PHYSIOLOGY
SUXAMETHONIUM
PHARMACOKINETICS
NMBAs side effects
100

•Name the acetylcholine receptors

Ach receptors

•Nicotinic

•Muscarinic

100

•How are muscle relaxant classified?

•Depolarizing

•Non-depolarizing

100

Non-depolarizing  muscle relaxant are competitive antagonist for Ach receptors

•True

•False

TRUE

100

•Two common side-effects of pancurium on CVS and its causes

HTN and Bradycardia

•Vagolytic effects and sympathetic stimulation

200

•What is the structure of the acetylcholine receptor?

•Five glycoprotein subunits: two α subunits; and single β, δ, and ε subunits

•These are arranged in a cylindric fashion; the center of the cylinder is an ion channel. ACh binds to the a-subunits.

200

what is the onset and duration time of suxamethonium?

•30-60s

•5-10min

200

What is the defasciculating dose of rocuronium?

0.1mg/kg

200

•Name 3 clinical conditions potentiate the action of muscle relaxants

•Respiratory acidosis

• Metabolic alkalosis

•Hypothermia

• Hypokalemia

• Hypercalcemia

• Hypermagnesemia potentiate blockade. 

Hepatic or renal dysfunction

300

•How is Acetylcholine metabolized?

•Acetylcholine is metabolized by acetylcholinesterase/ specific cholinesterase or true cholinesterase into acetate and choline.

300

what is the indication of suxa in anesthesia practice?

RSII

300

•Rocuronium (at a dose of 0.9–1.2 mg/kg) has an onset of action that approaches succinylcholine of 60–90 s) 

True or false


TRUE

300

Which mode of nerve stimulation is most commonly used to assess degree of blockade?

 TOF 

400

•Explain in brief the physiology of neuromuscular junction

•As a nerve’s action potential depolarizes its terminal, an influx of calcium ions through voltage-gated calcium channels into the nerve cytoplasm allows storage vesicles to fuse with the terminal plasma membrane and release acetylcholine and the later binds to nicotinic receptors and trigger an end-plate action potential.

400

•Succinylcholine-induced depolarization hyperkalemia increase potassium by

a.0.5 mmol/l

b.1.0 mmol/l 

a

400

 Define Hofman elimination and name the drug eliminated by that process

•Hofman elimination: spontaneous breakdown at physiologic temperature and PH

•Atracurium

400

•For surgical purposes, based on nerve stimulation, what is adequate muscular relaxation?

•Adequate relaxation is generally present when one to two twitches of the TOF response are present, correlating with 80% depression of single-twitch height.

500

by which process acetylcholine is released through the presynaptic cell membrane?

exocytosis

500

•A marked increase in masseter muscle tone preventing laryngoscopy is abnormal and can be a premonitory sign of malignant hyperthermia.

a.True

b,False

a

500

 What is the precurarization dose of vecuronium for a 70Kg old man?

0.7mg

1/10 of the total dose

500

what is SUGAMADEX?

•A modified cyclodextrin that forms extremely tight water-soluble complexes with relaxants having steroidal nuclei (rocuronium > vecuronium >> pancuronium) and terminate their action at the NMJ.