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Anesthesia MM/TL > Autonomics + acetylcholinesterase inhibitors > Flashcards

Autonomics + acetylcholinesterase inhibitors Flashcards

1
Q

What is the neurotransmitter for the parasympathetic nervous system?

A

Acetylcholine

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2
Q

What are the two kinds of cholinergic receptors?

A

Muscarinic

Nicotinic

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3
Q

What do nicotinic receptors do?

A

Autonomic ganglia

Skeletal muscle

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4
Q

What do the muscarinic receptors stimulate?

A

End-organ effector cells in bronchial smooth muscle, salivary glands, and SA node

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5
Q

Which drugs block nicotinic receptors?

A

Neuromuscular blockers

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6
Q

Which drugs block muscarinic receptors?

A

Anticholinergics

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7
Q

What is carbachol?

A

Topical anticholinergic used for wide angle glaucoma

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8
Q

How do acetylcholinesterase inhibitors work?

A

By binding to the enzyme.

The type of bond determines the duration

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9
Q

What are organophosphates?

A

A class of acetylcholinesterase inhibitors that form irreversible binds to the enzyme

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10
Q

What kind of bond does neostigmine form?

A

Covalent

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11
Q

What kind of bond does edrophonium make?

A

Electrostatic and hydrogen (short-lived)

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12
Q

What kind of bond does pyridostigmine make?

A

Covalent

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13
Q

What other mechanisms does neostigmine have?

A

Directly activate nicotinic receptors (weakly)

Causes mor mobilization of acetylcholine

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14
Q

What may happen with high dosages of these drugs?

A

Potentiation of nondepolarizing blockade

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15
Q

What do acetylcholinesterase inhibitors do to succinylcholine blockade?

A

Prolongs it

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16
Q

What are the acetylcholinesterase inhibitors effects on CV?

A

Bradycardia and asystole

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17
Q

What are the pulmonary effects of acetylcholinesterase inhibitors?

A

Bronchospasm

Increased secretions

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18
Q

What are the GI effects?

A

Increases peristalsis
Increased salivation
fecal and urinary incontinence

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19
Q

How are acetylcholinesterase inhibitors metabolized?

A

25-50% in the liver

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20
Q

How are the acetylcholinesterase inhibitors excreted?

A

50-75% in urine

21
Q

Why doesn’t neostigmine cross the bbb?

A

It has a quaternary ammonium group

22
Q

What is the maximum recommended dose of neostigmine?

A

.08 mg/kg up to 5 mg

23
Q

When is the peak effect of neostigmine?

A

10 minutes

24
Q

When can you first see signs of neostigmine working?

A

5 minutes

25
Q

What is the duration of action of neostigmine?

A

1 hour

26
Q

What is the onset of action of glycopyrrolate

A

5-10 minutes

27
Q

Does neostigmine cross the placental barrier?

A

Yes –> fetal bradycardia

28
Q

What anticholinergic should you use in a pregnant patient getting neostigmine?

A

Atropine

29
Q

Are neostigmine and pyridostigmine lipid soluble?

A

No

30
Q

What is this dosage of pyridostigmine?

A

0.25 mg/kg

31
Q

What is the onset of action of pyridostigmine?

A

10-15 minutes

32
Q

What is the duration of action of pyridostigmine?

A

2 hours

33
Q

How much glycopyrrolate should you give with pyridostigmine?

A

0.05 mg per 1 mg

34
Q

What is the dosing of physostigmine

A

.01-.03 mg/kg

35
Q

How is physostigmine useful?

A

It reverses some of the CNS depression and delirium associated with BZDs and volatile anesthetics

Can help post op shivering

Partially antagonizes morphine induced respiratory depression

36
Q

How is physostigmine metabolized?

A

Plasma esterases

37
Q

How is sugammadex eliminated?

A

Unchanged in urine

38
Q

What is the dosage of sugammadex?

A

4-8 mg/kg

39
Q

What is L-cysteine?

A

An endogenous amino acid that is often added to TPN regimens to enhance calcium and phosphate solubility.

40
Q

Which neuromuscular blockers does L-cysteine work on?

A

Gantacurium (fumarate) ultra-short acting

41
Q

How does L-cysteine work?

A

Forms more inactive metabolites through adduct formation

42
Q

What is the duration of atropine?

A

15-30 minutes

43
Q

What acetylcholinesterase inhibitor should it be paired with?

A

Edrophonium

44
Q

What is the duration of glycopyrrolate?

A

2-4 hours

45
Q

What is the duration of neostigmine IV?

A

4-6 hrs

46
Q

What is the onset of IV neostigmine?

A

7-11 minutes

47
Q

What is IV scopolamine given for?

A

Amnesia in hemodynamic ally unstable patients

48
Q

What drug should be used for scopolamine delirium/overdose?

A

Physostigmine

Anesthesia MM/TL (36 decks)

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