Rocuronium

Question 1

Brand Name

Answer 1

Zemuron

Question 2

Broad Category

Answer 2

Nondepolarizing neuromuscular blocking agent (NMBA)

Question 3

Pharmacological class

Answer 3

Aminosteroid

Question 4

MOA

Answer 4

Presynaptic: prevents release of ACh

Postsynaptic: binds to one or both alpha subunits of nicotinic acetylcholine receptor on motor endplate blocking acetylcholine from binding

Question 5

Indications

Answer 5

• Routine induction
• surgical relaxation
• RSI
• Defasiculation for SCh

Question 6

Volume of distribution

Answer 6

small confined to ECF

Question 7

CV effects?

Answer 7

Highly stable

Question 8

Resp effects

Answer 8

paralysis

Question 9

Histamine release?

Answer 9

Rare to none

Question 10

Allergic reaction?

Answer 10

second major cause of anaphylaxis

Question 11

Reversals?

Answer 11

• Sugammadex
• Anticholinergics (Neostigmine)

Question 12

Considerations (receptor upregulation)

Answer 12

Denervation, burns, trauma, immobility, hemiplegia etc results in upregulations of immature extrajunctional nicotinic ACh receptors, resulting in RESISTANCE

Question 13

Considerations (down regulation)

Answer 13

Myasthenia gravis results in fewer ACH receptors resulting in INCREASED sensitivity

Question 14

Precautions

Answer 14

Hepatic impairment

Question 15

Pregnancy Duration?

Answer 15

Prolonged and more sensitive, need reduction of dosing

Question 16

Elderly considerations

Answer 16

Prolonged duration due to decreased liver capacity

Question 17

Normal induction

Answer 17

0.6 mg/kg

(0.3-1.1)

Question 18

RSI dosing

Answer 18

1.2 mg/kg

Question 19

Infusion dosing

Answer 19

5-12 mcg/kg/min

Question 20

Defasiculation dose

Answer 20

5 mg

Question 21

Maintenance Bolus dosing

Answer 21

0.1 - 0.2 mg/kg

Question 22

Onset

Answer 22

1-2 mins

Question 23

Duration

Answer 23

30-70 mins

dose dependent

Question 24

Metabolism

Answer 24

Insignificant or none

Question 25

Excretion/ Elimination

Answer 25

Eliminated primarily by the Liver (biliary excretion) unchanged

Question 26

Lipophilicity?

Answer 26

No highly water soluble and highly ionized at physiological pH