|
Pronunciation |
|
(pan
kyoo ROE nee
um) |
|
|
U.S. Brand
Names |
|
Pavulon® |
|
|
Generic
Available |
|
Yes |
|
|
Synonyms |
|
Pancuronium Bromide |
|
|
Pharmacological Index |
|
Neuromuscular Blocker Agent, Nondepolarizing |
|
|
Use |
|
Drug of choice for neuromuscular blockade except in patients with
renal failure, hepatic failure, or cardiovascular instability; produce skeletal
muscle relaxation during surgery after induction of general anesthesia, increase
pulmonary compliance during assisted respiration, facilitate endotracheal
intubation, preferred muscle relaxant for neonatal cardiac patients, must
provide artificial ventilation |
|
|
Pregnancy Risk
Factor |
|
C |
|
|
Contraindications |
|
Hypersensitivity to pancuronium, bromide, or any
component |
|
|
Warnings/Precautions |
|
Ventilation must be supported during neuromuscular blockade. Electrolyte
imbalance alters blockade. Use with caution in patients with myasthenia gravis
or other neuromuscular diseases, pre-existing pulmonary, hepatic, renal disease,
and in the elderly. |
|
|
Adverse
Reactions |
|
1% to 10%:
Cardiovascular: Elevation in pulse rate, elevated blood pressure,
tachycardia, hypertension
Dermatologic: Rash, itching
Gastrointestinal: Excessive salivation
<1%: Skin flushing, edema, erythema, burning sensation along the vein,
profound muscle weakness, wheezing, circulatory collapse, bronchospasm,
hypersensitivity reaction
Causes of prolonged neuromuscular blockade:
Excessive drug administration
Cumulative drug effect, decreased metabolism/excretion (hepatic and/or renal
impairment)
Accumulation of active metabolites
Electrolyte imbalance (hypokalemia, hypocalcemia, hypermagnesemia,
hypernatremia)
Hypothermia
Drug interactions
Increased sensitivity to muscle relaxants (eg, neuromuscular disorders such
as myasthenia gravis or polymyositis) |
|
|
Overdosage/Toxicology |
|
Symptoms of overdose include apnea, respiratory depression, cardiovascular
collapse; pyridostigmine, neostigmine, or edrophonium in conjunction with
atropine will usually antagonize the action of pancuronium |
|
|
Drug
Interactions |
|
Increased toxicity: Magnesium sulfate, furosemide can increase or decrease
neuromuscular blockade (dose-dependent)
Prolonged neuromuscular blockade:
Inhaled anesthetics
Local anesthetics
Calcium channel blockers
Antiarrhythmics (eg, quinidine or procainamide)
Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin)
Immunosuppressants (eg, cyclosporine) |
|
|
Stability |
|
Refrigerate; however, is stable for up to 6 months at room temperature; I.V.
form is incompatible when mixed with diazepam at a Y-site
injection |
|
|
Mechanism of
Action |
|
Blocks neural transmission at the myoneural junction by binding with
cholinergic receptor sites |
|
|
Pharmacodynamics/Kinetics |
|
Peak effect: I.V.: Within 2-3 minutes
Duration: 40-60 minutes (dose dependent)
Metabolism: 30% to 45% in the liver
Half-life: 110 minutes
Elimination: In urine (55% to 70% as unchanged drug) |
|
|
Usual Dosage |
|
Based on ideal body weight in obese patients. I.V.:
Continuous I.V. infusions are not recommended due to case reports of
prolonged paralysis
Dosing adjustment in renal impairment: Elimination half-life is
doubled, plasma clearance is reduced and rate of recovery is sometimes much
slower
Clcr 10-50 mL/minute: Administer 50% of normal dose
Clcr <10 mL/minute: Do not use
Dosing adjustment/comments in hepatic disease: Elimination half-life
is doubled, plasma clearance is doubled, recovery time is prolonged, volume of
distribution is increased (50%) and results in a slower onset, higher total
dosage and prolongation of neuromuscular blockade
Patients with liver disease may develop slow resistance to nondepolarizing
muscle relaxant; large doses may be required and problems may arise in
antagonism |
|
|
Administration |
|
May be administered undiluted by rapid I.V. injection |
|
|
Monitoring
Parameters |
|
Heart rate, blood pressure, assisted ventilation status; cardiac monitor,
blood pressure monitor, and ventilator required |
|
|
Nursing
Implications |
|
Does not alter the patient's state of consciousness; addition of sedation and
analgesia are recommended; may be administered undiluted by rapid I.V.
injection |
|
|
Dosage Forms |
|
Injection, as bromide: 1 mg/mL (10 mL); 2 mg/mL (2 mL, 5
mL) |
|
Copyright © 1978-2000 Lexi-Comp Inc. All Rights Reserved
|