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Anesthesia Pharm (Spring 2023) Drugs and Doses Only > NMBD Reversal Agents (Exam IV) > Flashcards

NMBD Reversal Agents (Exam IV) Flashcards

1
Q

How long, generally, until NMJ blockade is fully reversed with neostigmine?

A

20-30 min

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2
Q

Do AChE inhibitors work with deep neuromuscular blockade?

A

No

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3
Q

Reversal of NMJ blockade is dependent on these 5 factors:

A
  1. Depth of block
  2. Drug choice (neo vs edro)
  3. Dose
  4. Rate of plasma clearance
  5. Anesthetic agent and depth
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4
Q

Which paralytic has to be reconstituted with 10mL of H₂O ?

A

Vecuronium

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5
Q

What is the max dosage of neostigmine?

A

40 - 70 mcg/kg

0.04 - 0.07 mg/kg

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6
Q

What is the onset and duration of neostigmine?

A

Onset: 5 - 10 min
Duration: 60 min

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7
Q

What is the dosage of edrophonium?

A

0.5 - 1 mg/kg

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8
Q

What is the max dosage of edrophonium?

A

1.5 mg/kg

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9
Q

What is the onset and duration of edrophonium?

A

Onset: 1-2 min
Duration: 5-15 min

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10
Q

What percentage of neostigmine is renally excreted?

A

50%

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11
Q

What percentage of both pyridostigmine and edrophonium are renally excreted?

A

75%

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12
Q

How are NMB reversal agents cleared if the patient has no innate renal function?

A

30 - 50% cleared hepatically

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13
Q

What is the major side effect of NMBD reversal agents?

A

↑PSNS activity (from increased nACh and mACh activity)

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14
Q

What drugs would be coupled with NMBD reversal agents to prevent adverse side effects from these drugs?

A

Anti-cholinergic / Anti-muscarinics

  • Atropine
  • Glycopyrrolate
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15
Q

If you’re concerned about someone’s cardiac status due to existing disease, which Anticholinergic drug would you use?

A

Glycopyrrolate

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16
Q

What NMBD(s) is glycopyrrolate used with?

A
  • Neostigmine
  • Pyridostigmine
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17
Q

What NMBD(s) is atropine used with?

A

Edrophonium

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18
Q

What is the dose of Atropine?

A

7 - 10 mcg/kg

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19
Q

What common side effects are seen right after atropine administration?

A
  • Mydriasis
  • Tachycardia
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20
Q

What is the maximum dose of glycopyrrolate?

A

1mg max dose

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21
Q

How long does glycopyrrolate need to be administered over?

A

2 - 5 min

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22
Q

What reversal drug is specific to mivacurium?

A

Purified human plasma cholinesterase

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23
Q

What reversal drug is specific to gantacurium?

A

Cystiene

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24
Q

What reversal drug is very specific to rocuronium?

A

Sugammadex

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25
What type of drug is sugammadex?
Selective relaxant-binding agent
26
What should be known about sugammadex's organic structure and physical properties?
- γ-cyclodextrin - Dextrose units from starch - Very H₂O-soluble
27
What is the MOA of Sugammadex?
Encapsulates rocuronium via: - Van der Waals forces - H-bonds - Hydrophobic interactions
28
What drugs does sugammadex work with?
**Roc** > Vec > Pancuronium
29
What is the E ½ time of sugammadex?
2 hours
30
How is sugammedex eliminated?
Urine: - 70% gone in 6 hours - 90% gone in 24 hours
31
Differentiate a moderate block vs a deep block.
- Moderate: 2/4 twitches on TOF - Deep: No twitches to TOF
32
What is the Sugammadex dose for a moderate block?
2 mg/kg
33
What is the Sugammadex dose for a deep block?
4 mg/kg
34
What is the sugammadex dose for an extreme (overdose) block?
8 - 16 mg/kg
35
What are the side effects of Sugammadex?
- Bradycardia - dose-related N/V - dose-related Pruritis - dose-related Urticaria
36
What drugs/conditions are relative contraindications to sugammadex?
- Contraceptives - Toremifene (displaces roc from sugammadex) - Coagulopathy - ESRD (excreted renally)
37
What is recurarization?
Resumption of NMJ blockade after period of reversal
38
What s/s would indicate recurarization? *Say you just brought the patient to PACU*.
- ↓ SpO₂ - ↓ respiratory effort - Floppy/uncoordinated - Unresponsive
39
What drug and dose would be a good choice for a recurarizing patient in the PACU? Why might this be a good choice?
- Neostigmine 0.05 mg/kg IV - Longer duration of action
40
What are the NMBD reversal agents
edrophonium neostigmine
41
What are the anti-cholinergic agents
atropine sulfate glycopyrrolate
42
What is the lastest NMBD reversal agents
sugammadex
43
What is the dose (mg/kg) and mg/ml of Succinylcholine (Anectine)
mg/kg: 1 - 1.5 mg/ml: 20
44
What is the dose (mg/kg) and mg/ml of Cisatricurium (Nimbex)
mg/kg: 0.1 mg/ml: 1
45
What is the dose (mg/kg) and mg/ml of Vecuromium (Norcuron)
mg/kg: 0.1 mg/ml: 1
46
What is the dose (mg/kg) and mg/ml of Rocuronium (Zemuron)
mg/kg: 0.6 (1.2) mg/ml: 10
47
What is the dose (mg/kg) and mg/ml of Pancuronium (Pavulon)
mg/kg: 0.1 mg/ml: 2
48
What is the onset and duration of Succinylcholine (Anectine)
onset: 30-60 sec Duration: 5-10 min
49
What is the onset and duration of Cisatricurium (Nimbex)
onset: 2-3 min duration: 40-75min
50
What is the onset and duration of Vecuronium (Norcuron)
Onet: 2-3min Duration: 45-90min
51
What is the onset and duration of Rocuronium (Zemuron)
onset: 2-3 (1.5)min duration: 35 -75 min
52
What is the onset and duration of Pancuronium (Pavuion)
onet: 2-3 min duration: 60 min
53
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for **d- Tubocuratine**
ED50: 0.23 ED95: 0.48 CE50: 370 Keo: 0.13
54
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for **Pancuronium**
ED50: 0.036 ED95:0.067 CE50:88 Keo: -
55
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for** Rocuronium**
ED50: 0.147 ED95: 0.305 CE50: 3510 Keo: 0.405
56
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for **Vecuronium**
ED50: 0.027 ED95:0.043 CE50: 92 Keo: 0.17
57
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for **Atracrium**
ED50: 0.12 ED95: 0.21 CE50: 449 Keo: 0.13
58
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for **Cisatracurium**
ED50: 0.026 ED95: 0.04 CE50:126 - 158 Keo: 0.07 -0.09
59
What is the: ED50 (mg/kg) ED95 (mg/kg) CE50 (mg/ml) Keo (min) for Mivacurium
ED50: 0.039 ED95:0.067 CE50:79.9 Keo: 0.18
60
Whatis the is the: intubation dose (mg/kg) maximum block (%) Time to maxium block (min) Clinical duration of reponse (min) for d- Tubocurarine
intubation dose (mg/kg): 0.6 maximum block (%): 97 Time to maximum block (min): 5.7 Clinical duration of reponse (min): 81
61
Whatis the is the: intubation dose (mg/kg) maximum block (%) Time to maxium block (min) Clinical duration of reponse (min) for pancuronium
intubation dose (mg/kg): 0.1 maximum block (%): 100 Time to maxium block (min): 2.9 Clinical duration of reponse (min): 86
62
Whatis the is the: intubation dose (mg/kg) maximum block (%) Time to maximum block (min) Clinical duration of reponse (min) for rocuronium
intubation dose (mg/kg): 0.6 maximum block (%): 100 Time to maximum block (min): 1.7 Clinical duration of reponse (min): 36
63
Whatis the is the: intubation dose (mg/kg) maximum block (%) Time to maxium block (min) Clinical duration of reponse (min) for Vecuromium
intubation dose (mg/kg): 0.1 maximum block (%): 100 Time to maxium block (min): 2.4 Clinical duration of reponse (min): 44
64
What is the intubation dose (mg/kg) maximum block (%) Time to maxium block (min) Clinical duration of reponse (min) for Atracurium
intubation dose (mg/kg): 0.5 maximum block (%): 100 Time to maxium block (min) : 3.2 Clinical duration of reponse (min): 46
65
Whatis the is the: intubation dose (mg/kg) maximum block (%) Time to maximum block (min) Clinical duration of reponse (min) for Cisatracuium
intubation dose (mg/kg): 0.1 maximum block (%): 100 Time to maxium block (min): 5.2 Clinical duration of reponse (min): 45
66
Whatis the is the: intubation dose (mg/kg) maximum block (%) Time to maximum block (min) Clinical duration of reponse (min) For Mivacurium
intubation dose (mg/kg): 0.15 maximum block (%): 100 Time to maximum block (min): 3.3 Clinical duration of reponse (min): 16.8
67
What are the side effects NMBD reversal agents other than increaed nicotinic and muscainic activity?
**CV:** Bradycardia, dysrhythmias, asystole, ↓SVR **Pulmonary**: Bronchoconstriction, increased airway resistance, increased salivation **GI: ** Hyperperistalsis, enhanced gastric fluid secretion, PONV **Eyes**: Miosis
68
What are the interventions for persistent NM blockade?
sedation and postop ventilation
69
What is the MOA for persistent NM blockade
* inhibit Acetylcholinesterase
70
What factors infulence NMBD reversal
* Intensity of block * NMBD use * volatile anesthetic * reversal drug use * Metabolic acidosis * Respiratory acidosis * Hypothermia
71
After waiting 5 mins after reversal, what is the NMBA that can be re-adminstered and the dose
Rocuronium 1.2mg/kg
72
After waiting 4hours after reversal, what is the NMBA that can be re -adminstered? What is the dose
Rocuronium - 0.6 mg/kg Vecuronium - 0.1 mg/kg

Anesthesia Pharm (Spring 2023) Drugs and Doses Only (20 decks)

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