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Anticholinesterase reversal — FRCA Primary MCQ

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HardPharmacologyAnticholinesterase reversalFRCA Primary

A patient has four twitches with fade after vecuronium and requires conventional reversal with antimuscarinic cover. Which drug reverses the block?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Neostigmine

Neostigmine increases acetylcholine at the neuromuscular junction and reverses non-depolarising block when recovery is adequate. Glycopyrronium is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Ephedrine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Dexamethasone is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Salbutamol is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. In Primary FRCA pharmacology, link the clinical effect to the receptor, distribution or elimination mechanism rather than memorising isolated facts.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF; Primary FRCA textbooks