Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Top Drawer Medications > NMBA Reversal Agents > Flashcards

NMBA Reversal Agents Flashcards

1
Q

other name for neostigmine

A

Prostigmin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dose for prostigmin

A

0.04-0.08 mg/kg

*5 mg max (comes in 5 mg vial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MOA of neostigmine

A

inhibit hydrolysis of ACh by AChE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

T or F: the more neostigmine you give, the more it reverses

A

F - has a ceiling effect!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T or F: Prostignmin easily crosses BBB

A

F - it is a quarternary ammonium thus does not cross well (its charged)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what medication (and what dose) is usually given with neostigmine. Why is this given?

A

glycopyrollate

0.2 mg per mg of neostigmine

decrease muscarinic effects of neostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

is neostigmine a reversal for depolarizing or non-depolarizing NMBD

A

non-depolarizing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Neostigmine:

onset-

duration-

metabolism-

excretion-

A

onset- 15 min (depend on twitches)

duration- 1-2 hours

metabolism- hepatic

excretion: urinary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

other name for edrophonium

A

enlon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dose of enlon

A

0.5-1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is typically given with edrophonium

A

Atropine
0.014 mg/mg of enlon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

dose for enlon plus

A

0.05 - 0.1 mg/kg slowly over 1 minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MOA of endrophonium

A

inhibit hydrolysis of ACh by AChE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

IF you have a profound block, is neostigmine or endrophonium the better reversal agent?

A

neostigmine d/t longer DOA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T or F: Enlon easily crosses BBB

A

F - quarternary amine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Edrophonium

onset -

DOA

A

onset -1-2 min

DOA - very short

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

other name for pyridostigmine

A

regonol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

indications for Regonol

A
  • reversal
  • myasthenia gravis
  • pretreatment for soman nerve gas exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

typically used in gulf-war as a oral dose prophylactically and if exposed, would take again

A

pyridostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Regonol

onset-

DOA-

A

O- 2-5 min

DOA- 2-3 horus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T or F: Regonol does not easily cross BBB

A

T - its a quatenary amine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

other name for physostigmine

A

antilirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

the only anticholinesterase that crosses BBB

A

physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

dose of physostigmine

A

IV - 1-2 mg

*may repeat Q1-2 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

indications for antilirium

A
  • treatment for central anticholinergic syndrome
  • treat anticholinergic toxicity
  • not generally used as a reversal agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

MOA of physostigmine

A

inhibits cholinesterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CNS effects of physostigmine

A
  • agitation
  • restless
  • disoriented
  • shivers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Physostigmine

onset-

DOA-

A

o- 5 min

DOA- 1-2 hours

*metabolism is rapid and may require repeat dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

other name for sugammadex

A

bridion

30
Q

dosage of bridion

A

routine:
2 mg/kg TOF2
4 mg/kg no TOF but 1-2 PTC

emergent reversal of RSI:
16 mg/kg

31
Q

indications for suggamadex

A

reversal of zemuron and vecuronium

32
Q

MOA of suggamadex

A

selective relaxant binding agent that encapsulates roc, vec, or pancuronium preventing their effects/actions

33
Q

side effects of Suggamadex

A

At high dose =

Bradycardia
Hypotxn,
Cardiac arrest,
Headache,
N/V,
Anaphylaxis and
Hypersensitivity
May hinder effects of birth control and some antibiotics up to 7 days (Hormonal contraceptives and Toremifene)

34
Q

contraindications (use caution in) of suggamadex

A

renal impairment

wait 24 hours before re-adminstering Roc/Vec/Panc

35
Q

what meds are bridion incompatible with

A
  • verapamil
  • zofran
  • ranitidine
36
Q

onset of action for Bridion

A

~ 3 min

37
Q

Suggamadex is modified ______________

A

y- cyclodextrin

38
Q

How does Sugammadex alter coagulation?

A

Increases risk of coagulopathy and bleeding –> increases aPTT and PT, especially in those patients who were being treated with heparin or LMW heparin for thromboprophylaxis

39
Q

Which drug increases a patient’s risk for coagulopathy and bleeding by increasing aPTT, and PT (especially in patients being treated with heparin or LMW heparin for thromboprophylaxis)?

A

sugammadex

40
Q

Which drug interacts with hormonal contraceptives?

A

sugammadex

41
Q

Sugammadex metabolism:

A

NOT metabolized; excreted UNCHANGED by kidneys, so take caution in patients with renal failure

42
Q

N/V, hypotension, and headache are common adverse reactions to which NMB reversal agent?

A

Sugammadex

43
Q

How can we prevent Sugammadex-induced bradycardia?

A

Give 100 mg over 1 min, then give the next 100 mg, etc.

44
Q

Sugammadex dose (with TOF of 2):
conc:
time until recovery:

A

2 mg/kg
(100 mg/cc)
2 mins until recovery

45
Q

Sugammadex dose (with 1-2 PTC and no TOF twitches):
conc:
time until recovery:

A

4 mg/kg
(100 mg/cc)
3 mins until recovery

46
Q

Sugammadex dose (just after administering RSI dose of Rocuronium):
conc:
time until recovery:

A

16 mg/kg
(100 mg/cc)
1.5 mins until recovery

47
Q

Physostigmine dose to treat anticholinergic toxicity:

A

give 1-2 mg every 1-2 hrs, as needed

48
Q

What drugs may cause anticholinergic toxicity?

A
  • atropine
  • scopolamine
  • antihistamines
  • antipsychotics
  • cyclic antidepressants
49
Q

Anticholinergic toxicity s/s:

A

flushing, dry skin and mucous membranes, mydriasis with loss of accommodation, altered mental status, fever and urinary retention

CNS: restlessness, shivers, agitation, disoriented

50
Q

Cholinergic Syndrome crisis treatment:

A

Atropine, benzos (versed/valium), oximes (pralidoxime, obidoxime) –> oximes free AChAse from the anticholinesterase that is bound to it

51
Q

Enlon-plus dose:

A

0.05-0.1 mg/kg IV
SLOWLY OVER 1 MIN

52
Q

Edrophonium dose:
conc:
onset:
duration:

A

0.5-1 mg/kg IV
(10 mg/cc)
For every 1 mg of edrophonium, mix with 0.014 mg atropine (to prevent bradycardia)

onset: 1-2 mins

duration: short

53
Q

Edrophonium is used for (light/moderate/deep) block reversal.

A

moderate

54
Q

Edrophonium is a (tertiary amine/quaternary ammonium) and, therefore, (does/does not) cross the BBB.

A

quaternary ammonium; DOES NOT

55
Q

___ is a mixture of Edrophonium and atropine together in the same vial.

A

Enlon-Plus

56
Q

Edrophonium is administered with ___ in order to prevent ___ caused by the rapid ___ of Edrophonium.

A

Atropine
bradycardia
onset

57
Q

Neostigmine dose:
conc:
onset:
duration:

A

0.05 mg/kg IV (max 5 mg)
(1 mg/cc)
for every 1 mg of Neostigmine, administer 0.2 mg Glycopyrrolate (0.2 mg/cc) to decrease muscarinic side effects (and GIVE GLYCO FIRST in case something happens between; we can handle tachycardia better than bradycardia)

onset: starting at 15 mins (twitch dependent)
duration: 1-2 hrs

58
Q

Neostigmine is used for (light/moderate/deep) block reversal. How do we know when to use?

A

deep (use when 4 tactile TOF counts are present at adductor pollicis)

(more effective with moderate blocks)

59
Q

What is our max dose of Neostigmine?

A

5 mg –> d/t ceiling effect

60
Q

Neostigmine is a (tertiary amine/quaternary ammonium) compound and, therefore (does/does not) cross the BBB.

A

quaternary ammonium

does not

61
Q

Neostigmine is used with ___ to decrease the ___ side effects of Neostigmine.

A

glycopyrrolate (anticholinergic)

muscarinic

62
Q

Neostigmine blocks AChAse at ____________, causing (parasympathetic/sympathetic) effects.

A

ALL cholinergic synapses
parasympathetic

63
Q

Physostigmine –> drug class:

A

acetylcholinesterase inhibitor (crosses BBB)

64
Q

Edrophonium –> drug class:

A

acetylcholinesterase inhibitor

65
Q

Neostigmine –> drug class:

A

acetylcholinesterase inhibitor

66
Q

Sugammadex drug class:

A

selective relaxant binding agent

67
Q

Which drugs are our acetylcholinesterase inhibitors?

A

Neostigmine
Edrophonium
Physostigmine (crosses BBB)

68
Q

What side effects are caused by the administration of acetylcholinesterase inhibitors?

A

Think –> TOO MUCH ACh!!
SLUDGE (PNS activation)
Increased bronchial secretions/bronchospasm
Bradycardia caused by slowing conduction velocity of the cardiac impulse through the AV node
CNS excitement (physostigmine only)

69
Q

Acetylcholinesterase inhibitors are used for what 3 purposes?

A

reversal of NMBs
myasthenia gravis (diagnosis and treatment)
treatment of central anticholinergic syndrome

70
Q

___ is the enzyme responsible for the rapid hydrolysis of released acetylcholine.

A

Acetylcholinesterase

71
Q

What are the two ways to reverse a patient from NMBs?

A

spontaneously
reversal drug

72
Q

What 5 factors affect the reversal of NMBs?

A
  1. intensity of the block
  2. dose and choice of NMB
  3. drug interactions
  4. choice of reversal agent
  5. disease process (liver failure)

Top Drawer Medications (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions