Flashcards in Muscle relaxant clinical use (11) Deck (20)
what can potentiate depolarizers (sux)?
cholinesterase inhibitors (Neostigmine)
Uses for Sux?
facilitate intubation (RSI)
short duration relaxant (bolus/gtt)
exact timing of relaxation
*overall ease of paralysis, recovery, and re-paralysis*
side effects of sux?
-MUSCLE PAIN (MYALGIA)
-bradycardia, brady arrythmias, asytole
-HYPERKALEMIA (increases 1 mEq/L
-Increased intragastric pressure
-unmasked cholinesterase deficiences
-sustained muscle contractions
-MH RISK (masseter muscle spasm)
how can you lessen the cardiac arrythmias, myalgia, and elevations of IOP, and intragastric pressure with SUX?
pretreat with Non-Depolarizer
(will not affect K+ release)
Which patients are at the highest risk of getting hyperkalemic with SUX?
up regulated pt's (denervation injury)
Contraindications for SUX?
-denervation after 24-28 hours
-immobilization after 3 days
-burns after 2 days
-Homozygous atypical plasma cholinesterase deficiency
-serum K+ >5.5
down and dirty how do depolarizers work
bind to and activates sustained depolarization of nicotinic receptor
down and dirty how do Non-depolarizers work
Bind to post synaptic nicotinic ACh receptors and competitively inhibit action of ACh
with Non-depolarizing greater than what % of ACh receptors must be blocked to inpair motor nerve conduction?
what potentiates Non-depolarizing drugs?
-Dantrolene (crazy b/c this is the reversal for MMH)
Reasons to use Pancuronium (pavulon)?
what Non-depolarizing drug would be good to use to balance out the narcotic induced bradycaria in patients?
pancuronium (pavulon) b/c it increases the HR
Side effets of Pancuronium (pavulon)?
-increased HR r/t vagolysis at post ganglionic nerve terminal, muscarinic blockade, and catecholamine release
-inhibits plasma cholinesterase
Reasons to use for Vecuronium (Norcuron)?
-suitiable for ischemic heart disease
-suitable for ambulatory surgeries
-low incidence of residual muscle paralysis
Side effects of Vecuronium (Norcuron)?
minimal to none
Reasons to use Rocuronium (Zemuron)?
-1.7th potency of Vecuronium
-NON-DEPOLARIZING RSI ABILITY
-rapid onset (60 sec) with 1.5 mg/kg dose
-can replace SUXs for RSI
Side effects of Rocuronium (Zemuron)?
-minimal to none
why the fuck not just use this!!!!!
***perfect test question*****
what is the main benefit of Cis-Atricurium (Nimbex)? and why?
**organ independent metabolism
--you don't need organ function to metabolize
** b/c of Hofman elimination 2/3 (and 1/3 ester hydrolysis)
what is Hofman elimination (associated with Cis-atricurium)
the drug is metabolized and removed independent of organs.