Nagelhout Pharm 2-Final UPDATED ACTUAL Questions and CORRECT Answers

Nagelhout Pharm 2-Final UPDATED
ACTUAL Questions and CORRECT
Answers
Ultra short acting Depolarizing neuromuscular blocker

(Length of duration) - CORRECT ANSWER - Succinylcholine
(5 - 15 minutes)


Short Acting Nondepolarizing NMBs

(Length of duration) - CORRECT ANSWER - Mivacurium
(20-30 minutes)


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)


NMB Reversal Agents (3) - CORRECT ANSWER - Neostigmine
Edrophonium
Sugammadex

,NMBs work at ____ receptors - CORRECT ANSWER - Nicotinic Cholinergic (sub-m)


Nicotinic Cholinergic (sub-m) use positive or negative feedback? - CORRECT
ANSWER - Positive feedback. This explains fade with NDMBs.



Neurotransmitter of the NM junction - CORRECT ANSWER - acetylcholine



Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWER -
acetylcholinesterase


Phase 2, Non-depolarizing agents are: agonists or antagonists - CORRECT ANSWER -
Antagonist


Phase 1, Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWER -
Agonist then antagonist


Train of Four Ratio - CORRECT ANSWER - Strength of 4th twitch:Strength of 1st twitch
(when it is 90% patient considered recovered)


Best nerve/muscle to measure onset of NMB - CORRECT ANSWER - Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
(negative-black electrode over nerve)


Best nerve/muscle to measure emergence from NMB - CORRECT ANSWER - Ulnar
Nerve
Adductor Pollicis
Measures thumb adduction (Red proximal)

,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
*Succ has no fade, all 4 twitches equal*


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
0 = call for ventilator (>9 minutes til TOF)
4 = 4 minutes until TOF possible
8= 0-2 minutes until TOF


Sequence of muscle paralysis - CORRECT ANSWER - 1. Eyelids (Protective muscles of
pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles

, 5. Diaphragm


Muscles not affected by NMBs (4) - CORRECT ANSWER - 1. Cardiac muscle
Smooth muscle:
2. Bronchi (can't treat bronchospasm with NMBs)
3. Uterus
4. GI/bowels


Sequence of muscle recovery from NMB - CORRECT ANSWER - 1. Diaphragm
2. Abdominal muscles
3. Chest (upward)
4. Extremities
5. Eyelids
*6. Protective muscles reflexes of pharynx


1/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWER - 30 minutes



2-3/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWER - 4-15
minutes (intermediate acting relaxant)
30 minutes (Pancuronium)


4/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWER - 5 minutes
with Neostigmate
2-3 minutes with Edrophonium


0/4 TOF responses = ___% blockade - CORRECT ANSWER - 100%



1/4 TOF responses = ___% blockade - CORRECT ANSWER - 90% (ideal for surgery)