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Pharma > Skeletal muscle relaxants acting on the NMJ > Flashcards

Skeletal muscle relaxants acting on the NMJ Flashcards

1
Q

Name the non-depolarising skeletal muscle relaxants?
Competitive antagonists of Nm
- Isoquinolines

A 
D-tubocurarine
Mivacurium 
Cistracurium
Atracurium
Doxacurium
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2
Q

Which non-depolarising SM relaxant is metabolised by Pseudocholinesterase?

A

Mivacurium

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3
Q

How are Cistracurium and Atracurium metabolised?

A

Spontaneous (Hoffmann-elimination)

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4
Q

Which non-depolarising skeletal muscle relaxants are metabolised spontaneously?

A

Cistracurium and atracurium

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5
Q

What is the duration of action of Mivacurium?

A

Short acting (10-15 mins)

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6
Q

What is the duration of action of Cistracurium?

A

Intermediate acting (20-30 mins)

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7
Q

What is the duration of action of Atracurium?

A

Intermediate acting (15-35 mins)

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8
Q

What is the duration of action of Doxacurium?

A

Long acting

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9
Q

What is the duration of action of D-tubocurarine?

A

> 35 mins

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10
Q

Which drug is safe in renal and hepatic impairment?

Why?

A

Atracurium

Because it is spontaneously inactivated to Laudonosine (therefore does not use the liver or kidneys in its metabolism)

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11
Q

What is the break down product of Atracurium?

A

Laudonosine

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12
Q

In which patients do we not use Mivacurium?

A

In those who are quick metabolisers (pseudocholinesterase). It already has a short duration of action.

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13
Q

How do you reverse the block induced by non-depolarising SM relaxants?

A

Competitive non depolarising SM relaxants are competitive so you over come the effects by increasing the concentration of the ligand of the receptor; in this case, Ach - so you use an AchE inhibitor.

You use Neostigmine (quartenary AchE inhibitor) - cannot enter the CNS.

Not physostigmine as it is a tertiary amine and can enter the CNS

Not Edrophonium as it has a short half life.

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14
Q

Name the non-depolarising SM relaxants?

Steroids

A

Vecuronium
Rocuronium
Pancuronium
Pipecuronium

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15
Q

Which non depolarising SM relaxants are metabolised by the Liver?

A

Vecuronium

Rocuronium

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16
Q

Which non depolarising SM relaxants are metabolised by kidney filtration?

A

Pancuronium

Pipecuronium

17
Q

Which is the longest acting non-depolarising SM relaxant?

A

Pancuronium

18
Q

What is the duration of action of Vecuronium?

A

Intermediate acting

19
Q

What is the duration of action of Rocuronium?

A

Intermediate acting (dose dependent)

20
Q

What is the duration of action of Pancuronium?

A

Long acting

21
Q

What is the duration of action of Pipecuronium?

A

Long acting

22
Q

What are the long acting SM relaxants?

A

Doxacurium
Pancuronium
Pipecuronium

23
Q

What are the intermediate acting SM relaxants?

A

Vecuronium
Rocuronium
Atracuronium
Cistracuronium

24
Q

What are the short acting SM relaxants?

A

Mivacurium

25
Q

What is the time order o the curare-induced muscle paralysis?

A
  1. Outer eye muscles
  2. Facial muscles
  3. Pharyngeal muscles
  4. Extremities
  5. Truncal muscles
  6. Respiratory muscles
  7. Full Paralysis
26
Q

How long does it take to reach full paralysis?

A

2-6 mins

27
Q

What can be used to terminate the effect of the steroid non-depolarising SM relaxants?

A

Sugammadex

28
Q

What is the depolarising non competitive SM relaxant?

A

Succinylcholine

29
Q

How is Succinylcholine metabolised?

A

Pseudocholinesterase

30
Q

What is the time order of the Succinylcholine induced muscle paralysis?

A
  1. Arms
  2. Neck
  3. Legs
  4. Respiratory muscles
  5. Facial muscles
  6. Pharyngeal muscles

Pharma (23 decks)

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