Term
| what class of drug is succinylcholine? |
|
Definition
| depolarizing muscle relaxant |
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Term
| what class and subclass of drugs does vecuronium belong to? |
|
Definition
| nondepolarizing, aminosteroid |
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Term
| what class and subclass of drugs does cis-astracurium belong to? |
|
Definition
| nondepolarizing, Benzylisquinoline |
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Term
| Which class of NMBAs cause malignant hyperthermia? which class is safe? |
|
Definition
| depolarizing agents cause malignant hyperthermia, nondepolarizing agents don't |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
|
Term
| anti-spasmotic tx for malignant hyperthermia |
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Definition
|
|
Term
| pralidoxime chloride drug class |
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Definition
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Term
| key enzyme for Ach synthesis |
|
Definition
| choline acetyltransferase |
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Term
| AchE cleaves Ach into what two components? |
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Definition
|
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Term
| miniature endplate potentials (MEPP) are caused by what? |
|
Definition
| spontaneous release of Ach |
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|
Term
| what membrane are AchE located on? |
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Definition
|
|
Term
| subunit of the AchR that is present in development but is replaced later? what is it replaced by? |
|
Definition
| gamma subunit; replaced by epsilon |
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Term
| which subunit of the AchR does Ach bind to? how many binding sites are there and how many must be bound for depolarization? |
|
Definition
| alpha subunit; there are two sites and both must be bound for action potentiation |
|
|
Term
| how many binding sites must be blocked by NMBA in order to inhibit depolarization of sarcolemma? |
|
Definition
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|
Term
| function of presynaptic Ach receptors |
|
Definition
| feedback mechanism for the release of Ach; release more in higher freq stimulus |
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|
Term
| effect of reduced nerve activity on Ach receptors |
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Definition
| increased proliferation of Ach receptors; immature receptors proliferate and spread over entire post junctional membrane, degrade after neural influence returns. these are highly sensitive to agonists, but resistant to nondepolarizers |
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Term
| what is the effect of succinylcholine when administered in burn, trauma, immobility settings? |
|
Definition
| highly sensitive, massive activation which produced increased serum K+ which leads to v fib. |
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|
Term
| etiology of multiple pterygia (escobar) syndrome |
|
Definition
| mutation in gamma subunit of AchR; decreased muscle activity in utero which leads to webbing, syngnathia, ankyloglossia, micrognathia, restrictive lung disease (but by birth, AchR is normal but devel effects still present) |
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|
Term
| mechanism of depolarizers; name an example |
|
Definition
mimic the action of Ach, initially cause muscle contractino followed by blockade of NMJ. produces noticeable fasciculations which can be painful.
Eg succinylcholine |
|
|
Term
| mechanism of action for non-depolarizer drugs |
|
Definition
bind to post junctional nicotinic AchR
completely prevent binding of Ach
ion channel closed, no current can flow |
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|
Term
| class of drug for succinylcholine |
|
Definition
|
|
Term
| 2 phases of depolarizing drugs |
|
Definition
Phase 1: membrane is depolarized by openning AchR channels causing brief period of muscle fasciculation
Phase 2: End-plate eventually repolarizes, but because succinylcholine is not metabolized like Ach, it continues to occupy AchR to desensitize the end plate |
|
|
Term
| what is the effect of AChEIs on depolarizing agents' action? |
|
Definition
| AchEIs will augment the effect of depolarizing agents |
|
|
Term
| type of binding of nondepolarizers to AchR |
|
Definition
|
|
Term
|
Definition
bind to one or both alpha subunites on AchR and compete with Ach, channel remains closed.
competitive binding, presynaptic receptors also blocked at higher doses |
|
|
Term
| how do you reverse the effects of non-depolarizing agent? |
|
Definition
| increase levels of Ach at NMJ, ie give AchEIs |
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|
Term
| what is the difference between aminosteroids and benzylisoquinolines? what class of drugs do both belong to? |
|
Definition
aminosteroids are metabolized by the liver and kidney
benzylisoquinolines will be metabolized by the liver, but are spontaneously degraded at physiologic temp, so you can give to pts with liver or kidney dz |
|
|
Term
| MOA and class of pancuronium |
|
Definition
| nondepolarizing, aminosteroids, binds alpha subunit of AchR |
|
|
Term
| MOA and class of vecuronium |
|
Definition
| nondepolarizing, aminosteroid, binds alpha subunit on AchR |
|
|
Term
| moa and class of rocuronium |
|
Definition
| nondepolarizing aminosteroid, binds alpha subunit on AchR |
|
|
Term
| which nondepolarizing drug is the best choice in pts with liver or kidney dz? |
|
Definition
|
|
Term
| what happens when you administer an aminosteroid and a benzylisoquinoline together? |
|
Definition
| synergistic effect (you need less of each) |
|
|
Term
| moa and class for d-tubocurarine |
|
Definition
| nondepolarizing benzylisoquinoline, bind alpha subunit of AchR |
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|
Term
|
Definition
| increase concentration of Ach at NMJ |
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|
Term
| what medication must be administered with AchEI and why? |
|
Definition
| AchEIs are broad spectrum and bind to nicotinic and muscarinic sites alike, therefore, they must be administered with an anti-cholinergic agent such as atropine or glycopyrrolate to prevent widespread systemic effects |
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|
Term
| NMBAs are good at treating what kind of seizures? |
|
Definition
| those induced by electroconvulsive therapy (NOT indicated in grand mal epileptic seizures) |
|
|
Term
| what are some uses of NMBAs? |
|
Definition
facilitate endotracheal intubatino
muscle relaxation and immobility during surgery
facilitation of mechanical ventilation
treatment of seizures induced by electroconvulsive therapy |
|
|
Term
| what is major adverse effect of NMBAs given in ICU? |
|
Definition
| critical illness myopathy |
|
|
Term
| what characterizes critical illness myopathy? what is it associated with? |
|
Definition
| muscle weakness (quadriplegia) in with normal cranial and sensory nerve fxn. |
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|
Term
| sarin is what class of drug? |
|
Definition
|
|
Term
| differences between sarin and VX? |
|
Definition
| VX is more potent and harder to get rid of |
|
|
Term
| autonomic effect of sarin gas |
|
Definition
bradycardia
bronchorrhea
bronchospasm |
|
|
Term
| muscarinic effects of Sarin gas |
|
Definition
SLUDGE:
salivation, lacrimation, urination, diaphoresis, GI distress (D+), emesis |
|
|
Term
| nicotinic effects of sarin gas |
|
Definition
MTWThF:
mydriasis, tachycardia, weakness, hyperThermia, fasciculations (paralysis) |
|
|
Term
| which sarin treatment only treats muscle spasms and seizures? |
|
Definition
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|
Term
| first line of defense in sarin treatment |
|
Definition
|
|
Term
|
Definition
| competitive antagonist of muscarinic AchR |
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|
Term
| best combination of treatments for sarin poisoning |
|
Definition
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|
Term
| drug used to treat myasthenia gravis; what is its moa? |
|
Definition
| pyridostigmine, it is a reversible AchEI |
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Term
| drug used for prophylactic treatment of sarin poisoning |
|
Definition
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