Neuromuscular Blockers

Which non-depolarizing muscle relaxant is metabolized predominantly by ester hydrolysis?

Atracurium

The primary means of elimination of rocuronium is?

Biliary elimination

Ranks the order in which the structures would exhibit paralysis after administration of NMB?

Eye muscles, extremities, abdominal muscles, diaphragm

Which sequence accurately describes the progression of paralysis following the administration of NMB?

Eyes, extremities, abdominal, diaphragm

Which of the following would be most appropriate to assess muscle relaxation prior to ETT placement?

Facial

Which nerve would be most appropriate to monitor using a PNS to determine adequacy of muscle relaxation prior to intubation?

Facial nerve

Ciasatracurium is primarily metabolized by?

Hoffman elimination

In neonate, cisatracurium is primarily metabolized by ?

Hoffman elimination

Which of the following would explain a duration of action for succinylcholine of 6-8 hours?

Homozygous Atypical pseudocholinesterase

Which of the following conditions would most likely prolong or potentiate the effects of NMB? (1)

Hypothermia (1)

A patient has a known history of homozygous atypical plasma cholinesterase. Which of the following should be avoided in this patient?

Mivacurium

The drugs most commonly involved in anesthesia related allergic reactions are?

NMB and antibiotics

Match the cholinesterase inhibitor with the characteristic with which it is associated?

Neostigmine = 0.7mg/kg max dose Pyridostigmine = 0.1-0.3 mg/kg Edophonium= shortest duration of action of the reversal agents Physostigmine = has tertiary chemical structure

What are characteristics of a phase II block from succinylcholine administration?

Post-tetanic potentiation & fade on train of four

Which of the following conditions would explain why a dose of succinylcholine could last for 20-30 minutes?

Pregnancy

During IV induction, you administer 10% of your calculated rocuronium dose followed by your induction agent, then the rest of the rocuronium dose. This technique is known as?

Priming

You administer succinylcholine in a high dose to a patient that has pseduocholinesterase deficiency. What results would you expect to see?

Prolonged phase II block

The action of which of the following non-depolarizing muscle relaxants would be prolonged in the presence of liver failure?

Rocuronium and Pancuronium

Which neuromuscular blocking agent is best suited for RSI intubation?

Rocuronium; when Succinylcholine is contraindicated

Which NMB is contraindicated in patient's with muscle denervation from CVA, spinal cord injury, or myelopathy?

Succinylcholine

Which of the following agents are capable of producing a phase I block?

Succinylcholine

Which of the following is a metabolite of succinylcholine?

Succinylmonocholine

Which nerve supplies the adductor pollicis muscle?

Ulnar

Atracurium should be refrigerated because?

it loses potency if not refrigerated

Which of the following is associated with decreased concentrations of plasma cholinesterase and a prolonged duration of action by succinylcholine?

muscular dystrophy

Select two disorders where succinylcholine is avoided?

myotonia and muscular dystrophy

The speed at which hoffman elimination acts to degrade atracurium depends primarily on?

pH and temperature

Which of the following conditions is NOT associated with an increased risk of hyperkalemia following succinylcholine administration?

scoliosis

What is the dibucaine number in a normal, healthy adult?

70 or higher

What is the recommended IV intubating dose of succinylcholine in a normal, healthy adult?

1.0-1.5mg/kg

You have performed a TOF assessment on your patient using a PNS. What is the minimum amount of time you should wait before repeating the test?

12 seconds

Which of the following conditions would most likely prolong or potentiate the effects of NMB? (2)

Acidosis (2)

What would you expect to see when performing a TOF test on a patient with a partial depolarizing block?

All four contractions diminish equally

Rhabdo in a peds patient who has received succinylcholine is associated with undiagnosed?

Duchenne's muscular dystrophy

Which cholinesterase inhibitor has the shortest duration of action?

Edrophonium

Atracurium is metabolized primarily by?

Non-specific tissue esterase

Place the muscle groups in the correct order in which they would become paralyzed by a non-depolarizing muscle group?

Occular muscles, extremities, diaphragm

Vecuronium is chemically derived from what other NMB?

Pancuronium