Nagelhout-Pharm 2-Exam 1 ACTUAL
Questions and CORRECT Answers
Ultra short acting neuromuscular blocker
(Length of duration) - CORRECT ANSWER - Succinylcholine
(5 - 15 minutes)
Depolarizing NMB - CORRECT ANSWER - Succinylcholine
Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - CORRECT ANSWER - Atracurium
Cisatracurium
Vecuronium
Rocuronium
(30-60 minutes)
Long Acting Nondepolarizing NMB
(Length of duration) - CORRECT ANSWER - Pancuronium
60-90 minutes
Short Acting Nondepolarizing NMBs
(Length of duration) - CORRECT ANSWER - Mivacurium
(20-30 minutes)
NMB Reversal Agents (3) - CORRECT ANSWER - Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
,NMBs work at ____ receptors - CORRECT ANSWER - Nicotinic Cholinergic (sub-M)
Neurotransmitter of the NM junction - CORRECT ANSWER - acetylcholine
What is the role of acetylcholine? - CORRECT ANSWER - Acetylcholine causes muscles
to contract
Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWER -
acetylcholinesterase
Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWER - Agonist then
antagonist
Non-depolarizing agents are: agonists or antagonists - CORRECT ANSWER - Antagonist
Do non-depolarizers have any contractile properties - CORRECT ANSWER - No, just a
classical receptor blocker
Onset time definition - CORRECT ANSWER - time from drug administration to
maximum effect
Clinical duration definition - CORRECT ANSWER - time from drug administration to
25% recovery of twitch response
Total duration of action definition - CORRECT ANSWER - time from drug administration
to 90% recovery of twitch response (point at which pt is recovered)
Recovery index definition - CORRECT ANSWER - time from 25% to 75% recovery of
twitch response (how fast?)
, Train of Four Index - CORRECT ANSWER - compares the 4th twitch of TOF with the 1st
twitch of TOF. when the 4th twitch is 90% of the first, recovery is indicated.
Muscle stimulated by ulnar nerve in TOF - CORRECT ANSWER - Adductor pollicis
Best nerve/muscle to measure emergence from NMB - CORRECT ANSWER - Ulnar
Nerve
Adductor Pollicis
Best nerve/muscle to measure onset of NMB - CORRECT ANSWER - Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
What is fade and why does it occur? - CORRECT ANSWER - - Fade is the inability to
sustain a response to repetitive nerve stimulation
- Fade occurs because non-depolarizer block not only postsynaptic ACh neuromuscular junction
sites, but also block the positive feedback loop in the presynaptic acetylcholine receptors, which
is responsible for sustaining muscle function.
Single Twitch Test - CORRECT ANSWER - 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - CORRECT ANSWER - A series of 4 twitches at 2 Hz every half a
second for two seconds
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Questions and CORRECT Answers
Ultra short acting neuromuscular blocker
(Length of duration) - CORRECT ANSWER - Succinylcholine
(5 - 15 minutes)
Depolarizing NMB - CORRECT ANSWER - Succinylcholine
Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - CORRECT ANSWER - Atracurium
Cisatracurium
Vecuronium
Rocuronium
(30-60 minutes)
Long Acting Nondepolarizing NMB
(Length of duration) - CORRECT ANSWER - Pancuronium
60-90 minutes
Short Acting Nondepolarizing NMBs
(Length of duration) - CORRECT ANSWER - Mivacurium
(20-30 minutes)
NMB Reversal Agents (3) - CORRECT ANSWER - Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
,NMBs work at ____ receptors - CORRECT ANSWER - Nicotinic Cholinergic (sub-M)
Neurotransmitter of the NM junction - CORRECT ANSWER - acetylcholine
What is the role of acetylcholine? - CORRECT ANSWER - Acetylcholine causes muscles
to contract
Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWER -
acetylcholinesterase
Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWER - Agonist then
antagonist
Non-depolarizing agents are: agonists or antagonists - CORRECT ANSWER - Antagonist
Do non-depolarizers have any contractile properties - CORRECT ANSWER - No, just a
classical receptor blocker
Onset time definition - CORRECT ANSWER - time from drug administration to
maximum effect
Clinical duration definition - CORRECT ANSWER - time from drug administration to
25% recovery of twitch response
Total duration of action definition - CORRECT ANSWER - time from drug administration
to 90% recovery of twitch response (point at which pt is recovered)
Recovery index definition - CORRECT ANSWER - time from 25% to 75% recovery of
twitch response (how fast?)
, Train of Four Index - CORRECT ANSWER - compares the 4th twitch of TOF with the 1st
twitch of TOF. when the 4th twitch is 90% of the first, recovery is indicated.
Muscle stimulated by ulnar nerve in TOF - CORRECT ANSWER - Adductor pollicis
Best nerve/muscle to measure emergence from NMB - CORRECT ANSWER - Ulnar
Nerve
Adductor Pollicis
Best nerve/muscle to measure onset of NMB - CORRECT ANSWER - Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
What is fade and why does it occur? - CORRECT ANSWER - - Fade is the inability to
sustain a response to repetitive nerve stimulation
- Fade occurs because non-depolarizer block not only postsynaptic ACh neuromuscular junction
sites, but also block the positive feedback loop in the presynaptic acetylcholine receptors, which
is responsible for sustaining muscle function.
Single Twitch Test - CORRECT ANSWER - 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - CORRECT ANSWER - A series of 4 twitches at 2 Hz every half a
second for two seconds
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
