NMB Reversal & Anticholinergics (5.3) Flashcards by Kelly K

What type of bond is formed when edrophonium binds to the anionic site on acetylcholinesterase?
a. electrostatic
b. hydrogen
c. covalent
d. ester

NMB reversal

a. electrostatic

pre-lesson Q1

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Which statements regarding anticholinesterase drugs are true? (Select 2)
a. 50% of neostigmine is metabolized by the liver
b. edrophonium & neostigmine has a synergistic effect
c. renal failure necessitates a second dose
d. neostigmine is more potent than pyridostigmine

NMB reversal

a. 50% of neostigmine is metabolized by the liver
d. neostigmine is more potent than pyridostigmine

pre-lesson Q2

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Which side effect is least likely to occur after neostigmine administration?
a. bronchospasm
b. mydriasis
c. nausea
d. prolonged QT

NMB reversal

b. mydriasis

causes miosis

pre-lesson Q3

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Compared to atropine, glycopyrrolate is more likely to cause:
a. tachycardia
b. xerostomia
c. sedation
d. mydriasis

NMB reversal

b. xerostomia (aka dry mouth)

does not cross BBB

pre-lesson Q4

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Which neuromuscular blocker is most effectively antagonized by sugammadex?
a. mivacurium
b. rocuronium
c. cisatracurium
d. succinylcholine

NMB reversal

b. rocuronium

pre-lesson Q5

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What type of bond is formed when neostigmine binds to acetylcholinesterase?
a. covalent
b. hydrogen
c. ester
d. electrostatic

NMB reversal

c. ester

stronger bond, longer DOA

post lesson quiz

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After administering 50 mg of rocuronium to an 80-kg patient, the CRNA encounters a “can’t intubate and can’t ventilate” scenario. How much sugammadex should be administered at this time? (mg)

NMB reversal

1280 mg

16 mg/kg

post lesson quiz

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Which side effect is least likely to occur after neostigmine administration?
a. prolonged QT interval
b. miosis
c. bronchodilation
d. nausea

NMB reversal

c. bronchodilation

causes bronchoconstriction

post lesson quiz

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Compared to scopolamine, atropine is more likely to cause:
a. tachycardia
b. cycloplegia
c. xerostomia
d. sedation

NMB reversal

a. tachycardia

post lesson quiz

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List the competitive and noncompetitive ACH inhibitors.

NMB reversal

competitive:
-pyridostigmine
-edrophonium
-neostigmine
-physostigmine

noncompetitive:
-organophosphate
-echothiophate

lesson 1 flashcard

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List 4 drugs that reduce the incidence of shivering in the PACU.

NMB reversal

physostigmine
meperidine
clonidine
dexmedetomidine

lesson 2 flashcard

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List 2 acetylcholinesterase inhibitors that are best paired with glycopyrrolate.

NMB reversal

neostigmine
pyridostigmine

lesson 2 flashcard

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Which acetylcholinesterase inhibitor has a tertiary amine in its chemical structure?

NMB reversal

physostigmine

allows it to penetrate the BBB

lesson 2 flashcard

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What does DUMBBELLS stand for and what is the mnemonic used for?

NMB reversal

acetylcholinesterase inhibitors
D-diarrhea
U-urination
M-miosis
B-bradycardia
B-bronchoconstriction
E-emesis
L-lacrimation
L-laxation
S-salivation

lesson 3 flashcard

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Which muscarinic antagonist increases heart rate the most?

NMB reversal

atropine

section 4 flashcard

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Which muscarinic antagonist has the strongest sedative effect?

NMB reversal

scopolamine

lesson 4 flashcard

Which muscarinic antagonist is best for preventing motion-induced nausea?

NMB reversal

scopolamine

lesson 4 flashcard

Which muscarinic antagonist increases heart rate the least?

NMB reversal

scopolamine

lesson 4 flashcard

Which muscarinic antagonist does not produce sedation?

NMB reversal

glycopyrrolate

lesson 4 flashcard

Which muscarinic antagonist does not prevent motion-induced nausea?

NMB reversal

glycopyrrolate

lesson 4 flashcard

What physiologic effects are associated with glycopyrrolate administration?

NMB reversal

-decreased gastric acid secretion
-decreased salivation
-increased heart rate
-relaxes smooth muscle

lesson 4 flashcard

An otherwise fit 75-kg patient, recovering from a rocuronium-induced train-of-4 ratio of 0 requires immediate reversal. Calculate the sugammadex reversal dose. (mg)

NMB reversal

1200 mg

16 mg/kg

lesson 5 flashcard

An 80-kg patient has a moderate level of rocuronium-induced block with a train-of-4 count of 2. Calculate the sugammadex reversal dose. (mg)

NMB reversal

160 mg

2 mg/kg

lesson 5 flashcard

Calculate the sugammadex dose in mg for a 70-kg patient who received an intubating dose of rocuronium 4 minutes ago.

NMB reversal

1120 mg

16 mg/kg

lesson 5 flashcard

Sugammadex antagonizes a nondepolarizing neuromuscular blockade by encapsulating: a. rocuronium only b. benzylisoquinolines c. benzylisoquinolines & aminosteroids d. aminosteroids ## Footnote NMB reversal

d. aminosteroids ## Footnote review exam

Match the acteylcholinesterase inhibitor to its dose. 1. pyridostigmine 2. neostigmine 3. edrophonium a. 0.05 mg/kg b. 1 mg/kg c. 0.3 mg/kg ## Footnote NMB reversal

1c 2a 3b ## Footnote review exam

Match the drug to its onset of action. Assume that there is a steady state concentration of nondepolarizing neuromuscular blocker in the plasma. 1. Neostigmine 2. Pyridostigmine 3. Edrophonium a. 1 minute b. 10 minutes c. 15 minutes ## Footnote NMB reversal

1b 2c 3a ## Footnote review exam

Neostigmine antagonizes rocuronium by: a. decreasing acetylcholine hydrolysis b. competing with rocuronium at the nicotinic receptor c. potentiating acetylcholinesterase activity d. reversibly binding to butyrylcholinesterase ## Footnote NMB reversal

a. decreasing acetylcholine hydrolysis | reversibly binds to the enzyme acetylcholinesterase at NMJ ## Footnote review exam

Select the best acetylcholinesterase inhibitor to antagonize a block with 90 percent twitch suppression. a. neostigmine b. edrophonium c. physostigmine d. pyridostigmine ## Footnote NMB reversal

a. neostigmine ## Footnote review exam

Which acetylcholinesterase inhibitors in clinical use prolong the duration of succinylcholine? (Select 2) a. pyridostigmine b. edrophonium c. neostigmine d. physostigmine ## Footnote NMB reversal

a. pyridostigmine c. neostigmine | inhibit pseudocholinesterase in the plasma ## Footnote review exam

The following are well absorbed from the gastrointestinal tract except: a. atropine b. scopolamine c. glycopyrrolate d. physostigmine ## Footnote NMB reversal

c. glycopyrrolate | quaternary ammonium ionizes in the plasma; no pass BBB/GI tract/placenta ## Footnote review exam

Select the best statement regarding the use of an anticholinergic agent and edrophonium when used to antagonize neuromuscular blockade. a. atropine is given after edrophonium b. glycopyrrolate should be mixed in the same syringe as edrophonium c. atropine should be avoided because of CNS side effects d. atropine pairs better than glycopyrrolate. ## Footnote NMB reversal

d. atropine pairs better than glycopyrrolate | onset and duration are similar; also crosses BBB ## Footnote review exam

In the PACU, an 85-year-old female who received scopolamine is agitated and confused. What is the best intervention at this time? a. physostigmine b. reduce environmental stimuli c. midazolam d. pyridostigmine ## Footnote NMB reversal

a. physostigmine | crossess the BBB; antidote for antimuscarinic overdose ## Footnote review exam

Rank the following drugs according to their tendency to cause cycloplegia. (1-most likely, 4-least likely) a. glycopyrrolate b. scopolamine c. atropine ## Footnote NMB reversal

1. scopolamine 2. atropine 3. glycopyrrolate ## Footnote review exam