NAGELHOUT PHARM 2-FINAL EXAM QUESTIONS AND ANSWERS GRADED A+ 2025/2026

NAGELHOUT PHARM 2-FINAL EXAM
QUESTIONS AND ANSWERS GRADED A+
2025/2026




Ultra short acting Depolarizing neuromuscular blocker

(Length of duration) - ANS Succinylcholine
(5 - 15 minutes)


Short Acting Nondepolarizing NMBs

(Length of duration) - ANS Mivacurium
(20-30 minutes)


Intermediate Acting Nondepolarizing NMBs (4)

(Length of duration) - ANS Atracurium
Cisatracurium
Vecuronium
Rocuromium
(30-60 minutes)


Long Acting Nondepolarizing NMB

(Length of duration) - ANS Pancuronium
(60-90 minutes)


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,NMB Reversal Agents (3) - ANS Neostigmine
Edrophonium
Sugammadex


NMBs work at ____ receptors - ANS Nicotinic Cholinergic (sub-m)


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


Neurotransmitter of the NM junction - ANS acetylcholine


Breaks down acetylcholine at the NM synapse/junction - ANS acetylcholinesterase


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


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


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


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


Best nerve/muscle to measure emergence from NMB - ANS Ulnar Nerve
Adductor Pollicis


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,Measures thumb adduction (Red proximal)


Single Twitch Test - ANS 1.0 Hz
Single stimulus
Compares pre (baseline) and post NMB hand twitch


Train of Four Test - ANS 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 - ANS 2 - 50 Hz twitches
0.75 seconds apart
Compares 2 twitches to monitor for fade


Tetanus Test - ANS 100 Hz twitch for 5 seconds
Painful


Posttetanic Count Test - ANS 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 - ANS 1. Eyelids (Protective muscles of pharynx)
2. Extremities
3. Chest (neck downward)


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, 4. Abdominal muscles
5. Diaphragm


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


Sequence of muscle recovery from NMB - ANS 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 - ANS 30 minutes


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


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


0/4 TOF responses = ___% blockade - ANS 100%


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


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