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NSU AA Denver Drugs and Inhalational Agents > Reversal Agents > Flashcards

Reversal Agents Flashcards

1
Q

What is the typical dose of Neostigmine used for reversal of non-depolarizing neuromuscular blockade?

A

0.04-0.08 mg/kg

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2
Q

What is the typical onset time of Neostigmine?

A

5-10 minutes

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3
Q

What is the duration of action of Neostigmine when used for reversal?

A

30-60+ minutes

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4
Q

Neostigmine must be administered with which type of medication to prevent muscarinic side effects?

A

Anticholinergics

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5
Q

Which of the following is NOT a common side effect of Neostigmine?

A

Excess salivation (Dry mouth common)

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6
Q

Does Neostigmine reverse non-depolarizing neuromuscular blockers by inhibiting acetylcholinesterase?

A

Yes

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7
Q

Can Neostigmine cross the blood-brain barrier?

A

No – It is a quaternary ammonium compound and does not cross the BBB

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8
Q

Should Neostigmine be used without an anticholinergic agent like glycopyrrolate or atropine?

A

No – It should be paired to reduce muscarinic side effects

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9
Q

Is Neostigmine ineffective for reversing deep neuromuscular blockade?

A

Yes – It’s best used when some spontaneous recovery has begun

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10
Q

Is Bradycardia a potential side effect of Neostigmine administration?

A

Yes, can even cross the placenta and cause fetal bradycardia

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11
Q

What is the typical IV dose of Neostigmine used for neuromuscular blockade reversal?

A

0.04–0.08 mg/kg IV

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12
Q

What is the usual onset time for Neostigmine?

A

5–10 minutes

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13
Q

What is the duration of Neostigmine’s effect?

A

30–60 minutes

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14
Q

What is the mechanism of action of Neostigmine?

A

It inhibits acetylcholinesterase, increasing acetylcholine at neuromuscular junctions to reverse non-depolarizing blockade

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15
Q

Why is an anticholinergic co-administered with Neostigmine?

A

To counteract muscarinic side effects like bradycardia and bronchial secretions

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16
Q

Which anticholinergics are commonly used with Neostigmine?

A

Glycopyrrolate or Atropine

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17
Q

When is Neostigmine typically used in anesthesia?

A

To reverse non-depolarizing neuromuscular blocking agents at the end of surgery

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18
Q

What are some muscarinic side effects of Neostigmine?

A
  • Bradycardia
  • Increased secretions
  • Bronchospasm
  • Abdominal cramping
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19
Q

What is the typical IV dose of Edrophonium for neuromuscular blockade reversal?

A

0.5-1.0 mg/kg

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20
Q

What is the usual onset time of Edrophonium?

A

30 seconds–2 minutes

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21
Q

How long does Edrophonium typically last?

A

10–30 minutes

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22
Q

What is Edrophonium’s primary mechanism of action?

A

Reversible acetylcholinesterase inhibitor

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23
Q

Which of the following is a key clinical use of Edrophonium?

A

Diagnosis of myasthenia gravis

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24
Q

Edrophonium has a faster onset than Neostigmine?

A

Yes

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25
Q

Edrophonium is a quaternary ammonium compound that cannot cross the blood-brain barrier?

A

Yes

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26
Q

Is Edrophonium used to reverse depolarizing neuromuscular blockade (e.g., succinylcholine)?

A

No – It is used for non-depolarizing blockade

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27
Q

Should Edrophonium always be administered with an anticholinergic agent?

A

Yes – Typically Atropine due to similar onset time

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28
Q

Is Edrophonium’s duration of action longer than that of Neostigmine?

A

No – It’s shorter

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29
Q

What is the typical IV dose range of Edrophonium for neuromuscular blockade reversal?

A

0.5-1.0 mg/kg

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30
Q

What is the onset time for Edrophonium?

A

Within 30 seconds to 2 minutes

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31
Q

What is the approximate duration of action of Edrophonium?

A

10–30 minutes

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32
Q

What is the mechanism of action of Edrophonium?

A

It is a reversible acetylcholinesterase inhibitor, increasing acetylcholine at the neuromuscular junction

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33
Q

Why is Atropine preferred over Glycopyrrolate when co-administered with Edrophonium?

A

Because Atropine has a quicker onset, matching Edrophonium’s rapid onset

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34
Q

What diagnostic test uses Edrophonium and what condition does it evaluate?

A

The Tensilon test for diagnosing Myasthenia Gravis

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35
Q

List two common side effects of Edrophonium.

A
  • Bradycardia
  • Increased salivation
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36
Q

When is Edrophonium not ideal for reversal of neuromuscular blockade?

A

When blockade is deep or complete—it’s best when some spontaneous recovery has occurred

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37
Q

What is the usual IV dose of Atropine in adults?

A

0.01-0.03 mg/kg

38
Q

What is the maximum cumulative dose of Atropine for treating bradycardia?

39
Q

What is the typical onset time of IV Atropine?

A

30–60 seconds

40
Q

How long does Atropine’s effect usually last when given IV?

A

30–60 minutes

41
Q

Which of the following is a major clinical use of Atropine?

A

Management of bradycardia

42
Q

What is Atropine’s primary mechanism of action?

A

Muscarinic receptor antagonism

43
Q

In which scenario is Atropine most commonly used during anesthesia?

A

Reversal of neuromuscular blockade, paired with anticholinesterase

44
Q

Does Atropine increase parasympathetic nervous system activity?

A

No – It blocks parasympathetic activity

45
Q

Does Atropine cross the blood-brain barrier?

46
Q

Should Atropine be administered slowly in cases of bradycardia to avoid paradoxical effects?

47
Q

Is Atropine contraindicated in patients with glaucoma?

A

Yes – Especially narrow-angle glaucoma

48
Q

Does Atropine cause miosis (pupil constriction)?

A

No – It causes mydriasis (pupil dilation)

49
Q

What is the standard adult IV dose of Atropine for bradycardia?

A

0.5 mg IV every 3–5 minutes, up to a total of 3 mg

50
Q

What is the onset of action of Atropine given IV?

A

Approximately 30–60 seconds

51
Q

How long do the effects of IV Atropine last?

A

30–60 minutes

52
Q

What is the mechanism of action of Atropine?

A

It competitively inhibits muscarinic acetylcholine receptors, reducing parasympathetic tone

53
Q

Why is Atropine administered with Edrophonium during neuromuscular blockade reversal?

A

To counteract muscarinic side effects like bradycardia and salivation due to increased acetylcholine

54
Q

List two common side effects of Atropine.

A
  • Dry mouth
  • Tachycardia
55
Q

Name a surgical situation in which Atropine might be used.

A

During reversal of non-depolarizing neuromuscular blockade or to treat bradycardia during anesthesia

56
Q

What are signs of Atropine overdose?

A
  • Flushed skin
  • Dry mouth
  • Blurred vision
  • Tachycardia
  • Confusion
  • Hallucinations
57
Q

What are some non-clinical uses of Atropine?

A

Treat organophosphate poisoning and nerve gas exposure

58
Q

What is the typical IV dose of Glycopyrrolate given with neostigmine for neuromuscular blockade reversal in adults?

A

0.2 mg per 1 mg of neostigmine (typically 0.01-0.02 mg/kg)

59
Q

What is the usual onset time of Glycopyrrolate when administered IV?

A

2–3 minutes, but full effect may take up to 5 minutes

60
Q

What is the duration of action of Glycopyrrolate when given IV?

A

2–4 hours

61
Q

What is the primary mechanism of action of Glycopyrrolate?

A

Blocks muscarinic acetylcholine receptors

62
Q

Which of the following is a clinical use of Glycopyrrolate?

A

Antisialogogue before surgery

63
Q

Why is Glycopyrrolate preferred over Atropine in many surgical settings?

A

Does not cross the blood-brain barrier, so fewer CNS effects

64
Q

Is Glycopyrrolate commonly used to reduce secretions in the airway?

65
Q

Does Glycopyrrolate cross the blood-brain barrier?

66
Q

Can Glycopyrrolate cause dry mouth and blurred vision as side effects?

67
Q

Is Glycopyrrolate used to potentiate neuromuscular blockade?

A

No – It is used to reverse muscarinic effects during reversal of neuromuscular blockade

68
Q

Is Glycopyrrolate a cholinesterase inhibitor?

A

No – It is an antimuscarinic agent

69
Q

What is the typical IV dose of Glycopyrrolate?

A

0.01-0.02 mg/kg

70
Q

What is the onset time of Glycopyrrolate IV?

A

2–3 minutes

71
Q

What is the duration of action of Glycopyrrolate?

A

2–4 hours

72
Q

What is the primary mechanism of action of Glycopyrrolate?

A

It is a competitive antagonist of muscarinic acetylcholine receptors, reducing parasympathetic activity

73
Q

List two clinical uses of Glycopyrrolate.

A
  • Reduction of secretions (antisialogogue)
  • Prevention of bradycardia during neuromuscular blockade reversal
74
Q

Why is Glycopyrrolate preferred over Atropine in CNS-sensitive patients?

A

Because it does not cross the blood-brain barrier, reducing the risk of CNS side effects such as confusion

75
Q

Name two common side effects of Glycopyrrolate.

A
  • Dry mouth
  • Tachycardia
76
Q

In which perioperative scenario would you administer Glycopyrrolate?

A

To reduce airway secretions before intubation or to counteract bradycardia and muscarinic effects during reversal of non-depolarizing neuromuscular blockade

77
Q

What differentiates Glycopyrrolate from other anticholinergics like Scopolamine?

A

Glycopyrrolate does not cross the blood-brain barrier, leading to fewer CNS side effects

78
Q

What is the mechanism of action of Sugammadex?

A

Encapsulation of aminosteroid neuromuscular blockers

79
Q

Which neuromuscular blocking agents does Sugammadex primarily reverse?

A

Rocuronium and Vecuronium

80
Q

What is the typical onset of action for Sugammadex after IV administration?

A

1–3 minutes

81
Q

What is the recommended Sugammadex dose for immediate reversal of a high dose of Rocuronium?

A

2 mg/kg, 4 mg/kg, or 16 mg/kg (16 for the high dose)

82
Q

Which of the following is a potential side effect of Sugammadex?

A

Bradycardia

83
Q

Does Sugammadex reverse both depolarizing and non-depolarizing neuromuscular blockers?

A

No - It reverses non-depolarizing aminosteroid NMBAs only, like Rocuronium and Vecuronium

84
Q

Does Sugammadex have minimal cardiovascular effects compared to neostigmine?

85
Q

Does the use of Sugammadex eliminate the need for co-administration of anticholinergic agents?

86
Q

Is Sugammadex ineffective against Benzylisoquinolinium NMBAs like Cisatracurium?

87
Q

Sugammadex works by increasing acetylcholine concentrations at the neuromuscular junction?

88
Q

What is the mechanism of action of Sugammadex?

A

Sugammadex encapsulates and inactivates aminosteroid neuromuscular blocking agents such as rocuronium and vecuronium, removing them from the neuromuscular junction

89
Q

What is the recommended dose of Sugammadex for moderate blockade reversal (TOF 2/4)?

A

2 mg/kg IV

90
Q

When is Sugammadex preferred over Neostigmine for reversal of neuromuscular blockade?

A

In cases where rapid and complete reversal is desired, particularly with aminosteroid NMBAs, or when avoiding anticholinergic side effects is important

91
Q

List two common side effects of Sugammadex.

A
  • Bradycardia
  • Hypotension
92
Q

What is the duration of action of Sugammadex?

A

Approximately 2–3 hours, depending on dose and renal function

NSU AA Denver Drugs and Inhalational Agents (17 decks)

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