Primary Examination SAQs

Study notes for the ANZCA Primary Examination SAQs

NMBDs

with 4 comments

2011a(8)01a(14)97b(11) How may drugs potentiate the action of non-depolarizing muscle relaxants at the neuromuscular junction?

2009a(4)99a(11) Compare & contrast atropine and glycopyrrolate. Discuss the clinical implications of these differences

2009b(5) Describe the factors that may decrease the clinical response to non-depolarizing neuromuscular blocking agents

2008a(7) Describe the terms train of four stimulation & double burst stimulation with respect to peripheral nerve stimulators. Describe their advantages & disadvantages when used to evaluate non-depolarising neuromuscular blockade

2007a(1) Describe the potential adverse effects of administering neostigmine post-operatively

2006b(4) Describe the advantages and disadvantages of rocuronium for a rapid sequence induction

2006a(6) Explain the possible mechanisms for prolonged neuromuscular blockade after a 4hr procedure using a non-depolarising muscle relaxant

2005a(4) Outline the mechanisms of action of drugs that inhibit cholinergic transmission at the neuromuscular junction giving examples

2004b(6)01b(13)97a(12) Compare and contrast the pharmacology of edrophonium, neostigmine and organophosphates

2003a(8) Describe the onset and offset of neuromuscular block at the diaphragm, larynx and adductor pollicus after 2.5xED95 vecuronium. Comment on the differences observed. What are the clinical implications of these differences?

2002b(5)96b(16) Outline briefly the possible reasons for prolongation of paralysis induced by an IV dose of 1mg/kg of suxamethonium. Briefly indicate consequences of prolonged blockade

2000b(16) Compare and contrast the pharmacology of atracurium and cis-atracurium

1999a(12) Explain fade and post-tetanic fasciculation associated with the NMBDs

1998b(13) Draw and explain the characteristics of a log dose-response curve that describes the major clinical effect of vec. List factors encountered in clinical practice that may alter this curve

Advertisements

Written by primarysaqs

December 31, 2009 at 8:28 am

4 Responses

Subscribe to comments with RSS.

  1. Hi Amanda! Many, many thanks for your example answers. Regarding 1999a(11), atropine, scopolamine and glycopyrrolate, I noticed that your pharmacokinetics are for hyoscine butylbromide (i.e. buscopan) rather than scopolamine (hyoscine). I know it’s unlikely they’ll ask us about scopolamine as it’s not available in Australia, but “hyoscine” is still in the syllabus and I’m never sure if they mean scopolamine or hyoscine butylbromide! If the middle column is indeed hyoscine/scopolamine, then this may be more correct:

    Absorption: Well absorbed via transdermal patch, as well as IV/IM. Dose: 0.3-0.6mg IV; 1.5mg in 72hr patch (10-20mg is hyoscine hydrobromide, not scopolamine). SoO: 10 mins IV, transdermal variable, up to 6 hours. Duration Action: 2-4 hours following IV bolus. Distribution: (2L/kg probably correct). Metabolism: conjugation in the liver (not ester hydrolysis which is how hyoscine hydrobromide is metabolised). Cheers!

    Riaz

    January 19, 2013 at 7:30 pm

    • Hi Riaz

      I think it’s safer for you to answer a question based on drugs that are commonly available in Australia or New Zealand. If you are getting bogged down on a drug based on which salt it is conjugated with, it may be that you are over-thinking the question. Also bear in mind that this question hasn’t been asked in nearly 14 years, and with the new syllabus, is unlikely to be asked in this format – they seem to be working hard to make the exam more relevant. AD.

      primarysaqs

      January 19, 2013 at 8:21 pm

  2. Hi Amanda,

    Great website. Thanks very much for providing as a resource. For the question on train-of four vs DBS, according to Peck, Hill and William, disappearance of T4 corresponds to receptor occupancy of 90%. Further, at 75% receptor occupancy, T4:T1 is 0.75.

    A study published by McGrath and Hunter in BJA (2003) also states that T4 disappears at 75% depression of T1.

    The answer given states disappearance of fourth twitch represents 75% block which I think is incorrect.

    Thanks
    Luke Tobin

    Luke

    February 24, 2013 at 11:45 am

    • Many thanks for the feedback – sorry for the late reply! The answer has been corrected.

      primarysaqs

      March 4, 2014 at 3:35 pm


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: