Skeletal Muscle Relaxers and Neuromuscular Blockers Flashcards
Another name for NMB is ___________. How and where do they work?
Paralytic.
Potent ACh blockers
all skeletal muscles and diaphragm
Most NMB are given how?
IV
PO agents are less potent and do not affect the diaphram
T or F. IV NMB require oxygen via nasal cannula.
T or F. PO NMB do not require mechanical ventilation.
F - mechanical ventilation
T - they don’t affect the diaphragm
How are the NMB used?
anesthesia (reduces dose of anesthesia necessary)
surgery
mechanical ventilation
NMBs require _______ and ___________ when given.
Sedation
Anxiolysis
How do you monitor the patient being given NMB?
Train of Four
How do you reverse NMB? What are some side effects of these?
AChesterase Inhibitors (increases ACh)
Neostigmine
cholinergic - GI upset
What are two classifications of NMB? What do they mean?
Depolarizing - ring door bell (patient twitches before paralysis)
Non-depolarizing - do not ring door bell (no twitching)
Name a depolarizing NMB. How fast or slow does it act/dissipate?
Succinylcholine - rapid on/off
What is Curare?
Natural NMB that native americans used to cover their arrow heads in.
-“onium” is a typical ending for what kind of NMB?
Non-depolarizing NMB
How does Botox work?
blocks release of ACh
How do skeletal muscle relaxers work?
they are a heterogenous group of meds - different MOAs
T or F. Carisoprodol (Soma) works directly on the skeletal muscles.
F - reticular formation of the spinal cord (indirectly)
Which SMB is commonly abused with alcohol and narcotics and therefore should be cautiously be prescribed in those with hx of drug dependency
Carisoprolol
What schedule are the majority of the SMB in Kentucky?
C-4
Which SMB is a third cousin to the Benzos? What kind of drug is it and what is the off-labeled use?
Meprobamate (Equanil)
short-term anti-anxiety agent, w/ off label use for muscle relaxer
Which SMB is closely related to amitriptyline? What kind of drug is A? What does this mean about the SMB?
Cyclobenzaprine (Flexeril)
TCA
Very anticholinergic
What cautions should you keep in mind when using cyclobenzaprine?
TCA cautions
heart disease (arrythmias)
urinary hesitancy
Can’t use within 14 days of MAOI
How do you treat Cyclobenzaprine OD?
TCA OD with bicarb.
Which SMB has an off-label use for intractable hiccups? Which patients commonly get these?
Baclofen (Lioreseal)
ventilated patients
Which SMB has been administered intrathecally?
Baclofen - epidurals
Which SMB may good be a good option for elderly? Why so?
Metaxalone (Skelaxin)
It has reduced anticholinergic effects (like sedation and cardiac risk)
What SMB is an alpha-2 agonist? How does it work? What drug is it chemically related to?
Tizanidine (Zanaflex) - decreases excitatory output of alpha motor neurons within the spinal cord
Clonidine
