Ex4 NMBA 2

Question 1

long acting NDMR

Answer 1

pancuronium

Question 2

pancuronium ED95

Answer 2

0.07 mg/kg

Question 3

pancuronium intubating dose

Answer 3

0.1mg/kg

Question 4

pancuronium onset

Answer 4

slow

3-5minutes

Question 5

pancuronium DOA

Answer 5

long

60-90min

Question 6

DOA pancuronium will be prolonged with

Answer 6

renal dz
cirrhosis
biliary obstruction
aging

Question 7

Pancuronium metabolism

Answer 7

Renal elimination: 80% unchanged in urine
Hepatic deacetylation (10-40%)
*3-desacetylpancuronium =50% as potent

Question 8

Pancuronium - CV effects

Answer 8

Increased HR, MAP, CO, myocardial O2 consumption

• more profound increases w/ AV conduction abnormalities
• avoid in CAD pts (ischemia)

Question 9

Pancuronium CV effects are due to

Answer 9

antagonism of cardiac mAChRs (SA node)

Question 10

Pancuronium structure

Answer 10

bisquaternary aminosteroid

Question 11

priming dose - intmd NMDR

Answer 11

hastens speed of onset
20% ED95 prior to induction
after induction: remaining balance adm

Question 12

why is a priming dose used?

Answer 12

onset of intubating conditions is faster

Question 13

defasciculating dose

Answer 13

20% of ED95 of NDMR prior to induction

** larger dose of Sux required

Question 14

intermediate acting NDMRs

Answer 14

Vecuronium
Rocuronium
Atracurium
Cisatracurium

Question 15

Vecuronium bromide structure

Answer 15

monoquaternary aminosteroid

Question 16

Vecuronium ED95

Answer 16

0.05 mg/kg

Question 17

Vecuronium intubating dose

Answer 17

0.1 mg/kg

Question 18

Vecuronium onset

Answer 18

3-5 minutes

Question 19

Vecuronium DOA

Answer 19

20-35min

Question 20

Vecuronium elimination

Answer 20

renal + hepatic

Question 21

vecuronium metabolism

Answer 21

deacetylation to 3-desacetylvecuronium (50-70%) as potent as vec

Question 22

rocuronium structure

Answer 22

monoquaternary aminosteroid

Question 23

rocuronium intubating:
dose
onset
DOA

Answer 23

0.6 mg/kg
1-2minute onset
20-35minute DOA

Question 24

rocuronium RSI:
dose
onset
DOA

Answer 24

1.2 mg/kg
30-45s onset
60-90minute DOA

Question 25

rocuronium metabolism

Answer 25

excreted -unchanged in bile -renally (30%) liver/renal dz can prolong effects

Question 26

rocuronium side effects

Answer 26

no CV effects | no histamine release

Question 27

atracurium structure

Answer 27

bisquaternary benzylisoquinolinium | mix of 10 stereoisomers in solution

Question 28

atracurium ED95

Answer 28

0.2 mg/kg

Question 29

atracurium intubating dose

Answer 29

0.5mg/kg

Question 30

atracurium onset

Answer 30

3-5min

Question 31

atracurium DOA

Answer 31

20-35min

Question 32

atracurium elimination

Answer 32

Cleared by: | Hofmann Elimination + hydrolysis by non-specific esterases

Question 33

atracurium metabolism

Answer 33

laudanosine produced = CNS stimulant | -increases MAC, epileptogenic, cleared renally

Question 34

atracurium rapid admin of 2xED95 results in

Answer 34

increased HR | decreased BP

Question 35

atracurium rapid admin of 3xED95 results in

Answer 35

facial/truncal flushing (histamine release)

Question 36

atracurium pediatric considerations

Answer 36

infants 1-6months = decrease dose 50% for same effect as full dose in adults --recovery more rapid in infants

Question 37

atracurium elderly considerations

Answer 37

no change in pharmacokinetics

Question 38

cisatracurium bromide structure

Answer 38

benzylisoquinolinium | purified form of one of 10 stereoisomers of atracurium

Question 39

cisatracurium ED95

Answer 39

0.04 mg/kg

Question 40

cisatracurium onset

Answer 40

3-5min

Question 41

cisatracurium DOA

Answer 41

20-35min

Question 42

cisatracurium elimination

Answer 42

Hoffman --> laudanosine | *NO metabolism by nonspecific esterases

Question 43

cisatracurium is similar to which other NMDA?

Answer 43

atracurium | *except slower onset, no histamine release

Question 44

cisatracurium may be given to?

Answer 44

pts w/ renal/hepatic dz w/o prolonged effect

Question 45

Which two NMDAs are indistinguishable regarding CV effects in CAD

Answer 45

cis + vec