NSU AA Denver Drugs and Inhalational Agents > Reversal Agents > Flashcards

Reversal Agents Flashcards

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1
Q

What is the typical dose of Neostigmine used for reversal of non-depolarizing neuromuscular blockade?

A

0.04-0.08 mg/kg

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2
Q

What is the typical onset time of Neostigmine?

A

5-10 minutes

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3
Q

What is the duration of action of Neostigmine when used for reversal?

A

30-60+ minutes

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4
Q

Neostigmine must be administered with which type of medication to prevent muscarinic side effects?

A

Anticholinergics

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5
Q

Which of the following is NOT a common side effect of Neostigmine?

A

Excess salivation (Dry mouth common)

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6
Q

Does Neostigmine reverse non-depolarizing neuromuscular blockers by inhibiting acetylcholinesterase?

A

Yes

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7
Q

Can Neostigmine cross the blood-brain barrier?

A

No – It is a quaternary ammonium compound and does not cross the BBB

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8
Q

Should Neostigmine be used without an anticholinergic agent like glycopyrrolate or atropine?

A

No – It should be paired to reduce muscarinic side effects

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9
Q

Is Neostigmine ineffective for reversing deep neuromuscular blockade?

A

Yes – It’s best used when some spontaneous recovery has begun

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10
Q

Is Bradycardia a potential side effect of Neostigmine administration?

A

Yes, can even cross the placenta and cause fetal bradycardia

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11
Q

What is the typical IV dose of Neostigmine used for neuromuscular blockade reversal?

A

0.04–0.08 mg/kg IV

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12
Q

What is the usual onset time for Neostigmine?

A

5–10 minutes

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13
Q

What is the duration of Neostigmine’s effect?

A

30–60 minutes

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14
Q

What is the mechanism of action of Neostigmine?

A

It inhibits acetylcholinesterase, increasing acetylcholine at neuromuscular junctions to reverse non-depolarizing blockade

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15
Q

Why is an anticholinergic co-administered with Neostigmine?

A

To counteract muscarinic side effects like bradycardia and bronchial secretions

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16
Q

Which anticholinergics are commonly used with Neostigmine?

A

Glycopyrrolate or Atropine

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17
Q

When is Neostigmine typically used in anesthesia?

A

To reverse non-depolarizing neuromuscular blocking agents at the end of surgery

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18
Q

What are some muscarinic side effects of Neostigmine?

A
  • Bradycardia
  • Increased secretions
  • Bronchospasm
  • Abdominal cramping
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19
Q

What is the typical IV dose of Edrophonium for neuromuscular blockade reversal?

A

0.5-1.0 mg/kg

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20
Q

What is the usual onset time of Edrophonium?

A

30 seconds–2 minutes

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21
Q

How long does Edrophonium typically last?

A

10–30 minutes

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22
Q

What is Edrophonium’s primary mechanism of action?

A

Reversible acetylcholinesterase inhibitor

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23
Q

Which of the following is a key clinical use of Edrophonium?

A

Diagnosis of myasthenia gravis

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24
Q

Edrophonium has a faster onset than Neostigmine?

A

Yes

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25
Edrophonium is a quaternary ammonium compound that cannot cross the blood-brain barrier?
Yes
26
Is Edrophonium used to reverse depolarizing neuromuscular blockade (e.g., succinylcholine)?
No – It is used for non-depolarizing blockade
27
Should Edrophonium always be administered with an anticholinergic agent?
Yes – Typically Atropine due to similar onset time
28
Is Edrophonium's duration of action longer than that of Neostigmine?
No – It’s shorter
29
What is the typical IV dose range of Edrophonium for neuromuscular blockade reversal?
0.5-1.0 mg/kg
30
What is the onset time for Edrophonium?
Within 30 seconds to 2 minutes
31
What is the approximate duration of action of Edrophonium?
10–30 minutes
32
What is the mechanism of action of Edrophonium?
It is a reversible acetylcholinesterase inhibitor, increasing acetylcholine at the neuromuscular junction
33
Why is Atropine preferred over Glycopyrrolate when co-administered with Edrophonium?
Because Atropine has a quicker onset, matching Edrophonium’s rapid onset
34
What diagnostic test uses Edrophonium and what condition does it evaluate?
The Tensilon test for diagnosing Myasthenia Gravis
35
List two common side effects of Edrophonium.
* Bradycardia * Increased salivation
36
When is Edrophonium not ideal for reversal of neuromuscular blockade?
When blockade is deep or complete—it’s best when some spontaneous recovery has occurred
37
What is the usual IV dose of Atropine in adults?
0.01-0.03 mg/kg
38
What is the maximum cumulative dose of Atropine for treating bradycardia?
3 mg
39
What is the typical onset time of IV Atropine?
30–60 seconds
40
How long does Atropine’s effect usually last when given IV?
30–60 minutes
41
Which of the following is a major clinical use of Atropine?
Management of bradycardia
42
What is Atropine's primary mechanism of action?
Muscarinic receptor antagonism
43
In which scenario is Atropine most commonly used during anesthesia?
Reversal of neuromuscular blockade, paired with anticholinesterase
44
Does Atropine increase parasympathetic nervous system activity?
No – It blocks parasympathetic activity
45
Does Atropine cross the blood-brain barrier?
Yes
46
Should Atropine be administered slowly in cases of bradycardia to avoid paradoxical effects?
Yes
47
Is Atropine contraindicated in patients with glaucoma?
Yes – Especially narrow-angle glaucoma
48
Does Atropine cause miosis (pupil constriction)?
No – It causes mydriasis (pupil dilation)
49
What is the standard adult IV dose of Atropine for bradycardia?
0.5 mg IV every 3–5 minutes, up to a total of 3 mg
50
What is the onset of action of Atropine given IV?
Approximately 30–60 seconds
51
How long do the effects of IV Atropine last?
30–60 minutes
52
What is the mechanism of action of Atropine?
It competitively inhibits muscarinic acetylcholine receptors, reducing parasympathetic tone
53
Why is Atropine administered with Edrophonium during neuromuscular blockade reversal?
To counteract muscarinic side effects like bradycardia and salivation due to increased acetylcholine
54
List two common side effects of Atropine.
* Dry mouth * Tachycardia
55
Name a surgical situation in which Atropine might be used.
During reversal of non-depolarizing neuromuscular blockade or to treat bradycardia during anesthesia
56
What are signs of Atropine overdose?
* Flushed skin * Dry mouth * Blurred vision * Tachycardia * Confusion * Hallucinations
57
What are some non-clinical uses of Atropine?
Treat organophosphate poisoning and nerve gas exposure
58
What is the typical IV dose of Glycopyrrolate given with neostigmine for neuromuscular blockade reversal in adults?
0.2 mg per 1 mg of neostigmine (typically 0.01-0.02 mg/kg)
59
What is the usual onset time of Glycopyrrolate when administered IV?
2–3 minutes, but full effect may take up to 5 minutes
60
What is the duration of action of Glycopyrrolate when given IV?
2–4 hours
61
What is the primary mechanism of action of Glycopyrrolate?
Blocks muscarinic acetylcholine receptors
62
Which of the following is a clinical use of Glycopyrrolate?
Antisialogogue before surgery
63
Why is Glycopyrrolate preferred over Atropine in many surgical settings?
Does not cross the blood-brain barrier, so fewer CNS effects
64
Is Glycopyrrolate commonly used to reduce secretions in the airway?
Yes
65
Does Glycopyrrolate cross the blood-brain barrier?
No
66
Can Glycopyrrolate cause dry mouth and blurred vision as side effects?
Yes
67
Is Glycopyrrolate used to potentiate neuromuscular blockade?
No – It is used to reverse muscarinic effects during reversal of neuromuscular blockade
68
Is Glycopyrrolate a cholinesterase inhibitor?
No – It is an antimuscarinic agent
69
What is the typical IV dose of Glycopyrrolate?
0.01-0.02 mg/kg
70
What is the onset time of Glycopyrrolate IV?
2–3 minutes
71
What is the duration of action of Glycopyrrolate?
2–4 hours
72
What is the primary mechanism of action of Glycopyrrolate?
It is a competitive antagonist of muscarinic acetylcholine receptors, reducing parasympathetic activity
73
List two clinical uses of Glycopyrrolate.
* Reduction of secretions (antisialogogue) * Prevention of bradycardia during neuromuscular blockade reversal
74
Why is Glycopyrrolate preferred over Atropine in CNS-sensitive patients?
Because it does not cross the blood-brain barrier, reducing the risk of CNS side effects such as confusion
75
Name two common side effects of Glycopyrrolate.
* Dry mouth * Tachycardia
76
In which perioperative scenario would you administer Glycopyrrolate?
To reduce airway secretions before intubation or to counteract bradycardia and muscarinic effects during reversal of non-depolarizing neuromuscular blockade
77
What differentiates Glycopyrrolate from other anticholinergics like Scopolamine?
Glycopyrrolate does not cross the blood-brain barrier, leading to fewer CNS side effects
78
What is the mechanism of action of Sugammadex?
Encapsulation of aminosteroid neuromuscular blockers
79
Which neuromuscular blocking agents does Sugammadex primarily reverse?
Rocuronium and Vecuronium
80
What is the typical onset of action for Sugammadex after IV administration?
1–3 minutes
81
What is the recommended Sugammadex dose for immediate reversal of a high dose of Rocuronium?
2 mg/kg, 4 mg/kg, or 16 mg/kg (16 for the high dose)
82
Which of the following is a potential side effect of Sugammadex?
Bradycardia
83
Does Sugammadex reverse both depolarizing and non-depolarizing neuromuscular blockers?
No - It reverses non-depolarizing aminosteroid NMBAs only, like Rocuronium and Vecuronium
84
Does Sugammadex have minimal cardiovascular effects compared to neostigmine?
Yes
85
Does the use of Sugammadex eliminate the need for co-administration of anticholinergic agents?
Yes
86
Is Sugammadex ineffective against Benzylisoquinolinium NMBAs like Cisatracurium?
Yes
87
Sugammadex works by increasing acetylcholine concentrations at the neuromuscular junction?
No
88
What is the mechanism of action of Sugammadex?
Sugammadex encapsulates and inactivates aminosteroid neuromuscular blocking agents such as rocuronium and vecuronium, removing them from the neuromuscular junction
89
What is the recommended dose of Sugammadex for moderate blockade reversal (TOF 2/4)?
2 mg/kg IV
90
When is Sugammadex preferred over Neostigmine for reversal of neuromuscular blockade?
In cases where rapid and complete reversal is desired, particularly with aminosteroid NMBAs, or when avoiding anticholinergic side effects is important
91
List two common side effects of Sugammadex.
* Bradycardia * Hypotension
92
What is the duration of action of Sugammadex?
Approximately 2–3 hours, depending on dose and renal function

NSU AA Denver Drugs and Inhalational Agents (19 decks)

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