Neuromuscular junction chapter 28 Blocking agents

Question 1

Describe nerve communication

Answer 1

Nerves communicate with skeletal muscle fibers at neuromuscular junction (NMJ) – end result is muscle contraction
-Acetylcholine (ACh) is neurotransmitter required for this process to occur
-Ach sends messages to the tubules down the muscle fibers tells the tubules to open up and release calcium so that muscles can contract

NMJ blockers interfere with muscle function

Question 2

What is rocuronium (Zemuron)?

Answer 2

Nondepolarizing neuromuscular junction Blockers

Question 3

What is therapeutic actions of rocuronium (Zemuron)?

Answer 3

Nondepolarizing neuromuscular junction Blockers

-Antagonist to ACh at NMJ
-Does not allow depolarization (contraction) of muscle cells

Question 4

What are indications of rocuronium (Zemuron)?

Answer 4

Nondepolarizing neuromuscular junction Blockers

-Adjuncts to general anesthesia
-Mechanical ventilation

Question 5

What are pharmacokinetics of rocuronium (Zemuron)?

Answer 5

Nondepolarizing neuromuscular junction Blockers
Metabolized in serum by cholinesterase

Question 6

what are Adverse effects of rocuronium (Zemuron)?

Answer 6

Nondepolarizing neuromuscular junction Blockers
-r/t paralysis of muscles
-Decreased resp, apnea

Question 7

what are contras with rocuronium (Zemuron)?

Answer 7

Nondepolarizing neuromuscular junction Blockers
-Myasthenia Gravis – aggravates disease
-Renal/hepatic disease

Question 8

what are cautions with rocuronium (Zemuron)?

Answer 8

Nondepolarizing neuromuscular junction Blockers
-h/o malignant hyperthermia
-Histamine release

Question 9

What are drug interactions with rocuronium (Zemuron)?

Answer 9

Nondepolarizing neuromuscular junction Blockers
Aminoglycosides, CCB’s increases blockade effects

Question 10

What is succinylcholine (Anectine, Quelicin)?

Answer 10

Depolarizing Neuromuscular Junction Blocker

Question 11

What is therapeutic actions of succinylcholine (Anectine, Quelicin)?

Answer 11

Depolarizing Neuromuscular Junction Blocker
-ACh agonist, attaches to ACh site causing prolonged depolarization (contraction), then flaccid paralysis

Question 12

What are indications of succinylcholine (Anectine, Quelicin)?

Answer 12

Depolarizing Neuromuscular Junction Blocker

-Adjunct to general anesthesia
-Mechanical ventilation
-Intubations

Question 13

What are pharmacokinetics of succinylcholine (Anectine, Quelicin)?

Answer 13

Depolarizing Neuromuscular Junction Blocker
-Metabolized in serum by cholinesterase
-Rapid onset, short duration

Question 14

What are adverse effects of succinylcholine (Anectine, Quelicin)?

Answer 14

Depolarizing Neuromuscular Junction Blocker

Same as NMJ blockers
Muscle pain

Question 15

What are contras/cautions of succinylcholine (Anectine, Quelicin)?

Answer 15

Depolarizing Neuromuscular Junction Blocker
Same as NMJ blockers
Low plasma cholinesterase

Question 16

Nursing considerations: NMJ Blockers
Assess

Answer 16

Co-morbidities:
Malignant hyperthermia
Liver/ Kidney
Allergies
Baseline labs
VS and resp status
Physical assessment  skin

Question 17

Nursing considerations: NMJ Blockers
diagnosis

Answer 17

Impaired gas exchange r/t depressed respirations
Impaired skin integrity r/t immobility from prolonged drug effects
Pain r/t prolonged muscle contraction (D-NMJ blocker)

Question 18

Nursing considerations: NMJ Blockers
Implementation

Answer 18

Emergency equipment available
Monitor temp for detection of malignant hyperthermia
have dantrolene available
Pressure ulcer prevention
T&R q 2hrs (when able!); pad bony prominences; freq. skin assessment
Monitor pain level using 0-10 scale
Fall precaution measures
Monitor for adverse effects
(esp. resp suppression)

Question 19

Nursing considerations: NMJ Blockers
evaluation

Answer 19

Pt response  adequate paralysis
Effectiveness of comfort measures