NMJBs or Paralytics

Question 0

Drugs for mechanical ventilation

Answer 0

Pancuronium (pavulon)
Rocuronium (zemuron)
Vecuronium (norcuron)
Atracurium (tracium)
Cisatracurium (nimbex)

Question 1

Drugs for endotracheal intubation

Answer 1

Succinylcholine (anectine)
Rocuronium (zemuron)
Vecuronium (norcuron)

Short onset and short duration of action

Question 2

Succinylcholine (anectine)

Answer 2

nAChR agonist
Depolarizing agent
Endotracheal intubation
ADR: muscle fasciculations, myalgia, hyperkalemia, malignant hyperthermia(esp. With volatile anesthetics), histamine release
CI: patients with CHF, burns, or major trauma
DDI: volatile anesthetics, CCBs, aminoglycoside abxs.

Question 3

Pancuronium (pavulon)

Answer 3

Amino steroid based
Mechanical ventilation
Active metabolites with renal and hepatic elimination=>avoid in renal and hepatic dysfxn
3-hydroxy is active metabolite
ADR: myopathy(weakness), HTN, tachycardia (cv effects from ACh like structure that can bind M2 receptors in heart)

Question 4

Rocuronium (zemuron)

Answer 4

Amino steroid based
Mechanical and endotracheal intubation
Elimination is hepatic and some renal, no active metabolizes so it is ok to use in renal and hepatic dysfxn
No significant histamine release
ADR: myopathy

Question 5

Vecuronium (norcuron)

Answer 5

Amino steroid based, desmethyl analog of pancuronium
Mechanical ventilation and endotracheal intubation
All Active metabolites with renal and hepatic elimination=>avoid in renal and hepatic dysfxn
No histamine release, no sognifficant CV effects
ADR: myopathy

Question 6

Atracurium (tracium)

Answer 6

Tetrahydroisoquinoline based
Mechanical ventilation
Non-hepatic metabolism through ester hydrolysis
All inactive metabolites, Laudanosine is the inactive metabolite that can accumulate and cause Seizures
Hofmann elimination: useful for renal and hepatic dysfxn
Histamine release
ADR: myopathy, higher doses may cause HYPOtension

Question 7

Cisatracurium (nimbex)

Answer 7

Tetrahydroquinoline based
Cis isomer of atracurium=>less laudanosine production and less histamine release
No active metabolites
Hoffmann elimination=>useful in renal or hepatic dysfxn
ADR: myopathy

Question 8

Drugs for Reversal of NM blockade

Used post-operatively to reverse NM blockade by non-depolarizing agents

Answer 8

Neostigmine (AChE inhibitor and and increases ACh release from pre-synaptic neuron)
Edrophonium (AChE inhibitor)
AChE inhibitors give non-specific SLUDE effects b/c of increase ACh binding to muscarenic receptors
Sugammadex (Inactivates steroidal NM non-depolarizing blockers by binding and forming inactive complex. Can reverse paralysis immediately. Not available in U.S.

Question 9

Non-depolarizing NM blockers with active metabolites

Active metabolites–>avoid in pts. With renal or hepatic dysfxn

Answer 9

Pancuronium (pavulon) active metabolite is 3-hydroxy (liver)

Vecuronium (norcuron) all active metabolites

Question 10

Non-depolarizing NM blockers with inactive metabolites

Answer 10

Rocuronium (zemuron)
Atracurium (tracium)
Cisatracurium (nimbex)

Question 11

Neuromuscular blockers act…

Answer 11

Primarily At the neuromuscular junction (motor end plate). They can be specific to nAChR or they can act on AChE enzyme. They do not act centrally. All they really do is paralyze (no anesthetic or analgesic effects)