Paralytics - Rocuronium

Question 1

What is the recommended paralysis dose of rocuronium? (Select all that apply)

A) 0.6 mg/kg IV
B) 1.4 mg/kg IV
C) 0.6 mg/kg IM
D) 10 mg IV

Answer 1

A) 0.6 mg/kg IV

Question 2

What is the appropriate modified rapid sequence intubation (RSI) dose of rocuronium?

A) 0.6 mg/kg IV
B) 1.2 mg/kg IV
C) 0.3 mg/kg IV
D) 10 mg IV

Answer 2

B) 1.2 mg/kg IV

Question 3

When rocuronium is used to prevent fasciculations before succinylcholine, what is the recommended defasciculating dose?

A) 0.6 mg/kg IV
B) 1.2 mg/kg IV
C) 10 mg IV
D) 0.3 mg/kg IV

Answer 3

C) 10 mg IV

-Defasciculating dose: 10 mg IV 3 minutes before Succinylcholine

Question 4

Which of the following factors should be considered when calculating the appropriate dose of rocuronium? (Select 2)

A) The patient’s ideal body weight (IBW)
B) The patient’s total body weight (TBW)
C) The patient’s age
D) The type of procedure (e.g., RSI or paralysis)

Answer 4

A) The patient’s ideal body weight (IBW)
D) The type of procedure (e.g., RSI or paralysis)

Question 5

What is the concentration of rocuronium in a standard vial? (Select all that apply)

A) 5 mg/mL
B) 10 mg/mL
C) 15 mg/mL
D) 20 mg/mL

Answer 5

B) 10 mg/mL

Question 6

How does rocuronium achieve neuromuscular blockade? (Select 3)

A) Binds to nicotinic acetylcholine receptors at the synaptic end plate
B) Prevents the opening of monovalent cation channels
C) Causes depolarization of the muscle membrane
D) Prevents depolarization of the muscle membrane

Answer 6

Answer: A, B, D

Question 7

Which of the following are true regarding rocuronium’s quaternary ammonium groups? (Select 3)

A) They are highly ionized.
B) They make rocuronium water-soluble.
C) They allow rocuronium to cross the blood-brain barrier (BBB).
D) They limit its volume of distribution (VD) to extracellular fluid (ECF).

Answer 7

A) They are highly ionized.
B) They make rocuronium water-soluble.
D) They limit its volume of distribution (VD) to extracellular fluid (ECF).

Question 8

Rocuronium does not cross which of the following barriers? (Select all that apply)

A) Blood-brain barrier (BBB)
B) Placenta
C) Renal tubules
D) Synaptic end plate

Answer 8

Answer: A, C

o MOA: Binds to nicotinic acetylcholine receptors at synaptic end plate and prevents opening of monovalent cation channels, thus preventing depolarization. Quaternary ammonium groups (Highly ionized, H2O sol). VD limited to ECF. No crossing BBB, renal tubules (Phase II block)

Question 9

What is the typical onset time for rocuronium in standard doses and in modified RSI doses? (Select 2)

A) 1-2 minutes for modified RSI
B) 3 minutes for standard doses
C) 5 minutes for modified RSI
D) 10 minutes for standard doses

Answer 9

A) 1-2 minutes for modified RSI
B) 3 minutes for standard doses

Question 10

What is the typical half-life of rocuronium in standard doses and in modified RSI doses? (Select 2)

A) 25 minutes for standard doses
B) 35 minutes for standard doses
C) 60-75 minutes for modified RSI doses
D) 90 minutes for modified RSI doses

Answer 10

B) 35 minutes for standard doses
C) 60-75 minutes for modified RSI doses

Question 11

Rocuronium is eliminated primarily by which of the following pathways? (Select 2)

A) 25% excreted unchanged by the kidneys
B) 75% excreted unchanged via bile
C) Significant metabolism in the liver
D) 50% excreted by the kidneys

Answer 11

A) 25% excreted unchanged by the kidneys
B) 75% excreted unchanged via bile

Question 12

How does liver or renal disease affect the use of neuromuscular blocking drugs (NMBDs)? (Select 2)

a) Prolongs the duration of action
b) Reduces the required dose
c) Affects the reversal agent, prolonging its effect
d) Has no impact on NMBDs

Answer 12

a) Prolongs the duration of action,
c) Affects the reversal agent, prolonging its effect

Question 12

Which of the following is true about rocuronium’s metabolism? (Select 3)

A) Rocuronium undergoes minimal metabolism.
B) Rocuronium is extensively metabolized in the liver.
C) Rocuronium is primarily excreted unchanged.
D) Rocuronium has no active metabolite.

Answer 12

A) Rocuronium undergoes minimal metabolism.
C) Rocuronium is primarily excreted unchanged.
D) Rocuronium has no active metabolite.

Question 13

Rocuronium belongs to which class of neuromuscular blocking drugs (NMBDs)? (Select 2)

A) Aminosteroid NMBD
B) Benzylisoquinolinium NMBD
C) Depolarizing NMBD
D) Non-depolarizing NMBD

Answer 13

Answer: A, D

Question 14

Which populations are affected by prolonged neuromuscular blockade? (Select 2)

a) Pregnant women
b) Elderly individuals
c) Children
d) Individuals with acute infections

Answer 14

a) Pregnant women,
b) Elderly individuals

Question 15

Among neuromuscular blocking drugs (NMBDs), which one is known for having the greatest risk of causing allergic reactions?
a) Vecuronium
b) Rocuronium
c) Succinylcholine
d) Atracurium

Answer 15

c) Succinylcholine

Precautions: Most common allergic reaction of ndNMBDs (Succinylcholine has greatest reaction); affected by liver/renal disease (prolonged reversal agent too, so all good); prolonged slightly in pregnant and elderly;

Question 16

Which of the following statements accurately describes the side effects related to histamine release for neuromuscular blocking drugs (NMBDs)? (Select 2)

a) NMBDs with no histamine release can cause a slight increase in heart rate.
b) NMBDs that release histamine can cause a decrease in heart rate.
c) The slight increase in heart rate is due to a vagolytic response.
d) Histamine release from NMBDs is a common side effect leading to anaphylaxis.

Answer 16

a) NMBDs with no histamine release can cause a slight increase in heart rate,
c) The slight increase in heart rate is due to a vagolytic response

Question 17

What mechanism is responsible for the slight increase in heart rate associated with Rocuronium? (Select all that apply)

a) Direct stimulation of beta-adrenergic receptors
b) Blockade of M2 receptors at the SA node
c) Release of catecholamines
d) Histamine release

Answer 17

b) Blockade of M2 receptors at the SA node

S/E: No histamine release = slight vagolytic response (inc HR) via slight M2 receptor block at SA node

Question 18

· Paralytics Information to know

-Why you shouldn’t give sux after you’ve reversed a patient? If reversed with Neostigmine, this will cause a reduction in pseudocholinesterase activity and prolonged block. Also, reversal of a nondepolarizer will increase Ach at the synapse causing cholinergic syndrome and an increased depolarization of Succ. Possibility of phase II block

-Know how to monitor twitching in a stroke/paralyzed patient