Atropine
Onset, peak, DOA
O: 45-60sec IV (10-20 sec. via ET tube)
P: 2min
DOA: Vagal block 1-2 hours
Antisialagogue: 4 hours
Atropine doses
- SB/ACLS: 0.5-1.0mg; may repeat up to 40mcg/kg
- Preop: 0.5-1.0mg
- Reversal: 0.015mg/kg (1mg for 70kg) with neo 0.05mg/kg or Enlon 0.5-1.0mg/kg
Atropine Dose for a result of decrease HR and relaxation of gastro-esophageal sphincter
Adults: <0.5mg
Scopolamine Doses
- 0.3-0.65mg IV (0.006mg/kg in peds)
- 1.5mg patch
Glycopyrrolate doses
- Preop/ vagalytic: 0.1-0.2mg
- Reversal: 0.01mg/kg
- With Neo: 0.05mg/kg (0.2mg for each 1mg of Neo or 5mg of Pyrid)
Glycopyrrolate
Onset, Peak, Duration
O: 60 seconds
P: 5 min.
D: Vagal block 2-3hr; Antisialagogue 7 hr
Name the Anticholinesterase drugs
- Neostigmine
- Edrophonium
- Pyridostigmine
- Physostigmine
Neostigmine (Prostigmine)
- Usage
- Doses
- Reversal
- 0.05mg/kg (max 5mg)
- with Atropine IV, 0.015mg/kg
- with Glycopyrrolate, 0.01mg/kg
Edrophonium (Enlon, Tensilon)
- usage
- doses
- Reversal
- 0.5-1.0mg/kg IV (max 40mg)
- with Atropine 0.015mg/kg
- with Glycopyrrolate 0.01mg/kg
Neostigmine (Prostigmine)
Onset, peak, DOA
O: <3min
P: 3-14min
D: 40-60 min (50min)
Edrophonium (Enlon, Tensilon)
Onset, Peak, DOA
O: 30-60 sec (45sec)
P: 1-5min
D: 5-20min
Pyridostigmine (Regonal)
- Usage
- Dosage
- Reversal
- 0.25mg/kg IV (max 30mg)
- With Atropine 0.015 mg/kg
- With Glycopyrrulate 0.01mg/kg
Pyridostigmine (Regonal)
Onset, Peak, DOA
O: 2-5min (3min)
P: <15min
D: 2-3hr
Physostigmine
- usage
- doses
- For reversal of anticholinergic drugs
- 0.5-2mg IV, repeat Q20min PRN or until reversed
Max dose of Neostigmine (Prostigmine)
5mg
Max dose of Edrophonium (Enlon, Tensilon)
40mg
Max dose of Pyridostigmine (Regonal)
30mg
Doses of Atropine & Glycopyrrolate to give with Anticholinesterase drugs (Neostigmine, Edrophonium, Pyridostigmine)
- Atropine 0.015mg/kg
- Glycopyrrulate 0.01mg/kg
What is Sugammedex & how dose it work
- A modified y-cyclodextrine that forms tight, 1:1 bonds with aminosteroid relaxants
- Concentration gradient causes aminosteroidal NMBD to detach from nicotinic Ach receptors and return to plasma for encapsulation
What drug class/ structure WON’T Sugammedex work on
benzylisoquinolinium
What drugs will Sugammedex work on
-Aminosteroids (Rocuronium, Vecuronium, Pancuronium)
What will be the benefit of Sugammedex
Rapid results without side effects or need for anticholinergics
How much Glycopyrrulate (Robinul) for each 1mg of Neostigmine or 5mg of Pyrid?
0.2mg
Define Myasthenia Gravis
AUTOIMMUNE process that decreases FUNCTIONAL nicotinic receptors on endplate. (Not the amount of receptors). There are less places for Ach to bind. Causes weakness. Treated with anticholinesterase drugs.
