Nursing Pharmacology Chapter 20:  Neuromuscular Blockers

• Chemistry/Structure

  • NMJ blockers: Structural similarity to acetylcholine

    • Succinylcholine (Anectine) {depolarizing blocker, SCh} is composed 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)