Exam 2 part V Flashcards
__________________ are anticholinesterases that form irreversible bonds to anticholinesterase
organophosphates (physostigmine)
which anticholinesterase is commonly used in pesticides and chemical warfare, and are tertiary amines (meaning they cross the BBB, GI, and placenta)
organophosphates
organophosphates are anticholinesterases that are rapidly absorbed through the _________________
skin
what is the maximum dose of neostigmine
5 mg
what is the dose of neostigmine
0.04 - 0.08 mg/kg up to 5 mg
onset of neostigmine
5-11 min; peak at 10
DOA of neostigmine
65-80 minutes
with neostigmine _______________ & ____________ pts are more sensitive –> more rapid onset and require a smaller dose
peds; elderly
_______________ decreases pseudocholinesterase + anticholinesterase, thus will prolong the neuromuscular block of succinylcholine
neostigmine
neostigmine should be give with what anticholinergic due to similar onset times
glycopyrolate
how much glycopyrolate should be given with neostigmine?
0.2 mg per mg of neostigmine
when should neostigmine be given with atropine
in pregnant pts due to neostigmine causing fetal bradycardia
what dose of neostigmine can be given intrathecally as an adjunct to intrathecal block to prolong sensory and motor blockade
50-100 mcg
MOA of neostigmine as intrathecal block adjunct
blocks the breakdown of spinal cord acetycholine
side effects of intrathecal neostigmine
- pruritus 2. nausea 3. vomiting 4. fecal incontinance 5. delayed recovery room discharge 6. atropine resistant bradycardia
pyridostigmine is ____________ as potent as neostigmine
20%
dose of pyridostigmine
0.1-0.4 mg/kg up to 20 mg
onset of pyridostigmine
10-16 min
DOA of pyridostigmine
80-130 min
what anticholinergic should pyridostigmine be administered with for NDMR reversal due to similar onset times
glycopyrolate
how much glycopyrolate should be given with pyridostigmine for NDMR reversal
0.05 mg per mg pyridostigmine
Edrophonium is less than _______% as potent as neostigmine
10
dose of edrophonium
0.5-1 mg/kg
onset of edrophonium
1-2 min
DOA of edrophonium
40-70 min
edrophonium doses in elderly pts should be _______________
increased
high dose of edrophonium prolong the DOA > __________
1 hr
what anticholinergic is edrophonium typically administered with for NDMR reversal
atropine
mg of atropine to administer with edrophonium for NDMR reversal
0.014 mg per mg edrophonium
___________________ can be used with edrophonium for NDMR reversal, but it must be given a few minutes prior
glycopyrolate
if you use glycopyrolate with edrophonium for NDMR (not the go to); how much glycopyrolate do you give?
0.007 mg per mg edrophonium
____________________ is the reversal of choice for mivacurium
edrophonium + atropine or glycopyrolate
dose of physostigmine for NDMR reversal
0.01 - 0.03 mg/kg
onset of physotigmine
5 min
DOA of physostigmine
30-300 min
___________ mg of physostigmine will produce analgesic effects similar to demerol (50 mg)
2mg
metabolism of physostigmine
completely metabolized by plasma esterases
________________ is used in the tx of anticholinergic toxicity caused by ODs of atropine or scopolamine
physostigmine
_________________ can be used to reverse the CNS depression of benzos and volatile anesthetics
physostigmine
____________ mg/kg of physostigmine can be given for postop shivering
0.04
doses of physostigmine may be repeated every _____________
1-2 hrs
in high doses cholinesterase inhibitors potentiate _______________
depolarizing muscle relaxants (succinylcholine)
T/F: mixtures of anticholinesterase drugs have no clinical advantage over the use of the individual drugs alone
TRUE
anticholinesterase drugs are metabolized in the _________________ and excreted in the _________________.
liver (25-50%) renal (50-75%)
elimination times of anticholinesterase meds are greatly prolonged by _________________
renal failure
cholinergic antagonists aka ____________ = ________________ = _____________
anticholinergic; antimuscarinic; parasympatholytic
NDMR are cholinergic antagonists but Anticholinergic medications (like glycopyrolate) are ______________ selective
antimuscarinic
DO NOT administer an anticholinesterase without also giving an __________________ for NDMR reversal
anticholinergic
________________ linkage is essential for an anticholinergic to bind with the nicotinic Ach receptors
ester
MOA of anticholinergics
highly selective competetive antagonists at all muscarinic Ach receptors
effects of administering an anticholinergic medication
- tachycardia 2. arrhythmias 3. cutaneous dilation (flushing) 4. bronchodilation 5. inhibit secretions (GI and bronchial) 6. can cause CNS stimulation or depression depending on the drug 7. decreased intestinal mobility 8. decreased lower esophageal tone
adult pre-tx dose of atropine
0.2-0.6 mg
dose of atropine for bradycardia (adult)
0.4-1.0 mg up to 2.0 mg
pre medication dose of atropine in peds
10 mcg/kg
pediatric dose of atropine for bradycardia
20 mcg/kg
which anticholinergic/anticholinesterase medications are tertiary amines
- atropine 2. scopolamine 3. physostigmine “PAS”
which anticholinergic medications are quaternary amines
glycopyrolate and ipratropium bromide
considerations with atropine
- potent effects on heart and bronchial smooth muscle 2. most efficacious for treating bradyarrythmias 3. associated with mild post-op memory deficits 4. produces the MOST tachycardia out of any anticholinergic
atropine onset time
1 min
DOA of atropine IV
15-30 min
