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Pharmacology > Neuromuscular Reversal Agents + Monitoring > Flashcards

Neuromuscular Reversal Agents + Monitoring Flashcards

1
Q

Acetylcholinesterase rapidly hydrolyzes

A

Ach

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2
Q

AchE inhibitors

A

antagonize the residual effects of NMBD

Accelerate recovery from non-depolarizing drugs

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3
Q

AchE drugs include

A

neostigime
edrophonium
pyridostigmine

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4
Q

What AchE has a ceiling effect?

A

neostigimine

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5
Q

AchE inhibitors cause a build up of Ach in

A

NMJ

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6
Q

Once you’ve hit ceiling effect

A

max block depth that can be antagonized corresponds to return of fourth twitch in TOF
Cannot antagonize profound or deep levels of blockade
Administering more inhibitor may be detrimental

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7
Q

Antagonism of NMBD depends on

A 
depth of blockade when reversal is attempted
inhibitor chosen
dose
rate of spontaneous clear of NMBD
choice and depth of anesthesia
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8
Q

Max Effective DOse of Neostigmine

A

0.06-0.08mg/kg

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9
Q

Max effective Dose of Edrophonium

A

1.0-1.5 mg.kg

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10
Q

Cardiovascular Side effects of Ach Inhibitor

A

muscarinic effects must be blocked by anticholinergic

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11
Q

Dose of Glycopyrrolate

A

0.01-0.005 mcg/kg

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12
Q

Dose of Atropine

A

0.007-0.01mcg/kg

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13
Q

Pulmonary side effects of Ach Inhibitor

A

bronchoconstriction
increased airway secretions
increased salivation

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14
Q

GI side effects of Ach Inhibitor

A

Increased bowel motilite

No effect on incidence of PONV

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15
Q

Sugammadex

A

modified gamma-cyclogextrin

reversal of shallow and profound aminosteroid-induced blockade

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16
Q

Sugammadex is

A

selective relaxant-binding

no effect on acetylcholinesterase

17
Q

Dosing of Sugammadex

A

TOF> 2: 2mg/kg
TOF 1-2 4 mg/kg
TOF 0: 8-16 mg/kg

18
Q

Sugammadex doesnt work against

A

succinylcholine

benzlisoquinoliniums

19
Q

Side effects of Sugammadex

A

possible allergic reactions and bleeding

20
Q

Onset of relaxation

A

eye muscles > extremities> trunk> abdominal muscles> diaphragm
b/c blood flow is greatest to the head neck and diaphargm

21
Q

TOF

A

four separate stimuli every 0.5 seconds at 2Hz

22
Q

To ensure reversal of NMBD

A

TOF > 0.9

23
Q

TOF less then 0.9 is associated with

A

difficulty speaking
difficulty swallowing
visual disturbances
aspiration risk

24
Q

AchE inhibitor side-effects

A

bronchoconstriction (increased airway restriction, increased salivation)
increased bowel motility
muscarinic effects must be blocked by antocholinergic

25
Q

Why do we monitor NMB?

A

proper administration of NMBD is essential to surgery (under or over dosing)

26
Q

Contraction of adductor muscle of thumb is

A

preferred method of determining level of blockade

27
Q

Facial nerve monitoring involves stimulation of

A

orbicularis oculi muscle (facial nerve)

28
Q

Blood flow greatest to head and neck and diaphragm

A

onset measured in facial nerves

recovery best measured in the hand

29
Q

Onset of paralysis in non-depolarizing agent there is a decrease in

A

in twitch response between T1-T4 (fade)

30
Q

TOF can aid in determining degree of block

A

Most sensitive between 70-100% paralysis

31
Q

T4

A

75-80%

32
Q

T3

A

80-85%

33
Q

T2-4

A

90-95%

34
Q

Tetany

A

continous electrical stimulation for 5 seconds at 50-100Hz
reliable for detecting fade
sustained contraction w/o fade, significant paralysis unlikely

35
Q

Posttetanic count-

A

tetany followed in 3 seconds by single twitch stimulations

higher the count (>8) the less intense the block

36
Q

Single Twitch

A

single twitch at 0.1-1Hz for 0.1-0.2ms

determine whether 100% paralysis is present

37
Q

Double Burst Suppression

A

Seems to improve ability to detect residual paralysis

evaluating 2 rather than 4 twitches facilitates detection

38
Q

Not reliable indictor for endotracheal extubation

A

5 second head life
toF ratio <0.6
generate peak negative inspiratory pressure 20-30 cmH20

Pharmacology (14 decks)

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