Exam 2 part V

Question 1

__________________ are anticholinesterases that form irreversible bonds to anticholinesterase

Answer 1

organophosphates (physostigmine)

Question 2

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

Answer 2

organophosphates

Question 3

organophosphates are anticholinesterases that are rapidly absorbed through the _________________

Answer 3

skin

Question 4

what is the maximum dose of neostigmine

Answer 4

5 mg

Question 5

what is the dose of neostigmine

Answer 5

0.04 - 0.08 mg/kg up to 5 mg

Question 6

onset of neostigmine

Answer 6

5-11 min; peak at 10

Question 7

DOA of neostigmine

Answer 7

65-80 minutes

Question 8

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

Answer 8

peds; elderly

Question 9

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

Answer 9

neostigmine

Question 10

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

Answer 10

glycopyrolate

Question 11

how much glycopyrolate should be given with neostigmine?

Answer 11

0.2 mg per mg of neostigmine

Question 12

when should neostigmine be given with atropine

Answer 12

in pregnant pts due to neostigmine causing fetal bradycardia

Question 13

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

Answer 13

50-100 mcg

Question 14

MOA of neostigmine as intrathecal block adjunct

Answer 14

blocks the breakdown of spinal cord acetycholine

Question 15

side effects of intrathecal neostigmine

Answer 15

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

Question 16

pyridostigmine is ____________ as potent as neostigmine

Answer 16

20%

Question 17

dose of pyridostigmine

Answer 17

0.1-0.4 mg/kg up to 20 mg

Question 18

onset of pyridostigmine

Answer 18

10-16 min

Question 19

DOA of pyridostigmine

Answer 19

80-130 min

Question 20

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

Answer 20

glycopyrolate

Question 21

how much glycopyrolate should be given with pyridostigmine for NDMR reversal

Answer 21

0.05 mg per mg pyridostigmine

Question 22

Edrophonium is less than _______% as potent as neostigmine

Answer 22

10

Question 23

dose of edrophonium

Answer 23

0.5-1 mg/kg

Question 24

onset of edrophonium

Answer 24

1-2 min

Question 25

DOA of edrophonium

Answer 25

40-70 min

Question 26

edrophonium doses in elderly pts should be _______________

Answer 26

increased

Question 27

high dose of edrophonium prolong the DOA > __________

Answer 27

1 hr

Question 28

what anticholinergic is edrophonium typically administered with for NDMR reversal

Answer 28

atropine

Question 29

mg of atropine to administer with edrophonium for NDMR reversal

Answer 29

0.014 mg per mg edrophonium

Question 30

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

Answer 30

glycopyrolate

Question 31

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

Answer 31

0.007 mg per mg edrophonium

Question 32

____________________ is the reversal of choice for mivacurium

Answer 32

edrophonium + atropine or glycopyrolate

Question 33

dose of physostigmine for NDMR reversal

Answer 33

0.01 - 0.03 mg/kg

Question 34

onset of physotigmine

Answer 34

5 min

Question 35

DOA of physostigmine

Answer 35

30-300 min

Question 36

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

Answer 36

2mg

Question 37

metabolism of physostigmine

Answer 37

completely metabolized by plasma esterases

Question 38

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

Answer 38

physostigmine

Question 39

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

Answer 39

physostigmine

Question 40

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

Answer 40

0.04

Question 41

doses of physostigmine may be repeated every _____________

Answer 41

1-2 hrs

Question 42

in high doses cholinesterase inhibitors potentiate _______________

Answer 42

depolarizing muscle relaxants (succinylcholine)

Question 43

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

Answer 43

TRUE

Question 44

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

Answer 44

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

Question 45

elimination times of anticholinesterase meds are greatly prolonged by _________________

Answer 45

renal failure

Question 46

cholinergic antagonists aka ____________ = ________________ = _____________

Answer 46

anticholinergic; antimuscarinic; parasympatholytic

Question 47

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

Answer 47

antimuscarinic

Question 48

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

Answer 48

anticholinergic

Question 49

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

Answer 49

ester

Question 50

MOA of anticholinergics

Answer 50

highly selective competetive antagonists at all muscarinic Ach receptors

Question 51

effects of administering an anticholinergic medication

Answer 51

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

Question 52

adult pre-tx dose of atropine

Answer 52

0.2-0.6 mg

Question 53

dose of atropine for bradycardia (adult)

Answer 53

0.4-1.0 mg up to 2.0 mg

Question 54

pre medication dose of atropine in peds

Answer 54

10 mcg/kg

Question 55

pediatric dose of atropine for bradycardia

Answer 55

20 mcg/kg

Question 56

which anticholinergic/anticholinesterase medications are tertiary amines

Answer 56

1. atropine 2. scopolamine 3. physostigmine "PAS"

Question 57

which anticholinergic medications are quaternary amines

Answer 57

glycopyrolate and ipratropium bromide

Question 58

considerations with atropine

Answer 58

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

Question 59

atropine onset time

Answer 59

1 min

Question 60

DOA of atropine IV

Answer 60

15-30 min