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Atracurium in renal failure — FRCA Primary MCQ

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ModeratePharmacologyAtracurium in renal failureFRCA Primary

A patient with severe renal failure requires a benzylisoquinolinium neuromuscular blocker with organ-independent elimination. Which drug is most appropriate?

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

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Correct answer: A — Atracurium

Atracurium is suitable in renal impairment due to Hofmann elimination and ester hydrolysis. Magnesium sulphate is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Thiopental is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Propofol is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Glycopyrronium is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. In Primary FRCA pharmacology, link the clinical effect to the receptor, distribution or elimination mechanism rather than memorising isolated facts.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF; Primary FRCA textbooks