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
Adjuncts to general anesthetics to facilitate endotracheal intubation and relax skeletal muscle; to relax skeletal muscle to facilitate mechanical ventilation
Contraindications and Cautions
Contraindicated with hypersensitivity to NMJ blockers and the bromide ion.
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
CV: Increased heart rate
Hypersensitivity: Hypersensitivity reactions, especially rash
Musculoskeletal: Profound and prolonged muscle paralysis
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