TOTCD 5 (2)

Question 1

ROCURONIUM (ZEMURON) standard, bolus, priming 10% ID dosages

Answer 1

0.6mg/kg and 1.2mg/kg for RSI
Bolus 0.06-0.6 mg/kg
Priming 10% ID 0.5mg, give 3-5 min before intubation
10mg/ml concentration in a 5-10cc syringe

Question 2

ROCURONIUM (ZEMURON) mechanism of action, indication

Answer 2

NDMR quaternary amniosteroid, competes for cholinergic receptors at the motor end plate.

Question 3

ROCURONIUM (ZEMURON) concern/complication

Answer 3

Anaphylaxis
Onset time is decreased and DOA prolonged with increasing doses
CV stable, good for infusions (mix 200mg in 100mLD5W for 2mg/ml)

Question 4

VECURONIUM (NORCURON) standard, bolus, gtt and priming 10% ID dosages

Answer 4

0.1mg/kg
Bolus 0.01-0.05mg/kg 
Gtt 1-2mcg/kg/min
Priming 10% ID 0.5-1.0mg
1mg/ml concentration in a 10cc syringe

Question 5

VECURONIUM (NORCURON) mechanism of action, indication

Answer 5

Intermediate NDMR that competes with cholinergic receptors at the motor end plate. 1/3 as potent as pancuronium.

Question 6

VECURONIUM (NORCURON) concern/complication

Answer 6

1/3 as potent as pancuronium

Vagotonic effects can occur when combined with opioids.

Reconstitute with sterile water
Gtt 20 mg/100mL D5W for 0.2mg/mL

Question 7

CISATRACURIUM (NIMBEX) standard, bolus, gtt, and priming dose

Answer 7

0.15-0.2mg/kg
Bolus 0.02-0.1mg/kg
Gtt 1-5mcg/kg/min
Priming 1-2mg
2mg/ml concentration in 10cc syringe

Question 8

CISATRACURIUM (NIMBEX) mechanism of action, indication

Answer 8

Isomer of atracurium, competes for cholinergic receptors at the motor end plate.

Question 9

CISATRACURIUM (NIMBEX) concern/complication

Answer 9

Laudenosine is a metabolite of metabolism that can cause seizures.
Histamine release can cause tachycardia, hypotension, bronch- and laryngospasm.

Question 10

NEOSTIGMINE Reversal, max, w/atropine, w/ glycopyrrolate, MG Tx dose

Answer 10

Reversal 0.05mg/kg
MAX DOSE 5mg
With Atropine 0.015mg/kg
With Glycopyrrolate 0.01mg/kg
MG Tx 15-375mg PO QD

Question 11

NEOSTIGMINE mechanism of action, indication

Answer 11

Reversal of NDMRs, treatment of MG, postoperative ileus, and urinary retention. Inhibits hydrolysis of acetylcholine by inhibiting achetylcholinesterase at the esteric site.

Question 12

NEOSTIGMINE concern/complication

Answer 12

Cholinergic effects SLUDBBM
Cholinergic Crisis –> S/S: N/V, sweating, brady- or tachycardia, excessive salivation, sweating, bronchospasm, weakness, and paralysis. Treat with 10mcg/kg Atropine Q 3-10 min

Question 13

GLYCOPYRROLATE (ROBINUL) dose with neostigmine or pyridostigmine

Answer 13

0.2mg for each 1mg of Neostigmine or 5mg of pyridostigmine

or 0.01mg/kg on its own.

robinul vial concentration 0.2mg/mL

Question 14

GLYCOPYRROLATE (ROBINUL) mechanism of action, indication

Answer 14

Quaternary ammonium antimuscarinic. B/c of its polar nature it does not cross the BBB. It antagonizes muscarinic symptoms induced by cholinergic drugs on smooth muscle tissues. It produces less tachycardia than atropine.

Question 15

GLYCOPYRROLATE (ROBINUL) concern/complication

Answer 15

Reduces LES tone, spincters in the GI tract are relaxed by nitric oxide that is released by the parasympathetic NANC fibers.
Can increase IOP—caution in pts with glaucoma. Use with caution in pts with BPH, MG, paralytic ileus, or ulcerative colitis. SEs orthostatic hypotension, dry mouth, and urine retention.