Exam 4 Reversals Flashcards
What type of drugs are edrophonium & neostigmine?
Competitive antagonists
What causes the side effects of NMBD reversal agents?
Their binding to preganglionic SNS & PNS sites
What is the dose for neostigmine?
40 – 70 mcg/kg Max of 5 mg
What is the dose for edrophonium?
1-1.5 mg/kg
What is given in conjunction with neostigmine & its dose?
Glycopyrrolate 0.2 mg per mL of Neostigmine
What NMB agent is given for Pts with hepatic or renal failure?
- Cisatracurium or atracurium.
- They are cleared via Hoffmann elimination
Which has a higher renal clearance, neostigmine or edrophonium?
Edrophonium 75% vs 50%
What are the pulmonary side effects with NMBD reversal agents?
- Bronchoconstriction
- increased airway resistance & salivation
What are the CV side effects with NMBD reversal agents?
- Bradycardia
- dysrhythmias
- asystole
- decreased SVR
Which reversal agent is preferred in someone with cardiac disease?
- Neostigmine & glycopyrrolate
- Administer slowly over 2-5mins
What happens to AChE in persistent NM blockade?
AChE is maximally inhibited & ineffective
What other reversal works with Mivacurium?
Purified human plasma cholinesterase
What is the MOA of sugammadex?
Thru Hydrogen bonds, intermolecular forces & hydrophobic interactions encapsulates NMBD
What is the route of elimination of sugammadex & when do you not give it?
- 70% eliminated via urine in 6hrs.
- Do not give to someone on dialysis.
- It is not cleared via dialysis.
What is the sugammadex dose w/ 2 of 4 twitches? What about 0 of 4?
- T2= 2 mg/kg.
- T0= 4 mg/kg
What is the sugammadex dose for extreme blockades?
8-16 mg/kg
Sugammadex works with which NMBD?
- Rocuronium & vecuronium.
- It can work on light Pancuronium doses
What reversal works faster, neostigmine or sugammadex?
Sugammadex
What is/are the CV side effect/s of sugammadex?
Marked bradycardia
A Pt needs to be emergently re-intubated after just being reversed with sugammadex. What NMBD would you give?
- Cisatracurium or any benzylisoquinoline.
- You would have to wait 5mins before being able to give rocuronium 1.2 mg/kg.
What are the S/S of recurarization?
- Decreased O2 sats
- Unresponsive, floppy, or uncoordinated Pt.
- Ineffective abdominal & intercostal activity
What are the onsets & duration of edrophonium & neostigmine?
- Onset & duration edrophonium= 1-2mins & 5-15mins.
- Onset & duration neostigmine= 5-10mins & 60mins
