Competitive NMBs (Nursing)

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.