Nagelhout Pharm 2 test 3 Questions and
Verified Answers With Complete
Solutions||100- Guarantee Pass Exam
Guide (Latest 2026).
Ultra short acting Depolarizing neuromuscular blocker
(Length of duration) - CORRECT ANSWERS-Succinylcholine
(5 - 15 minutes)
Short Acting Nondepolarizing NMBs
(Length of duration) - CORRECT ANSWERS-Mivacurium
(20-30 minutes)
Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - CORRECT ANSWERS-Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
Long Acting Nondepolarizing NMB
(Length of duration) - CORRECT ANSWERS-Pancuronium
(60-90 minutes)
NMB Reversal Agents (3) - CORRECT ANSWERS-Neostigmine
Edrophonium
Sugammadex
NMBs work at ____ receptors - CORRECT ANSWERS-Nicotinic Cholinergic (sub-m)
Nicotinic Cholinergic (sub-m) use positive or negative feedback? - CORRECT
ANSWERS-Positive feedback. This explains fade with NDMBs.
Neurotransmitter of the NM junction - CORRECT ANSWERS-acetylcholine
Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWERS-
acetylcholinesterase
Phase 2, Non-depolarizing agents are: agonists or antagonists - CORRECT
ANSWERS-Antagonist
,Phase 1, Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWERS-
Agonist then antagonist
Train of Four Ratio - CORRECT ANSWERS-Strength of 4th twitch:Strength of 1st twitch
(when it is 90% patient considered recovered)
Best nerve/muscle to measure onset of NMB - CORRECT ANSWERS-Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
(negative-black electrode over nerve)
Best nerve/muscle to measure emergence from NMB - CORRECT ANSWERS-Ulnar
Nerve
Adductor Pollicis
Measures thumb adduction (Red proximal)
Single Twitch Test - CORRECT ANSWERS-1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - CORRECT ANSWERS-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 ANSWERS-2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - CORRECT ANSWERS-100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - CORRECT ANSWERS-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 ANSWERS-1. Eyelids (Protective muscles
of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
,Muscles not affected by NMBs (4) - CORRECT ANSWERS-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 ANSWERS-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 ANSWERS-30 minutes
2-3/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWERS-4-15
minutes (intermediate acting relaxant)
30 minutes (Pancuronium)
4/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWERS-5 minutes
with Neostigmate
2-3 minutes with Edrophonium
0/4 TOF responses = ___% blockade - CORRECT ANSWERS-100%
1/4 TOF responses = ___% blockade - CORRECT ANSWERS-90% (ideal for surgery)
2/4 TOF responses = ___% blockade - CORRECT ANSWERS-80-85%
3/4 TOF responses = ___% blockade - CORRECT ANSWERS-75-80%
4/4 (with fade) TOF responses = ___% blockade
(TOF ratio <.9) - CORRECT ANSWERS-70-75%
4/4 (without fade) TOF responses = ___% blockade
(TOF ratio >.9) - CORRECT ANSWERS-≤70%
Characteristics of Phase 1 Depolarizing block: - CORRECT ANSWERS-1. Muscle
fasiculation
2. Sustained response to tetanic stim
3. Absence of post-tetanic stim
4. No fade on TOF or DBS
5. Antagonized 20% by NDMB pretreatment
6. Potentiated by anticholinesterase meds
, Characteristics of Phase 2 Non-Depolarizers - CORRECT ANSWERS-1. Absence of
fasiculation
2. Tetanic fade occurs
3. Post-tetanic stimulation occurs
4. Fade with TOF and DBS occurs
5. Can be reversed with anticholinesterases
6. Rarely produced by overdosing succ >6mg/kg
Most reliable tests of 50% or more NMB reversed (4) - CORRECT ANSWERS-1. Head
lift (standard)
2. Hand grip
3. Sustained bite
4, NIF -40
5. Diplopia (most reliable)
Less reliable tests of recovery: - CORRECT ANSWERS-Vt 5 ml/kg = 20% recovered
Single twitch= 25% recovered
TOF no fade = 30% recovered
Sustainted tetanus = 30% recovered
VC 20 ml/kg = 30% recovered
DBS no fade = 30-40% recovered
Two steps of Succinylcholine breakdown - CORRECT ANSWERS-Succinylchoine
1. Succinylmonocholine + Choline (reused)
2. Succinylmonocholine → Succinic Acid (goes to Krebs) + Choline
Non-specific esterases - CORRECT ANSWERS-Paraoxonase
Albumin esterase
RBC esterase
Cholinesterases (2) - CORRECT ANSWERS-Enzyme; *Hydrolyzes* choline esters
faster than other esterases
1. Acteylcholinesterase (AChE) - in NMJ
2. Pseudo-cholinesterase (PChE) - in plasma
Acetylcholinesterase
1. Other names
2. Location - CORRECT ANSWERS-1. True, specific, genuine, Type 1
2. Erythrocytes, nerve endings, lungs, spleen, grey matter of brain
Pseudo-cholinesterase
1. Other names
2. Location - CORRECT ANSWERS-1. Plasma, serum, benzoyl, false, butytyl,
nonspecific, Type II
2. Plasma, liver, smooth muscle, intestines, pancreas, heart, white matter of brain
Verified Answers With Complete
Solutions||100- Guarantee Pass Exam
Guide (Latest 2026).
Ultra short acting Depolarizing neuromuscular blocker
(Length of duration) - CORRECT ANSWERS-Succinylcholine
(5 - 15 minutes)
Short Acting Nondepolarizing NMBs
(Length of duration) - CORRECT ANSWERS-Mivacurium
(20-30 minutes)
Intermediate Acting Nondepolarizing NMBs (4)
(Length of duration) - CORRECT ANSWERS-Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)
Long Acting Nondepolarizing NMB
(Length of duration) - CORRECT ANSWERS-Pancuronium
(60-90 minutes)
NMB Reversal Agents (3) - CORRECT ANSWERS-Neostigmine
Edrophonium
Sugammadex
NMBs work at ____ receptors - CORRECT ANSWERS-Nicotinic Cholinergic (sub-m)
Nicotinic Cholinergic (sub-m) use positive or negative feedback? - CORRECT
ANSWERS-Positive feedback. This explains fade with NDMBs.
Neurotransmitter of the NM junction - CORRECT ANSWERS-acetylcholine
Breaks down acetylcholine at the NM synapse/junction - CORRECT ANSWERS-
acetylcholinesterase
Phase 2, Non-depolarizing agents are: agonists or antagonists - CORRECT
ANSWERS-Antagonist
,Phase 1, Depolarizing agents act as: agonist or antagonist?? - CORRECT ANSWERS-
Agonist then antagonist
Train of Four Ratio - CORRECT ANSWERS-Strength of 4th twitch:Strength of 1st twitch
(when it is 90% patient considered recovered)
Best nerve/muscle to measure onset of NMB - CORRECT ANSWERS-Facial Nerve
Orbicularis Oculi (Corrugator supercilii = best)
(reflects diaphragm blockade)
(negative-black electrode over nerve)
Best nerve/muscle to measure emergence from NMB - CORRECT ANSWERS-Ulnar
Nerve
Adductor Pollicis
Measures thumb adduction (Red proximal)
Single Twitch Test - CORRECT ANSWERS-1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch
Train of Four Test - CORRECT ANSWERS-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 ANSWERS-2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade
Tetanus Test - CORRECT ANSWERS-100 Hz twitch for 5 seconds
Painful
Posttetanic Count Test - CORRECT ANSWERS-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 ANSWERS-1. Eyelids (Protective muscles
of pharynx)
2. Extremities
3. Chest (neck downward)
4. Abdominal muscles
5. Diaphragm
,Muscles not affected by NMBs (4) - CORRECT ANSWERS-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 ANSWERS-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 ANSWERS-30 minutes
2-3/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWERS-4-15
minutes (intermediate acting relaxant)
30 minutes (Pancuronium)
4/4 Train of Four will take ___ minutes for recovery - CORRECT ANSWERS-5 minutes
with Neostigmate
2-3 minutes with Edrophonium
0/4 TOF responses = ___% blockade - CORRECT ANSWERS-100%
1/4 TOF responses = ___% blockade - CORRECT ANSWERS-90% (ideal for surgery)
2/4 TOF responses = ___% blockade - CORRECT ANSWERS-80-85%
3/4 TOF responses = ___% blockade - CORRECT ANSWERS-75-80%
4/4 (with fade) TOF responses = ___% blockade
(TOF ratio <.9) - CORRECT ANSWERS-70-75%
4/4 (without fade) TOF responses = ___% blockade
(TOF ratio >.9) - CORRECT ANSWERS-≤70%
Characteristics of Phase 1 Depolarizing block: - CORRECT ANSWERS-1. Muscle
fasiculation
2. Sustained response to tetanic stim
3. Absence of post-tetanic stim
4. No fade on TOF or DBS
5. Antagonized 20% by NDMB pretreatment
6. Potentiated by anticholinesterase meds
, Characteristics of Phase 2 Non-Depolarizers - CORRECT ANSWERS-1. Absence of
fasiculation
2. Tetanic fade occurs
3. Post-tetanic stimulation occurs
4. Fade with TOF and DBS occurs
5. Can be reversed with anticholinesterases
6. Rarely produced by overdosing succ >6mg/kg
Most reliable tests of 50% or more NMB reversed (4) - CORRECT ANSWERS-1. Head
lift (standard)
2. Hand grip
3. Sustained bite
4, NIF -40
5. Diplopia (most reliable)
Less reliable tests of recovery: - CORRECT ANSWERS-Vt 5 ml/kg = 20% recovered
Single twitch= 25% recovered
TOF no fade = 30% recovered
Sustainted tetanus = 30% recovered
VC 20 ml/kg = 30% recovered
DBS no fade = 30-40% recovered
Two steps of Succinylcholine breakdown - CORRECT ANSWERS-Succinylchoine
1. Succinylmonocholine + Choline (reused)
2. Succinylmonocholine → Succinic Acid (goes to Krebs) + Choline
Non-specific esterases - CORRECT ANSWERS-Paraoxonase
Albumin esterase
RBC esterase
Cholinesterases (2) - CORRECT ANSWERS-Enzyme; *Hydrolyzes* choline esters
faster than other esterases
1. Acteylcholinesterase (AChE) - in NMJ
2. Pseudo-cholinesterase (PChE) - in plasma
Acetylcholinesterase
1. Other names
2. Location - CORRECT ANSWERS-1. True, specific, genuine, Type 1
2. Erythrocytes, nerve endings, lungs, spleen, grey matter of brain
Pseudo-cholinesterase
1. Other names
2. Location - CORRECT ANSWERS-1. Plasma, serum, benzoyl, false, butytyl,
nonspecific, Type II
2. Plasma, liver, smooth muscle, intestines, pancreas, heart, white matter of brain
