What happens to the Heart with SNS Stimulation?
What happens to the Heart with PNS Stimulation?
What happens to Bronchial Smooth Muscles with SNS Stimulation and PNS Stimulation?
What happens to Sphincters w/ SNS & PNS Stimulation?
What happens to the Uterus & Ureters w/ SNS & PNS Stimulation?
How does SNS Stimulation affect the Liver?
Glycogenolysis & Gluconeogenesis
How does PNS Stimulation affect the Liver?
What happens to the Pancreas w/ SNS & PNS Stimulation?
SNS: ↓B-Cell Secretion
PNS: ↑B-Cell Secretion
How are the Salivary & Sweat Glands affected by SNS & PNS Stimulation?
(More Salivary Secretions w/ PNS)
How are all Arterioles affected by SNS & PNS Stimulation?
(Beta SNS Stimulation of Coronary Arterioles = Relaxation)
Which Anticholinesterase Drug is classified as a Tertiary Amine?
Which Anticholinesterase Drugs are classified as Quaternary Ammoniums?
How does SNS & PNS Stimulation affect the Eyes?
How does Neostigmine, Pyridostigmine, & Physostigmine increase ACh Availability?
They get hydrolyzed by acetylcholinesterase, which then carbamylates and blocks the enzyme's ability to hydrolyze ACh
Which Reversal Agent forms magnetic/electrostatic bond that reversibly causes Acetylcholinesterase Inhibition?
What happens if you give Reversal Agents without there being any NMBs?
Overflow of ACh = fasciculations/muscle twitches
Can look like a Phase I NMB Block
What is the Onset of Action for Edrophonium?
How does Neostigmine compare to Edrophonium?
More Profound & Potent than Edrophonium
Slower Onset: 7-11 Min
What is the Duration of Action for all of the Reversal Agents?
What determines the Potency of Reversal Agents?
- The NMB being reversed
- Speed of Spont. Recovery
- Depth of Block when Reversal given
- End Point
Once anticholinergic enzymes are completely blocked by the reversal agent, how does re-dosing effect patient's recovery?
No benefits = keep patient sedated & intubated until spont recovery
What factors can slow down NMB Reversal?
What are the Muscuranic Side effects of having Increased ACh from Reversal Agents?
Which Reversal Agents have Marked & Prolonged Inhibition of Plasma Cholinesterase?
Neostigmine & Pyridostigmine
What can be mixed w/ Reversal Agents to minimize Muscuranic Side effects?
Anticholinergic Drugs w/ faster onset than Anticholinesterase
Which class of Anticholinesterase Drugs can cross the Blood Brain Barrier?
Tertiary Amines - Physostigmine
What can Physostigmine be used for as a Reversal other than for NMBs?
Central Anticholinergic Syndrome
What are some uses for Antiacetylcholinesterases outside of the OR?
Alzheimer's - Aricept, Razadyne, Exelon
What are treatments for Reversal Agent Overdose?
Pralidoxime - Acetylcholinesterase Reactivator
What are the naturally occuring anticholingergic that are tertiary amines?
Atropine & Scopolamine