TYK37
Which of the following neuromuscular blocking agents (NMBA) has a clinically significant metabolite in patients with renal failure?
A. Vecuronium
B. Rocuronium
C. Cisatracurium
D. Mivacurium
Answer
The answer is A. Vecuronium undergoes 30-40 metabolism in the LIVER. Its elimination is mixed (40-50% by the kidney and 50-60% by the liver). However, the extensive metabolism in the liver produces a 3-OH metabolite. This metabolite will accumulate in renal failure and is active with an 80% potency of vecuronium. Rocuronium has no metabolism or active metabolites. Its is eliminated by the kidney (10-25%) and the liver (70%). Cisatracurium undergoes Hoffman elimination (77%) with some kidney elimination (16%). Mivacurium is metabolized by butyrylcholinesterase (95-98%) with minor renal elimination (<5%). Mivacurium and cistracurium have some metabolites, but these are not known to have any significant clinical effect.
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