Workbook:

Neuromuscular Blockers Reversal Agents

Copyright 2016 APEX Anesthesia Review

AchE Inhibitors: MOA
How to AchE inhibitors reverse nondepolarizers? List 3 ways AchE can be inhibited:

1.

2.

3.

How do AchE inhibitors affect succinylcholine? What are the presynaptic effects of AchE inhibitors?
PK/PD
Edrophonium Neostigmine Pyridostigmine

Dose

Onset

Duration

Metabolism &
Elimination

Best Pairing

Key Facts:
Side Effects: AChE Inhibitors Side Effects: Antimuscarinics
D Atropine Scopolamine Glycopyrrolate

U
Increased HR
M

B Smooth muscle
relaxation
B
Sedation
E

L Antisialagogue

L
Mydriasis
S Cycloplegia

Why do these side effects occur? Prevents motion

induced nausea

Decreased gastric
H+ secretion

Discuss the chemical structures of these agents and relate this to their side effects.
Sugammadex
What NMBs are reversed by sugammadex? Which are not reversed?

What is the mechanism of action of sugammadex? (Relate this to its structure)

How is sugammadex an improvement over AChE inhibitors?

How is it dosed?

How is it metabolized? What are the risks?