Muscle relaxant clinical use (11) Flashcards Preview

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Flashcards in Muscle relaxant clinical use (11) Deck (20)
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1

what can potentiate depolarizers (sux)?

cholinesterase inhibitors (Neostigmine)
Aminoglycosides (mycins)
Local anesthesthetics
Volatile anesthtics
Magnesium
lithiuim

2

Uses for Sux?

facilitate intubation (RSI)
short duration relaxant (bolus/gtt)
exact timing of relaxation
*overall ease of paralysis, recovery, and re-paralysis*

3

side effects of sux?

-allergy
-FASICULATIONS
-MUSCLE PAIN (MYALGIA)
-bradycardia, brady arrythmias, asytole
-HYPERKALEMIA (increases 1 mEq/L
-Increased IOP
-Increased intragastric pressure
-Increased ICP
-unmasked cholinesterase deficiences
-sustained muscle contractions
-MH RISK (masseter muscle spasm)

4

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)

5

Which patients are at the highest risk of getting hyperkalemic with SUX?

up regulated pt's (denervation injury)

6

Contraindications for SUX?

-denervation after 24-28 hours
-immobilization after 3 days
-burns after 2 days
-MH risk'
-Homozygous atypical plasma cholinesterase deficiency
-serum K+ >5.5

7

down and dirty how do depolarizers work

bind to and activates sustained depolarization of nicotinic receptor

8

down and dirty how do Non-depolarizers work

Bind to post synaptic nicotinic ACh receptors and competitively inhibit action of ACh

9

with Non-depolarizing greater than what % of ACh receptors must be blocked to inpair motor nerve conduction?

75%

10

what potentiates Non-depolarizing drugs?

-aminoglycerides (mycins)
-local anesthetics
-volatile anesthetics
-Dantrolene (crazy b/c this is the reversal for MMH)
-Magnesium
-CCB

11

Reasons to use Pancuronium (pavulon)?

-long paralysis
-cardiac sx

12

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

13

Side effets of Pancuronium (pavulon)?

-increased HR r/t vagolysis at post ganglionic nerve terminal, muscarinic blockade, and catecholamine release
-inhibits plasma cholinesterase

14

Reasons to use for Vecuronium (Norcuron)?

-intermediate duration
-CV stable
-suitiable for ischemic heart disease
-suitable for ambulatory surgeries
-low incidence of residual muscle paralysis

15

Side effects of Vecuronium (Norcuron)?

minimal to none

16

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
-CV stabe

17

Side effects of Rocuronium (Zemuron)?

-minimal to none
why the fuck not just use this!!!!!

18

***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)

19

what is Hofman elimination (associated with Cis-atricurium)

the drug is metabolized and removed independent of organs.

20

what 2 factors can prolong Hofmann elimination?

hypothermia

acidosis