NMBAs pt II

Question 1

Rocuronium dose

Answer 1

0.6 mg/kg

Question 2

MIvacurium dose

Answer 2

0.15 mg/kg

Question 3

With the exception of Roc and Mivacurium the intubating dose for all other Non-depolarizing NMBAs is:

Answer 3

0.1mg/kg

Question 4

What dose of Roc will mimic the onset time of succinylcholine

Answer 4

1.2mg/kg

Question 5

Which non-depolarizing NMBA causes tachycardia, increased release of NE and increased CO

Answer 5

Pancuronium

Question 6

Insert increases or decreases:
Hypokalemia __________ sensitivity to non-depolarizing NMBAs and __________ sensitivity to succinylcholine

Answer 6

increases;decreases

Question 7

Insert increases or decreases:
HYPERkalemia ________ sensitivity to non-depolarizing NMBAs and __________ sensitivity to succinylcholine

Answer 7

decreases; increases

Question 8

Which NMBA is known to potentially cause malignant hyperthermia?

Answer 8

succ

Question 9

Which NMBA can cause histamine release (when given at a 3x dose/ rapidly)

Answer 9

Mivacurium

Question 10

Which Non-depolarizing NMBA can cause bronchospasm?

Answer 10

Mivacurium

Question 11

Which NMBA can cause dysrhythmias? Name the two specific rhythms mentioned in lecture

Answer 11

Succ; Sinus brady or sinus arrest

Question 12

Vecuronium’s duration of action will be prolonged if it is given (before or after) acidosis occurs.

Answer 12

before

(if body is already acidotic it should theoretically per lecture have compensated to some degree)

Question 13

Which Non-depolarizing NMBA is broken down via hoffman elimination?

Answer 13

Cisatricurium

Question 14

Succ dose

Answer 14

1mg/kg

Question 15

Succ dose for a MG pt

Answer 15

1.5-2mg/kg

Question 16

How many sites does succinylcholine have to bind to on an n-ACh receptor? What about non-depolarizing agents?

Answer 16

1 for succ; 2 site non-depolarizing

Question 17

What drugs may alter (prolong) the duration of some non-depolarizing agents? How?

Answer 17

Diuretics; corticosteroids; Metoclopramide; local anesthetics.

*MOA: Decrease cholinesterase activity / decrease ACh

Question 18

A patient is on an esmolol infusion prior to their catheter ablation. What might the CRNA expect in regard to their Rocuronium during induction?

Answer 18

delayed onset

Question 19

A patient had a dose of ephedrine in pre-op. What might the CRNA expect in regard to rocuronium during induction?

Answer 19

Increased onset

Question 20

In the hypothermic patient the duration of vec/ pancuronium will be (prolonged/decreased)

Answer 20

prolonged (doubled)

Question 21

What is the burn dose for Roc? How many days post-burn does it take before the dose adjustment is required? What is the suspected MOA ?

Answer 21

1.2 mg/kg
10 days
altered affinity of n-ACh receptors

Question 22

a patient with a stroke history and right sided hemiplegia is given a dose of rocuronium. Which upper extremity would you expect to be more resistant?

Answer 22

RUE (due to increased amt of extra junctional n-ACh receptors)

Question 23

Women need ____ % less Vec and ______ % less Roc

Answer 23

22% and 30%

Question 24

What are the aminosteroid non-depolarizing NMBAs?

Answer 24

Pancuronium Vecuronium Rocuronium

Question 25

Which non- depolarizing NMBA is broken down by plasma cholinesterase?

Answer 25

Mivacurium

Question 26

Pancuronium duration of action

Answer 26

60-90 minutes

Question 27

Vecuronium, Roc and cisatricurium duration of action

Answer 27

20-35 minutes

Question 28

Atricurium duration of action

Answer 28

12-20 minutes

Question 29

succinylcholine duration of action

Answer 29

3-5 minutes

Question 30

Succinylcholine onset

Answer 30

30-60 sec

Question 31

All of the non-depolarizing agents have an onset of 3-5 minutes with one exception. Which one is the exception and what is it’s onset?

Answer 31

Mivacurium; 2-3 minutes

Question 32

A patient is on a non-depolarizing gtt in the ICU for several days. The patient has been off the gtt for several hours with no signs of movement or spontaneous respirations. Which drug is known to build up with prolonged infusion d/t its active metabolite?

Answer 32

Vecuronium (50-80% active metabolite)