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Advanced Pharmacology ANE 8433 (Spring 2023) > Exam 4 Reversals > Flashcards

Exam 4 Reversals Flashcards

1
Q

What type of drugs are edrophonium & neostigmine?

A

Competitive antagonists

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2
Q

What causes the side effects of NMBD reversal agents?

A

Their binding to preganglionic SNS & PNS sites

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3
Q

What is the dose for neostigmine?

A

40 – 70 mcg/kg Max of 5 mg

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4
Q

What is the dose for edrophonium?

A

1-1.5 mg/kg

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5
Q

What is given in conjunction with neostigmine & its dose?

A

Glycopyrrolate 0.2 mg per mL of Neostigmine

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6
Q

What NMB agent is given for Pts with hepatic or renal failure?

A
  • Cisatracurium or atracurium.
  • They are cleared via Hoffmann elimination
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7
Q

Which has a higher renal clearance, neostigmine or edrophonium?

A

Edrophonium 75% vs 50%

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8
Q

What are the pulmonary side effects with NMBD reversal agents?

A
  • Bronchoconstriction
  • increased airway resistance & salivation
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9
Q

What are the CV side effects with NMBD reversal agents?

A
  • Bradycardia
  • dysrhythmias
  • asystole
  • decreased SVR
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10
Q

Which reversal agent is preferred in someone with cardiac disease?

A
  • Neostigmine & glycopyrrolate
  • Administer slowly over 2-5mins
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11
Q

What happens to AChE in persistent NM blockade?

A

AChE is maximally inhibited & ineffective

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12
Q

What other reversal works with Mivacurium?

A

Purified human plasma cholinesterase

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13
Q

What is the MOA of sugammadex?

A

Thru Hydrogen bonds, intermolecular forces & hydrophobic interactions encapsulates NMBD

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14
Q

What is the route of elimination of sugammadex & when do you not give it?

A
  • 70% eliminated via urine in 6hrs.
  • Do not give to someone on dialysis.
  • It is not cleared via dialysis.
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15
Q

What is the sugammadex dose w/ 2 of 4 twitches? What about 0 of 4?

A
  • T2= 2 mg/kg.
  • T0= 4 mg/kg
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16
Q

What is the sugammadex dose for extreme blockades?

A

8-16 mg/kg

17
Q

Sugammadex works with which NMBD?

A
  • Rocuronium & vecuronium.
  • It can work on light Pancuronium doses
18
Q

What reversal works faster, neostigmine or sugammadex?

A

Sugammadex

19
Q

What is/are the CV side effect/s of sugammadex?

A

Marked bradycardia

20
Q

A Pt needs to be emergently re-intubated after just being reversed with sugammadex. What NMBD would you give?

A
  • Cisatracurium or any benzylisoquinoline.
  • You would have to wait 5mins before being able to give rocuronium 1.2 mg/kg.
21
Q

What are the S/S of recurarization?

A
  • Decreased O2 sats
  • Unresponsive, floppy, or uncoordinated Pt.
  • Ineffective abdominal & intercostal activity
22
Q

What are the onsets & duration of edrophonium & neostigmine?

A
  • Onset & duration edrophonium= 1-2mins & 5-15mins.
  • Onset & duration neostigmine= 5-10mins & 60mins

Advanced Pharmacology ANE 8433 (Spring 2023) (16 decks)

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