REVERSAL AGENTS Flashcards
Naloxone (Narcan)
-Bolus dose: 1-4 mcg/kg IV (20-40 mcg reverse RR depression, but not analgesia)
-Continuous dose: 5mcg/kg/hr IV
-Shock dose: >1 mg/kg IV
o Concentration: 0.4mg in 10mL for 40mcg/mL
o Onset: 1-2 minutes onset for duration of 30 minutes (redose)
o C/I: Reversal of buprenorphine analgesia will reverse pain but not resp depression, causing withdrawals.
o Precautions: CV stimulant; inc SNS tone; can wear off before opioid causing resp depression to return; negative pressure pulmonary edema d/t laryngospasm from pt waking up(indirect)
Flumazenil (Romazicon)
o Dose Range: 0.2mg IV and titrated in 0.1mg increments q1 min to 3mg total. 0.3-0.6 mg to reverse sedation. 0.5-1.0mg to abolish therapeutic dose.
o Concentration: 1mg/10mL
o Duration: 30-60min (short duration so may need redosing)
o Action: reversal approximately in 2 min.
C/I: antiepileptic drugs. Precipitates acute withdrawal seizures.
o S/E: Unlike post-op opioid reversal with naloxone (which causes a profound increase in SNS tone), post-op BZD reversal with flumazenil does not increase SNS tone, anxiety or neuroendocrine evidence of stress. In chronic bzd usage, reversal can precipitate signs of withdrawal, including seizures. Tends to reverse the sedative effects more than the amnestic effects of bzd.
