Exam 4 Reversals

Question 1

What type of drugs are edrophonium & neostigmine?

Answer 1

Competitive antagonists

Question 2

What causes the side effects of NMBD reversal agents?

Answer 2

Their binding to preganglionic SNS & PNS sites

Question 3

What is the dose for neostigmine?

Answer 3

40 – 70 mcg/kg Max of 5 mg

Question 4

What is the dose for edrophonium?

Answer 4

1-1.5 mg/kg

Question 5

What is given in conjunction with neostigmine & its dose?

Answer 5

Glycopyrrolate 0.2 mg per mL of Neostigmine

Question 6

What NMB agent is given for Pts with hepatic or renal failure?

Answer 6

• Cisatracurium or atracurium.
• They are cleared via Hoffmann elimination

Question 7

Which has a higher renal clearance, neostigmine or edrophonium?

Answer 7

Edrophonium 75% vs 50%

Question 8

What are the pulmonary side effects with NMBD reversal agents?

Answer 8

• Bronchoconstriction
• increased airway resistance & salivation

Question 9

What are the CV side effects with NMBD reversal agents?

Answer 9

• Bradycardia
• dysrhythmias
• asystole
• decreased SVR

Question 10

Which reversal agent is preferred in someone with cardiac disease?

Answer 10

• Neostigmine & glycopyrrolate
• Administer slowly over 2-5mins

Question 11

What happens to AChE in persistent NM blockade?

Answer 11

AChE is maximally inhibited & ineffective

Question 12

What other reversal works with Mivacurium?

Answer 12

Purified human plasma cholinesterase

Question 13

What is the MOA of sugammadex?

Answer 13

Thru Hydrogen bonds, intermolecular forces & hydrophobic interactions encapsulates NMBD

Question 14

What is the route of elimination of sugammadex & when do you not give it?

Answer 14

• 70% eliminated via urine in 6hrs.
• Do not give to someone on dialysis.
• It is not cleared via dialysis.

Question 15

What is the sugammadex dose w/ 2 of 4 twitches? What about 0 of 4?

Answer 15

• T2= 2 mg/kg.
• T0= 4 mg/kg

Question 16

What is the sugammadex dose for extreme blockades?

Answer 16

8-16 mg/kg

Question 17

Sugammadex works with which NMBD?

Answer 17

• Rocuronium & vecuronium.
• It can work on light Pancuronium doses

Question 18

What reversal works faster, neostigmine or sugammadex?

Answer 18

Sugammadex

Question 19

What is/are the CV side effect/s of sugammadex?

Answer 19

Marked bradycardia

Question 20

A Pt needs to be emergently re-intubated after just being reversed with sugammadex. What NMBD would you give?

Answer 20

• Cisatracurium or any benzylisoquinoline.
• You would have to wait 5mins before being able to give rocuronium 1.2 mg/kg.

Question 21

What are the S/S of recurarization?

Answer 21

• Decreased O2 sats
• Unresponsive, floppy, or uncoordinated Pt.
• Ineffective abdominal & intercostal activity

Question 22

What are the onsets & duration of edrophonium & neostigmine?

Answer 22

• Onset & duration edrophonium= 1-2mins & 5-15mins.
• Onset & duration neostigmine= 5-10mins & 60mins