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Neuromuscular blockers Flashcards

1
Q

Main action of neuromuscular blockers (3)

A

muscle relaxing:

  1. decrease of the muscle tone
  2. temporary paralysis
  3. complete muscle relaxation w/o effect on the CNS (consciousness is retained)
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2
Q

The neurotransmitter for neuromusclar blockers

A

Ach release

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3
Q

What does the neurotransmitter for neuromuscular blockers do?

A

Ach depolarizes the post synaptic membrane

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4
Q

What is in the synaptic gap for neuromuscular blockers?

A

acetylcholinesterases

-enz that degrades Ach

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5
Q

What are the indications (when do we use) of neuromuscular blockers?(4)

A
  • surgery
  • intubation
  • diagnositc prodecures
  • emergency medicine
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6
Q

What is the action of neuromuscular blockers in the synapse?

A
  • block neuromuscular transmission at neuromuscular junction or motor endplate
  • pre & post synaptic
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7
Q

What is the motor endplate? (2)

A
  • synapse between neuron and striated muscle

- nicotinic receptors

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8
Q

What is necessary to use with neuromuscular blockers? why? (3)

A
  • anesthesia
  • assisted ventillation
  • Because patient will remain in apnea (suspension of breathing) and will be aware of it
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9
Q

Define apnea

A

suspension of breathing

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10
Q

Mechanism of action for neuromuscular blockers

A
  1. inhibit Ach release (ex. botulinum toxin)

2. Acting on Ach receptors (post synaptic)

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11
Q

What neuromuscular blockers inhibit Ach release?

A

botulinum toxin

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12
Q

What neuromuscular blockers are depolarizing blocking? (3)

A
  • Decamethonium

- suxamethonium: succinylcholine

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13
Q

What neuromuscular blockers are non-depolarizing blocking? (5)

A
  • Pancuronium
  • Tubocurarine
  • Rocuronium
  • Atracurium
  • Cisatracurium
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14
Q

What is the mechanism of action for depolarizing neuromuscular blockers? (2)

A
  • depolarizing skeletal fiber membrane

- Persistent depolarization = muscle fiber resistant to more Ach stimulation

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15
Q

Depolarizing neuromuscular blocking agents produce: (3 steps)

A

fasciculation (brief spontaneous contraction) –> blocking –> flaccid paralysis

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16
Q

Define fasciculation (2)

A
  • brief spontaneous contraction affecting a small number of muscle fibres.
  • causes a flicker of movement under the skin.
17
Q

Depolarizing neuromuscular blocking agents have a ____ onset of action and ______ disappearance of the effect

A

Rapid & rapid

18
Q

Depolarizing neuromuscular blocking agents onset of action is….

19
Q

Depolarizing neuromuscular blocking agents rate of disappearance of the effect is ……

20
Q

Depolarizing neuromuscular blocking agents adverse effects: (3)

A
  • muscle pain
  • prolonged muscle paralysis (cholinesterase deficiency, the elderly, newborns, liver disease)
  • malignant hyperthermia (antidote dantrolene)
21
Q

The antidote dantrolene is used for…

A

malignant hyperthermia in patients using depolarizing neuromuscular blocking agents

22
Q

Muscle paralysis is NOT reversed by

A

acetylcholinesterase inhibitors

23
Q

What can cause prolonged muscle paralysis? (2)

A

cholinesterase deficiency (depolarizing neuromuscular blocking agents)

24
Q

What is the mechanism of action with non-depolarizing neuromuscular blocking agents?

A

Competitively blocking binding of Ach

25
Q

What is the effect of non-depolarizing neuromuscular blocking agents?

A
  • produce muscle weakness then flaccid paralysis

- maintain awareness and sensitivity to pain

26
Q

What are the adverse effects of non-depolarizing neuromuscular blocking agents? (4)

A
  • respiratory paralysis
  • bronchospasm
  • hypotension(histamine liberation)
  • tachycardia
27
Q

What causes hypotension (adverse effect) when using non-depolarizing neuromuscular blocking agents?

A

histamine liberation

28
Q

Interactions (increasing the effect) when using non-depolarizing neuromuscular blocking agents? (4)

A
  • local anesthetics
  • antiarrhythmics
  • Ca-anagonist
  • aminoglycosides
29
Q

What is the antidote for muscle paralysis? What drug causes it? (2)

A 
Antidote:
-acetylcholinesterase inhibitors
-Increasing Ach
Cause:
-non-depolarizing neuromuscular blocking agents
30
Q

What drugs can be used to produce muscle relaxation? (3)

A

Neuromuscular blockers:

  • depolarizing neuromuscular blocking agents
  • non-depolarizing neuromuscular blocking agents

Other:
-Benzodiazepines

31
Q

What effects do benzodiazepines have as a muscle relaxant?

A
  • mild-moderate muscle relaxation

- CNS depressant (reducing level of consciousness)

Pharm (14 decks)

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