Non-depolarizing neuromuscular blockers

These drugs bind competitively to the nicotinic acetylcholine receptors of the motor end-plate, so acetylcholine cannot trigger muscle contraction and skeletal muscle is paralyzed. They have no effect on consciousness or pain. Anticholinesterases such as neostigmine, given with atropine or glycopyrrolate, reverse the block by raising acetylcholine; sugammadex reverses rocuronium by binding the drug itself.

• RocuroniumIts fast onset suits rapid sequence intubation, and sugammadex, which binds it, can reverse it even from deep block.
• AtracuriumIts organ-independent breakdown suits patients with liver or kidney failure, and its action is not tied to plasma cholinesterase levels.

• Tracheal intubation, including rapid sequence (rocuronium)
• Muscle relaxation for surgery and mechanical ventilation

• Anaphylaxis, sometimes fatalKnown forSerious
• Residual or prolonged paralysisKnown forSerious
• Flushing from histamine release (atracurium)
• Low blood pressure
• Bronchospasm and wheezeSerious
• Fast heart rate
• Slow heart rate
• Myopathy after long ICU use with steroidsSerious
• Seizures in ICU patients (atracurium)Serious
• Itching, rash and hives

What the class has in common. Each drug's card has its own, and Known for marks what an exam expects you to know.

• They do not sedate or relieve pain: always give them with adequate anesthesia, or a patient may be awake but paralyzed.
• Use only with intubation, ventilation and a reversal agent at hand, and monitor the block with a nerve stimulator.
• Aminoglycosides, magnesium, lithium, inhaled and local anesthetics deepen and prolong the block.
• Myasthenia gravis greatly increases sensitivity; burns and chronic anticonvulsants can cause resistance.

Written for biofideX in plain words, after checking these references:

• Rocuronium bromide injection: label (DailyMed)
• Atracurium besylate injection: label (DailyMed)
• Sugammadex injection: label (DailyMed)
• Rocuronium bromide 10 mg/ml solution for injection/infusion: SmPC (emc)
• Atracurium besilate 10 mg/ml solution for injection/infusion: SmPC (emc)

For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.