Neuromuscular Blocking Agents Flashcards
Which of the following is not an indication for neuromuscular blocking agents (NMBAs)?
A. facilitate invasive mechanical ventilation
B. Reduce intracranial pressure
C Prevent Shivering
D. motor disorders characterized by increases in muscle tone
E. endotracheal intubation
D. Motor Disorders characterized by increases in muscle tone
You use muscle relaxers for D
What do NNBA do when doing an endotracheal intubation?
A. Unconsciousness
B. Prevent adverse reflex responses like tachycardia, HTN, or elevated intracranial pressure
C. Prevent adverse reflex responses like blocking the gag reflex or minimizing aspiration risks
D. rapid temporary paralysis
E. A and B
F. C and D
F. C and D
Which of the NBMA is not used for endotracheal intubation?
A. Succinylcholine
B. Pancuronium
C. Vecuronium
D Rocuronium
B. Pancuronium
REMEMBER SVR and Pancuronium lasts 90-100minutes in the body compared to the SVR ones that last less than 60
Which of the following is not an adverse effect of succinylcholine?
A. myopathy
B. Hyperkalemia
C. Muscle fasciculations
D. Rhadomyolysis
A. Myopathy
Which of the following NMBAs causes malignant hyperthermia?
A. Vecuronium
B. Rocuronium
C. Cisatracurium
D. Succinylcholine
D. Succinylcholine
Which of the following drugs causes myopathy? (select all that apply)
A. Succinylcholine
B. Rocuronium
C. Vecuronium
D. Atracurium
B,C, D
La-A presents to the ER with an allergic reaction to peanuts. ( Her nemesis Sharquesha, gave her a penut infused brownie so she can die). La-A is short of breath, and has significant toungue and laryngeal swelling. The physicial Dr. Scratch-n-sniff decides to intubate poor La-A. Which of the following NMBA is appropriate for the intubation?
A. Pancuronium
B. Vecuronium
C. Cisatracurium
D. Atracurium
B. Vecuronium
Remember SVR for endotracheal intubation
What pharmacologic agents are needed for endotracheal intubation?
A. Pretreatment (lidocain, fentanyl)
B. Induction like a sedative
C. Neuromuscular Blocking Agents
D. A and B
E. All of the Above
E. All of the Above
In an alternate universe Dobby is apparated to the nearest hospital where he can be saved. Upon trying to save him Dobby started to crash. He became hypotensive and his oxygen levels were decreasing. The doctor then decided to intubate. He pulled out his wand and used the Accio spell to get which NMBA.
A. Epinephrine
B. Ketamine
C. Atracurium
D. Rocuronium
D. Rocuronium
When are NMBA indicated for Invasive Mechanical Ventilation? ( select all that apply)
A. At the request of the patient
B. refractory hypoxemia and ventilator asyncrony
C. Sedation insuficient to provide effective lung ventilation
D. When there is one twitch on the TOF monitoring
B, C
TOF is train of four monitoring and that’s when you count the number of twiches.
Which of the following NMBA is not indicated for mechanical ventilation?
A. Pancuronium
B. Vecuronium
C. Rocuronium
D. succinylcholine
D. Succinylcholine
Succinylchline increases the risk of adverse effects
Which of the following NMBA are indicated for mechanical ventilation?
A. Vecuronium
B. Atracurium
C. Cisatricurium
D. Curare
(select all that apply)
A, B, C
Which of the following drugs have active metabolites? (select all that apply)
A. Cisatracurium
B. Rocuronium
C. Vecuronium
D. Pancuronium
C,D
Which medication has “minimal” renal elimination?
A. Pancuronium
B. Vecuronium
C. Rocuronium
D. Atracurium
E. Cisatracurium
C. Rocuronium
Which NMBA are renally eliminated? (select all that apply)
A. Pancuronium
B. Vecuronium
C. Rocuronium
D. Atracurium
E. Succinylcholine
A, B
Which NMBA is not hepatically eliminated?
A. Cisatracurium
B. Rocuronium
C. Pancuronium
D. Vecuronium
A. Cisatracurium
Which NMBA causes tachycardia and hypertension?
A. Pancuronium
B. Vecuronium
C. Rocuronium
D. Atracurium
A. Pancuronium
Pancho Barraza is a mexican singer/ songwriter with liver disease. He is found on the side of the highway one night wounded. He is rushed to the hospital where the ER doc sends him to the ICU. Dr. Scratch-n-sniff would like to start a NMBA to improve his lung function. Which of the following are appropriate agents for this patient?
A. Vecuronium
B. Rocuronium
C. Cisatracurium
D. Pancuronium
C. Cisatracurium
He has liver disease and cisatracurium is not hepatically eliminated
Jeanette is a 26 yo female that looks like Lidia from bettlejuice. She can’t have caffeine because she gets severe tachycardia. Which NMBA should Jeanette not get if she was to receive mechanical ventilation?
A. Vecuronium
B. Rocuronium
C. Pancuronium
D. Atracurium
C. Pancuronium
El Coyote is a mexican banda singer with a PMH of HTN, dyslipidemia, diabetes, CKD, and COPD. He is put on a mechanical ventilation due to acute respiratory failure. Which NMBA agent is appropriate to use to improve his lung ventilation?
A. Vecuronium
B. Cisatracurium
C. Rocuronium
D. Pancuronium
B. Cisatracurium
The rest of the medications are renally eliminated or minimally renally eliminated.
El Coyote is placed on the Cisatracurium to improve his lung ventilation. What is your target Train of Four?
A. 4/4
B. 3/4
C. 0/4
D. 2/4
D. 2/4
True or False
No Twitches means that there may be prolonged effects from the NMBA?
True
How many twitches means that the NMBA is suitable for short term relaxation and long term mechanical ventilation? (select all that apply)
A. No Twitches
B. One twitches
C. two twitches
D. three twitches
E. four twitches
B, C
True or False
Pancuronium, Vecuronium, Rocuronium, Atracurium, and Cisatracurium all cause myopathy
True
Which NMBA causes prolonged paralysis? ( select all that apply)
A. Pancuronium
B. Vecuronium
C. Rocuronium
D. Atracurium
E. Cisatracurium
A,B
What Skeletal Muscle Relaxants is not indicated for Spasticity?
A. Lioresal
B. Zanaflex
C. Valium
D. Skelaxin
D. Skelaxin
Which muscle relaxant is at risk for abuse?
A. tizanidine
B. baclofen
C. diazepam
D. metaxalone
C. diazepam
Which skeletal muscle relaxant causes hypotension? (select all that apply)
A. baclofen
B. tizanidine
C. valium
D. orphenadrine
B. tizanidine
Tadeo is a 42 yo hispanic male who presents to your pharamcy along with his girlfriend Irene. They both came to pick up Tadeo’s prescription for Flexeril. Which of the following is not an important counseling point to discuss with them?
A. he may feel drowsy and sleepy
B. It is important to avoid alcohol
C. take with food
D. he should not drive while on this medication
C. Take with food
