Reversal Agents - Sugammadex Flashcards
Sugammadex
(Used at ARMC if you have 0/4 twitches and case is done or when infiltration of IV is seen after reversing)
Intense – period of no response, 3 – 6 minutes after intubating dose of non-depolarizing NMBD
Neostigmine reversal impossible; high dose of sugammadex (16 mg/kg) for reversal
Deep – absence of TOF but presence of at least one response to post-tetanic count stimulation
Neostigmine reversal usually impossible; dose of sugammadex (4 mg/kg) for reversal
Moderate – gradual return of the 4 responses to TOF stimulation appears
Neostigmine reversal after 4/4 TOF; dose of sugammadex (2 mg/kg) for reversal
What is the recommended dose of Sugammadex if the patient is experiencing a intense neuromuscular block after recent neuromuscular blocking drug (NMBD) administration?
A) 2 mg/kg
B) 4 mg/kg
C) 8 mg/kg
D) 16 mg/kg
D) 16 mg/kg
Ericksen
Intense – period of no response, 3 – 6 minutes after intubating dose of non-depolarizing NMBD
Neostigmine reversal impossible; high dose of sugammadex (16 mg/kg) for reversal
Deep – absence of TOF but presence of at least one response to post-tetanic count stimulation
Neostigmine reversal usually impossible; dose of sugammadex (4 mg/kg) for reversal
Moderate – gradual return of the 4 responses to TOF stimulation appears
Neostigmine reversal after 4/4 TOF; dose of sugammadex (2 mg/kg) for reversal
What adverse effect can occur if Sugammadex is pushed too quickly via IV?
A) Hypertension
B) Bradycardia
C) Hypotension (HoTN)
D) Tachycardia
C) Hypotension (HoTN)
When would you administer Sugammadex at a dose of 2 mg/kg?
A) When there are 2 twitches in the train-of-four (TOF) count
B) When there is 1 post-tetanic twitch
C) When the patient is under deep neuromuscular block
D) When the patient has 0/4 twitches in TOF count
A) When there are 2 twitches in the train-of-four (TOF) count
What is the primary mechanism of action of Sugammadex?
A) Competitive inhibition at nicotinic acetylcholine receptors
B) Enzymatic breakdown of neuromuscular blocking drugs (NMBDs)
C) Encapsulation and inactivation of aminosteroid NMBDs, forming a water-soluble complex
D) Reversal of benzylisoquinolinium-induced neuromuscular block
C) Encapsulation and inactivation of aminosteroid NMBDs, forming a water-soluble complex
MOA: Encapsulates and inactivates aminosteroid NMBDs (Roc>Vec); results in formation of water-soluble complex; reverses profound aminosteroid-induced block
You encounter a patient with 1 post-tetanic twitch after a neuromuscular block. What is the appropriate dose of Sugammadex for reversal?
A) 2 mg/kg
B) 4 mg/kg
C) 8 mg/kg
D) 16 mg/kg
B) 4 mg/kg
What is the onset time of Sugammadex when administered intravenously?
A) 1 minute
B) 3 minutes
C) 5 minutes
D) 10 minutes
B) 3 minutes
Tx Wes Reference:
1-4 min
Which concentration of Sugammadex is available for use?
A) 50 mg/mL
B) 100 mg/mL
C) 150 mg/mL
D) 200 mg/mL
B) 100 mg/mL
What is the half-life of Sugammadex in patients with normal renal function?
A) 30 minutes
B) 2 hours
C) 6 hours
D) 19 hours
B) 2 hours
½ Life: 2 hours (depends on renal function; up to 19 hours in severe impairment)
How is Sugammadex primarily eliminated from the body?
A) Metabolized by the liver
B) Excreted in bile
C) Mostly excreted unchanged in urine
D) Metabolized by the kidneys
C) Mostly excreted unchanged in urine
Elimination: No metabolites; mostly excreted unchanged in urine;
70% out in 6 hours
90% out by 24 hours;
What percentage of Sugammadex is eliminated within 6 hours after administration?
A) 50%
B) 70%
C) 90%
D) 100%
B) 70%
What type of molecule is Sugammadex classified as?
A) Gamma-Cyclodextrin
B) Beta-Blocker
C) Cholinesterase inhibitor
D) Neuromuscular blocking agent
A) Gamma-Cyclodextrin
How long does it take for 90% of Sugammadex to be excreted from the body in patients with normal renal function?
A) 6 hours
B) 12 hours
C) 24 hours
D) 48 hours
C) 24 hours
Sugammadex is contraindicated in which of the following scenarios? (Select 2)
A) Hypersensitivity to Sugammadex
B) Hypersensitivity to cyclodextrins
C) Renal impairment
D) Hepatic failure
A) Hypersensitivity to Sugammadex
B) Hypersensitivity to cyclodextrins
C/I: In hypersensitivity to Sugammadex (0.3%) in past or cyclodextrins.
