NMBD Reversal Agents (Exam IV) Flashcards
How long, generally, until NMJ blockade is fully reversed with neostigmine?
20-30 min
Do AChE inhibitors work with deep neuromuscular blockade?
No
Reversal of NMJ blockade is dependent on these 5 factors:
- Depth of block
- Drug choice (neo vs edro)
- Dose
- Plasma clearance
- Anesthetic agent and depth used
Which paralytic has to be reconstituted with 10mL of H₂O ?
Vecuronium
What is the max dosage of neostigmine?
40 - 70 mcg/kg
0.04 - 0.07 mg/kg
What is the onset and duration of neostigmine?
Onset: 5 - 10 min
Duration: 60 min
What is the dosage of edrophonium?
0.5 - 1 mg/kg
What is the max dosage of edrophonium?
1.5 mg/kg
What is the onset and duration of edrophonium?
Onset: 1-2 min
Duration: 5-15 min
What percentage of neostigmine is renally excreted?
50%
What percentage of both pyridostigmine and edrophonium are renally excreted?
75%
How are NMB reversal agents cleared if the patient has no innate renal function?
30 - 50% cleared hepatically
What is the major side effect of NMBD reversal agents?
↑PSNS activity (from increased nACh and mACh activity)
What drugs would be coupled with NMBD reversal agents to prevent adverse side effects from these drugs?
Anti-cholinergic / Anti-muscarinics
- Atropine
- Glycopyrrolate
If you’re concerned about someone’s cardiac status due to existing disease, which Anticholinergic drug would you use?
Glycopyrrolate - anticholinergic with minimal cardiac effects. It does not cross blood brain barrier, so it is less likely to cause tachycardia, but it does prevent bradycardia