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Anesthesia Pharm (Spring 2023) Drugs and Doses Only > NMBD Reversal Agents (Exam IV) > Flashcards

NMBD Reversal Agents (Exam IV) Flashcards

1
Q

How long, generally, until NMJ blockade is fully reversed with neostigmine?

A

20-30 min

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2
Q

Do AChE inhibitors work with deep neuromuscular blockade?

A

No

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3
Q

Reversal of NMJ blockade is dependent on these 5 factors:

A
  1. Depth of block
  2. Drug choice (neo vs edro)
  3. Dose
  4. Rate of plasma clearance
  5. Anesthetic agent and depth
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4
Q

Which paralytic has to be reconstituted with 10mL of H₂O ?

A

Vecuronium

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5
Q

What is the max dosage of neostigmine?

A

40 - 70 mcg/kg

0.04 - 0.07 mg/kg

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6
Q

What is the onset and duration of neostigmine?

A

Onset: 5 - 10 min
Duration: 60 min

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7
Q

What is the dosage of edrophonium?

A

0.5 - 1 mg/kg

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8
Q

What is the max dosage of edrophonium?

A

1.5 mg/kg

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9
Q

What is the onset and duration of edrophonium?

A

Onset: 1-2 min
Duration: 5-15 min

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10
Q

What percentage of neostigmine is renally excreted?

A

50%

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11
Q

What percentage of both pyridostigmine and edrophonium are renally excreted?

A

75%

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12
Q

How are NMB reversal agents cleared if the patient has no innate renal function?

A

30 - 50% cleared hepatically

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13
Q

What is the major side effect of NMBD reversal agents?

A

↑PSNS activity (from increased nACh and mACh activity)

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14
Q

What drugs would be coupled with NMBD reversal agents to prevent adverse side effects from these drugs?

A

Anti-cholinergic / Anti-muscarinics

  • Atropine
  • Glycopyrrolate
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15
Q

If you’re concerned about someone’s cardiac status due to existing disease, which Anticholinergic drug would you use?

A

Glycopyrrolate

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16
Q

What NMBD(s) is glycopyrrolate used with?

A
  • Neostigmine
  • Pyridostigmine
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17
Q

What NMBD(s) is atropine used with?

A

Edrophonium

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18
Q

What is the dose of Atropine?

A

7 - 10 mcg/kg

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19
Q

What common side effects are seen right after atropine administration?

A
  • Mydriasis
  • Tachycardia
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20
Q

What is the maximum dose of glycopyrrolate?

A

1mg max dose

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21
Q

How long does glycopyrrolate need to be administered over?

A

2 - 5 min

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22
Q

What reversal drug is specific to mivacurium?

A

Purified human plasma cholinesterase

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23
Q

What reversal drug is specific to gantacurium?

A

Cystiene

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24
Q

What reversal drug is very specific to rocuronium?

A

Sugammadex

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25
Q

What type of drug is sugammadex?

A

Selective relaxant-binding agent

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26
Q

What should be known about sugammadex’s organic structure and physical properties?

A
  • γ-cyclodextrin
  • Dextrose units from starch
  • Very H₂O-soluble
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27
Q

What is the MOA of Sugammadex?

A

Encapsulates rocuronium via:

  • Van der Waals forces
  • H-bonds
  • Hydrophobic interactions
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28
Q

What drugs does sugammadex work with?

A

Roc > Vec > Pancuronium

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29
Q

What is the E ½ time of sugammadex?

A

2 hours

30
Q

How is sugammedex eliminated?

A

Urine:

  • 70% gone in 6 hours
  • 90% gone in 24 hours
31
Q

Differentiate a moderate block vs a deep block.

A
  • Moderate: 2/4 twitches on TOF
  • Deep: No twitches to TOF
32
Q

What is the Sugammadex dose for a moderate block?

A

2 mg/kg

33
Q

What is the Sugammadex dose for a deep block?

A

4 mg/kg

34
Q

What is the sugammadex dose for an extreme (overdose) block?

A

8 - 16 mg/kg

35
Q

What are the side effects of Sugammadex?

A
  • Bradycardia
  • dose-related N/V
  • dose-related Pruritis
  • dose-related Urticaria
36
Q

What drugs/conditions are relative contraindications to sugammadex?

A
  • Contraceptives
  • Toremifene (displaces roc from sugammadex)
  • Coagulopathy
  • ESRD (excreted renally)
37
Q

What is recurarization?

A

Resumption of NMJ blockade after period of reversal

38
Q

What s/s would indicate recurarization?

Say you just brought the patient to PACU.

A
  • ↓ SpO₂
  • ↓ respiratory effort
  • Floppy/uncoordinated
  • Unresponsive
39
Q

What drug and dose would be a good choice for a recurarizing patient in the PACU?
Why might this be a good choice?

A
  • Neostigmine 0.05 mg/kg IV
  • Longer duration of action
40
Q

What are the NMBD reversal agents

A

edrophonium
neostigmine

41
Q

What are the anti-cholinergic agents

A

atropine sulfate
glycopyrrolate

42
Q

What is the lastest NMBD reversal agents

A

sugammadex

43
Q

What is the dose (mg/kg) and mg/ml of Succinylcholine (Anectine)

A

mg/kg: 1 - 1.5
mg/ml: 20

44
Q

What is the dose (mg/kg) and mg/ml of Cisatricurium (Nimbex)

A

mg/kg: 0.1
mg/ml: 1

45
Q

What is the dose (mg/kg) and mg/ml of Vecuromium (Norcuron)

A

mg/kg: 0.1
mg/ml: 1

46
Q

What is the dose (mg/kg) and mg/ml of Rocuronium (Zemuron)

A

mg/kg: 0.6 (1.2)
mg/ml: 10

47
Q

What is the dose (mg/kg) and mg/ml of Pancuronium (Pavulon)

A

mg/kg: 0.1
mg/ml: 2

48
Q

What is the onset and duration of Succinylcholine (Anectine)

A

onset: 30-60 sec
Duration: 5-10 min

49
Q

What is the onset and duration of Cisatricurium (Nimbex)

A

onset: 2-3 min
duration: 40-75min

50
Q

What is the onset and duration of Vecuronium (Norcuron)

A

Onet: 2-3min
Duration: 45-90min

51
Q

What is the onset and duration of Rocuronium (Zemuron)

A

onset: 2-3 (1.5)min
duration: 35 -75 min

52
Q

What is the onset and duration of Pancuronium (Pavuion)

A

onet: 2-3 min
duration: 60 min

53
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for d- Tubocuratine

A

ED50: 0.23
ED95: 0.48
CE50: 370
Keo: 0.13

54
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for Pancuronium

A

ED50: 0.036
ED95:0.067
CE50:88
Keo: -

55
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for** Rocuronium**

A

ED50: 0.147
ED95: 0.305
CE50: 3510
Keo: 0.405

56
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for Vecuronium

A

ED50: 0.027
ED95:0.043
CE50: 92
Keo: 0.17

57
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for Atracrium

A

ED50: 0.12
ED95: 0.21
CE50: 449
Keo: 0.13

58
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for Cisatracurium

A

ED50: 0.026
ED95: 0.04
CE50:126 - 158
Keo: 0.07 -0.09

59
Q

What is the:
ED50 (mg/kg)
ED95 (mg/kg)
CE50 (mg/ml)
Keo (min)
for Mivacurium

A

ED50: 0.039
ED95:0.067
CE50:79.9
Keo: 0.18

60
Q

Whatis the is the:
intubation dose (mg/kg)
maximum block (%)
Time to maxium block (min)
Clinical duration of reponse (min)
for d- Tubocurarine

A

intubation dose (mg/kg): 0.6
maximum block (%): 97
Time to maximum block (min): 5.7
Clinical duration of reponse (min): 81

61
Q

Whatis the is the:
intubation dose (mg/kg)
maximum block (%)
Time to maxium block (min)
Clinical duration of reponse (min)
for pancuronium

A

intubation dose (mg/kg): 0.1
maximum block (%): 100
Time to maxium block (min): 2.9
Clinical duration of reponse (min): 86

62
Q

Whatis the is the:
intubation dose (mg/kg)
maximum block (%)
Time to maximum block (min)
Clinical duration of reponse (min)
for rocuronium

A

intubation dose (mg/kg): 0.6
maximum block (%): 100
Time to maximum block (min): 1.7
Clinical duration of reponse (min): 36

63
Q

Whatis the is the:
intubation dose (mg/kg)
maximum block (%)
Time to maxium block (min)
Clinical duration of reponse (min)
for Vecuromium

A

intubation dose (mg/kg): 0.1
maximum block (%): 100
Time to maxium block (min): 2.4
Clinical duration of reponse (min): 44

64
Q

What is the
intubation dose (mg/kg)
maximum block (%)
Time to maxium block (min)
Clinical duration of reponse (min)
for Atracurium

A

intubation dose (mg/kg): 0.5
maximum block (%): 100
Time to maxium block (min) : 3.2
Clinical duration of reponse (min): 46

65
Q

Whatis the is the:
intubation dose (mg/kg)
maximum block (%)
Time to maximum block (min)
Clinical duration of reponse (min)
for Cisatracuium

A

intubation dose (mg/kg): 0.1
maximum block (%): 100
Time to maxium block (min): 5.2
Clinical duration of reponse (min): 45

66
Q

Whatis the is the:
intubation dose (mg/kg)
maximum block (%)
Time to maximum block (min)
Clinical duration of reponse (min)
For Mivacurium

A

intubation dose (mg/kg): 0.15
maximum block (%): 100
Time to maximum block (min): 3.3
Clinical duration of reponse (min): 16.8

67
Q

What are the side effects NMBD reversal agents other than increaed nicotinic and muscainic activity?

A

CV: Bradycardia, dysrhythmias, asystole, ↓SVR
Pulmonary: Bronchoconstriction, increased airway resistance, increased salivation
**GI: ** Hyperperistalsis, enhanced gastric fluid secretion, PONV
Eyes: Miosis

68
Q

What are the interventions for persistent NM blockade?

A

sedation and postop ventilation

69
Q

What is the MOA for persistent NM blockade

A
  • inhibit Acetylcholinesterase
70
Q

What factors infulence NMBD reversal

A
  • Intensity of block
  • NMBD use
  • volatile anesthetic
  • reversal drug use
  • Metabolic acidosis
  • Respiratory acidosis
  • Hypothermia
71
Q

After waiting 5 mins after reversal, what is the NMBA that can be re-adminstered and the dose

A

Rocuronium 1.2mg/kg

72
Q

After waiting 4hours after reversal, what is the NMBA that can be re -adminstered?
What is the dose

A

Rocuronium - 0.6 mg/kg
Vecuronium - 0.1 mg/kg

Anesthesia Pharm (Spring 2023) Drugs and Doses Only (20 decks)

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