Chaper 28, 30 and 31

nondepolarizing neuromuscular junction blocking agents

Act as antagonists to acetylcholine (ACh) at the NMJ and prevent

depolarization of muscle cells

depolarizing neuromuscular junction blocking agents

• One drug

• Acts as an ACh agonist at the NMJ, causing stimulation of the muscle cell

and preventing it from repolarizing

class for the prototype pancuronium

nondepolarizing NMJ blockers

prototype for the class nondepolarizing NMJ blockers

pancuronium

pancuronium therapeutic actions/uses

• Serve as an adjunct to general anesthetics during surgery when reflex muscle movement

could interfere with procedure or delivery of anesthesia

• Facilitate mechanical intubation by preventing resistance to passing of endotracheal

tube or when patients “fight” or resist the ventilator

• Facilitate various endoscopic diagnostic procedures when reflex muscle reaction could

interfere

pancuronium adverse effects

• Associated with muscle paralysis

• Depressed respiration, bronchospasm, apnea

• Histamine release  respiratory obstruction with

wheezing and bronchospasm

• Hypotension, cardiac arrhythmias

• GI dysfunction

• Pressure ulcers

• Hyperkalemia

pancuronium contraindications

• Allergy

• Myasthenia gravis

• Renal or hepatic disease

• Pregnancy

pancuronium precautions

• Personal or family history of malignant

hyperthermia

• Pulmonary or CV dysfunction

• Altered fluid and electrolyte imbalance

• Some respiratory conditions

• Lactation

pancuronium nursing interventions

• Maintain continuous cardiac and respiratory monitoring.

• Have equipment ready for resuscitation and mechanical

ventilation.

• Monitor for return of respiratory function when medication is

discontinued.

• Administer a cholinesterase inhibitor, neostigmine, to reverse the

action of nondepolarizing neuromuscular blocking agents as

needed.

prototype for the class deopolarizing NMJ blocker

succinylcholine

class for the prototype succinylcholine

depolarizing NMJ blocker

succinylcholine therapeutic actions

• Attaches to ACh receptor site on muscle cell, causing prolonged depolarization of the

muscle

• Causes stimulation and contraction, then flaccid paralysis

• Serve as an adjunct to general anesthetics during surgery when reflex muscle movement

could interfere with procedure or delivery of anesthesia

• Facilitate mechanical intubation by preventing resistance to passing of endotracheal

tube or when patients “fight” or resist the ventilator

• Facilitate various endoscopic diagnostic procedures when reflex muscle reaction could

interfere

succinylcholine contraindications

• Some are the same as those for nondepolarizing

• Boxed warning: pediatric patients

• Malignant hyperthermia

succinylcholine precautions

• Fractures

• Narrow-angle glaucoma or penetrating eye injuries

• Paraplegia or spinal cord injuries

• Genetic or disease-related conditions causing low plasma cholinesterase levels

succinylcholine adverse effects

• Same as those for nondepolarizing NMJ blockers

• Muscle pain

• Malignant hyperthermia

• Manifestations include muscle rigidity accompanied by increased temperature, as

high as 43° C (109.4° F). Other manifestations include cardiac dysrhythmias,

unstable b/p, electrolyte imbalances, and metabolic acidosis.

• Must give dantrolene (muscle relaxer)

succinylcholine nursing interventions

• Maintain continuous cardiac and respiratory monitoring.

• Have equipment ready for resuscitation and mechanical

ventilation.

• Monitor for return of respiratory function when medication is

discontinued.

• Malignant hyperthermia interventions

malignant hyperthermia interventions for succinylcholine

• Monitor vital signs.

• Stop succinylcholine and other anesthetics.

• Administer oxygen at 100%.

• Initiate cooling measures

• Administer dantrolene to decrease metabolic activity of skeletal muscle.

prototype for the class alpha/beta-adrenergic agonists

epinephrine

class for the prototype epinephrine

alpha/beta-adrenergic agonists

other alpha/beta-adrenergic agonists

ephedrine, norepinephrine

epinephrine therapeutic actions

• Effects mediated by the adrenergic receptors in target organs: heart rate increases, bronchi dilate,

blood vessels constrict, intraocular pressure decreases, glycogenolysis occurs throughout the body,

pupils dilate, sweating can increase

• Specific actions vary by drug

epinephrine therapeutic use

• Treatment of hypotension with shock

• Prolong effects of regional anesthetic

• Primary treatment for bronchospasm; to produce local vasoconstriction that prolongs effect

of local anesthetics

• Emergency treatment of allergic reactions

epinephrine adverse reactions

• Chest pain

• Myocardial infarction

• Hypertensive crisis

• Cardiac arrhythmias

• Tissue necrosis and extravasation

• Tachycardia

• Tremors

• Nervousness

• Seizures

• Cerebral hemorrhage

• Pulmonary edema

epinephrine contraindications

• No contraindications in life threatening situations

• Know hypersensitivity to sympathomimetics

epinephrine precautions

• Cerebrovascular disorders

• History of hypertension

epinephrine admin

• Can be administered

subcutaneously or intramuscularly

for anaphylaxis

• For cardiovascular dysfunction can

be administered intravenously, via

intraosseous or endotracheal tube.

• Central line is preferred for

intravenous administration

• Rapid onset and short half-life

• Titration is based on perfusion

• Hypovolemia should be corrected

prior to administration, if possible

epinephrine interventions

• Monitor hemodynamics

• Monitor cardiac rhythm

• Monitor level of consciousness

• Closely monitor renal function

• Monitor blood glucose levels (can

cause hyperglycemia

• Monitor extravasation if given

peripherally

epinephrine client instructions

• Only administered for cardiovascular dysfunction in the hospital

• Inform clients of continuous monitoring

• Report chest pain to staff immediately

alpha-selective adrenergic agonists

• Bind primarily to alpha-receptors rather than to beta-receptors

• Drugs

• Clonidine: Treatment of ADHD

• Phenylephrine: Cold and allergies; perioperative hypotension; vasodilatory shock;

supraventricular tachycardias; glaucoma; allergic rhinitis; otitis media

clonidine and phenylephrine are which type of drugs?

alpha-selective adrenergic agonists

beta-specific adrenergic agonists

• Most are beta2-selective

agonists

• Used to manage and

treat bronchial spasm,

asthma, and other

obstructive pulmonary

conditions

• Drugs

• Albuterol (AccuNeb, others)

• Arformoterol (Brovana)

• Formoterol (Foradil, Perforomist)

• Isoproterenol (Isuprel)

• Levalbuterol (Xopenex)

• Metaproterenol (generic)

• Olodaterol (Striverdi Respimat)

• Salmeterol (Serevent Diskus)

• Terbutaline (generic)

nonselective adrenergic blocking agents

• Block both alpha- and beta-adrenergic receptors

• Primarily used to treat cardiac-related conditions

• Amiodarone (Nexterone, Pacerone): Treatment of life-threatening

ventricular arrhythmias, atrial fibrillation

• Carvedilol (Coreg, Coreg CR): Treatment of hypertension, left

ventricular dysfunction after MI, HF in adults

• Labetalol (Trandate): Treatment of hypertension, hypertension

associated with pheochromocytoma, clonidine withdrawal

amiodarone, carvedilol, labetalol are which type of drugs

nonselective adrenergic blocking agents