• no effect on brain, but cannot breathe
• block Na Channels at NMJ
• isoquinolines or aminosteroids
• tubocurarine: isoquinoline alkaloid
• malouetine: aminosteroid
• pancuronium is an NDMR aminosteroid

• -curium (no exceptions)
• cause histamine release (ADR), which causes drop in bp, bronchoconstriction, and tachycardia

• -curonium (w/o exception)
• vagolytic, which causes tachycardia
• pan- (most vagolytic), pipe-, ve-, ro-

pronounced tachycardia

30% hepatic metabolism, 60% renal elimination

long-acting (60-90 minutes)

hepatic metabolism, renal elimination

90-120 minutes

hepatic metabolism

renal & biliary elimination

intermediate acting (30-40 min)

not metabolized

renal and biliary elimination

intermediate acting (30-40 min)

ester link metabolized by plasma ChE

short duration (5-15 min)

shortest of all NDMR

metabolized by plasma esterases

cocaine, esmelol, remifentanil, mivacurium, atracurium

mixture of 10 isomers (most important is cis)

metabolized by Hofmann degradation (blood pH 7.4) and plasma esterases

intermediate duration (20 min)

laudanosine is a CNS activator metabolite

synthetic isolate (cis only)

metabolized by Hofmann degradation

laudanosine

intermediate duration, longer than atracurium (30 min)

not metabolized

renal elimination

long duration (120 min)

relaxometer: train of four, put cables along ulnar nerve, 4 elec impulses to see if thumb adducts

if there is no MR: 4 equivalent amplitude movements, if MR: fading

DO NOT USE if patient is awake

DO NOT USE if patient is not ventilated