Pharm I, Exam 3: Neuromuscular
Blockade Questions And Correct
Solutions
You gave your patient succinylcholine at induction for an extremely brief
procedure. It appears that the dose of succinylcholine you administered has
lasted about 20 minutes. What type of pseudocholinesterase deficiency do
you suspect? - Ans--Heterozygous deficiency
Dibucaine number between 30 and 70
Acetylcholine is synthesized in the cytoplasm of the nerve terminal from -
Ans--Acetyl coenzyme A
choline
The elimination half life of succinylcholine is - Ans--47 seconds
twitch depression results in the blockade of what receptor? - Ans--
Postsynaptic nicotinic acetylcholine receptors
Succinylcholine is classified as a _______________agent and acts on the
postsynaptic nicotinic receptor via an ________________ type interaction.
- Ans--Depolarizing, agonist
the two enzymes that hydrolysis actetylcholine are _________ and
__________ - Ans--Acetylcholinesterase (NMJ) and butyrylcholinesterase
(plasma)
the neuromuscular junction transmits electrical impulse from the nerve
terminal to the skeletal muscle using the chemical transmitter - Ans--
Acetylcholine
,A patient in the anesthesia preop clinic informs you that they were slow to
wake up after their last procedure and needed a breathing tube for a few
hours afterward. They cannot provide any additional information. You
suspect pseudocholinesterase deficiency. Your hospital does not have the
ability to test for a dibucaine number. what test should you order? - Ans--
Fluoride resistance test
a result of 36 is consistent with the homozygous atypical
pseudocholinesterase function (60 is normal)
Depolarizing agents work at the end plate and desensitize the channel to
which they bind. At what type of receptor does this occur? On what type of
voltage-gated channel does this take place on? - Ans--Nicotinic, sodium
voltage-gated channel
Which opioid would present the greatest risk to a patient in liver failure?
A. Remifentanil
B. Fentanyl
C. Alfentanil
D. Meperidine - Ans--Meperidine
can be dangerous because the metabolite normeperidine can accumulate
and cause neurotoxicity
All neuromuscular blocking agents are structurally related to what chemical
messenger? - Ans--Acetylcholine
When acetylcholine molecules bind to the nicotinic acetylcholine receptor in
the NMJ, it opens an ion channel that allows sodium and _ to enter the
skeletal muscle cell and _________ to exit. - Ans--Calcium
Potassium
Where in the NMJ are the synaptic vesicles containing acetylcholine
predominantly located? - Ans--The presynaptic nerve terminal
,If not accompanied by an anti cholinergic, the administration of neostigmine
could produce - Ans--Salivation, bronchospasm and increased bowel
motility
Which patient is most likely to experience myalgia following the
administration of succinylcholine? - Ans--A healthy, 28 year old female
undergoing knee arthroscopy
Neuromuscular blockers are currently classified into two major categories,
these two categories are - Ans--Depolarizing and nondepolarizing agents
Which muscle relaxant would be LEAST appropriate for a patient with a
history of severe asthma? - Ans--Atracurium as it induces histamine
release
The elimination of succinylcholine follows what type of kinetics? - Ans--First
order
A nondepolarizing neuromuscular blocker competes with acetylcholine
receptor for the active binding sites that are postsynaptic. This type of
competitive interaction at the nicotinic receptor is called - Ans--Competitive
antagonism
During preoperative evaluation, a patient indicates that she needed a
breathing tube for a long time after her last surgery. You suspect
pseudocholinesterase deficiency. The lab tests come back with a dibucaine
number of 20. What does this indicate? - Ans--Homozygous deficiency
(any number below 30)
Mivacurium, succinylcholine and tetracaine are some of the drugs
dependent on this system for metabolism
The primary anatomic difference between smooth muscle cells and skeletal
muscle cells are that smooth muscle cells - Ans--Do not have regular arrays
of action and myosin
A patient has a fluoride resistant number of 60, what does this indicate? -
Ans--Normal butyrylcholinesterase function
, How long does it take to recover 90 percent of muscle strength following the
administration of 1 mg/kg of succinylcholine and what is the enzyme that is
responsible for this process? - Ans--9-13 minutes, butyrylcholinesterase
Which agent is most likely to prolong the effects of succinylcholine? - Ans--
Neostigmine because it can produce a significant decrease in
butyrylcholinesterase activity
Titanic fade is a response to blocking which type of receptor? - Ans--
Presynaptic nicotinic acetylcholine receptors
You gave your patient succinylcholine for induction and they are slow to
wake up. It has been 5 hours since administration of succinylcholine. they
are just now beginning to exhibit muscle movement. You suspect what kind
of pseduocholinesterase deficiency? - Ans--Homozygous deficiency
Succinylcholine is composed of two _________________ molecules
linked by _______________ groups - Ans--Acetylcholine
acetate methyl groups
A nondepolarizing block is characterized by several factors when assessed
by a peripheral nerve stimulator. What are the three factors? - Ans--
Decrease in twitch tension
Fade during repetitive stimulation
Post tetanic potentiation
Which of the following is a metabolite of succinylcholine? - Ans--
Succinylmonocholine which is then degraded into choline and succinic acid
A patient presents to your hospital with acute appendicitis. You are planning
a RSI induction with succinylcholine. You interview the patient who
indicates he had a positive fluoride test with a value of 36. What does this
indicated, what do you do, and what will you see clinically if you administer
SCh? - Ans--Homozygous pseudocholinesterase deficiency
avoid SCh
prolonged duration of action
Blockade Questions And Correct
Solutions
You gave your patient succinylcholine at induction for an extremely brief
procedure. It appears that the dose of succinylcholine you administered has
lasted about 20 minutes. What type of pseudocholinesterase deficiency do
you suspect? - Ans--Heterozygous deficiency
Dibucaine number between 30 and 70
Acetylcholine is synthesized in the cytoplasm of the nerve terminal from -
Ans--Acetyl coenzyme A
choline
The elimination half life of succinylcholine is - Ans--47 seconds
twitch depression results in the blockade of what receptor? - Ans--
Postsynaptic nicotinic acetylcholine receptors
Succinylcholine is classified as a _______________agent and acts on the
postsynaptic nicotinic receptor via an ________________ type interaction.
- Ans--Depolarizing, agonist
the two enzymes that hydrolysis actetylcholine are _________ and
__________ - Ans--Acetylcholinesterase (NMJ) and butyrylcholinesterase
(plasma)
the neuromuscular junction transmits electrical impulse from the nerve
terminal to the skeletal muscle using the chemical transmitter - Ans--
Acetylcholine
,A patient in the anesthesia preop clinic informs you that they were slow to
wake up after their last procedure and needed a breathing tube for a few
hours afterward. They cannot provide any additional information. You
suspect pseudocholinesterase deficiency. Your hospital does not have the
ability to test for a dibucaine number. what test should you order? - Ans--
Fluoride resistance test
a result of 36 is consistent with the homozygous atypical
pseudocholinesterase function (60 is normal)
Depolarizing agents work at the end plate and desensitize the channel to
which they bind. At what type of receptor does this occur? On what type of
voltage-gated channel does this take place on? - Ans--Nicotinic, sodium
voltage-gated channel
Which opioid would present the greatest risk to a patient in liver failure?
A. Remifentanil
B. Fentanyl
C. Alfentanil
D. Meperidine - Ans--Meperidine
can be dangerous because the metabolite normeperidine can accumulate
and cause neurotoxicity
All neuromuscular blocking agents are structurally related to what chemical
messenger? - Ans--Acetylcholine
When acetylcholine molecules bind to the nicotinic acetylcholine receptor in
the NMJ, it opens an ion channel that allows sodium and _ to enter the
skeletal muscle cell and _________ to exit. - Ans--Calcium
Potassium
Where in the NMJ are the synaptic vesicles containing acetylcholine
predominantly located? - Ans--The presynaptic nerve terminal
,If not accompanied by an anti cholinergic, the administration of neostigmine
could produce - Ans--Salivation, bronchospasm and increased bowel
motility
Which patient is most likely to experience myalgia following the
administration of succinylcholine? - Ans--A healthy, 28 year old female
undergoing knee arthroscopy
Neuromuscular blockers are currently classified into two major categories,
these two categories are - Ans--Depolarizing and nondepolarizing agents
Which muscle relaxant would be LEAST appropriate for a patient with a
history of severe asthma? - Ans--Atracurium as it induces histamine
release
The elimination of succinylcholine follows what type of kinetics? - Ans--First
order
A nondepolarizing neuromuscular blocker competes with acetylcholine
receptor for the active binding sites that are postsynaptic. This type of
competitive interaction at the nicotinic receptor is called - Ans--Competitive
antagonism
During preoperative evaluation, a patient indicates that she needed a
breathing tube for a long time after her last surgery. You suspect
pseudocholinesterase deficiency. The lab tests come back with a dibucaine
number of 20. What does this indicate? - Ans--Homozygous deficiency
(any number below 30)
Mivacurium, succinylcholine and tetracaine are some of the drugs
dependent on this system for metabolism
The primary anatomic difference between smooth muscle cells and skeletal
muscle cells are that smooth muscle cells - Ans--Do not have regular arrays
of action and myosin
A patient has a fluoride resistant number of 60, what does this indicate? -
Ans--Normal butyrylcholinesterase function
, How long does it take to recover 90 percent of muscle strength following the
administration of 1 mg/kg of succinylcholine and what is the enzyme that is
responsible for this process? - Ans--9-13 minutes, butyrylcholinesterase
Which agent is most likely to prolong the effects of succinylcholine? - Ans--
Neostigmine because it can produce a significant decrease in
butyrylcholinesterase activity
Titanic fade is a response to blocking which type of receptor? - Ans--
Presynaptic nicotinic acetylcholine receptors
You gave your patient succinylcholine for induction and they are slow to
wake up. It has been 5 hours since administration of succinylcholine. they
are just now beginning to exhibit muscle movement. You suspect what kind
of pseduocholinesterase deficiency? - Ans--Homozygous deficiency
Succinylcholine is composed of two _________________ molecules
linked by _______________ groups - Ans--Acetylcholine
acetate methyl groups
A nondepolarizing block is characterized by several factors when assessed
by a peripheral nerve stimulator. What are the three factors? - Ans--
Decrease in twitch tension
Fade during repetitive stimulation
Post tetanic potentiation
Which of the following is a metabolite of succinylcholine? - Ans--
Succinylmonocholine which is then degraded into choline and succinic acid
A patient presents to your hospital with acute appendicitis. You are planning
a RSI induction with succinylcholine. You interview the patient who
indicates he had a positive fluoride test with a value of 36. What does this
indicated, what do you do, and what will you see clinically if you administer
SCh? - Ans--Homozygous pseudocholinesterase deficiency
avoid SCh
prolonged duration of action
