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Pharm II test 3 > Skeletal Muscle Relaxers and Neuromuscular Blockers > Flashcards

Skeletal Muscle Relaxers and Neuromuscular Blockers Flashcards

1
Q

Another name for NMB is ___________. How and where do they work?

A

Paralytic.
Potent ACh blockers
all skeletal muscles and diaphragm

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2
Q

Most NMB are given how?

A

IV

PO agents are less potent and do not affect the diaphram

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3
Q

T or F. IV NMB require oxygen via nasal cannula.

T or F. PO NMB do not require mechanical ventilation.

A

F - mechanical ventilation

T - they don’t affect the diaphragm

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4
Q

How are the NMB used?

A

anesthesia (reduces dose of anesthesia necessary)
surgery
mechanical ventilation

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5
Q

NMBs require _______ and ___________ when given.

A

Sedation

Anxiolysis

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6
Q

How do you monitor the patient being given NMB?

A

Train of Four

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7
Q

How do you reverse NMB? What are some side effects of these?

A

AChesterase Inhibitors (increases ACh)
Neostigmine
cholinergic - GI upset

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8
Q

What are two classifications of NMB? What do they mean?

A

Depolarizing - ring door bell (patient twitches before paralysis)
Non-depolarizing - do not ring door bell (no twitching)

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9
Q

Name a depolarizing NMB. How fast or slow does it act/dissipate?

A

Succinylcholine - rapid on/off

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10
Q

What is Curare?

A

Natural NMB that native americans used to cover their arrow heads in.

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11
Q

-“onium” is a typical ending for what kind of NMB?

A

Non-depolarizing NMB

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12
Q

How does Botox work?

A

blocks release of ACh

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13
Q

How do skeletal muscle relaxers work?

A

they are a heterogenous group of meds - different MOAs

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14
Q

T or F. Carisoprodol (Soma) works directly on the skeletal muscles.

A

F - reticular formation of the spinal cord (indirectly)

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15
Q

Which SMB is commonly abused with alcohol and narcotics and therefore should be cautiously be prescribed in those with hx of drug dependency

A

Carisoprolol

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16
Q

What schedule are the majority of the SMB in Kentucky?

A

C-4

17
Q

Which SMB is a third cousin to the Benzos? What kind of drug is it and what is the off-labeled use?

A

Meprobamate (Equanil)

short-term anti-anxiety agent, w/ off label use for muscle relaxer

18
Q

Which SMB is closely related to amitriptyline? What kind of drug is A? What does this mean about the SMB?

A

Cyclobenzaprine (Flexeril)
TCA
Very anticholinergic

19
Q

What cautions should you keep in mind when using cyclobenzaprine?

A

TCA cautions
heart disease (arrythmias)
urinary hesitancy
Can’t use within 14 days of MAOI

20
Q

How do you treat Cyclobenzaprine OD?

A

TCA OD with bicarb.

21
Q

Which SMB has an off-label use for intractable hiccups? Which patients commonly get these?

A

Baclofen (Lioreseal)

ventilated patients

22
Q

Which SMB has been administered intrathecally?

A

Baclofen - epidurals

23
Q

Which SMB may good be a good option for elderly? Why so?

A

Metaxalone (Skelaxin)

It has reduced anticholinergic effects (like sedation and cardiac risk)

24
Q

What SMB is an alpha-2 agonist? How does it work? What drug is it chemically related to?

A

Tizanidine (Zanaflex) - decreases excitatory output of alpha motor neurons within the spinal cord
Clonidine

25
Q

If Tizanidine is chemically related to clonidine, what is the common AE?

A

Hypotension, sedation

26
Q

T or F. Benzodiazepines have been used as SMB in the past.

A

T

27
Q

Which drug is a direct acting SMB? How does it work?

A

Dantrolene

Blocks release of intercellular calcium

28
Q

What drug is used to treat both NMS and hyperthermia malignant syndrome?

A

Dantrolene - treats rigidity

29
Q

What is the newest reversal agent for NMBs? How does it work? What is the benefit?

A

Bridion (Sugammadex)
binds to NMB and patient clears it
No cholinergic effects (Gi upset)

30
Q

T or F. Dantrolene affects the diaphragm.

T or F. Dantrolene is given PO.

A

F. Does not affect the diaphragm

F. It is given IV.

Pharm II test 3 (8 decks)

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