Neuromuscular Blockers

Question 1

Rocuronium: Class

Answer 1

Steroidal non depolarizing muscle blocker

Question 2

Rocuronium: Use

Answer 2

RSI
NMB Maintenance

Question 3

Rocuronium: Mechanism of Action

Answer 3

Combines with nicotinic receptors of the channels of the motor end-plate. Competitively blocks acetylcholine from attaching to the receptors. Postsynaptic membrane remains polarized.

Question 4

Rocuronium: Dose

Answer 4

Induction: 0.6-1.2 mg/kg
RSI: 1.2 mg/kg

Question 5

Rocuronium: Pharmacokinetics

Answer 5

Absorption: IV

Onset: 3 minutes
Duration of action: 60 minutes

Metabolism: Hepatic and Renal

Excretion: Hepatic and Renal

Question 6

Rocuronium Considerations

Answer 6

May reverse with Sugammadex

Common cause of allergic reaction

DOA Prolonged with, inhaled gases, Lithium, Mg

DOA Shortened with, anti-epileptics, Steroids, Ca

Question 7

Rocuronium: Contraindications

Answer 7

Known hypersensitivity to Bromides

Question 8

Vecuronium: Class

Answer 8

Steroidal non depolarizing muscle blocker

Question 9

Vecuronium: Use

Answer 9

Maintenance of NMB

Question 10

Vecuronium: Mechanism of Action

Answer 10

Combines with nicotinic receptors of the channels of the motor end-plate. Competitively blocks acetylcholine from attaching to the receptors. Postsynaptic membrane remains polarized.

Question 11

Vecuronium: Dose

Answer 11

Induction Dose: 0.1 mg/kg

Question 12

Vecuronium: Pharmacokinetics

Answer 12

Absorption: IV

Onset: 4 minutes
Duration of action: 60 minutes

Metabolism: Hepatic and Renal

Excretion: Hepatic and Renal

Question 13

Vecuronium: Contraindications

Answer 13

Known allergy to Bromides

Question 14

Vecuronium: Considerations

Answer 14

May reverse with Sugammadex

Must be reconstituted

DOA Prolonged with, inhaled gases, Lithium, Mg

DOA Shortened with, anti-epileptics, Steroids, Ca

Question 15

Cistracurium: Class

Answer 15

Benzylisoquinolinium

Question 16

Cistracurium: Use

Answer 16

Standard Induction
Maintenance of NMB

Question 17

Cistracurium: Mechanism of action

Answer 17

Combines with nicotinic receptors of the channels of the motor end-plate. Competitively blocks acetylcholine from attaching to the receptors. Postsynaptic membrane remains polarized.

Question 18

Cistracurium: Dose

Answer 18

Induction: 0.1mg/kg

Question 19

Cistracurium: Pharmacokinetics

Answer 19

Absorption: IV

Onset: 4 minutes
Duration: 60 minutes

Metabolism: Hofman elimination and esterase hydrolysis
ACTIVE METABOLITE : Laudanosine

Excretion: Kidneys

Question 20

Cistracurium: Contraindications

Answer 20

Hypersensitivity

Question 21

Cistracurium: Considerations

Answer 21

Hofmann elimination is dependent on temperature and pH

Active metabolite (is CNS stimulant) that is really excreted

Prolonged DOA: inhaled gases, hypothermia, MA, Lithium

Shortened DOA: Anti-epileptics, Steroids

Question 22

Succinylcholine: Class

Answer 22

Depolarizing muscle blocker

Question 23

Succinylcholine: Use

Answer 23

RSI
Laryngospasm
ECT

Question 24

Succinylcholine: Mechanism of Action

Answer 24

Succinylcholine attaches to nicotinic receptors and cause motor end-plate to open and depolarize. Medication stays on the receptor because it can not be broken down by acetylcholinesterase. Does not allow the channel to repolarize.

Question 25

Succinylcholine: Dose

Answer 25

IV Induction: 1 mg/kg
IM Induction: 4 mg/kg

Laryngospasm: 40mg IV

Question 26

Succinylcholine: Pharmacokinetics

Answer 26

Absorption: IV, IM

Onset: 60 seconds
Duration of Action: 15 minutes

Metabolism: Plasma Cholinesterases
Prolonged with plasma cholinesterase deficiency

Excretion: Kidneys

Question 27

Succinylcholine: Contraindications

Answer 27

Hyperkalemia
Risk for Malignant Hyperthermia
Severe Burns
Neurologic Injury
Plasma Cholinesterase Deficiency

Question 28

Succinylcholine: Considerations

Answer 28

Can cause Bradycardia, can pair with atropine
Will cause an increase in plasma K levels
Increased Intraocular pressure and Intracranial pressures
Myalgias