NMB Reversal Agents Flashcards
Neostigmine: Class
anticholinesterase
Neostigmine: Use
Reversal of non-depolarizing neuromuscular blockade
treatment of myasthenia gravis
Neostigmine: Mechanism of Action
Act against acetylcholinesterase at the neuromuscular junction. Causes an increase in the concentration of Ach.
Excess acetylcholine displaces nondepolarizing neuromuscular blocking agents and binds to nicotinic receptors.
Neostigmine: Dose
25-50 mcg/kg. MAX 5mg
Based upon monitoring and clinical condition
Neostigmine: Pharmacokinetics
Absorption: IV, PO
Onset: 15 minutes
Duration of Action: 45 minutes
Metabolism: Pseudocholinesterases
Excretion: Kidneys
Neostigmine: Contradictions
Brady arrhythmias
Certain Respiratory conditions
Bowel Obstruction
Neostigmine: Considerations
Needs to be given with antimuscarinic Glycopyrrolate 1mg Neostigmine with 0.2mg Glycopyrrolate
Miosis
Bradycardia
Salivation
Bronchoconstriction
Sugammadex: Class
Selective Relaxant Binding Agent
Sugammadex: Use
Reversal of Steroidal Neuromuscular blockade
Sugammadex: Mechanism of Action
Irreversibly encapsulates steroidal neuromuscular blocking agents
Sugammadex: Dose
TOF 2-4: 2mg/kg
TOF 1: 4 mg/kg
Post tetanic count >2: 4 mg/kg
Post tetanic count < 2: 16 mg/kg
Sugammadex: Pharmacokinetics
Absorption: IV
Onset: 3 minutes
Metabolism: NOT METABOLIZED
Excretion: Kidneys
Sugammadex: Contraindications
Hypersensitivity: More common in Japan
Patients with ESRD
Sugammadex: Considerations
Need additional form of non-hormonal contraception for 7 days
Can cause Bradycardia
IF need to reparalyze, need to use Succinylcholine or a Bezylisoquinoline
