Med Review Paralytics Flashcards
What is the MOA of succinylcholine?
2 molecules of ACh bound together that mimic ACh and bind to ACh receptors at the NMJ ⇒ opens the channel and prevents resetting of the channel ⇒ paralysis
How is succinylcholine metabolized?
plasma cholinesterase
What major considerations must be made with administration of succinylcholine?
- MH trigger
- avoid in burn pt (upregulation of nACh receptors)
- avoid in renal failure (further increase in K⁺)
Cisatracurium is how much more potent and atracurium?
4 times more potent than atracurium
Why would cisatracurium be the drug of choice for a patient with renal failure?
metabolized via hoffman elimination, organ independent
How is vecuronium metabolized?
hepatic metabolism (30-40%)
- may accumulate in renal failure
How is rocuronium metabolized?
minimal to no metabolism
- excreted unchanged in urine and bile
What considerations should be made with administration of rocuronium with liver failure? Renal failure?
- Moderate prolongation in liver failure
- not affected by renal failure
How is rocuronium administration affected in elderly and pregnant patients?
slightly prolonged in both
What is the most common acetylcholinesterase inhibitor used to reverse paralytics?
Neostigmine (prostigmin)
What is the onset of action for edrophonium in paralytic reversal?
1-2 minutes
What is the onset for pyridostigmine in paralytic reversal?
16 minutes
What is the onset for neostigmine in paralytic reversal?
~5 - 10 minutes
What is the duration of action for edrophonium in paralytic reversal?
5-20 minutes
What is the duration of action for neostigmine in paralytic reversal?
40 - 60 minutes
what is the duration of action for pyridostigmine in paralytic reversal?
90 minutes
What drug is typically administered with acetylcholinesterase inhibitors to prevent profound bradycardia?
glycopyrrolate (robinul)
What is the onset and duration of glycopyrrolate?
Onset: 2-3 minutes
Duration: 2 hours
How does glycopyrrolate differ from administration of atropine?
- does not cross the BBB and thus doesn’t cause sedation
- also causes less tachycardia than atropine
What are the main effects of glycopyrrolate?
- tachycardia
- bronchodilation
- anti-sialogogue
Sugammadex (bridion) works best in reversal of which paralytic?
FDA approved for Rocuronium reversal
has also been shown to work with vecuronium and pancuronium
A shallow/medium blockade reversal can be done with what dose of sugammadex?
2 mg/kg
A deep blockade reversal can be done with what dose of sugammadex?
4 mg/kg
For immediate reversal, 3 minutes after administration of max 1.2mg/kg rocuronium what dose of sugammadex can be given for reversal?
16 mg/kg?
