Med Review Paralytics

Question 1

What is the MOA of succinylcholine?

Answer 1

2 molecules of ACh bound together that mimic ACh and bind to ACh receptors at the NMJ ⇒ opens the channel and prevents resetting of the channel ⇒ paralysis

Question 2

How is succinylcholine metabolized?

Answer 2

plasma cholinesterase

Question 3

What major considerations must be made with administration of succinylcholine?

Answer 3

• MH trigger
• avoid in burn pt (upregulation of nACh receptors)
• avoid in renal failure (further increase in K⁺)

Question 4

Cisatracurium is how much more potent and atracurium?

Answer 4

4 times more potent than atracurium

Question 5

Why would cisatracurium be the drug of choice for a patient with renal failure?

Answer 5

metabolized via hoffman elimination, organ independent

Question 6

How is vecuronium metabolized?

Answer 6

hepatic metabolism (30-40%)

• may accumulate in renal failure

Question 7

How is rocuronium metabolized?

Answer 7

minimal to no metabolism

• excreted unchanged in urine and bile

Question 8

What considerations should be made with administration of rocuronium with liver failure? Renal failure?

Answer 8

• Moderate prolongation in liver failure
• not affected by renal failure

Question 9

How is rocuronium administration affected in elderly and pregnant patients?

Answer 9

slightly prolonged in both

Question 10

What is the most common acetylcholinesterase inhibitor used to reverse paralytics?

Answer 10

Neostigmine (prostigmin)

Question 11

What is the onset of action for edrophonium in paralytic reversal?

Answer 11

1-2 minutes

Question 12

What is the onset for pyridostigmine in paralytic reversal?

Answer 12

16 minutes

Question 13

What is the onset for neostigmine in paralytic reversal?

Answer 13

~5 - 10 minutes

Question 14

What is the duration of action for edrophonium in paralytic reversal?

Answer 14

5-20 minutes

Question 15

What is the duration of action for neostigmine in paralytic reversal?

Answer 15

40 - 60 minutes

Question 16

what is the duration of action for pyridostigmine in paralytic reversal?

Answer 16

90 minutes

Question 17

What drug is typically administered with acetylcholinesterase inhibitors to prevent profound bradycardia?

Answer 17

glycopyrrolate (robinul)

Question 18

What is the onset and duration of glycopyrrolate?

Answer 18

Onset: 2-3 minutes
Duration: 2 hours

Question 19

How does glycopyrrolate differ from administration of atropine?

Answer 19

• does not cross the BBB and thus doesn’t cause sedation
• also causes less tachycardia than atropine

Question 20

What are the main effects of glycopyrrolate?

Answer 20

• tachycardia
• bronchodilation
• anti-sialogogue

Question 21

Sugammadex (bridion) works best in reversal of which paralytic?

Answer 21

FDA approved for Rocuronium reversal

has also been shown to work with vecuronium and pancuronium

Question 22

A shallow/medium blockade reversal can be done with what dose of sugammadex?

Answer 22

2 mg/kg

Question 23

A deep blockade reversal can be done with what dose of sugammadex?

Answer 23

4 mg/kg

Question 24

For immediate reversal, 3 minutes after administration of max 1.2mg/kg rocuronium what dose of sugammadex can be given for reversal?

Answer 24

16 mg/kg?