Neuromuscular blockers: sugammadex: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Neuromuscular blockers: sugammadex

Sample item

After a rocuronium-based anaesthetic, the anaesthetist reverses the block with sugammadex. Why is an antimuscarinic drug not needed along with it, unlike with neostigmine?

AIt encapsulates the steroidal blocker and does not inhibit acetylcholinesteraseBIt blocks muscarinic receptors itselfCIt increases acetylcholine release from motor nerve endingsDIt is a competitive antagonist at the nicotinic end-plate receptor

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. It encapsulates the steroidal blocker and does not inhibit acetylcholinesterase

Sugammadex is a modified cyclodextrin that forms a tight 1:1 complex with rocuronium (and vecuronium), removing it from the neuromuscular junction. Because it does not inhibit acetylcholinesterase, there is no muscarinic stimulation and so no need for atropine or glycopyrrolate. Neostigmine, in contrast, causes bradycardia and secretions.

Option by option

A. It encapsulates the steroidal blocker and does not inhibit acetylcholinesterase (correct)
Correct. Encapsulation of the blocker leaves acetylcholine metabolism untouched.
B. It blocks muscarinic receptors itself
Sugammadex has no receptor action of its own.
C. It increases acetylcholine release from motor nerve endings
It does not alter transmitter release; the reversal comes from binding the drug.
D. It is a competitive antagonist at the nicotinic end-plate receptor
Nicotinic antagonism would produce neuromuscular block rather than reversing it.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, It encapsulates the steroidal blocker and does not inhibit acetylcholinesterase. Sugammadex is a modified cyclodextrin that forms a tight 1:1 complex with rocuronium (and vecuronium), removing it from the neuromuscular junction.

Why is "It blocks muscarinic receptors itself" not the answer?

Sugammadex has no receptor action of its own.

Why is "It increases acetylcholine release from motor nerve endings" not the answer?

It does not alter transmitter release; the reversal comes from binding the drug.

Why is "It is a competitive antagonist at the nicotinic end-plate receptor" not the answer?

Nicotinic antagonism would produce neuromuscular block rather than reversing it.

What concept does this question test?

It tests Neuromuscular blockers: sugammadex in Pharmacology. Because it does not inhibit acetylcholinesterase, there is no muscarinic stimulation and so no need for atropine or glycopyrrolate. Neostigmine, in contrast, causes bradycardia and secretions.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuromuscular blockers: sugammadex?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.