Podcast
Questions and Answers
Which of the following neuromuscular blocking agents (NMBs) is classified as a non-depolarizing NMB?
Which of the following neuromuscular blocking agents (NMBs) is classified as a non-depolarizing NMB?
- Atracurium (correct)
- Succinylcholine
- Dantrolene
- Suxamethonium
Depolarizing neuromuscular blocking agents are characterized by the ability to cross the blood-brain barrier (BBB) and the placenta.
Depolarizing neuromuscular blocking agents are characterized by the ability to cross the blood-brain barrier (BBB) and the placenta.
False (B)
What is the primary mechanism of action of dantrolene in the context of malignant hyperthermia?
What is the primary mechanism of action of dantrolene in the context of malignant hyperthermia?
Inhibiting calcium release
Succinylcholine is rapidly metabolized by ______, leading to a short duration of action.
Succinylcholine is rapidly metabolized by ______, leading to a short duration of action.
Match the following neuromuscular blocking agents with their duration of action:
Match the following neuromuscular blocking agents with their duration of action:
A patient undergoing surgery develops malignant hyperthermia. Which of the following medications is the most appropriate initial treatment?
A patient undergoing surgery develops malignant hyperthermia. Which of the following medications is the most appropriate initial treatment?
An increase in serum potassium (K+) and arrhythmias are potential side effects associated with succinylcholine administration.
An increase in serum potassium (K+) and arrhythmias are potential side effects associated with succinylcholine administration.
Besides malignant hyperthermia, what is one other significant side effect of succinylcholine.
Besides malignant hyperthermia, what is one other significant side effect of succinylcholine.
An increase in ______ in the eye can lead to glaucoma.
An increase in ______ in the eye can lead to glaucoma.
Which NMB is the drug of choice in patients with both liver and kidney failure?
Which NMB is the drug of choice in patients with both liver and kidney failure?
Flashcards
Competitive NMBs
Competitive NMBs
Non-depolarizing neuromuscular blockers that are polar, act peripherally, and do not cross the blood-brain barrier or placenta.
d-Tubocurarine
d-Tubocurarine
A competitive NMB with a long duration of action (1-2 hours) that can cause hypotension and tachycardia.
Atracurium
Atracurium
An intermediate-acting competitive NMB (30 minutes) that causes hypotension; it's the drug of choice for patients with liver or kidney failure.
Depolarizing NMB
Depolarizing NMB
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Malignant Hyperthermia
Malignant Hyperthermia
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Dantrolene
Dantrolene
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Succinylcholine
Succinylcholine
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Study Notes
Pham / SMR (Skeletal Muscle Relaxants)
- Peripherally acts on NmB (Neuromuscular blocking agents)
- Can be either competitive or depolarizing
Depolarizing SMR
- Causes depolarization at the neuromuscular junction
Direct Muscle Relaxants
- Act directly on the muscle to inhibit Calcium release
- Dantrolene is used
Competitive NMB (Neuromuscular Blocking Agents)
- Acts as a non-depolarizing agent
- Polar, given XORALLY
- Poor permeability, does not cross the BBB (blood-brain barrier)
- Does not cross the placenta
Proto drug
- d-tubocurarine is a long acting drug - 1-2 hours
- Can cause hypotension and tachycardia
Atracurium
- Intermediate acting drug (30 minutes)
- Can cause hypotension
- Typically the drug of choice for patients with either liver or kidney failure
Pan curonium
- Causes increase in blood pressure (H.R)
- Can cause tachycardia
Depolarizing SMR
- Succinylcholine (Suxamethonium) is an example
Effects of SMR on Skeletal Muscle
- Causes twitching, followed by relaxation
Effects of SMR on Potassium
- Increases Potassium (K) levels
Effects of SMR on Cardiac system
- Can cause cardiac arrest and arrhythmias
Effects of SMR on the eyes
- Increases intraocular pressure (IOP), potentially leading to glaucoma
- Has a rapid onset (1 minute) and short duration (5 to 10 minutes)
- Metabolized by pseudo cholinesterase
Side Effects of SMR
- Increase in Potassium (K) levels, arrhythmia, and an increase in intraocular pressure ("glaucoma")
Malignant hyperthermia
- Increase in calcium and increased contraction, leading to hyperthermia
Succinylcholine Apnea
- Deficiency of pseudo cholinesterase
Dantrolene
- Direct "SPSmolytic" agent
- Interferes with calcium release, resulting in muscle relaxation
- Used in malignant hyperthermia
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