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STUDY GUIDE 1 - Reversal Agents

1. Reversal agents are drugs used to reverse the effects of anesthetics, narcotics, or potentially toxic agents. Common reversal agents include neostigmine, edrophonium, and pyridostigmine, which are anticholinesterases that increase the effects of acetylcholine to speed recovery from muscle relaxants. 2. While reversal agents help speed recovery of muscle function, they can also cause side effects by stimulating muscarinic cholinergic receptors. These side effects include bradycardia, bronchoconstriction, and increased secretions. Anticholinergic drugs like atropine or glycopyrrolate given with the reversal agent can selectively block the unwanted side effects.

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102 views4 pages

STUDY GUIDE 1 - Reversal Agents

1. Reversal agents are drugs used to reverse the effects of anesthetics, narcotics, or potentially toxic agents. Common reversal agents include neostigmine, edrophonium, and pyridostigmine, which are anticholinesterases that increase the effects of acetylcholine to speed recovery from muscle relaxants. 2. While reversal agents help speed recovery of muscle function, they can also cause side effects by stimulating muscarinic cholinergic receptors. These side effects include bradycardia, bronchoconstriction, and increased secretions. Anticholinergic drugs like atropine or glycopyrrolate given with the reversal agent can selectively block the unwanted side effects.

Uploaded by

Yuanita Lavinia
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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STUDY GUIDE #1: REVERSAL AGENTS= ANTIMUSCLE RELAXANTS


Reversal Agents
A reversal agent is any drug used to reverse the effects of anesthetics, narcotics or potentially toxic agents. Examples: Antilirium,
digibind, mestinon, narcan, neostigmine, protopam, pyridostigmine, romazicon, tensilon.

As patients emerge from anesthesia, they need to breathe autonomously, swallow normally, cough and clear lung secretions, and sit up.
To do these things, almost all the effects of neuromuscular blockers must be gone. However, on their own, muscle relaxants wear off
slowly. Therefore, after surgery, the anesthesiologist usually gives an "anti-muscle relaxant," a reversal agent. Reversal agents
anticholinesterases such as edrophonium (Enlon), neostigmine (Prostigmine), and pyridostigmine (Mestinon)increase the signaling
effect of the body's acetylcholine by slowing its normal breakdown.
Reversal agents are effective at speeding up patients' abilities to uses their muscles. Unfortunately, the reversal agents can cause their
own side effects: bradycardia, narrowing of the bronchi, contraction of intestinal muscles, and excess salivary and bronchial
secretions. These side effects are caused by stimulation of the muscarinic form of the cholinergic receptors, while the reversal effects
are cause by stimulation of the nicotinic form of the cholinergic receptors. Therefore, the unwanted side effects can be selectively
blocked by administering muscarinic anticholinergic drugs (atropine or glycopyrrolate) along with the reversal agent.
Drug side effects can be reported to the FDA at 1-800-FDA-1088
DRUG

DRUG INFO
0.4 mg/ml

ATROPINE
amine anticholinergic

DOSE: 15-70mcg/kg
ONSET: 15-30 s
PEAK: 2 m
DURATION: 1-2 hrs

REVERSAL AGENT FOR

DRUG

DRUG INFO

REVERSAL AGENT FOR

0.2 mg/ml
ROBINUL
(glycopyrrolate)
anticholinergic
NARCAN
(naloxone)

-ENLON
(TENSILON)=(Plain
Enlon, without Atropine)

DOSE: 10-20 mcg/kg


ONSET: 1m
PEAK: 5m
DURATION: 2-4hrs
0.4 mg/ml

-OPIOID ANTAGONIST (EX. Morphine; Versed


[Midazoliam] )

DOSE: 1-10mcg/kg
ONSET: 1-2m
PEAK: 5-15m
DURATION: 1-4hrs
-ANTICHOLINESTERASE
10mg/ml

DOSE: 0.5-1 mg/kg


ONSET: 30-60s
-ENLON PLUS=
PEAK: 1-5m
(Edrophonium + atropine); DURATION: 5-20m

- Edrophonium is indicated to reverse the


neuromuscular blockade produced by many
nondepolarizing agents, including atracurium,
gallamine, metocurine, mivacurium, pancuronium,
rocuronium, tubocurarine, and vecuronium

0.5-1 mg/ml
PROSTIGMINE
(neostigmine)

-ESTER ANTICHOLINESTERASE
DOSE: 0.04-0.07MG/KG
ONSET: 1-3m
PEAK: 5-7m
DURATION: 40-60m

DRUG

REGONAL OR
MESTINON
(pyridostigmine)

ROMAZICON
(flumazenil)

DRUG INFO

5 mg/ml
DOSE: 0.1-0.25mg/kg
ONSET: 2-5m
PEAK: 5-15m
DURATION: 90m
1 mg/ml

REVERSAL AGENT FOR

-ESTER
ANTICHOLINESTERASE

-BENZODIAZEPINE ANTAGONIST

DOSE:8-15 mcg/kg, 0.2mg typical adult


ONSET: 1-2m
PEAK: 6-10m
DURATION: 30-60m
Protamine sulphate neutralizes the anticoagulant
action of heparin: before surgery; after renal dialysis;
after open-heart surgery, if excessive bleeding occurs
and when an overdose has inadvertently been given.

PROTAMINE SULFATE

Below (pg. 4) is a list of reversal drugs not


commonly used in the O.R.
PHYSOSTIGMINE

Physostigmine is used to reverse CNS effects

DRUG

(ANTILIRIUM)

DIGIBIND (digoxin
immune FAB)

REVERSAL AGENT FOR


resulting from clinical or toxic dosages of drugs
(e.g., some antihistamines, antimuscarinics,
IV:
antiparkinsonian agents, phenothiazines) capable of
producing anticholinergic syndrome and from
0.52 mg; may repeat dose every 20 minutes until intoxication with certain plants (e.g., Atropa
response occurs or adverse cholinergic effects occur. belladonna [deadly nightshade], Brugmansia species
[angels trumpet], Datura stramonium [jimsonweed,
thorn apple, locoweed], Lantana camara.
Digoxin immune FAB is used as an antidote to treat
a life-threatening overdose of digoxin or digitoxin.

PROTOPAM (Pralidoxime
chloride)

Information Source: http://www.drugs.com/


(2011)

DRUG INFO

In the US, Pralidoxime (pralidoxime systemic) is a


member of the drug class antidotes and is used to
treat anticholinesterase overdose, nerve agent
poisoning and organophosphate poisoning (some
pesticides).

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