NAGELHOUT-PHARM 2-EXAM 1
QUESTIONS AND ANSWERS (GRADED
A+)
Ultra short acting neuromuscular blocker
(Length of duration) - ANSWER-Succinylcholine
(5 - 15 minutes)
Depolarizing NMB - ANSWER-Succinylcholine
Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - ANSWER-Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
Long Acting Nondepolarizing NMB
(Length of duration) - ANSWER-Pancuronium
60-90 minutes
Short Acting Nondepolarizing NMBs
(Length of duration) - ANSWER-None
(20-30 minutes)
NMB Reversal Agents (3) - ANSWER-Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
NMBs work at ____ receptors - ANSWER-Nicotinic Cholinergic (sub-m)
Neurotransmitter of the NM junction - ANSWER-acetylcholine
Breaks down acetylcholine at the NM synapse/junction - ANSWER-acetylcholinesterase
Non-depolarizing agents are: agonists or antagonists - ANSWER-Antagonist
Depolarizing agents act as: agonist or antagonist?? - ANSWER-Agonist then antagonist
Onset time definition - ANSWER-time from drug administration to maximum effect
, Clinical duration definition - ANSWER-time from drug administration to 25% recovery of
twitch response
Total duration of action definition - ANSWER-time from drug administration to 90%
recovery of twitch response (point at which pt is recovered)
Recovery index definition - ANSWER-time from 25% to 75% recovery of twitch
response (how fast?)
Train of Four Index - ANSWER-4th twitch of TOF/1st twitch of TOF
Muscle stimulated by ulnar nerve in TOF - ANSWER-Adductor pollicis
Best nerve/muscle to measure onset of NMB - ANSWER-Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
Best nerve/muscle to measure emersion from NMB - ANSWER-Ulnar Nerve
Adductor Pollicis
Single Twitch Test - ANSWER-1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - ANSWER-4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Double Burst Simulation (DBS) Test - ANSWER-2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - ANSWER-100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - ANSWER-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 - ANSWER-1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
QUESTIONS AND ANSWERS (GRADED
A+)
Ultra short acting neuromuscular blocker
(Length of duration) - ANSWER-Succinylcholine
(5 - 15 minutes)
Depolarizing NMB - ANSWER-Succinylcholine
Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - ANSWER-Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
Long Acting Nondepolarizing NMB
(Length of duration) - ANSWER-Pancuronium
60-90 minutes
Short Acting Nondepolarizing NMBs
(Length of duration) - ANSWER-None
(20-30 minutes)
NMB Reversal Agents (3) - ANSWER-Neostigmine
Edrophonium
Sugammadex (not approved by FDA)
NMBs work at ____ receptors - ANSWER-Nicotinic Cholinergic (sub-m)
Neurotransmitter of the NM junction - ANSWER-acetylcholine
Breaks down acetylcholine at the NM synapse/junction - ANSWER-acetylcholinesterase
Non-depolarizing agents are: agonists or antagonists - ANSWER-Antagonist
Depolarizing agents act as: agonist or antagonist?? - ANSWER-Agonist then antagonist
Onset time definition - ANSWER-time from drug administration to maximum effect
, Clinical duration definition - ANSWER-time from drug administration to 25% recovery of
twitch response
Total duration of action definition - ANSWER-time from drug administration to 90%
recovery of twitch response (point at which pt is recovered)
Recovery index definition - ANSWER-time from 25% to 75% recovery of twitch
response (how fast?)
Train of Four Index - ANSWER-4th twitch of TOF/1st twitch of TOF
Muscle stimulated by ulnar nerve in TOF - ANSWER-Adductor pollicis
Best nerve/muscle to measure onset of NMB - ANSWER-Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
Best nerve/muscle to measure emersion from NMB - ANSWER-Ulnar Nerve
Adductor Pollicis
Single Twitch Test - ANSWER-1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - ANSWER-4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Double Burst Simulation (DBS) Test - ANSWER-2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - ANSWER-100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - ANSWER-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 - ANSWER-1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
