Test 2: Steroids

Question 1

What is the structure of Pancuronium?

Answer 1

-Bisquaternary
-Resembles Ach enough to bind, but not depolarize

Question 2

What is the intubating and maintenance doses of Pancuronium?

Answer 2

I: 0.08 - 0.12 mg/kg
M: 0.01 mg/kg

Question 3

What is the onset of Pancuronium?

Answer 3

2-3 minutes

Question 4

What is the DOA of Pancuronium?

Answer 4

60-90 minutes (long-acting)

Question 5

What is the ED95 of Pancuronium?

Answer 5

0.07 mg/kg

Question 6

How is Pancuronium metabolized/excreted?

Answer 6

-Liver metabolism
-renal excretion
-Active metabolite (!): 3-desacetylpancuronium is 50% as potent
-high incidence of residual block

Question 7

What are the side effects associated with Pancuronium?

Answer 7

-Vagolytic: 10-15% increase in HR, MAP, and CO by blocking vagal muscarinic receptors of the SA Node (!)
-Vagolytic, espec at doses of 2x ED95 (!)

Question 8

What are the misc effects associated with Pancuronium?

Answer 8

-Prolonged with renal failure
-Cirrhosis = inc intubating dose but dec maintenance dose (inc Vd but dec clearance)
-Caution in patients with CAD where tachycardia is detrimental

Question 9

What is the structure of Vecuronium?

Answer 9

Monoquaternary - changes SE’s without changing potency

Question 10

What is the Intubating and maintenance doses of Vecuronium?

Answer 10

I: 0.08 - 0.12 mg/kg
M: 0.01 mg/kg

Question 11

What is the onset of Vecuronium?

Answer 11

3 min

Question 12

What is the DOA of Vecuronium?

Answer 12

30-45 minutes

Question 13

What is the ED95 of Vecuronium?

Answer 13

0.04 - 0.05 mg/kg

Question 14

What is the metabolism/excretion of Vecuronium?

Answer 14

-Primarily liver excretion
-Obese, infants, and neonates have a slower recovery
-Active metabolite (!)

Question 15

What are the side effects associated with Vecuronium?

Answer 15

-Females are 30% more sensitive than men
-No CV effects, but slight (minimal) increase in HR/BP

Question 16

What are the misc effects associated with Vecuronium?

Answer 16

-OK for renal failure patients, but may have increased DOA
-Prolonged paralysis in AIDS pts, elderly, post-partum, obese
-Precipitates with thiopental

Question 17

What is the structure of Rocuronium?

Answer 17

-Monoquaternary analogue of Vec
-1/6th - 1/8th as potent as vec
-less potent = rapid onset

Question 18

What is the intubating and maintenance dose of Rocuronium (Adults)?

Answer 18

I: 0.45 - 0.9 mg/kg
M: 0.15 mg/kg

Question 19

What is the RSI dose of Roc in kids?

Answer 19

Kids 2-12 years: 0.9-1.2 mg/kg

Infants: 1 mg/kg IM
Children: 2 mg/kg IM

Question 20

What is the onset of Rocuronium?

Answer 20

45 - 90 seconds

Question 21

What is the DOA of Rocuronium?

Answer 21

30 - 90 minutes

Question 22

What is the ED95 of Rocuronium?

Answer 22

0.3 mg/kg

Question 23

What is the metabolism/excretion of Rocuronium?

Answer 23

NO metabolism (!) and NO active metabolites
-Liver/renal elimination

Question 24

What are the misc effects associated with Rocuronium?

Answer 24

1.0 mg/kg dose will allow for intubating conditions as fast as 1.0 mg/kg of Succ (!)

-DOA prolonged by severe hepatic failure and pregnancy
-Increased DOA in elderly (dec muscle mass)
-Increased DOA in Obese patients

-Inc dose in liver dz patients
-Females more sensitive