Neuromuscular blockers reversal agents

Question 1

Acetylcholine is broken down into:

Answer 1

choline and acetate

Question 2

Do AchE inhibitors have a ceiling effect?

Answer 2

Yes, sometimes giving a higher dose may not lead to a better effect just cause more SE

Question 3

Which of the 4 passes the BBB?

Pyridostigmine, Physostigmine, Edrophonium, Neostigmine

Answer 3

Physostigmine

Question 4

What can happen if you give Neostigmine to a patient that is already fully reversed because enough time has gone by that the drug is fully metabolized

Answer 4

paradoxical muscle weakness

Question 5

2 acetylcholinesterase inhibitors have actions besides just reversal. What are they?

Answer 5

1. Neostigmine: analgesia (intrathecal 50-100 mcg)
2. Physostigmine: anti-shivering (40 mcg/kg)

Question 6

Which of the 3 anti-cholinergics we use frequently does not cross the BB?

Answer 6

Glyco

Question 7

If you give a small dose of Atropine, what are you risking?

Answer 7

paradoxical bradycardia

Question 8

Which of the 2 drug classes of NMB does Sugammadex work on?

Answer 8

aminosteroids
Roc > Vec > Pan

Question 9

How does Sugammadex work

Answer 9

It encapsulates Roc and renders it inactive

Question 10

How is the Roc/Sugammadex complex excreted?

Answer 10

Unchanged by the kidneys

Question 11

Is sugammadex dosed by IBW or total weight

Answer 11

TOTAL!

Question 12

How soon after giving Roc (as much as 1.2 mg/kg) can you reverse with Sugammadex? Dose?

Answer 12

3 min
16 mg/kg

Question 13

Sugammadex dose for TOF 2/4 or better

Answer 13

2 mg/kg

Question 14

Sugammadez dose for TOF 0/4 + 2 PTC or better

Answer 14

4 mg/kg

Question 15

What can you give if you need to re-paralyze after giving 16 mg/kg Sugammadex?

Answer 15

Give a non-aminosteroid NMB.

Ex: Sch, Atracurium, Nimbex, Mivacurium

Question 16

What can you give if you need to re-paralyze after giving < 4mg/kg Sugammadex?

Answer 16

You can redose with Vec or Roc.

If they got Sugammadex within the last 4 hours.. give Roc 1.2 mg/kg

Question 17

What can you give if you need to re-paralyze after giving < 4mg/kg Sugammadex?

Answer 17

You can redose with Vec or Roc.

If they got Sugammadex > 4 hours.. give Roc 0.6 mg/kg or Vec 0.1 mg/kg

Question 18

Which of the AchE-I lead to inhibition of pseudocholinesterase in the plasma

Answer 18

Neostigmine
Pyridostigmine

Question 19

What is the 1 reversal agent that crosses the BBB

Answer 19

Physostigmine

Question 20

Edrophonium dose

Answer 20

0.5-1.0 mg/kg

Question 21

Neostigmine dose

Answer 21

0.02-0.07 mg/kg

Question 22

Pyridostigmine dose

Answer 22

0.1-0.3 mg/kg

Question 23

Onset of Edrophonium

Answer 23

1-2 min

Question 24

Onset of Neostigmine

Answer 24

5-15 min

Question 25

Onset of Pyridostigmine

Answer 25

10-20 min

Question 26

Duration of Edrophonium

Answer 26

30-60 min

Question 27

Duration of Neostigmine

Answer 27

45-90 min

Question 28

Duration of Pyridostigmine

Answer 28

60-120 min