*NMBD Reversal Agents (Exam IV) Flashcards
What are the 3 classifications of NMBD Reversal Agents?
- AcetylcholineEsterase (AchE) Inhibitors
- Cholinergic Agents
- COMPETITIVE ANTAGONISTS
S9
What is the MOA if AChE
- Rapid hydrolysis (catalyze) of Ach
Inhibition of Esterase enzyme = more Acetylcholine available → Ach binds to alpha subunits
S9
Where is AChE available at?
- Preganglionic (SNS & PNS)
- NMJ: neuromuscular junction
S9
Do AChE inhibitors work with deep neuromuscular blockade?
No
S10
What do we do when patient has deep NM blocked according to Dr. Castillo?
WAIT
until we get a TOF and Tetany
What is the max dosage of neostigmine?
40 - 70 mcg/kg
0.04 - 0.07 mg/kg
S10
What is the max dosage of edrophonium?
1 mg/kg
S10
Reversal of NMJ blockade is dependent on these 5 factors:
- Depth of block
- AChE Inhibitor choice (neo vs edro)
- Dose
- Rate of plasma clearance
- Anesthetic agent choice and depth
S11
What is the ED50 and ED90 of Pancuronium?
ED50 = 0.036
ED90 = 0.067
What is the ED50 and ED90 of Rocuronium?
ED50 = 0.147
ED90 = 0.305
What is the ED50 and ED90 of Vecuronium?
ED50 = 0.027
ED90 = 0.043
What is the ED50 and ED90 of Atracurium?
ED50 = 0.12
ED90 = 0.21
What is the ED50 and ED90 of Cisatracurium?
ED50 = 0.026
ED90 = 0.040
What is the ED50 and ED90 of Mivacurium?
ED50 = 0.039
ED90 = 0.067
What is the onset and duration of neostigmine?
Onset: 5 - 10 mins
Duration: 60 mins
S14
What is the dosage of edrophonium?
0.5 to 1 mg/kg
S14
What is the onset and duration of edrophonium?
Onset: 1-2 mins
Duration: 5-15 mins
S14
What percentage of neostigmine is renally excreted?
50%
S16
What percentage of both pyridostigmine and edrophonium are renally excreted?
75%
S16
How does Chronic Renal Failure affect NMBD reversal agents?
decreases plasma clearance
→ prolonged action
S16
How are NMB reversal agents cleared if the patient has no innate renal function?
30 - 50% cleared hepatically
S16
What is the major side effect of NMBD reversal agents?
Increased Nicotinic/Muscarinic Activity
S17
What CV side effects of NMBD Reversal Agents?
- Bradycardia
- dysrhythmias
- asystole
- ↓SVR
S17
What pulmonary side effects of NMBD Reversal Agents?
- Bronchoconstriction
- increased airway resistance
- increased salivation
S17