Pancuronium Mivacurium

Nondepolarizing Blockers d-Tdbocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium, and Rapacuronium... 

By competition with acetylcholine (atracurium, cisatracurium, mivacurium, pancuronium, rocuro-nium, vecuronium). These drugs are competitive antagonists of acetylcholine. They do not cause depolarisation themselves but protect the endplate from depolarisation by acetylcholine. The result is a flaccid paralysis. 

Clinically important, potentially hazardous interactions with cisatracurium, doxacurium, mivacurium, pancuronium, rapacuronium... 

The effects of cisatracurium, mivacurium, pancuronium, rocuro-nium, tubocurarine, vecuronium, and probably other competitive neuromuscular blockers can be increased and prolonged by magnesium sulfate given parenterally. There is some evidence that magnesium may interact similarly with suxamethonium (succinylcholine), but also evidence from well-controlled trials that it does not. 

Vecuronium Rocuronium Pancuronium Atracurium Cis-atracurium Mivacurium Gallamine Tubocurare... 

Agent Tubocuranine Pancuronium Vecuronium Atracurium Rocuronium Cisatracurium Mivacurium Cis-trans isomer Trans-trans isomer C/s-c/s isomer... 

Clinically important, potentially hazardous interactions with aminophylline, atracurium, cisatracurium, doxacurium, epinephrine, ergometrine, mivacurium, non-depolarizing muscle relaxants, oxprenolol, oxytocin, pancuronium, rapacuronium, rifampin, vecuronium, xanthines... 

NMBAs are further differentiated by their duration of action during anesthesia. Succinylcholine and mivacurium are common ultra-short-acting competitive NMBAs (5-10 min). An intermediate duration of action (30-45 min) is maintained with the use of atracurium, cisatracurium, rocuronium and vecuronium. A long-lasting duration of action (90-100 min) is observed with d-tubocurarine, doxacurium, metocurine, pancuronium and pipecuronium. 

The skeletal muscle reiaxants provide muscle relaxation and/or immobility via N-receptor interactions. Most including d-tubocurarine, pancuronium, atracurium, and mivacurium, are competitive and nondepolarizing and can be reversed by AChE inhibitors. Succinylcholine is a depolarizing, noncompetitive agonist. 

Atracurium, doxacurium, pancuronium, pipecuronium, d-tubocurarine, mivacurium. and metocurine are examples of nondepolarizing blockers. 

Pharmacokinetics All agents are given parenterally. Drugs that are metabolized (eg, mivacurium, by plasma cholinesterase) or eliminated in the bile (eg, vecuronium) usually have shorter durations of action than those eliminated by the kidney (eg, doxacurium, pancuronium, tubocurarine). Atracurium clearance involves spontaneous breakdown (Hofmann elimination) to form laudanosine and other products is largely independent of hepatic or renal function. 

Anticipate the need to use more (possibly up to twice as much) doxacu-rium, metocurine, pancuronium, pipecuronium, rocuronium and vecuronium in patients who have taken these antiepileptics for more than a week, and expect an accelerated recovery. The effects on tubocurarine and atracurium appear only to be small or moderate, whereas mivacurium appears not to interact. 

Motamed C, Menad R, Farinotti R, Kirov K, Combes X, Bouleau D, Feiss P, Duvaldestin P. Potentiation of mivacurium blockade by low dose of pancuronium. A pharmacokinetic study. Anesfftesiology (2003) 98,1057-62. 

Erkola 0, Rautoma P, Meretoja OA, Mivacurium when preceded by pancuronium becomes a long-acting muscle relaxant. Anesthesiology (1996) 84,562-5,... 

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