skip to main content

Laudanosine CNS Excitation — FRCA Primary MCQ

Instant feedback + full explanation. One question, done properly.

HardPharmacology - NeuromuscularLaudanosine CNS ExcitationFRCA Primary

An ICU patient receives a prolonged atracurium infusion in severe renal and hepatic dysfunction. Which metabolite-related adverse effect is the principal theoretical concern if substantial accumulation occurs?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Central nervous-system excitation with seizure susceptibility

The best answer is “Central nervous-system excitation with seizure susceptibility”. Atracurium undergoes Hofmann degradation and ester hydrolysis; laudanosine is a metabolite with central nervous-system excitatory potential at high concentrations. It is not a depolarising neuromuscular blocker or acetylcholinesterase inhibitor. The concern is mainly theoretical with modern clinical dosing, but becomes more relevant during large or prolonged infusions and impaired elimination.

Reference: RCoA, Primary FRCA syllabus: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf; Atracurium besilate 10 mg/mL SmPC: https://www.medicines.org.uk/emc/medicine/772; Laudanosine, an atracurium and cisatracurium metabolite: https://pubmed.ncbi.nlm.nih.gov/12113608/