Muscle relaxants: atracurium: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Muscle relaxants: atracurium

Sample item

Why is atracurium suitable for a patient with hepatic and renal failure?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. It undergoes Hofmann elimination and ester hydrolysis independent of organ function

Atracurium breaks down spontaneously at body pH and temperature by Hofmann elimination and by ester hydrolysis, so organ failure does not prolong its action. Laudanosine, a metabolite, can cause seizures at very high levels.

Option by option

  • A. It is metabolised by CYP2D6

    CYP2D6 does not metabolise atracurium.

  • B. It undergoes Hofmann elimination and ester hydrolysis independent of organ function (correct)

    Correct. Organ-independent breakdown suits organ failure.

  • C. It is excreted unchanged in bile

    Biliary excretion is the main route of vecuronium and rocuronium.

  • D. It has no active metabolites at all

    Laudanosine is an active metabolite.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, It undergoes Hofmann elimination and ester hydrolysis independent of organ function. Atracurium breaks down spontaneously at body pH and temperature by Hofmann elimination and by ester hydrolysis, so organ failure does not prolong its action.

Why is "It is metabolised by CYP2D6" not the answer?

CYP2D6 does not metabolise atracurium.

Why is "It is excreted unchanged in bile" not the answer?

Biliary excretion is the main route of vecuronium and rocuronium.

Why is "It has no active metabolites at all" not the answer?

Laudanosine is an active metabolite.

What concept does this question test?

It tests Muscle relaxants: atracurium in Anaesthesia. Laudanosine, a metabolite, can cause seizures at very high levels.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Muscle relaxants: atracurium?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.