Paralytics - Vecuronium Flashcards
What is the recommended paralysis dose of Vecuronium? (Select all that apply)
a) 0.1 mg/kg IV based on ideal body weight (IBW)
b) 0.5 mg/kg IV based on ideal body weight (IBW)
c) 1 mg IV
d) 2 mg/kg IV based on actual body weight (ABW)
a) 0.1 mg/kg IV based on ideal body weight (IBW)
How do neuromuscular blocking drugs with quaternary ammonium groups affect renal function? (Select all that apply)
a) They cross renal tubules easily
b) They are metabolized in the renal tubules
c) Phase II block is observed in the renal tubules
d) They do not cross renal tubules
d) They do not cross renal tubules
(Phase II block)
What is the recommended defasciculating dose of Vecuronium when used in conjunction with Succinylcholine? (Select all that apply)
a) 0.1 mg/kg IV
b) 1 mg IV
c) 3 mg IV
d) 5 mg IV
b) 1 mg IV
1 mg IV 3 minutes before Succinylcholine
Which of the following statements accurately describe the pharmacokinetics Vecuronium with quaternary ammonium groups? (Select all that apply)
a) They are highly ionized and water-soluble
b) Their volume of distribution is limited to the extracellular fluid (ECF)
c) They readily cross the blood-brain barrier (BBB)
d) They do not cross the blood-brain barrier (BBB)
a) They are highly ionized and water-soluble,
b) Their volume of distribution is limited to the extracellular fluid (ECF),
d) They do not cross the blood-brain barrier (BBB)
What is the concentration of Vecuronium in a 10 mL syringe containing 10 mg of the drug? (Select all that apply)
a) 1 mg/mL
b) 2 mg/mL
c) 0.5 mg/mL
d) 10 mg/mL
a) 1 mg/mL
Concentration: 10mg in 10mL syringe= 1mg/mL
What percentage of Vecuronium is eliminated by the kidneys and liver, respectively? (Select all that apply)
a) 10% by kidneys and 90% by liver
b) 50% by kidneys and 50% by liver
c) 70% by kidneys and 30% by liver
d) 20% by kidneys and 80% by liver
b) 50% by kidneys and 50% by liver
What is the primary mechanism of action of Veuronium? (Select all that apply)
a) Binds to nicotinic acetylcholine receptors at the neuromuscular junction
b) Opens monovalent cation channels
c) Prevents the opening of monovalent cation channels
d) Enhances depolarization at the neuromuscular junction
a) Binds to nicotinic acetylcholine receptors at the neuromuscular junction,
c) Prevents the opening of monovalent cation channels
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)
What is the typical onset time for Vecuronium? (Select all that apply)
a) 1-2 minutes
b) 3-4 minutes
c) 5-6 minutes
d) 7-8 minutes
Answer: b) 3-4 minutes
a) Vecuronium is metabolized to 3-desacetylvecuronium, which is 50% as potent as the parent drug.
b) The 3-desacetylvecuronium metabolite is further metabolized to an inactive form.
c) Vecuronium is exclusively metabolized by the kidneys.
d) The active metabolite 3-desacetylvecuronium contributes to the drug’s effect for an extended duration.
a) Vecuronium is metabolized to 3-desacetylvecuronium, which is 50% as potent as the parent drug,
b) The 3-desacetylvecuronium metabolite is further metabolized to an inactive form
What is the half-life of Vecuronium? (Select all that apply)
a) 15 minutes
b) 30 minutes
c) 45 minutes
d) 60 minutes
c) 45 minutes
How is Vecuronium primarily metabolized in the body? (Select all that apply)
a) Hepatic metabolism
b) Renal metabolism
c) Metabolism to 3-desacetylvecuronium
d) Metabolism to an active metabolite
a) Hepatic metabolism,
c) Metabolism to 3-desacetylvecuronium
Elimination: hepatic metabolism c 3-desacetylvecuronium metabolite (50% as potent), but further metabolized to inactive metabolite; 50% eliminated by kidneys and 50% elimination by liver
What are the potential issues with using Vecuronium in the post-anesthesia care unit (PACU)? (Select all that apply)
a) Prolonged neuromuscular blockade leading to hypercarbia
b) Increased risk of immediate recurarization
c) Rapid recovery of neuromuscular function
d) Vicious cycle of worsening blockade and hypercarbia
a) Prolonged neuromuscular blockade leading to hypercarbia,
d) Vicious cycle of worsening blockade and hypercarbia
Vecuronium is classified as which type of neuromuscular blocking drug? (Select all that apply)
a) Aminosteroid NMBD
b) Benzylisoquinolinium NMBD
c) Depolarizing NMBD
d) Non-depolarizing NMBD
a) Aminosteroid NMBD, d) Non-depolarizing NMBD
Why should Vecuronium be used with caution in patients with renal or liver impairment? (Select all that apply)
a) It can lead to prolonged neuromuscular blockade due to altered metabolism and elimination.
b) It has a reduced onset time in these patients.
c) It may result in recurarization due to prolonged effects.
d) It is associated with increased risk of hypercarbia in the post-anesthesia care unit (PACU).
a) It can lead to prolonged neuromuscular blockade due to altered metabolism and elimination,
c) It may result in recurarization due to prolonged effects
What considerations should be made when using Vecuronium in the ICU? (Select all that apply)
a) Prolonged use can lead to tolerance, reducing neuromuscular response.
b) Long-term use can result in recurarization.
c) Tolerance may lead to dysregulation of neuromuscular function.
d) Short-term use is typically sufficient for critical care situations.
a) Prolonged use can lead to tolerance, reducing neuromuscular response,
c) Tolerance may lead to dysregulation of neuromuscular function
C/I: Don’t use with renal/liver pts d/t prolonged effect and recurarization; PACU hypercarbia after Vec prolongs blockade (vicious cycle); ICU prolonged use= tolerance (Rec dysfxn/ paralysis)
