Académique Documents
Professionnel Documents
Culture Documents
Pipecuronium 50-100
Vecuronium 20-40
Atracurium 20-40
Rocuronium 20-40
Succinyl 3-6
choline
Skeletal muscle relaxants
Depolarizing block ( Non-competitive ) :
Succinylcholine have affinity and sub
maximal intrinsic activity at NM receptors.
They open Na channels which
cause initial twitching and fasciculations.
It do not dissociate rapidly from the
receptors resulting in prolonged
depolarization and inactivation of the Na +
channels
Skeletal muscle relaxants
Depolarizing block (Non-competitive) :
Succinylcholine
• It causes muscle pain.
• It causes hyperkalemia.
• Malignant Hyperthermia.
Competitive Non-
Non-depolarizing Competitive
Depolarizing
Paralysis Flaccid Fasciculations---
› Flaccid
Neostigmine Antagonizes Exaggerate /
no effect.
Examples Pancuronium Succinylcholine
Skeletal muscle relaxants
USES OF NEUROMUSCULAAR
BLOCKERS :
• Adjuvant in general anesthesia
• Intubation and endoscopies
• Brief procedure – reduction of #.
Skeletal muscle relaxants
Directly acting muscle relaxants :
Dantrolene :
Depolarization triggered release of
calcium from the sarcoplasmic
contraction is blocked / reduced.
• Dantrolene is used orally/ i.v to reduces
spasticity in hemiplegia and cerebral
palsy.
• It is the drug of choice – malignant
hyperthermia
Central skeletal muscle
relaxants
• These produce selective action in the
cerebrospinal axis – acts as skeletal muscle
relaxants
• Theses depress the spinal and supraspinal
polysynaptic reflexes involved in the
regulation of muscle tone.
• Polysynaptic reflex in the RAS – involved in
the wakefulness also depressed – sedative
action.
Central skeletal muscle
relaxants
Examples of centrally acting skeletal
muscle relaxants :
• Chlorzoxazone, Methocarbamol
• Diazepam
• Baclofen
Ganglion blockers
• Ganglion blockers are competitive
antagonist at NN receptors in
autonomic ganglia.
• Net effect of the blocker is to reduce
the predominant tone.
• Effects are predictable and depend
on the relative dominance in terms of
PANS and SANS.
Ganglion blockers
Effector Dominant Effects of ganglionic
organs system blockade
Arterioles/ SANS Vasodilatation, hypotension
veins
Sweat glands SANS Anhydrosis
Beta blockers
Alpha agonist Pilocarpine PG analog
CA inhibitor
Glaucoma
Muscarinic cholinomimetics :
• Direct-acting : Pilocarpine, Carbachol
• Indirect-acting : Physostigmine
----> contraction of ciliary muscle open
the trabecular spaces so that aqueous
humor drains more easily.
----> iris pulled from angle of anterior
chamber widening the filtration angle and
opening the trabecular network
----> increased outflow of aqueous humor
----> decreased intraocular pressure.
Glaucoma
Beta adrenoceptor blockers :
Timolol, Betaxolol
• ----> decreased production of
aqueous humor by ciliary epithelium.
• No change in pupil size, No
headache, No fluctuations in IOT are
the advantages of the beta blockers.
Glaucoma
Carbonic anhydrase inhibitors :
• Dorzolamide
• It blocks the formation of aqueous humor by
blocking the carbonic anhydrase enzyme
required for the synthesis of it.
Alpha Adrenoceptor agonists :
• Apraclonidine
----> alpha 2 agonist acts by reducing the
formation of aqueous humor.
Glaucoma
Prostaglandins :
• Latanaprost
• It increases the aqueous drainage through
the alternate pathways – uveoscleral route.
• May eventually cause permanent darkening
of the iris to brown (heterochromia),
eyelashes reddening of the eyes.