Difference between revisions of "Vecuronium"
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Cornel Chiu (talk | contribs) (Brief summary, Uses, contraindication, precautions, pharmacodynamics, adverse effects, chemistry and formulation) |
Cornel Chiu (talk | contribs) (Precautions, brief summary) |
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Vecuronium is | 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<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->== | ==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->== | ||
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===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->=== | ===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->=== | ||
Known hypersensitivity | |||
* Known hypersensitivity | |||
===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->=== | ===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->=== | ||
Dose requirement can be unpredictable in patients with renal failure | * Prolonged duration of action in patients with cholestasis or cirrhosis | ||
* Dose requirement can be unpredictable in patients with renal failure | |||
* Patients with myasthenia gravis/myathenic syndrome | |||
* Amyotrophic lateral sclerosis | |||
* Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous | |||
* Familial periodic paralysis hyperkalemia | |||
* Guillain-Barré syndrome | |||
* Muscular dystrophy (Duchenne type) | |||
* Myotonia including dystrophic, congenital,, and paramyotonia | |||
* Patient may have resistance include: | |||
** Burn injury | |||
** Cerebral palsy | |||
** Hemiplegia (on the affected side) | |||
** Muscular denervation | |||
** Severe chronic infection such as tetanus and botulism | |||
==Pharmacology== | ==Pharmacology== | ||
===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->=== | ===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->=== | ||
Elimination via bile: 40% | * 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<!-- Describe the mechanism of action for the primary uses of the drug. -->==== | |||
* 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. | |||
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<!-- Describe any potential adverse effects of the drug. -->==== | ====Adverse effects<!-- Describe any potential adverse effects of the drug. -->==== | ||
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===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->=== | ===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->=== | ||
Duration of action of 40 minutes | |||
* Duration of action of 40 minutes | |||
==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 | |||
==History<!-- Describe the historical development of the drug. -->== | ==History<!-- Describe the historical development of the drug. -->== | ||
Revision as of 07:41, 4 January 2023
Vecuronium
 | |
| Clinical data | |
| Drug class |
Neuromuscular blocker |
|---|---|
| Routes of administration |
Intravenous |
| Dosage | |
| Pharmacodynamics | |
| Mechanism of action |
Nicotinic acetylcholine antagonism |
| Pharmacokinetics | |
| 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
- Dose requirement can be unpredictable in patients with renal failure
- Patients with myasthenia gravis/myathenic syndrome
- Amyotrophic lateral sclerosis
- Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous
- Familial periodic paralysis hyperkalemia
- Guillain-Barré syndrome
- Muscular dystrophy (Duchenne type)
- Myotonia including dystrophic, congenital,, and paramyotonia
- Patient may have resistance include:
- Burn injury
- Cerebral palsy
- Hemiplegia (on the affected side)
- Muscular denervation
- Severe chronic infection such as tetanus and botulism
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
Pharmacokinetics
- Duration of action of 40 minutes
Chemistry and formulation
- 2-desmethyl derivative of pancuronium
History
First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice
References
Top contributors: Cornel Chiu and Chris Rishel