Nagelhout-Pharm 2-Exam 1 Question and
Answer [2026] | UPDATED ACTUAL Exam |
Complete Exam Prep
• Depolarizing NMB -✓✓ Succinylcholine
• Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) -✓✓ Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
• Long Acting Nondepolarizing NMB
(Length of duration) -✓✓ Pancuronium
60-90 minutes
• Short Acting Nondepolarizing NMBs
(Length of duration) -✓✓ None
(20-30 minutes)
• NMB Reversal Agents (3) -✓✓ Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
• NMBs work at ____ receptors -✓✓ Nicotinic Cholinergic (sub-m)
• Neurotransmitter of the NM junction -✓✓ acetylcholine
• Breaks down acetylcholine at the NM synapse/junction -✓✓ acetylcholinesterase
• Non-depolarizing agents are: agonists or antagonists -✓✓ Antagonist
• Depolarizing agents act as: agonist or antagonist?? -✓✓ Agonist then antagonist
• Onset time definition -✓✓ time from drug administration to maximum effect
• Clinical duration definition -✓✓ time from drug administration to 25% recovery of twitch
response
• Total duration of action definition -✓✓ time from drug administration to 90% recovery
of twitch response (point at which pt is recovered)
, • Recovery index definition -✓✓ time from 25% to 75% recovery of twitch response (how
fast?)
• Train of Four Index -✓✓ 4th twitch of TOF/1st twitch of TOF
• Muscle stimulated by ulnar nerve in TOF -✓✓ Adductor pollicis
• Best nerve/muscle to measure onset of NMB -✓✓ Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
• Best nerve/muscle to measure emersion from NMB -✓✓ Ulnar Nerve
Adductor Pollicis
• Single Twitch Test -✓✓ 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
• Train of Four Test -✓✓ 4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
• Double Burst Simulation (DBS) Test -✓✓ 2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
• Tetanus Test -✓✓ 100 Hz twitch for 5 seconds
Painful
• Posttetanic Count Test -✓✓ 50 Hz stimulus for 5 sec → 3 sec pause → 1 Hz single
twitch every second
Only used when patient is 100% paralyzed
More post-tetanic twitches = closer to recovery
• Sequence of muscle paralysis -✓✓ 1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
• Muscles not affected by NMBs (4) -✓✓ 1. Cardiac muscle
Smooth muscle:
2. Bronchi (can't treat bronchospasm with NMBs)
3. Uterus
Answer [2026] | UPDATED ACTUAL Exam |
Complete Exam Prep
• Depolarizing NMB -✓✓ Succinylcholine
• Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) -✓✓ Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
• Long Acting Nondepolarizing NMB
(Length of duration) -✓✓ Pancuronium
60-90 minutes
• Short Acting Nondepolarizing NMBs
(Length of duration) -✓✓ None
(20-30 minutes)
• NMB Reversal Agents (3) -✓✓ Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
• NMBs work at ____ receptors -✓✓ Nicotinic Cholinergic (sub-m)
• Neurotransmitter of the NM junction -✓✓ acetylcholine
• Breaks down acetylcholine at the NM synapse/junction -✓✓ acetylcholinesterase
• Non-depolarizing agents are: agonists or antagonists -✓✓ Antagonist
• Depolarizing agents act as: agonist or antagonist?? -✓✓ Agonist then antagonist
• Onset time definition -✓✓ time from drug administration to maximum effect
• Clinical duration definition -✓✓ time from drug administration to 25% recovery of twitch
response
• Total duration of action definition -✓✓ time from drug administration to 90% recovery
of twitch response (point at which pt is recovered)
, • Recovery index definition -✓✓ time from 25% to 75% recovery of twitch response (how
fast?)
• Train of Four Index -✓✓ 4th twitch of TOF/1st twitch of TOF
• Muscle stimulated by ulnar nerve in TOF -✓✓ Adductor pollicis
• Best nerve/muscle to measure onset of NMB -✓✓ Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
• Best nerve/muscle to measure emersion from NMB -✓✓ Ulnar Nerve
Adductor Pollicis
• Single Twitch Test -✓✓ 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
• Train of Four Test -✓✓ 4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
• Double Burst Simulation (DBS) Test -✓✓ 2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
• Tetanus Test -✓✓ 100 Hz twitch for 5 seconds
Painful
• Posttetanic Count Test -✓✓ 50 Hz stimulus for 5 sec → 3 sec pause → 1 Hz single
twitch every second
Only used when patient is 100% paralyzed
More post-tetanic twitches = closer to recovery
• Sequence of muscle paralysis -✓✓ 1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
• Muscles not affected by NMBs (4) -✓✓ 1. Cardiac muscle
Smooth muscle:
2. Bronchi (can't treat bronchospasm with NMBs)
3. Uterus
