Medical Pharmacology Chapter 20: Neuromuscular Junction Blocker Practice Questions

NMJ blockers characteristic(s):
1. highly lipid-soluble
2. structural similarity to acetylcholine
3. both
4. neither
Isoquinoline derivative:
1. pancuronium (Pavulon)
2. vecuronium (Norcuron)
3. doxacurium (Nuromax)
4. pipecuronium (Arduan)
5. roncuronium (Zemuron)
Nondepolarizing neuromuscular agents -- elimination characteristics
1. agents with renal elimination: shorter half lives
2. agents with hepatic elimination longer half lives
3. both
4. neither
Hofmann elimination:
1. tubocurarine
2. mivacurium (Mivacron)
3. atracurium (Tracrium)
4. cisatracurium (Nimbex)
5. doxacurium (Nuromax)
Mainly hepatic (75-90%) elimination; usually shortest duration of action
1. pancuronium (Pavulon)
2. pipecuronium (Arduan)
3. roncuronium (Zemuron)
4. all of the above
Isoquinoline derivative; shortest duration of action
1. cisatracurium (Nimbex)
2. tubocurarine
3. mivacurium (Mivacron)
4. vecuronium (Norcuron)
Shortest duration of action: neuromuscular-blocking --
1. mivacurium (Mivacron)
2. gallamine (Flaxedil)
3. pipecuronium (Arduan)
4. succinylcholine (Anectine)
5. all of the above equally short
Most commonly used class of neuromuscular-blocking drugs:
1. intermediate-acting
2. long-acting
For elimination, vecuronium (Norcuron) & roncuronium (Zemuron) depend mainly upon this mechanism:
1. renal excretion
2. hepatic metabolism & biliary excretion
Most rapid onset among nondepolarizing blockers --
1. vecuronium (Norcuron)
2. pancuronium (Pavulon)
3. pipecuronium (Arduan)
4. roncuronium (Zemuron)
Shortest duration of action among nondepolarizing neuromuscular blocking drugs:
1. pancuronium (Pavulon)
2. pipecuronium (Arduan)
3. tubocurarine
4. mivacurium (Mivacron)
Mechanism of termination of action of succinylcholine (Anectine):
1. reuptake into presynaptic vesicles
2. diffusion away from postsynaptic receptors
3. metabolism by postsynaptic acetylcholinesterase
Succinylcholine (Anectine): duration of action
1. 5-10 minutes
2. 15-30 minutes
3. > 30 minutes
Dibucaine (Nupercainal, generic) number. indicative of possible abnormality in:
1. tyrosine hydroxylase
2. monoamine oxidase
3. catechol-O-methyltransferase
4. plasma cholinesterase
5. none of the above
Neuromuscular-blocking drug pharmacodynamic characteristics are determined by measuring:
1. speed the onset
2. duration of neuromuscular-blockade
3. both
4. either
Effect of volatile anesthetics on ED95 for neuromuscular-blocking agents:
1. usually increases ED95
2. usually decreases ED95
Sequence of events following IV neuromuscular-blocking injection (nondepolarizing drug) to an awake patient:{first presentations to last}
1. dysphagia, diplopia, ptosis,difficulty in focusing, mandibular muscle weakness
2. mandibular muscle weakness, ptosis, dysphagia, difficulty in focusing
3. difficulty in focusing, mandibular muscle weakness, ptosis, diplopia, dysphagia
4. all symptoms occur simultaneously
Blockade onset (nondepolarizing agents): more rapid, less intense at laryngeal muscles (vocal cords) first, then adductor pollicis
1. true
2. false
Intensity of initial blockade: greater at laryngeal muscle, less at adductor pollicis
1. true
2. false
Neuromuscular diaphragm blockade:
1. requires 2x the dose required for adductor policies muscle blockade
2. adductor pollicis monitoring; poor indicator of cricothyroid muscle (laryngea) relaxation
3. facial nerve stimulation with orbicularis oculi muscle responds monitoring -- good reflection of neuromuscular diaphragm blockade onset
4. orbicularis oculi muscle monitoring: preferable to monitoring adductor pollicis as indicator of laryngeal muscle blockade
5. all of the above