Neuromuscular Blockers & Med Errors

Question 1

What are examples of neuromuscular blockers?

Answer 1

• Succinylcholine
• Vecuronium

Question 2

What is an example of a direct muscle relaxant?

Answer 2

Dantrolene

Question 3

What are other common terms for neuro-muscular blockers?

Answer 3

NMBs, paralyzing agents

Question 4

What are neuro-muscular blockers used for?

Answer 4

• Goal is to suppress gag reflex- however you paralyze everything about the patient meaning they cannot breathe on their own!
• Paralyze all SKELETAL muscles including the diaphragm
  ~ Patients will need MECHANICAL VENTILATION
• Patients will receive these before being intubated
  ~ Critical Care
  ~ Surgery

Question 5

List a depolarizing NMB. Describe its mechanism of action.

Answer 5

• DEPOLARIZING NMB: Succinylcholine
• Mechanism of action:
  ~ Sounds just like acetylcholine!
  ~ Binds to NICOTONIC receptors at the Neuromuscular Junction (NMJ)
  ~ Once bound, it depolarizes the cells and stays in place. The cells cannot “recharge” and are stuck and cause flaccid paralysis

Question 6

List a non-depolarizing NMB. Describe its mechanism of action.

Answer 6

• NON- DEPOLARIZING NMB: Vecuronium
• Mechanism of action:
  ~ Blocks Acetylcholine from binding to NICOTINIC receptors at the Neuromuscular Junction (NMJ)
  ~ If Acetylcholine can’t work normally on the muscles, they become paralyzed

Question 7

What are some adverse effects of neuro-muscular blockers?

Answer 7

1) PARALYSIS
~ All muscles including the diaphragm (breathing muscles)
~ THEY MUST HAVE BREATHING SUPPORT AKA MECHANICAL VENTILATION
~ Patient will suffocate and DIE without BREATHING SUPPORT

2) MALIGNANT HYPERTHERMIA (SUCCINYLCHOLINE)

Question 8

What are some nursing considerations for neuro-muscular blockers?

Answer 8

• HIGH RISK DRUG- Identify appropriate indication
• Patients will be paralyzed- you must have artificial ventilation for them
• Monitor for Malignant Hyperthermia
• Patient will still be Alert and Oriented- we always combine with a sedative

Question 9

What is malignant hyperthermia (MH)?

Answer 9

• MEDICAL EMERGENCY
• Extremely rapid firing of skeletal muscles
  ~ Think of this as the most intense workout of your life

Question 10

What can cause malignant hyperthermia (MH)?

Answer 10

• Genetically Linked (1:5,000 to 1:100,000)
• Drugs that are used in the Operating Room
  ~ Neuromuscular Blocker- Succinylcholine
  ~ Volatile Gases used by Anesthesia- “Fluranes” such as Sevoflurane

Question 11

How do you manage malignant hyperthermia (MH)?

Answer 11

• Stop the culprit drug
• Activate emergency code in the OR
• Cool the patient down (hyperthermia is literally in the name)
  ~ Refrigerated IV fluids
  ~ Ice Bath
  ~ Cooling Blanket
• Administer 100% Oxygen
• Administer a Muscle Relaxant
  ~ Drug to Know: Dantrolene