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Anesthesia Pharm > Exam 2 part V > Flashcards

Exam 2 part V Flashcards

1
Q

__________________ are anticholinesterases that form irreversible bonds to anticholinesterase

A

organophosphates (physostigmine)

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2
Q

which anticholinesterase is commonly used in pesticides and chemical warfare, and are tertiary amines (meaning they cross the BBB, GI, and placenta)

A

organophosphates

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3
Q

organophosphates are anticholinesterases that are rapidly absorbed through the _________________

A

skin

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4
Q

what is the maximum dose of neostigmine

A

5 mg

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5
Q

what is the dose of neostigmine

A

0.04 - 0.08 mg/kg up to 5 mg

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6
Q

onset of neostigmine

A

5-11 min; peak at 10

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7
Q

DOA of neostigmine

A

65-80 minutes

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8
Q

with neostigmine _______________ & ____________ pts are more sensitive –> more rapid onset and require a smaller dose

A

peds; elderly

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9
Q

_______________ decreases pseudocholinesterase + anticholinesterase, thus will prolong the neuromuscular block of succinylcholine

A

neostigmine

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10
Q

neostigmine should be give with what anticholinergic due to similar onset times

A

glycopyrolate

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11
Q

how much glycopyrolate should be given with neostigmine?

A

0.2 mg per mg of neostigmine

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12
Q

when should neostigmine be given with atropine

A

in pregnant pts due to neostigmine causing fetal bradycardia

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13
Q

what dose of neostigmine can be given intrathecally as an adjunct to intrathecal block to prolong sensory and motor blockade

A

50-100 mcg

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14
Q

MOA of neostigmine as intrathecal block adjunct

A

blocks the breakdown of spinal cord acetycholine

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15
Q

side effects of intrathecal neostigmine

A
  1. pruritus 2. nausea 3. vomiting 4. fecal incontinance 5. delayed recovery room discharge 6. atropine resistant bradycardia
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16
Q

pyridostigmine is ____________ as potent as neostigmine

A

20%

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17
Q

dose of pyridostigmine

A

0.1-0.4 mg/kg up to 20 mg

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18
Q

onset of pyridostigmine

A

10-16 min

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19
Q

DOA of pyridostigmine

A

80-130 min

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20
Q

what anticholinergic should pyridostigmine be administered with for NDMR reversal due to similar onset times

A

glycopyrolate

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21
Q

how much glycopyrolate should be given with pyridostigmine for NDMR reversal

A

0.05 mg per mg pyridostigmine

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22
Q

Edrophonium is less than _______% as potent as neostigmine

A

10

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23
Q

dose of edrophonium

A

0.5-1 mg/kg

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24
Q

onset of edrophonium

A

1-2 min

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25
Q

DOA of edrophonium

A

40-70 min

26
Q

edrophonium doses in elderly pts should be _______________

A

increased

27
Q

high dose of edrophonium prolong the DOA > __________

A

1 hr

28
Q

what anticholinergic is edrophonium typically administered with for NDMR reversal

A

atropine

29
Q

mg of atropine to administer with edrophonium for NDMR reversal

A

0.014 mg per mg edrophonium

30
Q

___________________ can be used with edrophonium for NDMR reversal, but it must be given a few minutes prior

A

glycopyrolate

31
Q

if you use glycopyrolate with edrophonium for NDMR (not the go to); how much glycopyrolate do you give?

A

0.007 mg per mg edrophonium

32
Q

____________________ is the reversal of choice for mivacurium

A

edrophonium + atropine or glycopyrolate

33
Q

dose of physostigmine for NDMR reversal

A

0.01 - 0.03 mg/kg

34
Q

onset of physotigmine

A

5 min

35
Q

DOA of physostigmine

A

30-300 min

36
Q

___________ mg of physostigmine will produce analgesic effects similar to demerol (50 mg)

A

2mg

37
Q

metabolism of physostigmine

A

completely metabolized by plasma esterases

38
Q

________________ is used in the tx of anticholinergic toxicity caused by ODs of atropine or scopolamine

A

physostigmine

39
Q

_________________ can be used to reverse the CNS depression of benzos and volatile anesthetics

A

physostigmine

40
Q

____________ mg/kg of physostigmine can be given for postop shivering

A

0.04

41
Q

doses of physostigmine may be repeated every _____________

A

1-2 hrs

42
Q

in high doses cholinesterase inhibitors potentiate _______________

A

depolarizing muscle relaxants (succinylcholine)

43
Q

T/F: mixtures of anticholinesterase drugs have no clinical advantage over the use of the individual drugs alone

A

TRUE

44
Q

anticholinesterase drugs are metabolized in the _________________ and excreted in the _________________.

A

liver (25-50%) renal (50-75%)

45
Q

elimination times of anticholinesterase meds are greatly prolonged by _________________

A

renal failure

46
Q

cholinergic antagonists aka ____________ = ________________ = _____________

A

anticholinergic; antimuscarinic; parasympatholytic

47
Q

NDMR are cholinergic antagonists but Anticholinergic medications (like glycopyrolate) are ______________ selective

A

antimuscarinic

48
Q

DO NOT administer an anticholinesterase without also giving an __________________ for NDMR reversal

A

anticholinergic

49
Q

________________ linkage is essential for an anticholinergic to bind with the nicotinic Ach receptors

A

ester

50
Q

MOA of anticholinergics

A

highly selective competetive antagonists at all muscarinic Ach receptors

51
Q

effects of administering an anticholinergic medication

A
  1. 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
52
Q

adult pre-tx dose of atropine

A

0.2-0.6 mg

53
Q

dose of atropine for bradycardia (adult)

A

0.4-1.0 mg up to 2.0 mg

54
Q

pre medication dose of atropine in peds

A

10 mcg/kg

55
Q

pediatric dose of atropine for bradycardia

A

20 mcg/kg

56
Q

which anticholinergic/anticholinesterase medications are tertiary amines

A
  1. atropine 2. scopolamine 3. physostigmine “PAS”
57
Q

which anticholinergic medications are quaternary amines

A

glycopyrolate and ipratropium bromide

58
Q

considerations with atropine

A
  1. 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
59
Q

atropine onset time

A

1 min

60
Q

DOA of atropine IV

A

15-30 min

Anesthesia Pharm (18 decks)

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