|
Pronunciation |
|
(too
boe kyoor AR
een) |
|
|
Generic
Available |
|
No |
|
|
Synonyms |
|
d-Tubocurarine Chloride;
Tubocurarine Chloride |
|
|
Pharmacological Index |
|
Neuromuscular Blocker Agent, Nondepolarizing |
|
|
Use |
|
Adjunct to anesthesia to induce skeletal muscle
relaxation |
|
|
Pregnancy Risk
Factor |
|
C |
|
|
Contraindications |
|
Hypersensitivity to tubocurarine or any component; patients in whom histamine
release is a definite hazard |
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|
Warnings/Precautions |
|
Use with caution in patients with renal impairment, respiratory depression,
impaired hepatic or endocrine function, myasthenia gravis, and the elderly;
ventilation must be supported during neuromuscular blockade; rapid
administration may cause histamine release resulting in respiratory depression
and bronchospasm |
|
|
Adverse
Reactions |
|
1% to 10%: Cardiovascular: Hypotension
<1%: Edema, circulatory collapse, cardiac arrhythmias, increased heart
rate or bradycardia, skin flushing, rash, itching, erythema, increased
salivation, decreased GI motility, bronchospasm, hypersensitivity reactions,
allergic reactions |
|
|
Overdosage/Toxicology |
|
Symptoms of overdose include prolonged skeletal muscle weakness and apnea,
cardiovascular collapse
Use neostigmine, edrophonium or pyridostigmine with atropine to antagonize
skeletal muscle relaxation; support of ventilation and the cardiovascular system
through mechanical means, fluids, and pressors may be necessary.
|
|
|
Drug
Interactions |
|
Increased effect/toxicity with aminoglycosides, ketamine, magnesium sulfate,
verapamil, quinidine, clindamycin, furosemide |
|
|
Stability |
|
Refrigerate; incompatible with barbiturates |
|
|
Mechanism of
Action |
|
Blocks acetylcholine from binding to receptors on motor endplate inhibiting
depolarization |
|
|
Pharmacodynamics/Kinetics |
|
Elimination: ~33% to 75% of parenteral dose is excreted unchanged in urine in
24 hours; ~10% excreted in bile |
|
|
Usual Dosage |
|
I.V.:
Alternative adult dose: 6-9 mg once daily, then 3-4.5 mg as needed to
maintain paralysis
Dosing adjustment/comments in renal impairment: May accumulate with
multiple doses and reductions in subsequent doses is recommended
Clcr 50-80 mL/minute: Administer 75% of normal dose
Clcr 10-50 mL/minute: Administer 50% of normal dose
Clcr <10 mL/minute: Avoid use
Dosing comments in hepatic impairment: Larger doses may be necessary
|
|
|
Administration |
|
May also give I.M.; administer I.V. undiluted over 60-90 seconds and flush
I.V. cannula with NS or D5W |
|
|
Monitoring
Parameters |
|
Mean arterial pressure, heart rate, respiratory status, serum
potassium |
|
|
Mental Health: Effects
on Mental Status |
|
None reported |
|
|
Mental Health:
Effects on Psychiatric
Treatment |
|
None reported |
|
|
Nursing
Implications |
|
Parenteral: May infuse direct I.V. without further dilution over a period of
1-11/2
minutes |
|
|
Dosage Forms |
|
Injection, as chloride: 3 mg/mL [3 units/mL] (5 mL, 10 mL, 20
mL) |
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