Difference between revisions of "Vecuronium"
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{{Infobox drug reference | {{Infobox drug reference | ||
| trade_names = | | trade_names = Norcuron | ||
| drug_class = Neuromuscular blocker | | drug_class = Neuromuscular blocker | ||
| drug_class_color = neuromuscular_blocker | | drug_class_color = neuromuscular_blocker | ||
| uses = | | uses = Tracheal intubation, surgical relaxation, optimizing mechanical ventilation conditions, patients with ARDS | ||
| contraindications = | | contraindications = Known hypersensitivity | ||
| routes = Intravenous | | routes = Intravenous | ||
| dosage = | | dosage = | ||
| Line 11: | Line 11: | ||
| clearance = | | clearance = | ||
| halflife_elimination = | | halflife_elimination = | ||
| adverse_effects = | | adverse_effects = Anaphylactic reaction | ||
| metabolism = | | metabolism = Liver, bile, and renal | ||
| duration = | | duration = 40 | ||
| time_onset = | | time_onset = | ||
| dosage_calculation = vecuronium | | dosage_calculation = vecuronium | ||
| Line 44: | Line 44: | ||
* Prolonged duration of action in patients with cholestasis or cirrhosis | * Prolonged duration of action in patients with cholestasis or cirrhosis | ||
* | * Use in patients with renal failure | ||
==Pharmacology== | ==Pharmacology== | ||
| Line 76: | Line 62: | ||
* Anaphylactic reaction | * Anaphylactic reaction | ||
*Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm | |||
*Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately. | |||
*Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing. | |||
*Incomplete reversal of neuromuscular blocking agent leading to respiratory depression | |||
===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->=== | ===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->=== | ||
* Duration of action | * Duration of action after 1 x ED<sub>95</sub> is 40 minutes<ref name=":0">{{Citation|last=Lien|first=Cynthia A.|title=Neuromuscular Blockers and Reversal Drugs|date=2013|url=http://dx.doi.org/10.1016/b978-1-4377-1679-5.00019-3|work=Pharmacology and Physiology for Anesthesia|pages=325–348|publisher=Elsevier|access-date=2023-01-05|last2=Eikermann|first2=Matthias}}</ref> | ||
==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->== | ==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->== | ||
* 2-desmethyl derivative of pancuronium | * 2-desmethyl derivative of pancuronium<ref name=":0" /> | ||
*Supplied as crystalline particles that may be reconstituted with IV fluid<ref name=":1">{{Cite web|title=Login Selection - Lane Medical Library, Stanford University Medical Center|url=https://lane.stanford.edu/discoveryLoginPage.html?entityID=https%3A%2F%2Flane.stanford.edu%2Fshibboleth&return=https%3A%2F%2Flane.stanford.edu%2FShibboleth.sso%2FLogin%3FSAMLDS%3D1%26target%3Dss%253Amem%253Aafeae087fc51b2fb759e03714dfd19fe64f11fde03eebe29f6663b080e5d8858|access-date=2023-01-05|website=lane.stanford.edu}}</ref> | |||
==History<!-- Describe the historical development of the drug. -->== | ==History<!-- Describe the historical development of the drug. -->== | ||
First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice | |||
* First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice<ref name=":0" /> | |||
==References== | ==References== | ||
Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", ''Pharmacology and Physiology for Anesthesia'', Elsevier, pp. 325–348, retrieved 2023-01-05<ref name=":0" /> | |||
Anita Gupta, Nina Singh-Radcliff. ''Pharmacology in Anesthesia Practice''. Oxford University Press; 2013. Accessed January 5, 2023. <nowiki>https://search-ebscohost-com.laneproxy.stanford.edu/login.aspx?direct=true&db=nlebk&AN=603930&site=ehost-live</nowiki><ref name=":1" /> | |||
[[Category:Drug reference]] | [[Category:Drug reference]] | ||
[[Category:Neuromuscular blockers]] | [[Category:Neuromuscular blockers]] | ||
[[Category:Nondepolarizing neuromuscular blockers]] | [[Category:Nondepolarizing neuromuscular blockers]] | ||
Revision as of 08:07, 5 January 2023
Vecuronium
| Trade names |
Norcuron |
|---|---|
 | |
| Clinical data | |
| Drug class |
Neuromuscular blocker |
| Uses |
Tracheal intubation, surgical relaxation, optimizing mechanical ventilation conditions, patients with ARDS |
| Contraindications |
Known hypersensitivity |
| Routes of administration |
Intravenous |
| Dosage | |
| Pharmacodynamics | |
| Mechanism of action |
Nicotinic acetylcholine antagonism |
| Adverse effects |
Anaphylactic reaction |
| Pharmacokinetics | |
| Duration of action |
40 |
| Metabolism |
Liver, bile, and renal |
| Physical and chemical data | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Vecuronium is a steroidal intermediate acting non-depolarizing neuromuscular blocking agent used for tracheal intubation and surgical relaxation in patients. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.
Uses
- Optimizing tracheal intubation condition
- Abduction of vocal cords
- Opening of mouth
- Reduction in coughing and gagging
- Provide surgical relaxation
- Optimizing mechanical ventilation conditions
- Reduction in bucking/coughing
- Reduction in breath stacking
- Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering trans-pulmonary pressure reducing barotrauma.
Contraindications
Absolute contraindications
- Known hypersensitivity
Precautions
- Prolonged duration of action in patients with cholestasis or cirrhosis
- Use in patients with renal failure
Pharmacology
Pharmacodynamics
- Primarily eliminated via hepatic metabolism: 30-40%
- Elimination via bile: 40%
- Elimination via renal: 20-30%
- 3-desacetylvecuronium, 17-desacetylvecuronium and 3,17-desacetylvecuronium metabolites have neuromuscular blocking activity
Mechanism of action
- Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.
Adverse effects
- Anaphylactic reaction
- Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm
- Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
- Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.
- Incomplete reversal of neuromuscular blocking agent leading to respiratory depression
Pharmacokinetics
- Duration of action after 1 x ED95 is 40 minutes[1]
Chemistry and formulation
- 2-desmethyl derivative of pancuronium[1]
- Supplied as crystalline particles that may be reconstituted with IV fluid[2]
History
- First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice[1]
References
Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", Pharmacology and Physiology for Anesthesia, Elsevier, pp. 325–348, retrieved 2023-01-05[1]
Anita Gupta, Nina Singh-Radcliff. Pharmacology in Anesthesia Practice. Oxford University Press; 2013. Accessed January 5, 2023. https://search-ebscohost-com.laneproxy.stanford.edu/login.aspx?direct=true&db=nlebk&AN=603930&site=ehost-live[2]
- ↑ 1.0 1.1 1.2 1.3 Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", Pharmacology and Physiology for Anesthesia, Elsevier, pp. 325–348, retrieved 2023-01-05
- ↑ 2.0 2.1 "Login Selection - Lane Medical Library, Stanford University Medical Center". lane.stanford.edu. Retrieved 2023-01-05.
Top contributors: Cornel Chiu and Chris Rishel