium

D. Rocuronium

E. Vecuronium

A

A, D, E

Remember: the agents that end in Curonium are steroid derivatives

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7
Q

When treating with paralytics where can these drugs be therapeutically active?

A. nAChR

B. ACh degredation (AChE- acetylcholinesterase)

C. Motor neuron

D. All of the above

A

A

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8
Q

Succinylcholine acts as an _____ at the nAChR on the motor-end plate and is an example of a ______ neuromuscular blocker.

A. Antagonist, Depolarizing

B. Agonist, Non-Depolarizing

C. Antagonist, Non-Depolarizing

D. Agonist, Depolarizing

A

D

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9
Q

Look up Treatment of acute spasmolytic conditions to see the centrally acting agents such as carisprodol, chlorzoxazone, cyclobenazaprine, Metaxolone, methovarbamol, orphenadrine.

A
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10
Q

What are the side effects of diazepam?

A. Hypotension

B. Dizziness/drowsiness

C. Abuse

D. Rebound/withdrawal

E. All of the above

A

E

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11
Q

When muscarinic receptors are activated by acetylcholine all of the following effects can be seen EXCEPT:

A. Bradycardia and Vasodilation

B. Salivation and Emesis (Vomiting)

C. Lacrimation (tears) and Urination

D. Diaphoresis (sweating)

E. Tachycardia (elevated heart rate)

A

E

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12
Q

Which of thes spasmolytic medications are considered GABA agonists? (Select All)

A. Diazepam

B. Tizanidine

C. Dantrolene

D. Baclofen

A

A,D

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13
Q

T/F Dantrolene is the ONLY spasmolytic that acts peripherally at the muscle and the other spasmolytics act centrally

A

T

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14
Q

What class of drugs can be given to reverse Neuromuscular blockade?

A. Alpha Agonists

B. Cholinesterase inhibitors

C. Beta Agonists

D. Non-depolarizing neuromuscular blockers

A

B

Giving a cholinesterase inhibitor will cause less ACh to be broken down and thus cause an increase chance of stimulating the receptor and causing muscle contractions.

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15
Q

T/F Paralytic agents should be used as an Adjuvant to anesthesia and should never be used alone.

A

T

This is because the agents onlly paralyze they do not numb.

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16
Q

What is the mecahnism of action of Diazepam?

A Binds to AChE at the neuromuscular junction and inhibits its activity

B. Allosterically binds to the GABA-A receptor in order to increase GABA activity at GABA-A receptors and lets chloride into the cell, causing it to hyperpolarize.

C. Binds to GABA-B receptors and decrease the motor neuron activity in order to reduce muscualr simulation

D. Binds to Ryanodine in the muscle and prevent it from contracting.

A

B

By causing the cell to hyperpolarize it will decrease the ability for the muscle to contract.

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17
Q

All of the following drugs are Non-Depolarizing neuromuscular blockers EXCEPT:

A. Tubocurarine

B. Atracurium

C. Pancuronium

D. Rocuronium

E. Succinylcholine

A

E

Remember all the Non-depolarizing agents end in either curarine, curium or curonium

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18
Q

Which of the following are uses for Paralytic agents? (Select All)

A. Relaxation of muscles for Surgery

B. Acute muscle spasms due to strain/trauma

C. Placement of endotracheal tube

D. Chronic CNS conditions with abnormally high activity in skeletal muscle reflex arcs (Cerebral Palsy, Multiple sclerosis)

E. Better control of artificial ventiliation

A

A, C, E

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19
Q

An action potential arrives at the motor nerve terminal and causes the influx of ____ which causes the release of the neurotransmitter ____ from the secretory vesicles.

A. Chloride, ACh

B. Calcium, ACh

C. Calcium, NE

D. Chloride, NE

A

B

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20
Q

In reference to Paralytic medications, most are specific to nAChR at the _____ and have very little effect at nAChR at the ____

A. Neuron, Neuromuscular Junction

B. Neuromuscular Junction, Neuron

A

B

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21
Q

What are the side effects of Baclofen?

A. Hypotension

B. Dizziness

C. Drowsiness

D. All of the above

A

D.

Same side effects as diazepam except for the abuse and rebound/withdrawal

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22
Q

Which of these drugs is a Cholinesterase inhibitor? (Select All)

A. Pancuronium

B. Neostigmine

C. Edrophonium

D. Rocuronium

E. Atracurium

A

B,C

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23
Q

When ACh binds to the nAChR on the motor end plate what happens next?

A. Na+ ion influx that causes hyperpolarization

B. Ca+ ion influx that causes depolarization

C. Na+ ion influx that causes depolarization

D. Ca+ ion influx that causes hyperpolarization

A

C

24
Q

Diazepam is a ____ agonist and Baclofen is a ____ agonist.

A. GABA-A, GABA-B

B. GABA-B, GABA-A

A

A

25
Q

Cisatracurium is the ___isomer of atracurium and produces ____ Laudanosine (harmful metabolite) and Histamine than Atracurium.

A. Trans, More

B. Trans, Less

C. Cis, More

D. Cis, Less

A

D

26
Q

What are the adverse effects of Succinylcholine?

A. Myalgia (Rhabdomyolysis)

B. Increased intragastric pressure

C. Malignant Hyperthermia

D. Hyperkalemia and Histamine release

E. All of the above

A

E

27
Q

What is the mechanism of action of Tizanidine?

A. Activates Alpha-2 receptors on the motor neuron and decreases glutamate neurotransmitter release

B. Blocks AChE and increases ACh availability

C. Causes hyperpolarization of the muscle cells

D. Inhibits activation of the motor neuron

A

A

28
Q

Which of the following indications are spasmolytic medications used for? (Select All)

A. Spinal injury

B. Cerebral Palsy

C. Multiple sclerosis and stroke

D. Surgery preparation

E. Placement of endotracheal tube

F. Flexor and acute localized muscle spasms

A

A, B, C, F

29
Q

Which of the following are uses for Spasmolytics? (Select All)

A. Chronic CNS conditions with abnormally high activity in skeletal muscle reflex arcs (Cerebral Palsy, Multiple sclerosis)\

B. Relaxation of muscles for Surgery

C. Placement of endotracheal tube

D. Better control of artificial ventilation

E. Acute Muscle spasms due to strain/trauma

A

A, E

30
Q

(Sharpe)During surgery a Paralytic would cause a/an____ in mental function.

A. Increase

B. Decrease

C. No change

A

C

31
Q

T/F In comparison to ACh, succinylcholine is broken down much less by AChE and as a result leads to persistent depolarization

A
32
Q

(Sharpe) Which of the following is NOT a common clinical use of Paralytic Neuromuscular blockers?

A. Surgical relaxation of muscles

B. Aid in control of artificial ventilation

C. Treating muscle spasms caused by cerebral palsey

D. Assist in placement of endotracheal tube

A

C

33
Q

Which of the following statements are true regarding Nicotinic receptors? (Select All)

A. They can be Neuronal or Neuromuscular.

B. Neuronal nicotinic receptors have more subunits on their receptors than Neuromuscular receptors.

C. Neuronal nicotinic receptors have two different subunits on their receptors and neuromuscular receptors can have 5 different subunits.

D. Onlly neuronal nicotnic receptors require two ACh molecules to bind to the subunits to activate it. Neuromuscular only require one

E. Both Neuronal and Neuromuscular receptors require two molecules of ACh to bind to their subunits to activate it.

A

A, C, E

34
Q

Paralytics are neuromuscular blockers that work at the _____ and not the ____

A. CNS, Muscular End Plate

B. Muscular End Plate, CNS

A

B

35
Q

What is the mechanism of action of dantrolene?

A. Binds to the GABA-A receptor and causes chloride to enter the cell and hyperpolarize it

B. Blocks the Ryanodine (RyR1) receptor and interferes with the excitation-contraction coupling of the muscle fiber.

C. Binds to the GABA-B receptor on the presynaptic neuron and causes a decreased release of glutamate.

D. None of the above

A

B

36
Q

What is the mechanism of action of Non-Depolarizing Neuromuscular blockers?

A. They create an action potential that causes continued depolarization and paralysis

B. They inhibit AChE and cause depolarization and paralysis

C. They block nAChR on the motor-end plate

D. It inhibits things in the body…I ran out of ideas

A

C

37
Q

(Sharpe) Malignant hyperthermia can occur in patients who have recieved volatile anesthetics and _____.

A. Dantrolene

B. Diazepam

C. Pancuronium

D. Succinylcholine

A

D

Dantrolene is used to treat malignant hyperthermia.

38
Q

What are the side effects of cholinesterase inhibitors?

A. Non-specific increase in ACh in different areas of the body

B. Anti-SLUDE

C. SLUDE effects

D. A and C

E. All of the above

A

D

39
Q

What is the major side effect of Atracurium?

A. Unpredictable histamine release and ganglionic blockade possible

B. Metabolite Laudanosine can build up and cause siezures and histamine release

A

B

40
Q

T/F The primary role of dantrolene is to treat malignant hyperthermia

A

T

41
Q

Which of these receptors are acetylcholine receptors? (Select All)

A. Muscarinic

B. Alpha Adrenergic

C. Beta Adrenergic

D. Nicotinic

A

A, D

42
Q

What are the side effects of Tizanidine?

A. Hypotension

B. Drowsiness

C. Dry mouth

D. Muscle weakness

E. All of the above

A

E

43
Q

T/F Spasmolytics are meant to treat acute conditions while paralytics are meant to treat chronic conditions

A

F

44
Q

When ACh is released form the neuron at the neuromuscular junction it binds at the motor end plate. What receptors do they bind to on the motor end plate?

A. Beta Adrenergic

B. nAChR receptors

C. Alpha Adrenergic

D. All of the above

A

B

45
Q

Acetylcholinesterase inhibitors ____ the neuromuscular blockade following the administration of non-depolarizing neuromuscular blockers.

A. Increase

B. Decrease

C. No effect

D. Have a variable effect

A

B

Remember non-depolarizing neuromuscular blockers are competitive antagonists and acetylcholinesterase blockers will increase the amount of ACh available to compete with the non-depolarizing neuromuscular blockers

46
Q

Depolarizing agents are classified as _____ and Non-Depolarizing agents are classified as _____

A. Agonists, Antagonists

B. Antagonists, Agonists

A

A

47
Q

WHat is the mechanism of action of Baclofen? (select all)

A. Binds to the GABA-B receptor on the presynaptic motor neuron and inhibits glutamate release onto the motor neuron.

B. Binds to the GABA-A receptor on the motor neuron and causes the influx of chloride ions, hyperpolarizing the cell

C. Inhibits substance P in the spinal cord, decreasing pain.

D. Inhibits Ryanodine receptors at the muscle and prevents contraction

A

A, C

48
Q

Which of the following statements is true regarding Acetylcholinesterase Inhibitors? (Select All)

A. They could increase the effects of Non-depolarizing neuromuscular blockers and maintain paralysis

B. If they are given with Depolarizing neuromuscular blockers they will augment paralysis in Phase 1 only

C. If they are given with Depolarizing neuromuscular blockers they will augment paralysis in Phase 2 only

D. If they are given with Non-Depolarizing neuromuscular blockers they could reverse paralysis

E. If they are given with Depolarizing neuromuscular blockers they will reverse paralysis in Phase 2 only

A

B, D, E

49
Q

(Short Answer) Explain why giving an AChE Inhibitor can decrease the effect of non-depolarizing agents.

A

Non-Depolarizing neuromuscular blockers are competitive antagonists and block the nAChR at the motor-end plate but ACh is an agonist at the nAChR. If you give an AChE blocker then you will decrease the breakdown of ACh and increase the amount of ACh in the neuromuscular junction. This will give it a higher chance to out-compete any non-depolarizing neuromuscular blockers for the receptor sites and cause a revers in paralysis.

50
Q

What is the major side effect of Tubocurarine?

A. Unpredictable histamine release and ganglionic blockade

B. Metabolite Laudanosine can build up and cause siezures and histamine release

A

A

51
Q

Non-Depolarizing agents block smaller, faster muscles first and the larger muscles last. What is the correct order of muscles that are affected first to last?

I: Facial, Feet, Hands

II: Diaphragm, Intercostals

III. Abdomen, Trunk

A. I, II, III

B. III, II, I

C. I, III, II

D. II, I, III

A

C

Also the drug wears off in the reverse order. In other words the diaphragm is affected last and it will be the first muscle to become unparalyzed first. The feet, face and hands will be the last muscles to go back to normal.

52
Q

T/F Spasmolytic medications are meant to treat increased spasticity and/or increased tonic stretch reflexes

A

T

53
Q

The difference between Paralytics and spasmolytics is that Spasmolytics mostly act _____.

A. Peripherally

B. Centrally

A

B

54
Q

T/F At very high doses Non-depolarizing NM blockers can actually enter the pore of the nAChR and physically block it.

A
55
Q

T/F Paralytics will initially cause a muscle contraction and then paralysis.

A

T

Skeletal Muscle (7 decks)

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