Nondepolarizing Neuromuscular Junction Blockers (NMJ Blockers)
DANGEROUS DRUG
PREGNANCY CATEGORY C
Therapeutic Actions
NMJ blockers interfere with neuromuscular transmission and cause flaccid paralysis by blocking acetylcholine receptors at the skeletal neuromuscular junction.
Indications
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Adjuncts to general anesthetics to facilitate endotracheal intubation and relax skeletal muscle; to relax skeletal muscle to facilitate mechanical ventilation
Contraindications and Cautions
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Contraindicated with hypersensitivity to NMJ blockers and the bromide ion.
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Use cautiously with myasthenia gravis; pregnancy (teratogenic in preclinical studies; may be used in cesarean section, but reversal may be difficult if patient has received magnesium sulfate to manage preeclampsia); renal or hepatic disease, respiratory depression, altered fluid or electrolyte balance; patients in whom an increase in heart rate may be dangerous.
Adverse Effects
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CV: Increased heart rate
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Hypersensitivity: Hypersensitivity reactions, especially rash
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Musculoskeletal: Profound and prolonged muscle paralysis
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