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Pharmacology II > Neuromuscular block, Anesthesia > Flashcards

Neuromuscular block, Anesthesia Flashcards

1
Q

2 groups of neuromuscular blocking drugs

A
  1. Neuromuscular blockers -Muscle paralysis
    -work at the neuromuscular end plate, don’t act on CNS
    -structurally resemble acetylcholine
    Ex. Succinylcholine is a depolarizing agent
    Pancuronium - nondepolarizing (steroid derivative)
  2. Spasmolytics - Spasticity reducers
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2
Q

Neuromuscular blocking drugs: elimination by the plasma

A

Succinylcholine

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3
Q

Most potent neuromuscular blocking drugs

A
  • Pancuronium (kidney elim) [6]

- Vecuronium (kidney and liver elim) [6]

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4
Q

Which NBD is the guide for potency

A

Tubocurarine* (Isoquinoline derivatives)

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5
Q

Pharmacokinetics of NBD

A
  • Given IV
  • Rapid distribution phase
  • Slow elimination phase
  • Kidney excreted drugs have the longer half-lives
  • Liver eliminated drugs have shorter half-lives/durations of action
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6
Q

Succinylcholine

A

-Only depolarizing NBD
-agoninst at nicotinic acetylcholine receptors (may stimulate nicotinic ACh and cardiac muscarinic
Effect: transient contractions, followed by prolonged flaccid paralysis*

Uses: endotracheal tube placement

***Rapid metabolism in the plasma by plasma cholinesterase (duration ~5 min)

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7
Q

Succinylcholine: toxicities

A
  • Arrhythmia
  • Hyperkalemia
  • Increased intraocular pressure
  • postoperative muscle pain
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8
Q

Flaccid paralysis

A

patient is not breathing on their own

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9
Q

d-Tubocurarine (non-depolarizing)

A
  • competitive antagonist at nACh receptors
  • causes flaccid paralysis
  • histamine release**
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10
Q

Non-depolarizing neuromuscular blocking agents

A
  • d-Tubocurarine
  • Cisatracurium
  • Rocuronium
  • Vecuronium

Uses: 1. intubation 2. maintain skeletal muscle relaxation during surgery

-small rapidly moving muscle in face, eyes are affected first, then fingers, toes, extremities, trunk, intercostals. Diaphragm last!* (sequence reverses coming out of paralysis)

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11
Q

What can be given to shorten duration of neuromuscular blockade?

A

cholinesterase inhibitors

ex. neostigmine, pyridostigmine

(these are given with atropine to void the cardiac slowing effect)

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12
Q

Non-depolarizing neuromuscular blockade

A
  1. Aminoglycoside
    (ex. gentamicin, tobramycin)
    - act synergistically to enhance neuromuscular blockade
  2. CCB
    (ex. Verapamil)
    - enhance neuromuscular blocking effects of non-depolarizing agents
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13
Q

General anesthesia

A

state of unconsciousness, analgesia, and amnesia, with skeletal muscle relaxation and loss of reflexes

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14
Q

Stages of Anesthesia

A
  1. Analgesia
  2. Disinhibiition
  3. Surgical Anesthesia
  4. Medullary Depression
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15
Q

Stage 1: Analgesia

A
  • decreased awareness of pain

- Consciousness impaired but not lost

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16
Q

Stage 2: Disinhibition

A
  • delirious and excited
  • Amnesia
  • Enhanced reflexes
  • Irregular respirations
  • Retching
  • May have incontinence
17
Q

Stage 3: Surgical Anesthesia

A
  • unconscious
  • No pain reflexes
  • regular respirations
  • BP maintained
18
Q

Stage 4: Medullary Depression

A
  • Severe respiratory depression

- Severe cardiovascular depression

19
Q

What are the 5 primary effects of general anesthetics

A
  1. Unconsciousness
  2. Amnesia
  3. Analgesia
  4. Inhibition of autonomic reflexes
  5. Skeletal muscle relaxation
20
Q

Inhaled anesthetics

A
  1. Desflurane
  2. Enflurane
  3. Halothane
  4. Isoflurane
  5. Sevoflurane
  6. Nitrous oxide
21
Q

Inhaled anesthetics: effects

A
  • increase cerebral blood flow*
  • Enlurane and halothane decrease CO

-ALL decrease respiratory functions

  • concentration-dependent decrease in portal vein blood flow
  • Lung irritation (desflurane)
22
Q

rate of onset and recovery for inhaled anesthetics vary by what?

A

blood:gas partition coefficient

23
Q

Drugs of choice in patient with underlying airway problems

A
  • Halothane

- Sevoflurane

24
Q

What is the preferred method of inducing rapid anesthesia in adults?

A

IV

but IV is not the preferred method in kids

25
Q

IV anesthetics: Barbiturates

A
  • High lipid solubility***
  • fast onset
  • short duration
26
Q

IV anesthetics: Benzodiazepines (ex. Midozolam)

A
  • slower onset than barbiturates
  • longer duration than barbiturates
  • post operative respiratory depression reversed by flumazenil
27
Q

IV anesthetics: Dissociative (ex. Ketamine)

A

-blocks glutamate (excitatory)
-analgesia, amnesia, and catatonia - but- consciousness retained
-CV stimulation
ADE: increased ICP

28
Q

IV anesthetics: Imidazole (ex. Etomidate)

A
  • short duration

- no analgesia (painful injection)**

29
Q

IV anesthetics: Opiods (ex. Fentanyl, Alfentanil, Remifentanil, Morphine)

A
  • marked analgesia

- respiratory depression

30
Q

IV anesthetics: Phenols (Ex. Propofol, Fospropofol)

A

-Fast onset
-Fast recovery
ADE: hypotension, cardiovascular depression

Pharmacology II (31 decks)

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