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level: NEUROMUSCULAR BLOCKING AGENTS

Questions and Answers List

level questions: NEUROMUSCULAR BLOCKING AGENTS

Question	Answer
Block cholinergic transmission between motor nerve endings & nicotinic receptors on the skeletal muscle	NEUROMUSCULAR BLOCKING AGENTS
NEUROMUSCULAR BLOCKING AGENTS TWO TYPES	1 Nondepolarizing (competitive) blockers -antagonist 2 Depolarizing agents -agonist
NONDEPOLARIZING BLOCKERS	• Curare • Tubocurarine • Atracurium -> Cisatracurium • Pancuronium • Rocuronium • Vecuronium
employed by anesthesiologist to SHORTEN the duration and monitor the extent of NM blockade	LOW DOSE OF NONDEPOLARIZING BLOCKERS
– cannot be reversed by cholinesterase inhibitors – results to COMPLETE BLOCKADE, thus the muscles do not respond to direct electrical stimulation anymore	HIGH DOSE OF NONDEPOLARIZING BLOCKERS
NONDEPOLARIZING BLOCKERS Sequence of paralyzed muscles:	1.Small, rapidly contracting muscles of the face and eyes are most susceptible 2.Fingers, limbs, neck, trunk muscles, intercostal muscles 3.Diaphragm (CAUSES DEATH) RECOVERY follows the reverse manner
Adverse Effects of Pancuronium (NONDEPOLARIZING BLOCKERS )	increased heart rate
• Works by DEPOLARIZING the plasma membrane of the muscle fiber, similar to the action of ACh • Resistant to degredation by AChE	DEPOLARIZING AGENT
– ONLY DEPOLARIZING muscle relaxant in use today • Initially produces BRIEF MUSCLE FASCICULATIONS causing muscle soreness • Respiratory muscles are paralyzed last • DOA – extremely short due to PSEUDOCHOLINESTERASE	SUCCINYLCHOLINE
DEPOLARIZING AGENT (SUCCINYLCHOLINE) THERAPEUTIC USES	• Useful for rapid ENDOTRACHEAL INTUBATION required during induction of anesthesia • ELECTROCONVULSIVE SHOCK TREATMENT
First to be developed that can BLOCK NEUROMUSCULAR JUNCTURE. Used to PARALYZE PREY in the past Nondepolarizing	Curare
Alternative to Atracurium because Atracurium produces histamine and cause seizures. Nondepolarizing	Cisatracurium