Neuromuscular Blocker Reversal Review

Question 1

Cholinesterase Inhibitors work by?

Answer 1

Inhibiting the action of achetylcholinesterase which breaks down Ach therfore allowing more Ach to be at the junction longer overpowering the muscle relaxant.

Question 2

What drugs are given with Cholinesterase Inhibitors?

Answer 2

Glycopyrrolate and atropine

Question 3

You must have at least one of these to reverse a NDNMB?

Answer 3

1 twitch

Question 4

No twitch post 5 second tetanic stimulation means?

Answer 4

A very deep NDNMB

Question 5

Why do we give Glycopyrrolate or atropine with a cholinesterase Inhibitor?

Answer 5

To attenuate the effects of Ach on the muscurinic receptors preventing the over stimulation of the parasympathetic system (which will decrease your chances of bradycardia, bronchospasms and PONV)

Question 6

What part of the nervous system is affected by the Cholinesterase Inhibitors?

Answer 6

Presynaptically in the PSN

Question 7

What principle is used to reverse NDNMB?

Answer 7

Competitive Antagonism

Question 8

Which muscular relaxant is not reversible?

Answer 8

Suc’s (phase 1)

Question 9

Phase 2 block from Suc’s is reversed how?

Answer 9

Administration of a NDNMB and then reversed by acetylcholinesterase

Question 10

Name 4 Cholinesterase Inhibitors?

Answer 10

Neostigmine, edrophonium, physiostigmine, pyridostigmine

Question 11

The primary goal of reversing neuromuscular blockade is to?

Answer 11

Maximize nicotinic transmission and minimize muscarinic effect

Question 12

Which do you administer first the Cholinesterase inhibitor or the anticholinergic?

Answer 12

The anticholinergic because you want to inhibit the effects of the Cholinesterase inhibitor before they are already present.

Question 13

Whats the max dose of Neostigmine?

Answer 13

5 mg

Question 14

For every mg of Neostigmine you give how much Glycoprryrolate per rule of thumb?

Answer 14

0.2 mg