Non-depolarizing NMJs

Drug order Mechanism of Indication Contraindication Drug effects Nursing

action Responsibilities
Generic name: It antagonizes Indicated as • Systemic Side effects: Monitor the
Atracurium besylate the an addition mastocytosis ✓ Skin flushing or ✓ ECG
neurotransmitter to general • High amount redness ✓ HR
action of anesthesia of ✓ Injection site ✓ BP
Brand name: acetylcholine by to facilitate magnesium reactions throughout the
Tracrium binding endotracheal in the blood ✓ Hives administration.
competitively intubation • Low amount ✓ Itching
Classification: with cholinergic and provide of calcium in ✓ Wheezing Observe the
Benzylisoquinolinium receptor sites on skeletal the blood patient for
class the motor end- muscle • Low Adverse effects: residual muscle
plate. relaxation amount of ✓ Shortness of weakness and
Dose: 10 mg/mL during potassium in breath respiratory
surgery or the blood ✓ Allergic distress during
Route: Intravenous mechanical • Myasthenia reactions the recovery
injection ventilation. gravis, a ✓ Inadequate period.
skeletal musculoskeletal
Frequency: 0.1 to muscle block Monitor
0.2 mg/kg disorder ✓ Low BP infusion site
• Progressive ✓ Fast or slow HR frequently.
muscle
weakness If signs of tissue
with irritation or
carcinoma extravasation
• Low BP occur,
• Low Body discontinue and
temperature restart in
another vein.

Drug order Mechanism of Indication Contraindication Drug effects Nursing

action Responsibilities
Generic name: It acts as a Nimbex is • myasthenia Side effects: Monitor ECG,
Cisatracurium competitive indicated as gravis, a • slow heart heart rate, and
antagonist to an adjunct to skeletal rate BP throughout
Brand name: acetylcholine; general muscle administration.
• dizziness
Nimbex acetylcholinesterase anesthesia to disorder.
inhibitors such as facilitate • flushing Observe the
• a disease of
Classification: neostigmine tracheal (warmth, patient for
the lung.
Nondepolarizing antagonize this intubation in redness, or residual muscle
• a condition tingly feeling).
Neuromuscular action. The adults and in weakness and
with high
Blocker neuromuscular pediatric Adverse effects: respiratory
fevers and
blocking potency of patients 1
muscle • Bronchospasm distress during
Dose: 2mg/mL cisatracurium is • Bradycardia
contractions
 roughly three times month to 12 called • Flushing the recovery
Route: IV Injection that of atracurium years of age. malignant • Pruritus period.
hyperthermia. • Myositis Monitor infusion
Frequency: To provide ossificans site frequently.
0.02 mg/kg skeletal • Hypotension If signs of tissue
muscle • Rash irritation or
relaxation in extravasation
adults during occur,
surgical discontinue and
procedures or restart in
during another vein.
mechanical
ventilation in
the ICU

To provide
skeletal
muscle
relaxation
during
surgical
procedures
via infusion in
pediatric
patients 2
years and
older
 Drug order Mechanism of Indication Contraindication Drug effects Nursing
action Responsibilities
Generic name: It acts as a include Side effects: Assess
• low
Pancuronium competitive laryngeal • increased saliva cardiovascular
amount of
Bromide acetylcholine muscle • skeletal muscle and respiratory
antagonist on relaxation that magnesium weakness status
in the
Brand name: neuromuscular facilitates • drooling continuously.
blood
Pavulon junctions, displacing endotracheal • rash
acetylcholine (hence intubation, • low Adverse effects Observe patient
Classification: competitive) from its skeletal amount of • bronchospasm closely for
Muscle relaxant post-synaptic muscle calcium in • flushing residual muscle
nicotinic relaxation to the blood • redness weakness and
Dose: 1 mg/mL acetylcholine support • low blood signs of
2 mg/mL receptors it is a optimal • acidosis, a pressure respiratory
muscle relaxant surgical high level • high blood distress during
Frequency: 60 similar to curare conditions and of acid in pressure recovery period.
micrograms/kg exposure, and the blood
• rapid heartbeat.
every 1 to 1/2 chest wall and Monitor BP and
hours diaphragmatic • low vital signs.
muscle amount of Peripheral
relaxation to potassium
nerve
improve in the stimulator may
thoracic blood be used to
compliance in • overweight assess the
mechanically effects of
ventilated • myasthenia pancuronium
patients. gravis, a and to monitor
skeletal restoration of
muscle neuromuscular
disorder function.
• decreased
ability of
heart to
pump

• a disease
of the lung

• liver
problems

• complete
blockage of
a bile duct

• kidney
failure

•
• decreased
kidney
function

• visible
water
retention

• decreased
oxygen in
the tissues
or blood

• weakened
patient

• multiple
carcinomas
at the
same time
 Drug order Mechanism Indication Contraindication Drug effects Nursing
of action Responsibilities
Generic name: It is indicated for Side effects: Monitor ECG,
• low amount
Rocuronium inpatients and • hives, heart rate, and
bromide outpatients as an of BP throughout
adjunct to magnesium • difficulty administration.
Brand name: general anesthesia to in the blood
breathing,
Zemuron facilitate both rapid • low amount • swelling of Observe the
sequence and of calcium in your face, lips, patient for
Classification: routine the blood tongue, or residual muscle
Neuromuscular tracheal intubation, throat, weakness and
Blocker, and to provide • acidosis, a • severe respiratory
Nondepolarizing skeletal muscle high level of dizziness, distress during
relaxation during acid in the • ongoing muscle the recovery
Dose: surgery blood weakness, and period.
10mg/mL or mechanical • loss of
ventilation. • respiratory Monitor infusion
movement in
acidosis, an any part of site frequently. If
Route: acid-base your body signs of tissue
Intravenous disorder irritation or
Injection • alkalosis Adverse effects: extravasation
occur,
Frequency: • respiratory • Transient discontinue and
0.6 mg/kg alkalosis, an hypotension restart in another
acid-base • Hypertension vein.
imbalance of • Dose-related
the blood tachycardia
• low amount • Apnea
of potassium • Abnormal ECG
in the blood • Injection site
edema
• myasthenia • Hiccups
gravis, a • Pruritus
skeletal • Nausea
muscle • Wheezing
disorder • Residual
• progressive muscle
muscle weakness
weakness • Allergic or
with idiosyncratic
carcinoma hypersensitivity
reactions
• pulmonary
hypertension

• liver
problems
• decreased
kidney
function

• a condition
with high
fevers and
muscle
contractions
called
malignant
hyperthermia
 Drug order Mechanism of Indication Contraindication Drug effects Nursing
action Responsibilities
Generic name: Vecuronium is a It is indicated Side effects: Monitor:
Vecuronium nondepolarizing as an adjunct • low amount ✓ hourly
of • Bronchospasm
agent that achieves to general heart rate
Brand name: its skeletal muscle anesthesia, to magnesium ✓ blood
• Hypotension
Norcuron paralysis by facilitate in the blood pressure
competing with endotracheal • Edema ✓ oxygenation
• low amount
Classification: acetylcholine for intubation and saturation
of calcium in • Sinus
Neuromuscular cholinergic receptor to provide the blood during
tachycardia
Blockers, sites and binding skeletal muscle muscle
Nondepolarizing with the nicotinic relaxation • low amount Adverse effects: relaxation.
cholinergic receptor during surgery of potassium Ensure adequate
Dose: at the or mechanical in the blood • Erythema analgesia and/or
10mg postjunctional ventilation. • Urticaria sedation. Remain by
20mg membrane. • myasthenia the bedside until
gravis, a • Flushing effects of IV bolus
Route: skeletal Vecuronium are
muscle • Pruritus
Intravenous complete or the IV
injection disorder infusion has been
• Skin rash
• progressive running for at least
Frequency: 0.1 muscle 30 minutes.
mg/kg to 0.2 weakness
mg/kg in less than with
2 to 3 minutes carcinoma

• disease
affecting
muscles and
nerves

• hardening of
the liver

• blockage of
normal bile
flow

• morbid
obesity
 Depolarizing NMJ
Drug order Mechanism Indication Contraindication Drug effects Nursing
of action Responsibilities
Generic name: It adheres It is • Hyperkalemia Side effects: Monitor symptoms
Succinylcholine with post- indicated • Bedridden patients ✓ jaw rigidity of:
chloride synaptic as an • Rhabdomyolysis ✓ hypotension ✓ hyperkalemia
cholinergic adjunct to • Muscle trauma ✓ muscle ✓ bradycardia
Brand name: receptors of general • Burns fasciculation ✓ fatigue
Anectine and the motor anesthesia, • Infusion of which may ✓ weakness
Suxamenthonium endplate to neuromuscular result in ✓ numbness
inducing facilitate blocking agents postoperative ✓ tingling
continuous tracheal • Acute renal failure pain
Classification: disruption intubation • Chronic renal failure ✓ apnea Notify physician
Neorumuscular that results and to • Intraocular ✓ respiratory immediately if severe
Blockers, in provide hypertension, depression cases occur as it may
Depolarizing involuntary skeletal ✓ salivary gland lead to life-
• intracranial
muscle and enlargement threatening
hypertension
contractions muscle arrythmias and
• statin use
Dose: and relaxation Adverse effects: paralysis.
• malignant
• 20 subsequent during ✓ bradycardia
hyperthermia
mg/mL skeletal surgery or ✓ cardiac
• neuromuscular
• 100 muscle mechanical arrythmias
disease
mg/mL paralysis. ventilation. ✓ sinus
• spinal cord sectioning tachycardia
• bradycardia ✓ increased IOP
< 50 bpm ✓ excessive
Route:
Intravenous/ • succinylcholine salivation
Intramascular allergy ✓ rash
injection • pseudocholinesterase ✓ hypersensitivity
deficiency reaction
✓ myoglobinuria/
Frequency: 2.5 myoglobinemia
and 4.3 mg/min (rare)
References:

https://reference.medscape.com/drug/atracurium-343103

https://reference.medscape.com/drug/nimbex-cisatracurium-343104

https://www.rxlist.com/nimbex-drug.htm#indications

https://reference.medscape.com/drug/pancuronium-343108

http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/P006.html

https://www.rxlist.com/zemuron-drug.htm#indications

https://reference.medscape.com/drug/zemuron-rocuronium-343109#4

https://www.webmd.com/drugs/2/drug-94222/rocuronium-intravenous/details/list-contraindications

https://reference.medscape.com/drug/vecuronium-
343110#:~:text=Norcuron%20(vecuronium)%20dosing%2C%20indications,interactions%2C%20adverse%
20effects%2C%20and%20more

https://www.webmd.com/drugs/2/drug-12359/vecuronium-bromide-intravenous/details/list-
contraindications

https://www.ncbi.nlm.nih.gov/books/NBK493143/

https://www.rxlist.com/consumer_succinylcholine_anectine_quelicin/drugs-condition.htm