NMB reversal agents & anticholinergics 2

Question 1

Compared to atropine, glycopyrrolate is MORE likely to cause:
a. tachycardia
b. xerostomia
c. sedation
d. mydriasis

Answer 1

b. xerostomia

Question 2

_____________ & ________________ easily cross lipid membranes, including the BBB, GI tract, & placenta.

Answer 2

atropine & scopolamine

Question 3

Does glycopyrrolate cross the BBB?

Answer 3

nope it’s ionized

Question 4

_______________- increases the heart rate the most of all the muscarinic antagonists

Answer 4

atropine

Question 5

A very small dose of atropine can cause

Answer 5

paradoxical bradycardia

Question 6

_________________ is most effect at preventing motion sickness, providing sedation, and drying secretions.

Answer 6

Scopolamine

Question 7

Atropine & scopolamine are naturally occuring

Answer 7

tertiary amines

Question 8

Why can atropine cause paradoxical bradycardia?

Answer 8

in small doses it is probably due to the inhibition of the presynaptic M1 receptor on vagal nerve endings- blockade turns off the negative feedback loop and allows for continued Ach release & bradycardia

Question 9

Muscarinic antagonists do not affect the heart rate in patients with

Answer 9

a previous heart transplant (e.g. those with a denervated heart)

Question 10

Should you still give heart transplant patients a muscarinic antagonist?

Answer 10

yes, because they can experience other cholinergic effects from AchE inhibitors

Question 11

Which muscarinic antagonist increases heart rate the least?

Answer 11

scopolamine

Question 12

Which muscarinic antagonist does not prevent motion-induced nausea?

Answer 12

glycopyrrolate

Question 13

Which neuromuscular blocker is MOST effectively antagonized by sugammadex?
a. mivacurium
b. rocuronium
c. cisatracurium
d. succinylcholine

Answer 13

b. rocuronium

Question 14

Sugammadex is a

Answer 14

gamma-cyclodextrin that encapsulates the aminosteroid neuromuscular blockers in the bloodstream

Question 15

Sugammadex has the greatest affinity for

Answer 15

rocuronium

Question 16

Rocuronium can be used for ___________ without the drawbacks of succinylcholine

Answer 16

difficult intubation

Question 17

Sugammadex allows for a

Answer 17

dense block until the very end of the surgical procedure without the concerns of delayed extubation

Question 18

Side effects of Sugammadex include

Answer 18

anaphylaxis bradycardia, and a reduction in the effectiveness of hormonal contraceptives for up to 7 days

Question 19

If you need to reparalyze the patient after administering sugammadex, you can use

Answer 19

a neuromuscular blocker from outside the aminosteroid class; if you gave <4 mg/kg of sugammadex, you can redose rocuronium or vecuronium

Question 20

Sugammadex is excreted

Answer 20

unchanged by the kidneys

Question 21

What is the dose of post-intubation sugammadex?

Answer 21

16 mg/kg

Question 22

What is the dose of sugammadex for TOF 2/4 or better?

Answer 22

2 mg/kg

Question 23

What is the dose of sugammadex for TOF 0/4 + 2 PTC or better

Answer 23

4 mg/kg

Question 24

The patient’s ___________ should be used to dose sugammadex

Answer 24

actual body weight

Question 25

If the patient received sugammadex in the last 5 min. - 4 hours, you can give rocuronium at

Answer 25

1.2 mg/kg