Oral: NMB

Question 1

Class: SUCCINYLCHOLINE

Answer 1

Depolarizing NMB

Question 2

MOA: SUCCINYLCHOLINE

Answer 2

Mimics ACh at the NMJ, opening channels and depolarizing post junctional membrane and prohibiting effect of ACh. (causes excitation & fasciculations followed by flaccid paralysis–> inhibits muscle contraction and channels stay OPEN)

Question 3

Pharmacokinetics: SUCCINYLCHOLINE

Answer 3

NOT highly PB
Onset = 30-60sec
DOA = < 15min
Metabolism= Rapidly hydrolyzed by PChE
Elimination = renal
E1/2t = 4min

Question 4

SE: SUCCINYLCHOLINE

Answer 4

1. MH + masseter spasm
2. hyperK
3. rhabdo, myoglobinuria
4. inc ICP, IOP
5. HISTAMINE
6. dec HR BP

Question 5

CI: SUCCINYLCHOLINE

Answer 5

1. MH hx
2. renal pt w/ inc K (must be less than 5.5)
3. peds – unless emergency
4. asthma/COPD d/t histamine
5. musc weakness pts – DMD, paralysis

Question 6

Dose: SUCCINYLCHOLINE

Answer 6

I: 1 mg/kg
RSI: 1.5 mg/kg
Laryngo: 10-20 mg
Continuous infusion: 2.5 mg/min (0.5 to 10 mg/min). Dilute to 1-2 mg/ml

Question 7

Class: DANTROLENE

Answer 7

Direct, centrally acting muscle relaxant – used to treat MH

Question 8

MOA: DANTROLENE

Answer 8

dec muscle tone + metabolism by restoring the balance btw the release and uptake of Ca+

1. prevents the ongoing release of Ca+ from the sarcoplasmic reticulum = dec muscle contraction
2. blocks external entry of Ca+ into the sarcoplasm
3. hypothesized to inhibit Ca+ conductance through the Ryanodine channels

(Does NOT potentiate effects of NDMR and does NOT interfere w/ reversal of muscle relaxants )

Question 9

PK: DANTROLENE

Answer 9

Onset < 5min
DOA = 3hr
5-hydroxydantrolene, 30 – 50% potency 
Hepatic metabolism 
Hepatic and renal elimination
E1/2t = 10-15hrs

Question 10

SE: DANTROLENE

Answer 10

1. skeletal musc. weakness – may need to stay intubated
2. inc HR, labile BP
3. hepatitis if used > 60 days
4. phlebitis
5. seizures

Question 11

CI: DANTROLENE

Answer 11

Duchenne’s muscular dystrophy + pre-existing muscular dz pts

CCBs = life threatening hyperK and myocardial dep.

Question 12

Dose: DANTROLENE

Answer 12

Bolus: 2.5 mg/kg – followed by:
Maintenance: 2 mg/kg IV q5min for a total of 10 mg/kg
Then 70mg IV q6hrs for 72 hrs

can switch to PO dantrolene for a few days after MH is resolved

Question 13

Class: ATRACURIUM, CISATRACURIUM, MIVACURIUM, d-TUBOCURARINE

Answer 13

Nondepolarizing NMB

benzylisoquinolone

Question 14

MOA: All NDNMB

Answer 14

competitive antagonist

acts on pre/post syn cholinergic receptors and produces NMB by blocking passage of ions through nAChR

Question 15

PK: ATRACURIUM

Answer 15

80% PB
Water sol.
Onset = 1-3min
DOA = 30min
Active met = Laudanosine (accumulates w/ RF – can cause seizures)
Met = 2/3 ester hydrolysis, 1/3 hoffman elim – temp/pH dep.
Elim = renal
E1/2t = 30min

Question 16

SE: ATRACURIUM

Answer 16

1. HISTAMINE
2. dec BP inc HR
3. flushing
4. prolonged action w/ IA, abx, AEDs

Question 17

CI: ATRACURIUM

Answer 17

1. caution w/ metabolize w/ RF/LF
2. asthma/COPD
3. hypersensitivity

Question 18

Dose: ATRACURIUM

Answer 18

0.5 mg/kg

Redose: 0.1 mg/kg 15-45 min later

Question 19

PK: CISATRACURIUM

Answer 19

Water sol
Onset = 2-3min
DOA = 30min
Active met = Laudanosine – 1/5 of atrac
Met = 80% hoffman elim – temp/pH dep.
Elim = renal + feces
E1/2t = 30min

Good for RF
NO histamine!

Question 20

SE: CISATRACURIUM

Answer 20

1. MINIMAL se!!
2. prolonged action w/ abx, LA, Li
3. seizures w/ RF (d/t laudan)

Question 21

CI: CISATRACURIUM

Answer 21

1. hypersensitivity

2. musc weakness

Question 22

Dose: CISATRACURIUM

Answer 22

0.2 mg/kg

Redose: 0.02 mg/kg 40-60 min later

Question 23

PK: MIVACURIUM

Answer 23

Onset = 1-2min
DOA = 20min
Met = Rapidly hydrolyzed by PChE
Elim = renal 
E1/2t = 55min

Good for RF
Good for peds – faster onset + recovery
Can reverse w/ edrophonium

Question 24

SE: MIVACURIUM

Answer 24

1. HISTAMINE
2. inc HR dec BP
3. bronchospasm

Question 25

CI: MIVACURIUM

Answer 25

1. prolonged w/ atypical PChE activity 2. asthma/COPD 3. hypersensitivity

Question 26

Dose: MIVACURIUM

Answer 26

Intubation: 0.2-0.25 mg/kg

Question 27

Class: ROCURONIUM, VECURONIUM, PANCURONIUM

Answer 27

Nondepolarizing NMB | Steroidal

Question 28

PK: ROCURONIUM

Answer 28

``` Onset = 1-2min DOA = 30min Met = Hepatic Elim = Renal - 30% excreted unchanged 50% biliary excretion E1/2t = 1-2hr ``` NO histamine

Question 29

SE: ROCURONIUM

Answer 29

1. cardiac stable!! 2. dec doa w/ IA, LA 3. bronchospasm 4. salivation 5. inc doa w/ RF/LF

Question 30

CI: ROCURONIUM

Answer 30

1. hypersensitivity | 2. MG

Question 31

Dose: ROCURONIUM

Answer 31

I: 0.6 mg/kg RSI: 1.2 mg/kg

Question 32

PK: VECURONIUM

Answer 32

``` 70% PB Onset = 2-3min DOA = 30min Active met = 3-desacetyl vec – 50% as potent Met = Hepatic Elim = Renal - 30% excreted unchanged 50% biliary excretion E1/2t = 70min ``` NO histamine

Question 33

SE: VECURONIUM

Answer 33

1. bronchospasm 2. NO CV effects! 3. inc doa w/ IA + abx 4. 2. inc doa w/ RF/LF

Question 34

CI: VECURONIUM

Answer 34

1. hypersensitivity

Question 35

Dose: VECURONIUM

Answer 35

0.1 mg/kg and then 10% dose for redosing (for all?)

Question 36

PK: PANCURONIUM

Answer 36

``` Small PB Onset = 2-3min DOA = 60-90min Active met = 3-desacetyl panc – 50% as potent – accumulates in renal, biliary + liver dz, elderly + obese Met = 20% Hepatic Elim = Renal - 80% excreted unchanged 50% biliary excretion - dec dose 50% in LF E1/2t = 2hr ``` NO histamine Inhibits PCHE activity

Question 37

SE: PANCURONIUM

Answer 37

1. inc HR, BP, CO – hit them w/ a pan! 2. bronchospasm 3. ins doa w/ IA, abx, AEDs 4. musc weakness

Question 38

CI: PANCURONIUM

Answer 38

1. CAD, HF, HD 2. renal dysfx 3. hypersensitivity 4. pheochromocytopma

Question 39

Dose: PANCURONIUM

Answer 39

0.1 mg/kg and then 10% dose for redosing (for all?)