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NU 624
Exam 2 - Neuromuscular Blocking Drugs
| Question | Answer |
|---|---|
| Succinylcholine is a [depolarizing/nondepolarizing] neuromuscular blocker. | Depolarizing |
| Name 4 different intermediate acting nondepolarizing NMBDs. | Vecuronium, atracurium, rocuronium, mivacurium |
| Name 6 different long-acting nondepolarizing NMBDs. | d-tubocurarine, doxacurium, pancuronium, pipercuronium, metocurine, gallium |
| NMBDs have a similar structure to what neurotransmitter? | acetylcholine |
| Succinylcholine is consisted of two molecules of ____________________ that are linked together by _____________________ groups. | acetylcholine, acetate methyl |
| What chemical group helps to link 2 acetylcholine molecules together to form succinylcholine? | acetate methyl |
| Describe the structure of succinylcholine and what does this shape allow it to do? | Long, slender, flexible -- allows it to bind to and activate cholinergic receptors on skeletal muscle |
| Where are cholinergic receptors found? | Skeletal muscle |
| What do nondepolarizing agents structurally look like? | Bulky and rigid |
| True/False: Nondepolarizing NMBDs do not have any molecular similarity to acetylcholine. | False - they do contain portions that are similar to acetylcholine |
| What type of chemical group do NMBDs contain? Is it positively or negatively charged? | Quaternary ammonium. Positive charge. |
| How many quaternary ammonium groups do NMBDs generally have in their structure? | One or more |
| How is a quaternary ammonium formed? | Attachment of 4 carbon atoms to a nitrogen atom |
| Pancuronium has a quaternary ammonium group and is classified as a/an _____________. | Aminosteroid |
| Pancuronium is an aminosteroid [with/without] hormonal activity. | without |
| NMBDs (are/are not) able to cross lipid membranes. | Are not |
| Why are NMBDs not able to cross lipid membranes? | Contain quaternary amines, which do not cross biologic membranes |
| What part of NMBDs resembles acetylcholine? | The positive charge on the quaternary ammonium mimics the quaternary nitrogen of acetylcholine |
| What is the charge of the cholinergic receptor on a skeletal muscle cell? | Negative |
| What is the reason for the attraction of NMBDs to cholinergic receptors of skeletal muscle? | The positive charge on the quaternary ammonium of the NMBDs is attracted to the negatively charged cholinergic receptor of skeletal muscle. |
| Why are NMBDs able to affect muscle cells of other types of muscles besides skeletal muscles? | Lack of specificity |
| Where else in the body are the charged quaternary ammonium of NMBDs able to attach themselves? | cardiac and nervous systems |
| How is the specificity of a NMBD for an autonomic versus neuromuscular junction determined? | By the length of the carbon chain that separates the positively charged ammonium groups |
| How many positively charged ammonium groups does vecuronium have? Pancuronium? | Vec=1, Panc=2 |
| How many positively charged ammonium groups do most NMBDs have? | 2 |
| The presence of 2 ammonium groups is called ______________. | Bisquaternary |
| Name 2 mono-quaternary NMBDs. | Vecuronium, d-tubocurarine |
| Name 4 bisquaternary NMBDs. | Atracurium, cisatracurium, succinylcholine, doxacurium |
| Name 1 triquaternary NMBD. | Gallamine |
| How many distinct forms do NMBDs have? What is one distinct form? | 2, steroidal. |
| How is the steroidal structure of NMBDs composed? | 3 six-sided rings (benzene) and 1 five-membered ring |
| Name the 4 steroidal NMBDs. | Pancuronium, vecuronium, rocuronium, pipercuronium |
| Why does succinylcholine have a short duration of action? | It is quickly broken down by hydrolysis via plasma cholinesterase |
| What two products are formed from the breakdown of succinylcholine by plasma cholinesterase? | Succinylmonocholine, choline |
| The byproducts of succinylcholine metabolism is further broken down into what two products? | Succinic acid and choline |
| The metabolites of succinylcholine are (active/inactive). | Inactive |
| How is mivacurium metabolized and eliminated? | Metabolized by plasma cholinesterase, eliminated in the bile and urine |
| How is rocuronium eliminated? | Deacetylation via the liver |
| How does atracurium get eliminated? | Hoffman elimination in the plasma and tissues |
| What two variables does Hoffman elimination depend on? | pH and temperature |
| Which NMBD undergoes elimination by a three compartment model? | Vecuronium |
| How does pancuronium undergo elimination? | Triphasic elimination via the kidneys through glomerular filtration. |
Created by:
philip.truong
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