Nagelhout-Pharm 2-Exam 1 UPDATED
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
Rocuromium
(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 -None
(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
Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWER -
acetylcholinesterase
Non-depolarizing agents are: agonists or antagonists - CORRECT ANSWER -Antagonist
Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWER -Agonist then
antagonist
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 -4th twitch of TOF/1st twitch of TOF
Muscle stimulated by ulnar nerve in TOF - CORRECT ANSWER -Adductor pollicis
Best nerve/muscle to measure onset of NMB - CORRECT ANSWER -Facial Nerve
, Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
Best nerve/muscle to measure emersion from NMB - CORRECT ANSWER -Ulnar Nerve
Adductor Pollicis
Single Twitch Test - CORRECT ANSWER -1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - CORRECT ANSWER -4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Double Burst Simulation (DBS) Test - CORRECT ANSWER -2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - CORRECT ANSWER -100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - CORRECT 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 - CORRECT ANSWER -1. Eyelids (Protective muscles of
pharynx)
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
Rocuromium
(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 -None
(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
Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWER -
acetylcholinesterase
Non-depolarizing agents are: agonists or antagonists - CORRECT ANSWER -Antagonist
Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWER -Agonist then
antagonist
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 -4th twitch of TOF/1st twitch of TOF
Muscle stimulated by ulnar nerve in TOF - CORRECT ANSWER -Adductor pollicis
Best nerve/muscle to measure onset of NMB - CORRECT ANSWER -Facial Nerve
, Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
Best nerve/muscle to measure emersion from NMB - CORRECT ANSWER -Ulnar Nerve
Adductor Pollicis
Single Twitch Test - CORRECT ANSWER -1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - CORRECT ANSWER -4 - 2 Hz twitches
Compares 4th twitch to 1st twitch (fade)
Reflects 70-100% blockade
Double Burst Simulation (DBS) Test - CORRECT ANSWER -2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - CORRECT ANSWER -100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - CORRECT 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 - CORRECT ANSWER -1. Eyelids (Protective muscles of
pharynx)
