Anesthesia Pharmacology:  Neuromuscular Blocking Agents and Muscle Relaxants

• Chemistry/Structure

  • NMJ blockers: Structural similarity to acetylcholine

    •  Succinylcholine (Anectine) (depolarizing blocker, SCh) , consisting of  two linked acetylcholine molecules

    •  Nondepolarizing agents also contain a "double-acetylcholine" form; however this form is hidden by ring systems, e.g. pancuronium (Pavulon)

    •  Contains 1-2 quaternary nitrogens which result in limited lipid-solubility (limited CNS penetration)

    • Major classes of nondepolarizing blocking drugs:

       

      Isoquinoline

      •  Isoquinoline derivatives: 

        •  Tubocurarine

        •  Atracurium (Tracrium)

        •  Doxacurium (Nuromax)

        •  Mivacurium (Mivacron)

      •  Steroid derivatives:

        •  Pancuronium (Pavulon)

        •  Vecuronium (Norcuron)

        •  Pipecuronium (Arduan)

        •  Rocuronium (Zemuron)