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Pharmacology Exam 4 > NMB Reversals > Flashcards

NMB Reversals Flashcards

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1
Q

1995 Prospective Study on Vecuronium:
* No NM monitoring
* No Reversal

What was the Post-Op Residual NM Blockade?

A

33% ( n=435)

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2
Q

2002, 2003, 2004 Studies on NMB
* Used NM monitoring
* Reversal Used

What was the Post-Op Residual NM blockade?

A

4%

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3
Q

What is another name for neuromuscular monitoring?

A

Acceleromyography

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4
Q

The most common location, nerve, and muscle monitor are?

A
  • Hand
  • Abductor Pollicis
  • Ulnar Nerve
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5
Q

Clinical Duration Response of Pancuronium

A

86 minutes

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6
Q

Clinical Duration Response of Rocuronium

A

36 minutes

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7
Q

Clinical Duration Response of Vecuronium

A

44 minutes

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8
Q

Clinical Duration Response of Atracurium

A

46 minutes

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9
Q

Clincial Duration Response of Cistracurium

A

45 minutes

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10
Q

Clinical Duration Response of Mivacurium

A

8 minutes

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11
Q

Edrophonium is most commonly paired with _______.

A

Atropine Sulfate

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12
Q

Neostigmine is most commonly paired with ________.

A

Glycopyrrolate

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13
Q

Name the (3) NMB Reversal Agents

A
  • edrophonium
  • Neostigmine
  • Sugammadex
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14
Q

Name the (2) Anti-Cholinergic Agents that are paired with NMBD Reversals

A
  • Atropine
  • Glycopyrrolate
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15
Q

Name the (3) Classifications for NMBD Reversal Agents

A
  • Acetylcholine (AchE) Inhibitors
  • Cholinergic Agents
  • Competive Antagoinst
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16
Q

Time to Max Block: Panuronium

A

2.9 mins

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17
Q

Time to Max Block: Rocuronium

A
  • 1.7 mins
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18
Q

Time to Max Block: Vecuronium

A

2.4 Mins

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19
Q

Time to Max Block: Atracurium

A

3.2 mins

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20
Q

Time to Max Block: Cistracurium

A

5.2 mins

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21
Q

Time to Max Block: Mivacurium

A

3.3 mins

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22
Q

Acetylcholinesterase (AchE) Inhibitors MOA:
* rapid ________ of ACH.
* AchE Inhibition = ______ Acetylcholine available.
* ACH binds to _______ subunits.

A
  • Hydrolysis
  • more
  • alpha
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23
Q

Acetylcholinesterase is available at:
* _________ (SNS & PNS)
* _________ junction

A
  • Preganglionic
  • Neuromuscular Junction (NMJ)
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24
Q

Ceiling Effect of NMBD: Reversal Agents will not _______ with _____ NM Blockade

A
  • work
  • deep
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25
Q

Max dose of Neostigmine

Ceiling Dose

A

40 to 70 mcg/kg

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26
Q

Max dose of Edrophonium

ceiling dose

A

1mg/kg

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27
Q

Reversal of NM Blockade depends on (5) factors:
1. __________ of NM block
2. ________ inhibitor dose
3. ________ administed
4. Rate of Plasma __________ of NMBD
5. Anesthesia _________ of choice and depth (Post-Op Residual)

A
  1. Depth
  2. AchE
  3. Dose
  4. Clearance
  5. agent
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28
Q

Succinycholine (Anectine)
Dose/Onset/Duration

A
  • 1-1.5 mg/kg
  • 30-60 sec
  • 5-10 mins
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29
Q

Cisatricurium (Nimbex)
Dose/onset/duration

A
  • 0.1 mg/kg
  • 2-3 mins
  • 40-75 mins
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30
Q

Vecuronium (Norcuron)
dose/onset/duration

A
  • 0.1 mg/kg
  • 2-3 mins
  • 45-90 mins
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31
Q

Rocuronium (Zemuron)
RSI dose
dose/onset/duration

A
  • 1.2 mg/kg
  • 1.5 mins
  • 35-75 mins
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32
Q

Pancuronium (Pavulon)
dose/onset/duration

A
  • 0.1 mg/kg
  • 2-3 mins
  • 60-120 mins
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33
Q

Rocuronium (Zemuron)
dose/onset/duration

A
  • 0.6 mg/kg
  • 2-3 mins
  • 35-75 mins
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34
Q

Edrophonium
dose/onset/duration

A
  • 0.5-1 mg/kg
  • 1-2 mins
  • 5-15 mins
35
Q

Neostigmine
dose/onset/duration

A
  • 40-70 mcg/kg
  • 5-10 mins
  • 60 mins
36
Q

NMBD Reversal agents are excretely by the ________ and _________.

A
  • Renal
  • Hepatic
37
Q

Renal Excretion of NMBD:
* Neostigmine ____%
* Edrophonium ____%

A
  • 50%
  • 75%
38
Q

Chronic Renal failure _______ plasma clearance and causes a ________ action.

A
  • decreases
  • prolonged
39
Q

If there is no Renal Function, _____% to ____% of NMBD will be excreted Hepatically.

A
  • 30-50%
40
Q

Name the (5) systems that will have side effects associated with NMBD.

A
  • Nicotinic/Muscarinic
  • CV
  • Pulmonary
  • GI
  • Eyes
41
Q

NMBD _______ Nicotinic/Muscarinic Activity

A

Increase

42
Q

NMBD causes _________, dysrhythmias, _________, and ________ SVR

A
  • Bradycardia
  • asystole
  • decreased
43
Q

NMBD cause ______________, ____ airway resistance and _____ salivation in the Pulmonary system.

A
  • bronchoconstriction
  • increased
  • increased
44
Q

NMBD causes _________, _____ gastric fluid secretion and ________ in the GI system.

A
  • hyperperistalsis
  • enhanced
  • PONV
45
Q

NMBD causes ____ in the eyes.

A

Miosis

46
Q

To prevent side-effects _____ and _____ is given with NMBD reversals.

A
  • Atropine
  • Glycopyrolate
47
Q

Name the drug classifications for Atropine and Glycopyrrolate.

A
  • Anti-Cholinergic
  • Anti-Muscarinic
48
Q

With Cardiac disease, what Anti-Cholinergic/Anti-Muscarinic is prefered?

A
  • Glycopyrrolate
49
Q

Glycopyrolate should be given slowly over ___ - ___ minutes

A
  • 2-5 mins
50
Q

Atropine Dose

A
  • 7 -10 mcg/kg
51
Q

Name (2) side effects of Atropine

A
  • mydriasis
  • initial tachycardia
52
Q

Dose and Max Dose of Glycopyrolate

A
  • 7-15 mcg/kg
  • Max 1 mg
53
Q

A Persistent NM blockade is created when ______ is maximally inhibited and no further ______________ is effective.

A
  • Acetylcholinesterase
  • anticholinesterase
54
Q

With a peristent NM blockade, you need to ensure proper _______ and ______ _______.

A
  • sedation
  • postop ventilation
55
Q

Name (5) Factors Influencing NMBD Reversal:
* __________ of block
* __________ used
* Continued __________ Anesthetic
* _________ Drug used
* Patient condition

A
  • Intensity
  • NMBD
  • Volatile
  • Reversal
  • Patient condition
56
Q

Metabolic _______ , Respiratory _______ and Hypothermia can all affect NMB.

A
  • acidosis
  • acidosis
57
Q

Name (3) other Reversal Drugs for NMBD

A
  • Purified human plasma cholinesterase
  • Cystiene
  • Sugammadex
58
Q

Sugammadex is a selectively binding agent with _______.

A
  • aminosteroids
  • Rocuronium

Castillo kept relating Sugammadex to Roc in lcass. Notes say aminosteroi

59
Q

Name the NMBD that Cystience works well with.

A

Gantacurium

60
Q

AchE work by rapidly _______ of Acetylcholine.

A
  • hydrolysis (catalyze)
61
Q

Acetylcholine is available in the __________ and ________.

A
  • Preganglionic (SNS & PNS)
  • NMJ
62
Q

Sugammadex is a γ- ________, containes ______ units from starch and is _______ water soluble.

A
  • Cyclodextrin
  • dextrose
  • highly
63
Q

Sugammadex MOA is due to its intermolecular (___ ____ ____) forces, thermodynamic (__________) bonds and hydrophobic interactions that causes a very tight reversal by __________.

A
  • Van der Walls
  • Hydrogen
  • encapsulation
64
Q

Name the (3) NMBD that Sugammadex reverses

A
  • Rocuronium
  • Vecuronium
  • Pancuronium
65
Q

Sugammadex bind to _____ drug in the plasma.

A
  • Free
66
Q

Sugammadex major route of elimination is the _______.

A

Urine

67
Q

Sugammadex Moderate block Dose – reappearance of second twitch.

A
  • 2mg/kg
68
Q

Sugammadex dose for Deep Block — No twitch to TOF & 1-2 post-tentanic

A
  • 4 mg/kg
69
Q

The Elimination 1/2 time for Sugammadex is ___ hours.

A
  • 2 hours
70
Q

Sugammadex Dose with an extreme block

A
  • 8 -16 mg/kg
71
Q

Does Recurarization occur with Sugammadex?

A
  • Not observed at appropriate dose.
72
Q

Sugammade Side effects include N/V, ______, Urticaria, Anaphylaxis, _________, or it doesn’t work.

A
  • Pruritus
  • Bradycardia
73
Q

Suggamedex can cause issues when given to patient taking ______ contraceptives and ____________.

A
  • Oral Contraceptives
  • Toremifene
74
Q

Tomemifene (non-steroidal anti estrogen) _______ NMBD from Sugammadex.

A
  • displaces
75
Q

Sugammadex when given to a pt taking oral contraceptives can ________ with Progesterone for ___ day. Making the oral contraceptive __________.

A
  • Bind
  • 7
  • inactive
76
Q

Suggamadex can cause an increasing in __________/ __________ when given with Heparin/LMWH and can __________ PTT, PT and INR.

A
  • Coagulopathy/Bleeding
  • Elevated
77
Q

Recurarization (re-paralyzation) can only occur with Suggamedex when given a _________ than recommended dose.

A

Lower

78
Q

Recurarization is immediately apparent in PACU d/t declining _____ and _________ effort.

A
  • SaO2
  • Respiratory
79
Q

Signs and Symptoms of Recurarization include decrease O2 sats, ________ patient, appears _________ or uncoordinated and ineffective _____ and intercostal activity.

A

*unresponsive
* floppy
* abdominal

80
Q

Does Edrophonium or Neostigmine have a longer duration of action?

A

Neostigmine

81
Q

Treatment of Recurarixation is to treat urgently and _______, ________ the patient, and give additional ______ agents in divided doses.

A
  • aggressively
  • re-sedate
  • reversal
82
Q

When a patient experiences recurarization, the can sometime verbalize a _________ feeling, are unable to sustain a _____ lift or hand ______. In worst case senario, _________ collapse and respiratory obstruction.

A
  • suffocating
  • head
  • grasp
  • pharnygeal
83
Q

Which non-depolarizing NMBD has the longest time to maximum block?

A

Cistracurium (5.2 mins)

84
Q
A

Pharmacology Exam 4 (4 decks)

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