NMB reversal Flashcards
How does AchE terminate the effect of acetylcholine?
Hydrolyzing it into choline and acetate
What are the two ways AchE inhibitors increase the concentration of Ach at the nicotinic receptor ?
-Enzyme inhibition
-Presynaptic effects
What are the three ways AchE inhibitors can bind and inhibit ?
Electrostatic attachment
Carbamyl esters
Phosphorylation
What drugs inhibit through electrostatic ? competitive or non?
Edrophonium
What drugs inhibit through formation of carbamyl esters ? competitive or non?
***stigmine’s
Competitive
What drugs inhibit through phosphorylation? competitive or non?
Organophosphates and echothiopate
noncompetitive
in addition to enzyme inhibition what are the two mechanisms of presynaptic sites of action
- Inhibitors stimulate the presynaptic receptor and cause the release of additional Ach
- Inhibition of AchE near the presynaptic receptor increases the concentration of Ach in this region, so Ach actually is stimulating the receptor.
What NMB has its primary mechanism to be most likely presynaptic?
Edrophonium
How does renal failure affect the duration of action for AchE inhibitors and NMBs?
Prolongs the action, no need to adjust or reduce the inhibitor
Do AchE inhibitors produce a ceiling effect? Will more drug help?
It does have a ceiling effect and more drug will actually make side effects worse
With a deeper blockade, will it take longer to reach a peak effect?
Yes
What effect does mixing AchE inhibitors cause?
Additive
Is neostigmine faster in adults or children?
Faster in children
Which AchE inhibitor passes the BBB?
Physostigmine which is a tertiary amine
What happens when an AchE Inhibitor is given after full recovery?
Can cause paradoxical muscle weakness
Which AchE inhibitor can produce pain relief through a intrathecal catheter?
50-100 mcg of neostigmine
Side effects - PONV, pruritus and prolongation of block
Which AchE inhibitor can reduce postoperative shivering?
40mcg/kg of physostigmine.
Equally efficacious as meperidine and clonidine
Physiologic response to giving an AchE inhibitors?
Increased parasympathetic response.
Bronchoconstriction
Bradycardia
Miosis
Increased digestive
Increased tears and salvation
Chart of anticholinergic
Which anticholnergics cross the BBB?
Glycopyrrolate - Quaternary amine
What can small doses of Atropine cause?
Paradoxical bradycardia through inhibition of M1
Do muscarinic antagonists affect HR in patients with a denervated heart?
NO
What NMB does sugammadex work on?
Roc
Vec
Panc
How is sugammadex eliminated? How is Roc?
Sugammadex - Kidneys
Roc-Biliary system
Dosing for Roc/Vec? IBW or TBW?
TOF 2/4 - 2mg/kg
TOF 0/4 - 4mg/kg
TBW
Dosing for Roc after Intubating dose?
16mg/kg
After 3 minutes of administration of RSI dose of ROC
What NMB is used when 16mg/kg of sugammadex was given within 24 hours?
HAVE to use succ, atra, cis, or miva
What NMB is used when <4mg/kg of sugammadex was given?
5 min - 4 hours - Give 1.2 mg/kg of roc
> 4 hours. roc at 0.6 or vec at 0.1mg/kg
How many days does sugammadex block birth control?
Up to 7
