Reversal

Question 1

Where neostigmine and pyridostigmine work

Answer 1

Covalent bind to carbamyl group. Bind to esteric site of ach

Question 2

Where edrophonium works

Answer 2

Attach to anionic site of enzyme, reverses h binding

Question 3

Suggamadex reversal

Answer 3

Encapsulates roc and vec, can be used in deep block (1-2 PTCs)

Question 4

Factors influencing recovery time 10

Answer 4

Paralysis degree, pharmacokinetics/dynamics, gtt v bolus, antagonist used/dose, NM dysfunction, drug interactions, organ dysfunc, acid base alt, age

Question 5

Drug interactions that influence recovery time: IA and order

Answer 5

Enflurance, isoflurane, halothane

Question 6

Neostigmine: use when, ceiling effect over which dose

Answer 6

Deep block >90%.

.08 mg/kg

Question 7

Neostigmine

Onset, peak, give what w it

Answer 7

3 min. 7-10 min. Glyco (onset time similar)

Question 8

Neostigmine
Mixture and doses
Metabolism

Answer 8

.05-.07 mg/kg neo + .01.g/kg glyco

Cholinesterases in NMJ and liver

Question 9

Pyridostigmine
Potency
Onset
Duration

Answer 9

1/5 as neostigmine. Slower on, longer duration

Question 10

Pyridostigmine

Peak effect. Give w what. Dose

Answer 10

12 min. Glyco. .14-.25 mg/kg

Question 11

Pyridostigmine
___ in MG
Longer duration in

Answer 11

PO

Renal disease

Question 12

Endrophonium

Can give when, potency, onset, peak

Answer 12

All 4 twitches back. 1/10th as neo. Fast, 1-2 min

Question 13

Endrophonium
Increases presynaptic release of what
Give with what
Doses

Answer 13

Ach. Atropine (.01 mg/kg) + .5-1 mg/kg enro

Question 14

Fx inc Ach
Occur fastest for (order)
Cv
Pulm

Answer 14

Endro, neo, pyrido. Muscarinic: bradycardia/vagal. Muscarinic: bronchospasm

Question 15

Inc Ach fx
GI
Cerebral

Answer 15

Inc peristalsis and secretions, NV, fecal incont. Physostigmine crosses BBB

Question 16

Caution in which 3 disorders

Answer 16

Rate dependent cv disease, asthma, bronchospastic disease

Question 17

How anticholinergics work, structure atropine v glyco

Answer 17

Prevent cGMP or cAMP actions. Atropine- tertiary, cross BBB. Glyco- quat, doesnt cross BBB

Question 18

Atropine: onset, duration

Answer 18

1 min, 30-60 min

Question 19

Glyco: onset, duration

With which drug give several min prior

Answer 19

2-3 min. 2-4 hrs

Edrophonium to prevent bradycardia

Question 20

Scopolamine: uses, not used for

Answer 20

Good for sedation or secretions, not for NDMR reversal

Question 21

Neostigmine draw up calc

Answer 21

Every cc neo do a cc glyco.

70 kg x .05 ne0 = 3.5 mg (draw 4 cc). Also draw 4 cc glyco (4 x .02= .08 mg)

Question 22

Physostigmine

Crosses __. Use. Dose

Answer 22

BBB. Reversal of confusion after atropine and scop, somnolence after many drugs. 15-60 mcg/kg

Question 23

Echothiopate

Class. Use. Consideration

Answer 23

Organophosphate. Lowers IOP, miotic, long acting. May prolong sux 1 month after use (dec pseudocholinesterase activity)

Question 24

Suggamadex cautions

Answer 24

Bradycardia and arrest. NM block recurrence. Renal impairment- not recc for use if dialysis. Children <17

Question 25

Suggamadex
Dose if 1-2 PTC no TOF
Dose if spont recovery 2nd twitch TOF

Answer 25

4 mg/kg

2 mg/kg

Question 26

Suggamadex

Dose for roc if need to reverse quickly

Answer 26

16 mg/kg.

Question 27

More rapid recovery in which cases

Answer 27

Short acting NMB > long acting even w same reversal dose. Infiants/kids recover faster

Question 28

Clearance of reversals delayed in who

Answer 28

Renal failure

Question 29

Signs of adequate reversal

Answer 29

5 sec head lift, spont vent, eye open, tongue out, hand grip, leg raise- peds, cough, swallow, trying to get ett

Question 30

When TOF > ___ MOST nm function returned to normal

There should be no what

Answer 30

0.7

No detectable fade