Paralytics - Succinylcholine (Anectine)

Question 1

What is the recommended dose range of Succinylcholine for intravenous (IV) administration based on actual body weight?

A) 0.5-1 mg/kg
B) 1-1.5 mg/kg
C) 1.5-2 mg/kg
D) 2-3 mg/kg

Answer 1

B) 1-1.5 mg/kg

Question 2

What is the recommended dose range of Succinylcholine for intravenous (IV) administration after a defasciculating dose?
A) 0.5-1 mg/kg
B) 1-1.5 mg/kg
C) 1.5-2 mg/kg
D) 2-3 mg/kg

Answer 2

C) 1.5-2 mg/kg

Question 3

What is the concentration of Succinylcholine?

A) 10 mg/mL
B) 15 mg/mL
C) 20 mg/mL
D) 25 mg/mL

Answer 3

C) 20 mg/mL

Question 4

Which of the following describe the effects of Succinylcholine at the neuromuscular junction (NMJ)?

A) Binds to N-AchR at the synaptic endplate
B) Opens monovalent cation channels
C) Causes muscle depolarization
D) Induces a Phase II block

Answer 4

A) Binds to N-AchR at the synaptic endplate,
B) Opens monovalent cation channels,
C) Causes muscle depolarization (pre-syn, post-syn, and extra-jxn receptors)

Question 5

For Phase I Block, What is the typical onset time of action for Succinylcholine when administered intravenously?

A) 10-20 seconds
B) 30-60 seconds
C) 1-2 minutes
D) 3-5 minutes

Answer 5

B) 30-60 seconds

Question 6

What is the approximate half-life of Succinylcholine?

A) 1-2 minutes
B) 3-5 minutes
C) 6-10 minutes
D) 10-15 minutes

Answer 6

B) 3-5 minutes

Question 7

How is Succinylcholine primarily eliminated from the body?

A) Renal excretion
B) Hepatic metabolism
C) Hydrolysis by plasma cholinesterase
D) Biliary excretion

Answer 7

C) Hydrolysis by plasma cholinesterase

into succinylmonocholine (brady) and choline and diffused out of NMJ into plasma

Question 8

What are the primary products of Succinylcholine hydrolysis?

A) Succinylmonocholine and acetylcholine
B) Succinylmonocholine and choline
C) Succinic acid and choline
D) Succinic acid and acetylcholine

Answer 8

B) Succinylmonocholine and choline

Question 9

1. Succinylcholine Use in Tracheal Intubation
   Question: Succinylcholine is commonly used in which of the following clinical situations? (Select all that apply)

A) Rapid sequence intubation (RSI)
B) Pain management
C) Tracheal intubation
D) Prolonged muscle relaxation during surgery

Answer 9

Answer: A, C

Question 10

Question: The dibucaine number can be used to test for atypical cholinesterase activity. Which of the following statements are true? (Select all that apply)

A) It measures the percentage inhibition of cholinesterase by dibucaine.
B) A normal dibucaine number is around 80.
C) A dibucaine number of 20 suggests atypical pseudocholinesterase activity.
D) It is used to determine the efficacy of succinylcholine metabolism.

Answer 10

Answer: A, B, C, D

Dibucaine
Amide local anesthetic
Inhibits activity of normal variant butyrylcholinesterase (pseudocholinesterase)
% inhibition = dibucaine number

Dibucaine number
Reflects quality not quantity of enzyme
20: SCh 1mg/kg lasts 3 hours

94m
If have concern of whter have functioning pseudocholinesterase
Qualitity not quantity
% of inhibition that they don’t have, how well are pseudocholinesterase not working
80 – gonna metabolize sux normally
20 - their pseudocholinesterase not gonna work at all and gonna take them long time to metabolize the sux
So wont give sux to ppl who are greatly prolonged

Question 11

Question: In what context might succinylcholine be administered during a local anesthetic (LA) seizure? (Select all that apply)

A) To relax skeletal muscles.
B) To reverse the seizure activity.
C) To increase cholinesterase levels.
D) To assist with mechanical ventilation.

Answer 11

Answer: A, D

Question 12

Question: Why is succinylcholine contraindicated for induction in pediatric patients? (Select all that apply)

A) Increased risk of bradycardia due to stronger vagal tone.
B) Risk of hypokalemia.
C) Black Box warning.
D) Risk of increased intraocular pressure (IOP).

Answer 12

Answer: A, C

Question 13

Question: In which of the following conditions should succinylcholine be avoided? (Select all that apply)

A) Burn patients
B) History of malignant hyperthermia (MH)
C) Ocular trauma
D) Muscular dystrophy (e.g., Duchenne Muscular Dystrophy in children)
E) hyperkalemia

Answer 13

Answer: A, B, C, D, E

o C/I: Pediatric use for induction Black Box warning (if used still… give glyco to negate HR drop since children have stronger vagal tone); burn patients, hx of MH, **ocular trauma d/t 10 mmHg inc in IOP; **hyperK+, Severe muscle trauma, neuro injury, severe sepsis, muscle wasting/disorders, muscular dystrophy (Duchenne Muscular Dystrophy in children), allergy

Question 14

Question: Which of the following conditions increase the risk of succinylcholine-induced hyperkalemia? (Select all that apply)

A) Severe muscle trauma
B) Neuro injury
C) Severe sepsis
D) Muscle wasting disorders
E) Allergy

Answer 14

all of the above

Question 15

Question: Succinylcholine use can cause histamine release, which may lead to which of the following effects? (Select all that apply)

A) Bronchospasm
B) Hyperkalemia
C) Bradycardia
D) Urticaria (hives)

Answer 15

Answer: A, B, D

o Precautions: Histamine release; hyperkalemia especially with fetal/immature and neuronal nACh-Rs (5-10mOsm in short time); inc in plasma K+ by 0.5 mEq,

Question 16

Question: Which patient population is at higher risk for hyperkalemia due to succinylcholine use? (Select all that apply)

A) Patients with immature or fetal neuronal nicotinic acetylcholine receptors (nACh-Rs)
B) Patients with chronic renal failure
C) Patients with muscle wasting disorders
D) Burn patients

Answer 16

Answer: A, B, C, D

o Precautions: Histamine release; hyperkalemia especially with fetal/immature and neuronal nACh-Rs (5-10mOsm in short time); inc in plasma K+ by 0.5 mEq,

Question 17

Question: Succinylcholine can cause an increase in plasma potassium by how much, even in normal patients?

A) 0.1 mEq/L
B) 0.3 mEq/L
C) 0.5 mEq/L
D) 1.0 mEq/L

Answer 17

Answer: C

Question 18

1. Succinylcholine Side Effects: Fasciculations
   Question: Which of the following statements are true regarding fasciculations caused by succinylcholine? (Select all that apply)

A) Fasciculations are involuntary muscle contractions.
B) They can be minimized by administering a small dose of a non-depolarizing neuromuscular blocking drug (ndNMBD).
C) Fasciculations indicate a hypersensitivity reaction to succinylcholine.
D) They are common after succinylcholine administration.

Answer 18

Answer: A, B, D

Question 19

Succinylcholine and Heart Rate
Question: What is the typical effect of succinylcholine on heart rate with the first and second dose? (Select all that apply)

A) Tachycardia with the first dose
B) Bradycardia with the second dose
C) Tachycardia with both doses
D) Bradycardia with both doses

Answer 19

Answer: A, B

Question 20

Succinylcholine and Myalgia
Question: Which of the following side effects is common after succinylcholine administration and may cause discomfort postoperatively?

A) Myalgia
B) Hypothermia
C) Bronchospasm
D) Hyperthermia

Answer 20

Answer: A

Question 21

· 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