Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia Pharmacology > Lecture 15 NMBD Reversal Agents (Exam IV) -Grayson's Deck > Flashcards

Lecture 15 NMBD Reversal Agents (Exam IV) -Grayson's Deck Flashcards

1
Q

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

A

20-30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Do AChE inhibitors work with deep neuromuscular blockade?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Table with NMBD durations

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Reversal agents

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the max dosage of neostigmine?

A

40 - 70 mcg/kg

0.04 - 0.07 mg/kg

5 mg MAX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the onset and duration of neostigmine?

A

Onset: 5 - 10 min
Duration: 60 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the dosage of edrophonium?

A

1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the onset and duration of edrophonium?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NMBD Reversal Agents side effects:

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What percentage of neostigmine is renally excreted?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What percentage of both pyridostigmine and edrophonium are renally excreted?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

30 - 50% cleared hepatically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the major side effect of NMBD reversal agents?

A

↑PSNS activity (from increased nACh and mACh activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

Glycopyrrolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What AChE inhibitor is glycopyrrolate used with?

A
  • Neostigmine
  • Pyridostigmine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What NMBD(s) is atropine used with?

A

Edrophonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the dose of Atropine?

A

7 - 10 mcg/kg

20
Q

What common side effects are seen right after atropine administration?

A
  • Mydriasis
  • Tachycardia
21
Q

Persistent NM blockade reason

22
Q

Factors Influencing NMBD reversal

23
Q

What is the dose of glycopyrrolate?

What is the max dose?

A
  • 7 - 15 mcg/kg
  • 1mg max dose
24
Q

How long does glycopyrrolate need to be administered over?

25
What reversal drug is specific to mivacurium?
Purified human plasma cholinesterase
26
What reversal drug is specific to gantacurium?
Cystiene
27
What reversal drug is very specific to rocuronium?
Sugammadex
28
What type of drug is sugammadex?
Selective relaxant-binding agent (amino steroids mainly. Vec too but not as much)
29
What should be known about sugammadex's organic structure and physical properties?
- γ-cyclodextrin - Dextrose units from starch - Very H₂O-soluble
30
What is the MOA of Sugammadex?
Encapsulates rocuronium via: - Van der Waals forces - H-bonds - Hydrophobic interactions
31
What drugs does sugammadex work with?
**Roc** > Vec > Pancuronium
32
What is the E ½ time of sugammadex?
2 hours
33
How is sugammedex eliminated?
Urine(major route of elimination) - 70% gone in 6 hours - 90% gone in 24 hours
34
Differentiate a moderate block vs a deep block.
- Moderate: 2/4 twitches on TOF - Deep: No twitches to TOF, but will have a twitch w/ post tetanic stimulation
35
What is the Sugammadex dose for a moderate block?
2 mg/kg
36
What is the Sugammadex dose for a deep block?
4 mg/kg
37
What is the sugammadex dose for an extreme (overdose) block?
8 - 16 mg/kg
38
39
What are the side effects of Sugammadex?
- Bradycardia -Anaphylaxis - dose-related N/V - dose-related Pruritis - dose-related Urticaria
40
If 1.2 mg/kg of rocuronium needs to be re-administered after reversal with sugammedex. What is the minimum waiting time?
5 min
41
If 0.6 mg/kg of rocuronium needs to be re-administered after reversal with sugammedex. What is the minimum waiting time?
4 hours
42
If 0.1 mg/kg of vecuronium needs to be re-administered after reversal with sugammedex. What is the minimum waiting time?
4 hours
43
What drugs/conditions are relative contraindications to sugammadex?
- Contraceptives - Toremifene (displaces roc from sugammadex) - Coagulopathy (↑ bleeding)
44
What is recurarization?
Resumption of NMJ blockade after period of reversal
45
What s/s would indicated recurarization? *Say you just brought the patient to PACU*.
- ↓ SpO₂ - ↓ respiratory effort - Floppy/uncoordinated - Unresponsive
46
What drug and dose would be a good choice for a recurarizing patient in the PACU? Why might this be a good choice?
- Neostigmine 0.05 mg/kg IV - Longer duration of action
47
Recurarization

Anesthesia Pharmacology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions