NMBAs

Question 1

What are some ADRs of NMB?

Answer 1

crosstalk with autonomic ganglia and postganlionic parasympathetic can lead to cardioacccel, arrhythmia , hypotension. Also can cause histamine release

Question 2

TRUE/FALSE: NMB can cross BBB

Answer 2

false

Question 3

Where do NMBs block first?

Answer 3

eyes/fingers/speech to limbs to respiratory tract

Question 4

test to determine how many receptors blocked

Answer 4

train of 4:
4 twitches: 0-75% of receptors
3 twitches: at least 75%
2 twitches: 80%
1 twitch: 90% of receptors

Question 5

which drugs are additive to NMBs?

Answer 5

Antibiotics: aminoglycosides, lincosamides, & polymixins
Inhalation general anesthetics

Question 6

which drugs are reducing to NMBs

Answer 6

cholinergic drugs and corticosteroids

Question 7

causes initial muscle contraction (fasciculations) followed quickly by flaccid paralysis.

Rapidly hydrolyzed by plasma cholinesterases

Answer 7

succinylcholine

Question 8

ADRs of depolarizing NMB

Answer 8

hyperkalemia
respiratory depression
apnea
malignant hyperthermia
excessive salivation

Question 9

Contraindications of depolarizing NMBs

Answer 9

History of malignant hyperthermia
Narrow-angle glaucoma
taking other drugs that
decrease cholinesterase activity.

Question 10

Reversible competitive antagonists of ACh at postsynaptic neuromuscular cholinergic receptor sites.
temporary state of muscle paralysis.

Answer 10

Nondepolarizing NMBs

Question 11

Highest rate of all NMBAs to  histamine release
Effects include tachycardia, hypotension, bronchospasm, and urticaria.
prevent with pre-op anti-histamine & by slow injection

Answer 11

ADRs from Isoquinolone derivative non depolarizing NMBs (tubocurarine, cisatracurium)

Question 12

steroid derivative non depolarizing NMBs

Answer 12

vecuronium and rocuronium

Question 13

How do you treat OD of non depolarizing NMBs

Answer 13

O2, vasopressors, and cholinesterase inhibitors

Question 14

Mechanism of direct skeletal muscle relaxants

Answer 14

Direct effect on skeletal muscle fibers: decrease release of Ca2+ from binding sites in sarcoplasmic reticulum
Reduced contractibility of skeletal muscle
Affects ‘fast’ (e.g., reflex) > ‘slow’ (e.g., voluntary) muscles

Question 15

ADRs of Dantrolene

Answer 15

hepatotoxicity, especially with high doses (i.e., >400 mg/day) or long-term treatment
Risk of hepatic injury greater in females and patients > 35 years old

Question 16

Antidote of NMBs

Answer 16

SUGAMMADEX:

encapsulates it – becomes unavailable to interact with N-2 receptor at the NMJ
can reverse moderate to profound NMJ blockade within 2–5 min