Term
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Definition
Provide muscle relaxation, for use when patient is sedated. Works on post-synaptic membrane
- Therapeutic paralysis - adjuvant to anesthesia
- Corneal or retinal surgery |
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Term
| What are general properties of NMBAs? |
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Definition
Quaternary amines similar to Ach
Agonist - depolarizing agents (Succinylcholine)
Antagonist - non-depolarizing agents. 'curonium' and 'curium' |
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Term
| How does succinylcholine work? |
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Definition
Acts like Ach, binding to receptor and depolarizing. Resistant to degradation by ACHase. Blocks entrance of sodium.
**Short duration due to rapid hydrolyzation by 2 enzymes
**Drug of choice for RSI |
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Term
| What are warnings on the use of succinylcholine? |
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Definition
- Family history of MALIGNANT HYPERTHEMIA - do not use
- Can worsen hyperkalemia, myopathy, M. gravis
- Do not use with recent amphetamine/cocaine use
- Increases IOP, do not use in glaucoma |
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Term
| What are succinylcholine AEs? |
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Definition
- CV - bradycardia, ventricular arrhythmia, HTN
- Increased IOP
- Fasciculations - localized contractions, patient can be very sore.
- Hyperkalemia
- Increased ICP and intragastric pressure |
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Term
| What are non-depolarizing agents? |
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Definition
Block binding of Ach to receptor, acting as competitive antagonists. Effects are reversible by ACHase inhibitors
- Rocuronium/Zemuron - short acting. If pt has a contraindication to succinylcholine. Acidic
- Pancuronium/Pavulon - longer acting, do not use for infusion. Blockade for intubation. Avoid in CHF
- Vecuronium/Norcuron - least amount of cardio effects
- Atracurium/Tracrium - causes histamine release, bad AEs
- Cisatracurium/Nimbex - can use in hepatic and renal failure |
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Term
| What are advantages and disadvantages to NON-depolarizing NBAs? |
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Definition
- Advantages - no fasciculation, no hyperkalemia or hyperthemia
- Disads - histamine release w/ quick infusion, decreased BP, Incr HR. Renal dosing in many drugs. |
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Term
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Definition
Rapid Sequence Intubation - NMBAs used for proper placement
**Succinylcholine is drug of choice. Vecuronium and rocuronium are alternates. Cisatracurium in hepatic or renal failure |
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Term
| What drugs can reverse NMBA action? |
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Definition
- neostigmine - most common, give atropine prior. Renal dosing - 10-50 give 50% of dose
- pyridostigmine/Mestinon - give atropine prior
- Edrophonium - very rapid onset. Reduce renal dose.
- Atropine - counteracts Ach effects. reduces AEs of ACHase
**Only reverse non-depolarizing agents. PROLONG succinylcholine. Interacts w/ Beta blockers - bradycardia |
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Term
| What are the duration of actions of NMBAs? |
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Definition
- Succinylcholine/Anectine - Onset 1 minute, lasts 10 min
- Atracurium/Tracrium - Onset 3 min, lasts 45 min
- Cisatracurium/Nimbex - Onset 2-8 min, lasts 45-90 min
- Pancuronium/Pavulon - onset 3-4 min, lasts 85-100 min
- Rocuronium/Zemuron - Onset 1 min, lasts 36-73 min **Short acting
- Vecuronium/Norcuron - Onset 2-3 min, lasts 45 min |
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