Glycopyrrolate

Question 1

What is the recommended dose of glycopyrrolate when given in combination with neuromuscular blockade reversal?

Answer 1

• ~10-20 mcg/kg
  OR often
• 0.2 mg for every 1 mg of neostigmine

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2
Nagelhout (7th ed.), p. 174 - Table 12.11}

Question 2

What is the mechanism of action of glycopyrrolate?

Answer 2

Anticholinergic

• Competetive antagonism of acetylcholine at muscarinic receptors

_{Apex Unit 5: Pharmacology 2 - NMB Reversal Agents
Nagelhout (7th ed.), pp. 173-174}

Question 3

What is the rationale for the use of glycopyrrolate when reversing neuromuscular blockade with AchE inhibitors?

Answer 3

It can prevent or minimize cholinergic side effects

• bradycardia
• bronchoconstriction
• N/V
• salivation

Think of parasympathetic nervous system

_{Nagelhout (7th ed.), pp. 173-174}

Question 4

When administering neuromuscular blockade reversal, which AchE inhibitor is atropine usually paired with, and why?

Answer 4

• Neostigmine
• Their onset times are more favorably matched

_{Nagelhout (7th ed.), pp. 173, 174 - Table 12.11}

Question 5

What is the onset of action of glycopyrrolate?

Answer 5

• Within 60 seconds with maximum effect within 5 minutes

_{Anesthesia Guidebook - Episode 18: Anesthesia Top Drawer Run Down - Part 2
Nagelhout (7th ed.), p. 174 - Table 12.11
UpToDate - Glycopyrrolate (systemic): Drug Information}