PharmExamIV Flashcards
(271 cards)
What is the other name for neuromuscular monitoring?
Acceleromyography
The most common location, nerve, and muscle monitored are?
hand, ulnar nerve, adductor policis
What are the long acting NDNMBs?
Pancuronium
What are the intermediate acting NDNMBs?
- Rocuronium
- Vecuronium
- Cisatracurium
- Atracurium
What are the short acting NDNMBs?
Mivacurium
What two reversal agents are normally paired together?
Neostigmine and Glycopyrolate
What is the mechanism of action for AChE inhibitors?
Inhibit acetylcholine esterase at the NMJ, so that ACh can bind and cause muscle contraction.
Competitive antagonists
What subunits do ACh bind to?
Alpha
What locations do NMBD reversal agents work at?
Preganglionic (SNS & PNS)
NMJ (primary)
What is the ceiling effect?
The point at which the drug will no longer have any effect
What is the max dose of neostigmine?
5 mg
What is the max dose of Edrophonium
1 mg/kg
How many twitches do we need to see before we can reverse?
1-2 twitches. Muscular blockage cannot be reversed if there are 0 twitches.
What are the 5 factors that influence the reversal of NMB?
- Depth of block
- AChE inhibitor choice
- Dose administered
- Rate of plasma clearance
- Anesthesia agent choice and depth
–> Postoperative residual NM blockade
What is the dose range of neostigmine?
0.04-0.07 mg/kg
OR
40-70 mcg/kg
What’s important to note regarding paralytics and their reversal agents?
The paralytics can last longer than the reversal agents.
What is the onset time of neostigmine?
5-10 minutes
What is the duration of action for neostigmine?
60 minutes
How is glycopyrolate dosed with neostigmine?
0.2 mg per mg of neostigmine
What is the dose for sugammadex?
2-16 mg/kg
What is the onset time of sugammadex?
1-4 minutes
What is the duration of sugammadex?
1.5-3 hours
What is the dose for succinylcholine (Anectine)?
1-1.5 mg/kg
What is the onset of succiynlcholine (Anectine)?
30-60 seconds