Neuromuscular blockers

Question 1

True/false: in suxamethonium-induced neuromuscular blockade, atropine is indicated

Answer 1

True, Suxamethonium (succinylcholine) can cause bradycardia, especially with repeated doses or in children. S/E of Atropine = tachycardia, therefore it’s used to counteract the effects of suxamethonium

Question 2

True/false: orphenadrine is an agonist at muscarinic ACh receptors

Answer 2

False, its an Ach & Glutamate inhibitor

Question 3

True/false: suxamethonium is metabolised by plasma cholinesterase

Answer 3

True

Question 4

True/false: atracurium is a nicotinic receptor antagonist

Answer 4

True

Question 5

True/false: rocuronium induces more histamine release than mivacurium

Answer 5

False

Question 6

Which NMBs release histamine?

Answer 6

Delta-turbocurarine, Atracurium, Cisatracurium, Mivacurium

Question 7

This anticholinesterase drug prevents the hydrolysis of acetylcholine in the neuromuscular junction. It is therefore indicated for termination of neuromuscular blockade of muscle relaxants that are metabolized by plasma cholinesterases.

Answer 7

Neostigmine

Question 8

True/false: Pancuronium causes bradycardia

Answer 8

True

Question 9

True/false: Vecuronium antagonises the effects of Ach at the post-synaptic nicotinic receptor.

Answer 9

True, It’s a non-depolarising nicotinic antagonist.

Question 10

True/false: cisatracurium is metabolized in the liver.

Answer 10

False, undergoes Hofmann elimination

Question 11

True/false: pancuronium has a longer DOA than succinylcholine.

Answer 11

True, Pancuronium = long-acting, Succinylcholine = ultra-short acting

Question 12

True/false: vecuronium crosses the BBB.

Answer 12

False

Question 13

True/false: succinylcholine reverses muscle rigidity in pts with malignant hyperthermia.

Answer 13

False, It triggers malignant hyperthermia.

Question 14

True/false: Baclofen is a GABA mimetic agent.

Answer 14

True

Question 15

True/false: vecuronium is a nicotinic receptor antagonist.

Answer 15

True

Question 16

True/false: rifampicin prolongs the muscle relaxant effects of vecuronium.

Answer 16

False, Rifampicin is an enzyme inducer → reduces DOA

Question 17

True/false: atropine inhibits acetylcholinesterase.

Answer 17

False, Atropine is a muscarinic antagonist, not an AChE inhibitor

Question 18

True/false: vecuronium induces more histamine release than pancuronium.

Answer 18

False, Both induce minimal histamine release; atracurium releases more

Question 19

True/false: succinylcholine is a non-depolarising NMB.

Answer 19

False

Question 20

True/false: succinylcholine has a longer DOA than cisatracurium.

Answer 20

False

Question 21

True/false: succinylcholine competes with mivacurium for plasma cholinesterase.

Answer 21

True, Both are metabolised by plasma cholinesterase

Question 22

True/false: succinylcholine is used to treat malignant hyperthermia.

Answer 22

False

Question 23

True/false: succinylcholine causes hypertension.

Answer 23

False, may cause bradycardia/arrhythmias, not usually HPT

Question 24

True/false: vecuronium is metabolized by the Hoffman degradation pathway.

Answer 24

False, Cisatracurium is metabolized by Hoffman. Vecuronium is hepatically metabolized

Question 25

True/false: alcuronium is a nicotinic receptor antagonist.

Answer 25

True

Question 26

True/false: rocuronium has analgesic properties.

Answer 26

False

Question 27

True/false: vecuronium has a longer duration of action than succinylcholine.

Answer 27

True

Question 28

True/false: Succinylcholine is more cardiotoxic than vecuronium.

Answer 28

True

Question 29

True/false: Succinylcholine crosses the blood brain barrier.

Answer 29

False, hydrophyllic

Question 30

True/false: Succinylcholine causes muscle pain as an adverse effect.

Answer 30

True

Question 31

True/false: Succinylcholine-induced malignant hyperthermia is reversed by diazepam.

Answer 31

False, reversed by Dantrolene

Question 32

True/false: Succinylcholine is preferred to vecuronium in patients with myasthenia gravis.

Answer 32

False, Myasthenic pts are resistant to it, thus it’s not preferred

Question 33

True/false: dantrolene causes malignant hyperthermia.

Answer 33

False

Question 35

True/false: pancuronium crosses the BBB.

Answer 35

False

Question 36

True/false: succinylcholine has a shorter duration of action than vecuronium.

Answer 36

True

Question 37

True/false: rocuronium causes seizures as an adverse effect.

Answer 37

False

Question 38

True/false: diazepam inhibits calcium release from the sarcomere.

Answer 38

False, Dantrolene NOT Diazepam

Question 39

True/false: neostigmine reverses vecuronium-induced muscle paralysis.

Answer 39

True, Inhibits AChE → ↑ ACh → reverses non-depolarising block.

Question 40

True/false: cimetidine prolongs the muscle relaxant effects of vecuronium.

Answer 40

True, Inhibits hepatic metabolism, prolonging action

Question 41

True/false: baclofen reverses succinylcholine-induced malignant hyperthermia.

Answer 41

False, Dantrolene

Question 43

True/false: Pancuronium is a muscarinic receptor antagonist.

Answer 43

False, has antimuscarinic effects

Question 44

True/false: Pancuronium has a longer duration of action than mivacurium.

Answer 44

True

Question 45

True/false: Pancuronium is metabolized by acetylcholinesterase.

Answer 45

False

Question 46

True/false: Pancuronium is more cardiotoxic than vecuronium.

Answer 46

True, vecuronium has minimal CV effects

Question 47

True/false: Pancuronium is preferred to alcuronium in patients with porphyria.

Answer 47

True

Question 48

True/false: baclofen is an alpha-2-adrenoceptor agonist.

Answer 48

False, GABA agonist

Question 49

True/false: cis-atracurium is preferred to pancuronium in patients with hepatic dysfunction.

Answer 49

True, metabolized by Hoffman pathways as opposed to hepatic

Question 50

True/false: furosemide prolongs the neuromuscular blockade induced by pancuronium.

Answer 50

True

Question 51

True/false: vecuronium induces more histamine release than atracurium.

Answer 51

False, Atracurium causes more histamine release

Question 52

True/false: neostigmine potentiates the effects of pancuronium.

Answer 52

False, reverses NOT potentiates

Question 53

True/false: succinylcholine is a lipophilic drug.

Answer 53

False

Question 55

True/false: neostigmine reverses the effects of vecuronium.

Answer 55

True

Question 56

True/false: cimetidine prolongs the muscle relaxant effects of pancuronium.

Answer 56

True

Question 57

True/false: dantrolene causes malignant hyperthermia as an adverse effect.

Answer 57

False