Pancuronium bromide(***) -Nondeplr Neuromusl blckrs- Cura
Drug Name:Pancuronium bromide(***) -Nondeplr Neuromusl blckrs- Cura
List Of Brands:
Indication Type Description:
Drug Interaction
Indication
Adverse Reaction
Contra-Indications
Dosages/ Overdosage Etc
Pharmacology/ Pharmacokinetics
Pregnancy and lactation
Drug Interaction:
Interacting drugs-summary
+ Pancuronium bromide
Aminoglycosides / Tetracycline / Bacitracin / Polymyxin B / Clindamycin/ Lincomycin /Colistin and Sodium colimethate + Pancuronium
Parentral/intraperitoneal administration of high doses of certain antibiotics may
produce neuromuscular block on its own. If these agents are used preoperatively
or in conjunction with pancuronium during surgery, unexpected prolongation
of neuromuscular block is a possibility
+ Pancuronium or Pancuronium + Azathioprine
Azathioprine may cause reversal of neuromuscular blocking effects of pancuronium
Inhalation anesthetics - Halothane/ Enflurane/ Isoflurane + Pancuronium
Use of these drugs with pancuronium will enhance neuromuscular blockade.
Potentiation is most prominent with use of enflurane and isoflurane
Magnesium sulfate + Pancuronium
When administerd for themanagement of toxemia of pregnancy, may enhance
neuromuscular blockade
Metocurine/ Tubocurarine + Pancuronium
The combination of pancuronium and either metocurine or tubocurarine appears
to be synergistic, however, the duration of blockade is not prolonged
Pancuronium + Halothane/ Tricyclic antidepress
Patients receiving chronic tricyclic antidepressants therapy who are anesthesized
with halothane should have pancuronium administered with caution because severe
ventricular arrhythmias may result from the combination. The severity of
arrhythmias appears in part related to the dose of pancuronium
Quinidine + Pancuronium
Quinidine injected during recovery from use of other muscle relaxants suugests that
recurrent paralysis may occur. Consider this possibility for pancuronium bromide
injection
Succinylcholine + Pancuronium
Prior administration such as that used for endotracheal intubation enhances the
relaxant effect of pancuronium.and its duration of action. If succinylcholine is used
before pancuronium , delay administration of pancuronium until the effects of sucinyl
choline begin to subside. If a small dose of pancuronium is given at laest 3 minutes
prior to administration of succinyl choline to reduce the incidence and intensity of
succinylcholine-induced fasciculation, this dose may induce a degree of
neuromuscular block sufficient to cause respiratory depression in some patients
Indication:
Adjunct to anesthesia to induce sekeletal muscle relaxation.
Adverse Reaction:
Neuromuscular- The most important reactions are in extension of pahramcolgical actions beyond the period needed for surgery and anesthesia. This varies fromskeletal muscle weakness to profound and prolonged skeletal muscle relaxation, resulting in respiratory insufficiency or apnea. Inadequate reversal of the neurpomuscular blockade by anticholinestrases has also occured. Manage adverse reactions by manual or mechanical ventilation until there is adequate recovery.
Hypersensitivity reactions-(rare)- eg bronchospasm, flushing, redness, hypotension, tachycardia, and other reactions are possibly mediated by histamine release.
Cardiovascular- Increase in heart rate, arterial pressure and cardiac output, decrease in venous pressures
GI- Salivation during light anesthesia, especially with no anticholinergic premediaction.
Dermatoloigic- Transcient rash
Contra-Indications:
Hypersens,inadequate general anaesthesia,anuria.
Special precautions:
Myasthenia gravis, severe electrolyte disorders, severe cardiovascular disease, pregnancy. Liver and renal function impairment.
Altered circulation time- Conditions associated with slower circulation time (cardiovascular diease, old age and edematous states resulting in increased volume of distrubtuion) may continue too delay in onset time, dosage should be increased
Hepatic or biliary tract disease- The doubled elimination half-life and reduced plasma clearance determined in patients with hepatic or biliary tract disease as well as limited data showing that recovery time is prolonged an average by 65% in patients with biliary tract obstruction, suggest that prolongation of neuromuscular blockade may occur.
Warning-
Myasthenia gravis- in patients with myasthenia gravis or myasthenic syndrome, small doses of pancuronium may have profound effects. In such patients a periphral nerve stimulator and use of a small test dose may be of value in monitoring the response to administration of muscle relaxants.
Renal/Hepatic /pulmonary function impairment- although it has been used successfully in pre-existing , pulmonary hepatic or renal disease, because a major portion of pancuronium is excreted unchanged in urine.
Pregnancy- safety for use during pregnancy has not been established.
Children- dose rsponse with theexceptin of neonates , dosage requirements in children are the same as adults.
Dosages/ Overdosage Etc:
Indications:
Adjunct to anesthesia to induce sekeletal muscle relaxation.
Dosage:
For IV use only. To be used under expert medical supervision.
Adults- Initial IV dosage is 0.04 to 0.1mg/kg. .Later use incremental dose starting at 0.01mg/kg.
Overdosage-
Symptoms
Extended skeletal muscle weakness, decreased respiratory reserve, lower tidal volume, prolonged apnea, cardiovascular collapse and sudden release of histamine. sufficiently excessive doses of nondepolarizing muscle relaxants have no antidote.
Treatment
1. A peripheral nerve stimulator may be used to assesss the degree of residual neuromuscular blockade .
2. For residual neuromuscular blockade with respiratory paralysis or inadequate ventilation, maintain airway and administer manual or mechanical ventilation.
Missed dose-
1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.
3. Do not double doses.
Pharmacology/ Pharmacokinetics:
Pharmacology-
Pancuronium a non depolarizing neuromuscular blocking agent, posesses all of the characterstic pharmacological actions on the myoneural junction.
Pharmacokinetics-
The elimination half life of pancuronium ranges from 89 to 161 minutes.
Pregnancy and lactation:
Pregnancy- Safety for use during pregnancy has not beenestablished.
Children- Dose response with the exception of neonates , dosage requirements in children are the same as adults.
