NMJ agents

Question 1

-Curium

Answer 1

Isoquinolones: NM blocking drugs: nondepolarizing: must be given Parenterally: compete at nAChR: H release

Question 2

-Curonium

Answer 2

Steroid derivatives: NM blocking drugs: nondepolarizing: Must be given Parenterally: compete at nACHR: less H release

all metabolized to 3, 17, or 3,17 hydroxy derivatives: less potent

Question 3

Dantrolene

Answer 3

Spasmolytic: block RyR Ca channel: no heart effect

malignant hyperthermia

Question 4

Botulinum Toxin

Answer 4

Spasmolytic: cleaves SNARE: blocks ACh relase

cervical dystonia and blepharospam

Question 5

Ambenonium
Donepezil
Echothiophate

Answer 5

AChEI

Question 6

Edrophonium
Galantamine
Tacrine

Answer 6

AChEI

Question 7

Neostigmine
Physostigmine
Pyridostigmine
Rivastigmine

Answer 7

AChEI

physostigmine crosses BBB

Pyridostigmine in AChEI poisoning PROPHYLAXIS

Question 8

Anti-muscarinics

Answer 8

Atropine

Glycopyrrolate

Question 9

Cholinesterase Reactivators

Answer 9

Pralidoxime: used to counteract organophosphorus/cholinesterase complex at nAChR

Atropine only works at mAChR

Question 10

Succinylcholine

Answer 10

NM blocking: Depolarizing: ultra short duration: nAChR agonist: phase 1 (depolarizing) block, then phase II (desensitiing) block = similar to non depolarized block

Question 11

Reversal of Neuromuscular Blockade

Answer 11

Neo or pyridostigmine

Edrophonium (no transmitter release effects)

Antimuscarinics given (minimize bradycardia, nausea, vomit, bronchoconstriction)

Question 12

Adverse effects of nondepolarizing agents

Answer 12

histamine release (wheals) (tubocurarine lots of H release)

Question 13

Drug-Drug interactions in NM blockade

Answer 13

potentiate anesthetics (isoflurane)

Aminoglycoside Abx enhance NM block

Question 14

Atracurium

Answer 14

intermediate: hofmann elimination: laudanosine product crosses BBB - seizures

less histamine release than others

Question 15

Cisatracurium

Answer 15

intermediate, isomer of atracurium, fewer side effects

used w/ renal impairment, no CV effects

Question 16

Doxacurium

Answer 16

Long acting: do not use w/ Renal failure, no CV effects

Question 17

Mivacurium

Answer 17

short acting, profound H release, has CV effects

Question 18

Intermediate acting steroid muscle relaxants

Answer 18

vecuronium, rocuronium

Question 19

long acting steroid relaxants

Answer 19

pancuronium, pipecuronium

Question 20

Rocuronium

Answer 20

very rapid onsite, intermediate duration

alternative to succinylcholine in intubation

Question 21

Succinylcholine: adverse effects (7)

Answer 21

CV arr

HyperK

Inc. ocular and gastric pressure

pain

H release

Cardiac arrest

Malignant hyperthermia (dantrolen to treat) = oly when used w/ anesthetics

Question 22

Use of NM blocking drugs(4)

Answer 22

surgical relaxation, tracheal intubation, control of ventilation, treat convulsions

Question 23

3 types of AChEI

Answer 23

Alcohols (noncovalent and reversible) (edrophonium), 5-15minutes)

Carbamic acid esters (noncovalent and reversible) (stigmines, ambenonium, demecarium)(0.5-8 hours)

Organophosphates (covalent and irreversible) (echothiophate)(100hours)

all PNS effects

use to reverse paralysis after anestheisa

atropine to reverse

Question 24

Glaucoma

Answer 24

Physostigmine (crosses BBB), demecarium, echothiophate

Question 25

myasthenia gravis

Answer 25

pyridostigmine, neostigmine, ambenonium, edrophonium

Question 26

Edrophonium test:

Answer 26

diagnostic for MG

Question 27

Myasthenic crisis

Answer 27

weakness severe enough for intubation: edrophonium will improve this: assumed over cholinergic

Question 28

cholinergic crisis

Answer 28

muscle weakness: too much AChEI: edrophonium will make worse or no change