00:00
Okay, so let's look at each one of these drugs. Let's look at atracurium. Now, it's approved
for, it's a muscular relaxant during surgery. We can use it for intubation and mechanical
ventilation. Do we have problems with hypotension? Yes, and we really think it comes from
that histamine release. Now, it's eliminated from plasma cholinesterase. Okay. Let's look at
that word cholinesterase and break it down. A-s-e tells me that's an enzyme. So, underline
a-s-e. That always tells me it's some type of enzyme. Enzymes break things down. So, they
break down whatever is in front of it. Well, you see there you've got choline. So, how is it
eliminated? By the cholinesterase enzyme that's in your plasma. So, it doesn't depend on the
liver or the kidneys as much. It will be eliminated by those enzymes. It will last for about
30 minutes or less. So, this is good for patients with renal or liver dysfunction because
remember go back to how it's eliminated. It doesn't require the liver or the kidneys to do that.
01:07
So, those disorders if someone has kidneys that are not doing well or a liver that's not doing
well, this would be a good choice of a medication. Now, how do you study this type of
information? You're going on to get just some kind of an overall picture to know that we're
looking at this as a class. That's the most important. That you understand how competitive
non-depolarizing neuromuscular blockers work. You know the types of patients, that they're
going to last longer than the depolarizing, but you won't probably be able to memorize all
these facts about each individual drug. So, do your best to recognize what a neuromuscular
does, what the types of special monitoring we need to do, obviously respirations and watch
for low blood pressure. And then just walk with me through the kind of differences that we
have in each one of these drugs to understand you would choose one drug over another drug
in special situations. Now, let's look at this one. The approved uses, hey that should look really
familiar, right? This is cisatracurium. So, are we worried about hypotension? Not as much,
right? So, that's a pretty good deal. I still recommend as a category, you know that we're
watching for hypotension, we just know that certain drugs would have a higher risk of low
blood pressure than the others. How is it eliminated? Well, it's just spontaneous degradation.
02:32
So, I'm not worried about hepatic metabolism or renal excretion. So, these first 2 drugs would
be good choices for somebody who is having problems with their kidneys or their liver, last
about a minute. I mean last about an hour to an hour and 20 minutes. So, again the first
2 drugs are good for patients with renal or hepatic dysfunction. That's a good way to chunk
information. Start writing yourself a short list of which drugs would be good for renal or
hepatic dysfunction. You know that these 2 will be on it. Now, pancuronium is another one.
03:06
Look at the uses. Okay, so you're not going to memorize individual uses pretty much. These are
very similar, right? Hypotension, no. So, that's a good deal. We know that this one drug
would be one that we don't have to really worry about hypotension so much. How it's
eliminated? Through the urine. Okay, this isn't a great option for someone whose kidneys are
really struggling. This lasts a little bit longer, and we know it's got some vagolytic effects,
so it might produce a tachycardia, and you want to be careful with patients with liver disease.
03:38
So, if I have patients with renal or liver disease, look back at your notes and make sure
you're clear on which two you would consider. What's the benefit of this one? Well, hey,
you're not going to have the hypotension. That's a cool thing. So, pancuronium has no
hypotension, but it does have what, a risk of some tachycardia. There is no such thing as a
perfectly safe drug, but as you're studying just look for the main key differences between
these medications. Now, rocuronium muscle relaxation during surgery, intubation, mechanical
ventilation. We keep seeing that over and over and over again. So, that's not something you
have to keep working at memorizing. This one is also not bad for hypotension. It's eliminated
by the liver, so we know this isn't going to be our best option for somebody who has problems
with their liver. Now, we've got some special notes down there. How muscles relax about 1 to
3, and it'll last for about 20 to 40 minutes. The vecuronium is also often shortened to vec.
04:43
Same type of approved uses. We don't have any problems with high blood pressure. It's
excreted primarily in the bile. Okay, that one's a little different than the others. Lasts 30 to
40 minutes and paralysis might be prolonged with people with liver dysfunction. So, this isn't a
great option, but you already remember the 2 medications that are a good choice for someone
who has liver dysfunction.