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What are the clinical uses for neuromuscular blockers?
- Facilitate tracheal intubation
- Improve surgical working conditions
- Mechanical ventilation of lungs
- Treat laryngospasm
What do neuromuscular blockers do?
Interrupt transmission of nerve impulses at NMJ (postsynaptic receptor)
What are the two types of NMBs?
- Depolarizing or nondepolarizing
- Depolarizing: bind to/activates receptor (succinylcholine for example)
- Non depolarizing: bind to and block the receptor so that acetylcholine can not bind
What is the brand name for Succinylcholine?
What class of drug is Sux?
What is Sux?
2 acetylcholine molecules stacked end-to-end
How is Sux used?
What is the supplied concentration of Sux?
What is the intubation dose for Sux?
What is the laryngospasm concentration of Sux?
What is the onset of Sux?
What is the duration of action of Sux?
What are fasciculations?
- involuntary muscle twitches/contractions that are visible under the skin
- a clue that the Sux has become effective
What will prevent the fasciculations seen in Sux?
A small dose of rocuronium (5-10mg)
How is Sux metabolized?
By plasma cholinesterase- not dependent on liver or kidneys
What are Sux adverse effects?
- Hyperkalemia (increased blood postassium)
- Myalgia (muscle pain/soreness)
What is the brand name for Rocuronium?
What class of drug is rocuronium?
What is Roc used for?
- to induce paralysis
- For RSI
What is the onset for Roc?
1-2 minutes (can be faster if higher dose is given)
How long dose Roc last?
What is the metabolism of Roc?
Liver and kidneys
What is the intubation dose for Roc?
The maintenance dose?
The infusion dose?
- Maintenance: 0.1mg/kg
- Infusion: 5-12mcg/kg/min
What is the brand name for Vecuronium?
What class of drug is Vec?
What is Vec used for?
How is Vec supplied?
10mg powder vial reconstitued to 1mg/mL
What is the onset of Vec?
What is the duration of Vec?
How is Vec metabolized?
Liver and Kidneys
What are the doses of Vec?
- Intubation: 0.08-0.12mg/kg
- Infusion: 1-2mcg/kg/min
- Maintenance: 0.01mg/kg
What is the brand name for Cisatracurium?
What class of drug is cisatracurium?
Benzyl isoquinolinium, non-depolarizing
What is cisatracurium used for?
What is the supplied concentration of cisatracurium?
20mg vial (2mg/mL)
What is the dose of cisatracurium?
- Intubation: 0.1-0.15mg/kg
- Infusion: 1-2mcg/kg/min
What is the onset of cisatracurium?
What is the duration of cisatracurium?
Why would one want Cisatracurium over Rocuronium?
Cisatrascurium is good for patients with renal and hepatic dysfunction
- Pancuronium: 0.1mg/kg
- Vecuronium: 0.08-0.1 mg/kg
- Rocuronium: 0.6-1.2mg/kg
- Cisatracurium: 0.1mg/kg
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