NAGELHOUT PHARM 2 CERTIFICATION
EVALUATION EXAMS 2026 QUESTIONS WITH
SOLUTIONS GRADED A+
◉ Short-Acting Non-Depolarizing Blocker. Answer: -Mivacurium
◉ Intermediate-acting non-depolarizing blockers. Answer: Atracurium
Cisatracurium
Rocuronium
Vecuronium
◉ Long-Acting Non-Depolarizing Blocker. Answer: pancuronium
◉ How is acetylcholine synthesized? Metabolized by? Metabolites?
Answer: -Synthesized in presynaptic nerve terminal by N-
acetyltransferase, combines acetate and choline
-Metabolized acetylcholinesterase via rapid hydrolysis into choline and
acetic acid
-Choline re-enters the presynaptic terminal and used to make more Ach
, ◉ Single twitch test. Answer: -A single supramaximal electrical stimulus
ranging from 0.1-1.0 HZ
-Requires baseline before drug administration
-Only tells you 100% paralyzed (no twitch) or <100% (1 twitch)
◉ Train of Four Test. Answer: -A series of 4 twitches at 2 Hz every 0.5
sec for 2 seconds
-Reflects blockade from 70-100%; useful during onset, maintenance,
and emergence
-TOFR compares T4 to T1
◉ Double Burst Stimulation. Answer: Two short bursts of tetanus (2-4
pulses at 50 Hz) separated by 0.75sec.
- May be better at detecting fade than TOF (more Hz)
◉ Tetanus Test. Answer: Generally, consists of rapid delivery of a 30,
50, or 100 Hz stimulus for 5 seconds.
*Should be used sparingly for deep block assessment, painful.*
◉ Posttetanic count. Answer: 50-Hz. tetanus for 5 sec, a 3-sec pause,
then single twitches of 1 Hz
-used only when TOF, or DBS response is absent; count less than 8
indicates a deep block, prolonged recovery is likely
EVALUATION EXAMS 2026 QUESTIONS WITH
SOLUTIONS GRADED A+
◉ Short-Acting Non-Depolarizing Blocker. Answer: -Mivacurium
◉ Intermediate-acting non-depolarizing blockers. Answer: Atracurium
Cisatracurium
Rocuronium
Vecuronium
◉ Long-Acting Non-Depolarizing Blocker. Answer: pancuronium
◉ How is acetylcholine synthesized? Metabolized by? Metabolites?
Answer: -Synthesized in presynaptic nerve terminal by N-
acetyltransferase, combines acetate and choline
-Metabolized acetylcholinesterase via rapid hydrolysis into choline and
acetic acid
-Choline re-enters the presynaptic terminal and used to make more Ach
, ◉ Single twitch test. Answer: -A single supramaximal electrical stimulus
ranging from 0.1-1.0 HZ
-Requires baseline before drug administration
-Only tells you 100% paralyzed (no twitch) or <100% (1 twitch)
◉ Train of Four Test. Answer: -A series of 4 twitches at 2 Hz every 0.5
sec for 2 seconds
-Reflects blockade from 70-100%; useful during onset, maintenance,
and emergence
-TOFR compares T4 to T1
◉ Double Burst Stimulation. Answer: Two short bursts of tetanus (2-4
pulses at 50 Hz) separated by 0.75sec.
- May be better at detecting fade than TOF (more Hz)
◉ Tetanus Test. Answer: Generally, consists of rapid delivery of a 30,
50, or 100 Hz stimulus for 5 seconds.
*Should be used sparingly for deep block assessment, painful.*
◉ Posttetanic count. Answer: 50-Hz. tetanus for 5 sec, a 3-sec pause,
then single twitches of 1 Hz
-used only when TOF, or DBS response is absent; count less than 8
indicates a deep block, prolonged recovery is likely
