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NURA-671-01 Advanced Pharmacology > Oral: NMB > Flashcards

Oral: NMB Flashcards

1
Q

Class: SUCCINYLCHOLINE

A

Depolarizing NMB

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2
Q

MOA: SUCCINYLCHOLINE

A

Mimics ACh at the NMJ, opening channels and depolarizing post junctional membrane and prohibiting effect of ACh. (causes excitation & fasciculations followed by flaccid paralysis–> inhibits muscle contraction and channels stay OPEN)

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3
Q

Pharmacokinetics: SUCCINYLCHOLINE

A 
NOT highly PB
Onset = 30-60sec
DOA = < 15min
Metabolism= Rapidly hydrolyzed by PChE
Elimination = renal
E1/2t = 4min
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4
Q

SE: SUCCINYLCHOLINE

A
  1. MH + masseter spasm
  2. hyperK
  3. rhabdo, myoglobinuria
  4. inc ICP, IOP
  5. HISTAMINE
  6. dec HR BP
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5
Q

CI: SUCCINYLCHOLINE

A
  1. MH hx
  2. renal pt w/ inc K (must be less than 5.5)
  3. peds – unless emergency
  4. asthma/COPD d/t histamine
  5. musc weakness pts – DMD, paralysis
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6
Q

Dose: SUCCINYLCHOLINE

A

I: 1 mg/kg
RSI: 1.5 mg/kg
Laryngo: 10-20 mg
Continuous infusion: 2.5 mg/min (0.5 to 10 mg/min). Dilute to 1-2 mg/ml

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7
Q

Class: DANTROLENE

A

Direct, centrally acting muscle relaxant – used to treat MH

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8
Q

MOA: DANTROLENE

A

dec muscle tone + metabolism by restoring the balance btw the release and uptake of Ca+

  1. prevents the ongoing release of Ca+ from the sarcoplasmic reticulum = dec muscle contraction
  2. blocks external entry of Ca+ into the sarcoplasm
  3. hypothesized to inhibit Ca+ conductance through the Ryanodine channels

(Does NOT potentiate effects of NDMR and does NOT interfere w/ reversal of muscle relaxants )

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9
Q

PK: DANTROLENE

A 
Onset < 5min
DOA = 3hr
5-hydroxydantrolene, 30 – 50% potency 
Hepatic metabolism 
Hepatic and renal elimination
E1/2t = 10-15hrs
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10
Q

SE: DANTROLENE

A
  1. skeletal musc. weakness – may need to stay intubated
  2. inc HR, labile BP
  3. hepatitis if used > 60 days
  4. phlebitis
  5. seizures
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11
Q

CI: DANTROLENE

A

Duchenne’s muscular dystrophy + pre-existing muscular dz pts

CCBs = life threatening hyperK and myocardial dep.

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12
Q

Dose: DANTROLENE

A

Bolus: 2.5 mg/kg – followed by:
Maintenance: 2 mg/kg IV q5min for a total of 10 mg/kg
Then 70mg IV q6hrs for 72 hrs

can switch to PO dantrolene for a few days after MH is resolved

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13
Q

Class: ATRACURIUM, CISATRACURIUM, MIVACURIUM, d-TUBOCURARINE

A

Nondepolarizing NMB

benzylisoquinolone

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14
Q

MOA: All NDNMB

A

competitive antagonist

acts on pre/post syn cholinergic receptors and produces NMB by blocking passage of ions through nAChR

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15
Q

PK: ATRACURIUM

A 
80% PB
Water sol.
Onset = 1-3min
DOA = 30min
Active met = Laudanosine (accumulates w/ RF – can cause seizures)
Met = 2/3 ester hydrolysis, 1/3 hoffman elim – temp/pH dep.
Elim = renal
E1/2t = 30min
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16
Q

SE: ATRACURIUM

A
  1. HISTAMINE
  2. dec BP inc HR
  3. flushing
  4. prolonged action w/ IA, abx, AEDs
17
Q

CI: ATRACURIUM

A
  1. caution w/ metabolize w/ RF/LF
  2. asthma/COPD
  3. hypersensitivity
18
Q

Dose: ATRACURIUM

A

0.5 mg/kg

Redose: 0.1 mg/kg 15-45 min later

19
Q

PK: CISATRACURIUM

A 
Water sol
Onset = 2-3min
DOA = 30min
Active met = Laudanosine – 1/5 of atrac
Met = 80% hoffman elim – temp/pH dep.
Elim = renal + feces
E1/2t = 30min

Good for RF
NO histamine!

20
Q

SE: CISATRACURIUM

A
  1. MINIMAL se!!
  2. prolonged action w/ abx, LA, Li
  3. seizures w/ RF (d/t laudan)
21
Q

CI: CISATRACURIUM

A
  1. hypersensitivity

2. musc weakness

22
Q

Dose: CISATRACURIUM

A

0.2 mg/kg

Redose: 0.02 mg/kg 40-60 min later

23
Q

PK: MIVACURIUM

A 
Onset = 1-2min
DOA = 20min
Met = Rapidly hydrolyzed by PChE
Elim = renal 
E1/2t = 55min

Good for RF
Good for peds – faster onset + recovery
Can reverse w/ edrophonium

24
Q

SE: MIVACURIUM

A
  1. HISTAMINE
  2. inc HR dec BP
  3. bronchospasm
25
Q

CI: MIVACURIUM

A
  1. prolonged w/ atypical PChE activity
  2. asthma/COPD
  3. hypersensitivity
26
Q

Dose: MIVACURIUM

A

Intubation: 0.2-0.25 mg/kg

27
Q

Class: ROCURONIUM, VECURONIUM, PANCURONIUM

A

Nondepolarizing NMB

Steroidal

28
Q

PK: ROCURONIUM

A 
Onset = 1-2min
DOA = 30min
Met = Hepatic
Elim = Renal - 30% excreted unchanged
50% biliary excretion
E1/2t = 1-2hr

NO histamine

29
Q

SE: ROCURONIUM

A
  1. cardiac stable!!
  2. dec doa w/ IA, LA
  3. bronchospasm
  4. salivation
  5. inc doa w/ RF/LF
30
Q

CI: ROCURONIUM

A
  1. hypersensitivity

2. MG

31
Q

Dose: ROCURONIUM

A

I: 0.6 mg/kg
RSI: 1.2 mg/kg

32
Q

PK: VECURONIUM

A 
70% PB
Onset = 2-3min
DOA = 30min
Active met = 3-desacetyl vec – 50% as potent
Met = Hepatic
Elim = Renal - 30% excreted unchanged
50% biliary excretion 
E1/2t = 70min

NO histamine

33
Q

SE: VECURONIUM

A
  1. bronchospasm
  2. NO CV effects!
  3. inc doa w/ IA + abx
    1. inc doa w/ RF/LF
34
Q

CI: VECURONIUM

A
  1. hypersensitivity
35
Q

Dose: VECURONIUM

A

0.1 mg/kg and then 10% dose for redosing (for all?)

36
Q

PK: PANCURONIUM

A 
Small PB
Onset = 2-3min
DOA = 60-90min
Active met = 3-desacetyl panc – 50% as potent – accumulates in renal, biliary + liver dz, elderly + obese
Met = 20% Hepatic
Elim = Renal - 80% excreted unchanged
50% biliary excretion - dec dose 50% in LF
E1/2t = 2hr

NO histamine
Inhibits PCHE activity

37
Q

SE: PANCURONIUM

A
  1. inc HR, BP, CO – hit them w/ a pan!
  2. bronchospasm
  3. ins doa w/ IA, abx, AEDs
  4. musc weakness
38
Q

CI: PANCURONIUM

A
  1. CAD, HF, HD
  2. renal dysfx
  3. hypersensitivity
  4. pheochromocytopma
39
Q

Dose: PANCURONIUM

A

0.1 mg/kg and then 10% dose for redosing (for all?)

NURA-671-01 Advanced Pharmacology (18 decks)

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