Levetiracetam (Keppra) is an oral and intravenous antiepileptic drug (AED) indicated as adjunctive therapy for partial onset seizures, myoclonic seizures, and generalized tonic-clonic (“grand mal”) seizures in adults. The medication is used in the pediatric population as well for various reasons beyond my scope of practice. Most AEDs either enhance…
Vecuronium (Norcuron) is a nondepolarizing, aminosteroid neuromuscular junction blocker that, like rocuronium, works at the level of neuromuscular end plate’s nicotinic acetylcholine receptors (AChR) as a competitive antagonist. Because it competes with acetylcholine for a similar binding site, vecuronium’s effects can be overcome to increasing the amount of “normal” substrate…
Neostigmine is a polar acetylcholinesterase inhibitor (does NOT cross the blood-brain barrier) that is routinely used to reverse non-depolarizing neuromuscular blocking agents (NMBA) like rocuronium, vecuronium, and cisatracurium. These NMBAs are competitive inhibitors at the nicotinic acetylcholine receptor (AChR). Neostigmine prevents the degradation of acetylcholine (ACh) allowing more of this…
Cisatracurium (Nimbex) is a benzylisoquinolinium non-depolarizing neuromuscular blocking agent (NMBA) that works similar to rocuronium/vecuronium as a competitive nicotinic acetylcholine receptor (AChR) antagonist at the motor endplate.
Sugammadex (Bridion) is an intravenous reversal agent for rocuronium and vecuronium, two aminosteroid, non-depolarizing neuromuscular junction blockers (NMJBs). It’s a cyclodextrin molecule which encapsulates the NMJB within its core thereby preventing it from binding its normal receptor – the nicotinic acetylcholine receptor at the neuromuscular end plate. Although it failed…
Rocuronium is an aminosteroid nondepolarizing neuromuscular junction blocker (NMJB) I routinely use to facilitate tracheal intubation. The name rocuronium comes from the fact that it’s a rapid onset -curonium (referring to its steroid structure). With a “rapid sequence” dose (usually 1.2 mg/kg), it has an onset almost as fast as succinylcholine without…
Neuromuscular blocking agents (NMBAs or “paralytics”) are categorized as depolarizing (classically succinylcholine) and nondepolarizing. They’re important drugs to know because we routinely use them in the operating room, intensive care unit, and during elective endotracheal intubations. They have potential life threatening complications like malignant hyperthermia and anaphylaxis as well as…