Skeletal Muscle Relaxants

Question 1

What is malignant hyperthermia

Answer 1

Hyperthermia that results from massive release of calcium from Sarcoplasmic reticulum. Leads to uncontrolled contraction and stimulation of metabolism in skeletal muscles.

Question 2

Which enzyme Metabolizes succinylcholine

Answer 2

Cholinesterase in the liver and plasma but it is resistant to acetylcholinesterase

Question 3

What is the mechanism of action of succinyl choline

Answer 3

Depolarize is the neuromuscular junction. Continuous depolarization results in muscle relaxation and paralysis. In phase two there is repolarization

Question 4

What are the effects of continuous infusion of succinyl choline

Answer 4

Continuous depolarization changes into gradual repolarization with resistance (sensitization) to depolarization

Question 5

Why does Cisatracurium replace atracurium?

Answer 5

Because cisatracurium metabolite is less toxic (laudanosine)

Question 6

Which drugs are metabolized by the liver

Answer 6

1. Rocuronium
2. Vecuronium

Question 7

Which drug is used to reverse neuromuscular blockade in rocuronium and vecuronium

Answer 7

Sugammadex

Question 8

Cholinesterase inhibitors can be used to reverse the effects of the blocker succinylcholine in which phase

Answer 8

Phase 2

Question 9

What are the toxicities of neuromuscular blockers

Answer 9

1. Respiratory paralysis
2. Autonomic affects and histamine release
3. Special effects of succinylcholine ( Hyperkalemia, peripheral nerve dysfunction, muscle dystrophy)
4. Increase intragastric pressure
5. Malignant hyperthermia
   

Question 10

Patients who are deficient in pseudo esterases have which toxic effect toward succinylcholine

Answer 10

Prolonged apnoea

Question 11

Which drugs cause histamine release

Answer 11

1. Tubocurarine
2. Mivacurium

Question 12

How is malignant hyperthermia caused including succinylcholine

Answer 12

Interaction of succinylcholine with inhaled anaesthetics

Question 13

Which drugs prolong the relaxant action of neuromuscular blockers

Answer 13

1. Aminoglycosides antibiotics
2. antiarrhythmic drugs

Question 14

Which patients are more sensitive to non-depolarizing blockers

Answer 14

Patients with
1. myasthenia gravis
2. severe burns
3. upper motor neuron disease
4. renal failure

Question 15

Which drugs block cardiac muscarinic receptors

Answer 15

1. Pancuronium
2. Rocuronium 

Question 16

Which drug is able to reduce pain caused by severe spasms

Answer 16

Botulinum toxin

Question 17

Which spasmolytic drugs act in the spinal cord

Answer 17

1. Diazepam
2. baclofen
3. tizanidine

Question 18

Which drug acts as a GABA(B)  agonist And causes membrane hyper polarization

Answer 18

Baclofen

Question 19

Which spasmolytic drug is in alpha-2 agonist that acts in the spinal cord

Answer 19

Tizanidine

Question 20

Which Spasmolytic drug act in the skeletal muscle cell to reduce the release of activator calcium from SR. What receptor Channel does it act on.

Answer 20

Dantrolene On Ryanodine receptor Channel

Question 21

Which drugs cause malignant hyperthermia

Answer 21

Succinyl choline
tobocurarine

Question 22

What drug is given to treat malignant hyperthermia and how does it act. 

Answer 22

Dantrolene
blocks calcium release

Question 23

What are the adverse effects/toxicities of spasmolytic drugs

Answer 23

1. Diazepam - sedation
2. tolerance
3. tizanidine - asthenia, drowsiness, dry mouth, hypotension
4. dantrolene - muscle weakness

Question 24

Which drugs are used for acute muscle spasms

Answer 24

1. Cyclobenzaprine
2. Maraxalone
3. Methocarbamol
4. Orphenadrine

Question 25

Which Spasmolytic drug used for acute muscle spasms may cause confusion and visual hallucinations

Answer 25

Cyclobenzaprine

Question 26

What are the adverse effects of succinylcholine

Answer 26

1. Muscle pain 2. hyperkalaemia 3. increased intra-gastric and intraocular pressure

Question 27

Name non-depolarizing skeletal muscle relaxants

Answer 27

1. Tubocurarine 2. Atracurium 3. Cisatracurium 4. Mivacurium 5. Rocuronium 6. Vecuronium

Question 28

What are the adverse effects of cyclobenzaprine

Answer 28

1. M Block 2. sedation 3. confusion 4. ocular effects

Question 29

What is the second name for Succinyl choline

Answer 29

Suxamethonium

Question 30

Name two drug that is a depolarizing blocker

Answer 30

Succinyl choline decamethonium 

Question 31

Which drug acts directly on the skeletal muscle

Answer 31

Dantrolene

Question 32

Which drugs act on the CNS

Answer 32

1. Diazepam 2. methocarbamol 3. chlorzoxazone 3. tizanidine 4. baclofen 5. gabapentin 6. Thiocochicoside

Question 33

What happens when non-depolarizing blockers are used with antibiotics

Answer 33

Aminoglycosides inhibit release of acetylcholine tetracycline and clindamycin also have effects

Question 34

What is the effect of using loop diuretics or thiazides with non-depolarizing Blockers

Answer 34

Hypo kalaemia caused by loop diuretics/thiazides may potentiate the effect of non-depolarizing blockers

Question 35

What happens when succinyl choline and Thiopentone Are used together

Answer 35

IV Precipitation when mixed in the same syringe

Question 36

Which Group of drugs enhances the effect of non-depolarizing blockers

Answer 36

General anaesthetics and fluorinated anaesthetics

Question 37

What are the factors affecting the actions of neuromuscular blockers

Answer 37

1. pH changes 2. hypothermia 3. myasthenia gravis 4. aminoglycoside antibiotics 5. inhalation anaesthetics

Question 38

Why is a true been administered before neuromuscular blockers

Answer 38

To block the Muscarinic effects of anti-cholinesterase

Question 39

Which drugs are used to reduce the effect of tubocurarine 

Answer 39

Endorphonium Neostigmine

Question 40

Which drug is the most non-depolarizing neuromuscular blocking agent which can be used as an alternative to succinylcholine for tracheal intubation

Answer 40

Rocuronium