Neuromuscular Blocking Agents Flashcards
*NMB have zero ___ and zero ___.
*___ = Very first NMB, indian name for poison. Produce paralysis, NOT amnesia or analgesia.
- amnesia, analgesia
* Curare
Ach opens ___ causing depolarization and subsequent action potential at NMJ.
At neuromuscular junction is the ?
sodium channel
Nicotinic (N2) ligand-gated ion channel
NMBs work on the ___ on the Ach receptor - both have to be occupied. The ___ block the site (has no effect on the channel) block Ach from binding to receptor.
2 alpha subunits
Non-depolarizing neuromuscular blockers
Succinylcholine Side Effects:
- Hyperkalemia = increased susceptibility seen with ?????
- ___ = can give a non-depolarizer as a pre-treatment to block those receptors and then give succinylcholine
- Still the most effective/rapid acting drug for ?
- Do not give to patient with history of ? or increased ??
- burns, trauma, nerve damage, neuromuscular diseases, renal failure
- Muscle pains (fasciculations)
- Rapid Sequence Intubation (RSI)
- Malignant hyperthermia, ICP/IOP
___ are the ones that are important, Ach also works at ___ this is important for reversal!
nicotinic receptors
muscarinic receptors
Duration of Action of NDMRs:
By increasing the dose (mg/kg) will convert this drug from intermediate acting to rapid acting. Can do rapid sequence induction with ___.
If anticipating difficulty with airway do not use ___ lasts too long!! If can’t get patient intubated and can’t ventilate patient, patient will
die.
- rocuronium
- rocuronium
Rocuronium has a DOA of ?
Succinylcholine has a DOA of ?
30 min
5 min
Duration of Action of NDMRs:
- These drugs are preferred for maintenance or paralysis? List them.
- Onset?
- Duration?
*Intermediate acting rocuronium vecuronium atracurium cisatracurium *2-2.5 minutes *30-60 minutes
Duration of Action of NDMRs:
- Short Acting - List them.
- Onset?
- Duration?
*Rapacuronium mivacurium rocuronium *1-2 minutes *
Duration of Action of NDMRs: used more for really long cases
- Long Acting - List them.
- Onset?
- Duration?
Pancuronium - Pipecuronium Doxacurium - d-tubocurarine Metocurine - Gallamine Alcuronium *2-6 minutes *60-120 minutes
Agents that use Hoffman elimination for metabolism?
Agents that use plasma cholinesterase for metabolism?
These 2 are related to liver metabolism = ___.
-Atracurium and Cisatracurium
-Succinylcholine and mivacurium
(all 4 use metabolism)
-Vecuronium and rocuronium
biliary excretion
These are metabolized in the plasma, pH dependent? (not dependent on the liver)
- ___ and ___ = use pseudocholinesterase
- ___ and ___ = use hoffman elimination
- ___ will increase metabolism of these drugs.
- Plasma metabolism known as ___.
Succinylcholine and Mivacurium
Atracurium and Cisatracurium
-Alkalosis
-Hoffman elimination
1) ___ = 1/3 ester hydrolysis and1/3 hoffman elimination.
2) ___ = hoffman elimination
3) ___ = 100% renal excretion unchanged, avoid in renal failure.
4) ___ = Metabolism produces ___ (metabolite). Lowers the ___, in plasma, pH dependent.
1) Atracurium
2) Cisatracurium
3) Gallamine
4) Cisatracurium
ladanozene
seizure threshold
- Stimulates ganglion to produce increase in HR and BP?
- Avoid in patients with ?
-Used this drug in place of Sux, needed to increase dose to resemble similar effects? (careful an increase in dose = an increase in ?)
-Pancuronium
*CAD
-Atracurium
histamine release
Factors Affecting Degree of Muscle Relaxation: (5) +
___ = Can get a patient deep enough to have adequate vocal cord relaxation to intubate patient - this is usually on a normal health patient, usually a child because you have to give a high dose.
Antihypertensives Hepatic/renal disease Cholinesterase inhibitors Ketamine Lithium Inhalational Agents
