Pharm NMJ part I

Question 1

What are the nondepolarizing NMJ blocking drugs

Answer 1

cisatracurium
tubocurarine
pancuronium
rocuronium
vecuronium

Question 2

which nondepolarizing blocking drugs are steroid derivatives

Answer 2

pancuronium
rocuronium
vecuronium

Question 3

what is the depolarizing NMJ blocking drug

Answer 3

succinylcholine

Question 4

what drugs do we have that are muscle relaxants aka spasmolytics

Answer 4

dantrolene

botulinum toxin

Question 5

What are the AChEI

Answer 5

echothiophate
edrophonium
neostigmine
physostigmine
pyridostigmine

Question 6

what are the antimuscarinic agents

Answer 6

atropine

Question 7

what are the cholinesterase reactivators

Answer 7

pralidoxime

Question 8

what are the 2 main therapeutic groups of drugs that affect skel mm function

Answer 8

NMJ blockers

spasmolytics

Question 9

how do nondepolarizing NMJ blockers work

Answer 9

antagonists of nAChR

Question 10

how do depolarizing NMJ blockers work

Answer 10

excess depolarizing agonist, so AchR taken up

Question 11

What makes NMJ blockers hard to enter CNS

Answer 11

one or 2 quaternary nitrogens,, poorly lipid soluble

Question 12

how are NMJ blockers administered

Answer 12

parenterally because highly polar and inactive orally

Question 13

what muscles are more R to NMJ blockades

Answer 13

trunk, paraspinals and diaphragm

Question 14

what is the last muscle to be paralyzed and quickest to recover from a NMJ blockade

Answer 14

diaphragm

Question 15

what is the least potent nondepolarizing NMJ blocker

Answer 15

rocuronium

Question 16

how do you reverse a NMJ blockade

Answer 16

Ach or succinylcholine

Question 17

what cholinesterase inhibitors can antagonize nondepolarizing blockers blockade

Answer 17

neostigmine and pyridostigmine because increase ACh availability and increase release of NT from motor nerve terminal

Question 18

why is edrophonium less effective in reversing the effects of nondepolarizing blockers

Answer 18

no effect on NT release

Question 19

what is given to minimize adverse effects of cholinesterase inhbitors

Answer 19

anticholinergic agents like atropine

Question 20

what are the adverse effects of cholinesterase inhibitors

Answer 20

bradycardia, bronchoconstriction, salivation, nausea, vomiting

Question 21

adverse effects nondepolarizing NMJ blockers

Answer 21

histamine release which can cause wheal reaction, bronchospasm, hypotension and bronchial and salicary secretion

Question 22

at large doses tubocurarine and metocurine can cause what

Answer 22

ACh blockade at autonomin ganglia in adrenal medulla causing a dec in BP and tachycardia

Question 23

why is d tubocurarine not used anymore

Answer 23

long duration and caused significant histamine release

Question 24

what drugs can potentiate the NMJ blockade from nondepolarizing afents

Answer 24

inhaled anesthetics

aminoglycosides

Question 25

be careful with NMJ blockers in what population subtype

Answer 25

elderly because longer duration from decreased hepatic and renal clearance

Question 26

what patients are resistant to nondepolarizing muscle relaxants

Answer 26

patients with severe burns and with UMN disease

Question 27

which nondepolarizing NMJ blocker has very little to no CV effects

Answer 27

cisatracurium

Question 28

which nodepolarizing relaxant has the shortest duration of action

Answer 28

mivacurium

Question 29

inermediate acting steroid muscle relaxants are excreted how

Answer 29

biliary excretion or hepatic metabolism

Question 30

what metabolizes steroid mm relaxants

Answer 30

3- 17- or 3,17 hydroxy derivatives

Question 31

which muscle relaxant is least likely to cause histamine release

Answer 31

steroidal NMJ blockers

Question 32

agent of choice for patients with normal renal and hepatic function requireing paralysis for more than one hour

Answer 32

pancuronium

Question 33

adverse effects pancuronium

Answer 33

tachy HTN increased CO from vagal blockade

Question 34

most rapid time onset steroidaly relaxant

Answer 34

rocuronium

Question 35

common use rocuronium

Answer 35

used to facilitate a difficult tracheal intubation because rapid acting basically no CV effects

Question 36

alternative to rocuronium for intubation

Answer 36

vecoronium

Question 37

PK of succinylcholine

Answer 37

short duration because rapid hydrolysis and inactivation by butyrylcholinesterase

Question 38

What is the phase I block for succinylcholine

Answer 38

depolarizes motor end plate and spreads to adjacent membranes. remain depolarized (block)

Question 39

what augments the phase I depolarizing block ofd succinylcholine

Answer 39

cholinesterase inhibitors

Question 40

what is the phase II desensitizing block of succinylcholine

Answer 40

continued exposure causes intiial depolarization to decrease and membrane repolarized. R has to be desensitized until it can depolarize again

Question 41

what reverses the phase II block by succinylcholine

Answer 41

AChE inhibitors

Question 42

what occurs with standad dose IV succinylcholine

Answer 42

fasciculations within 30 sec then paralysis withing 90 sec | initiall arm and neck, leg muscles then respiratory muscles

Question 43

when is succinylcholine used

Answer 43

EM surgery when need to secure airway rapidly

Question 44

what degrades succinylcholine

Answer 44

plasma cholinesterases

Question 45

CV effects of succinylcholine

Answer 45

cardiac arrhythmias when administered with halothane anesthesia negative inotropic and chronotropic effects large doses cause positive inotropic and chronotropic effects

Question 46

What acid base status does succinylcholine cause

Answer 46

hyperkalemia

Question 47

adverse effects succinylcholine

Answer 47

increased intraocular P increased intragastric P muscle pain slight histamine release

Question 48

CI to succinylcholine

Answer 48

personal or familial Hx of malignant hyperthermia myopathies with elevated CPK values acute phase injury following major burns multiple trauma extensive denervation of skel mm or UMN injury

Question 49

black block warning on succinylcholine

Answer 49

acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death if administered to child with undiagnosed skel mm myopathy

Question 50

what drug if used with succinulcholine can induce malignant hypertermia

Answer 50

volatile anesthetics