D-1 Reversals Flashcards
Anticholinesterases or
Cholinesterase inhibitors MOA
Increase the amount of/lifespan of acetylcholine in the NMJ allowing for it to displace the NMBD
Also bind directly to nicotinic and muscarinic receptors promoting PNS response
Muscarinic receptors stimulation acronym
Defecation
Urination
Miosis (Pupillary constriction)
Bradycardia/bronchospasm
Emesis
Lacrimation
Salivation
Neostigmine
Inactivates AChE via electrostatic interaction which shifts covalent bonds of the enzyme (which makes it resistant to hydrolysis ie activation)
Dosing- 0.015-0.05 mg/kg higher doses=weaknes
Max adult= 5 mg
Onset 4-8 min, up to 30 for complete reversal
Duration- 60 min
50% renal excretion- rest hepatic/plasma esterase
Pyridostigmine
Used in management of myasthenia gravis
Generally not used, about 5x less potent than neo
Edrophonium
Useful for RAPID onset-short duration
30-60 sec onset, 30 min duration
Electrostatic AChE binding-prevents binding to ACh
Dose- 0.5 mg/kg - increasing dose has little effect
75%renal elimination
Main consideration with Edrophomium
Use atropine as anti muscarinic, due to rapid onset unless you want your patient to Brady and die
Sugammadex
Roc and Vec
Encapsulates in a 1:1 manner
Onset ~2 min
Dosing 2-16 mg/kg- depth dependent
Renal excretion of complex-avoid in severe renal failure
Transient increase in aPTT and INR
Recurarization
The return of residual neuromuscular blockade after reversal of block due to excess ND NMBD in relation to available reversal agent
Sugammadex special considerations
Interactions with oral contraceptives for 1 week
Neostigmine dosing, 4 twitches/no fade
0.015-0.025 mg/kg
Neostigmine, 4 twitches with fade
0.04 mg/kg
Neostigmine , 1-3 twitches
0.05 mg/kg
Neostigmine, no twitch reversal
Trick! Gotcha, wait till 2 twitches
