Cisatracurium - Revision history

Chris.Rishel: Many minor changes

2023-01-08T21:14:42Z

Many minor changes

← Older revision		Revision as of 14:14, 8 January 2023
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	\| clearance =		\| clearance =
	\| halflife_elimination =		\| halflife_elimination =
	\| adverse_effects = Anaphylactic reaction~~, histamine~~ release~~, muscle weakness from prolong use, PTSD if adequate sedation is not used, respiration depression if incomplete reversal~~		\| adverse_effects = Anaphylactic reaction
			Histamine release
	\| metabolism = Hofmann Elimination		\| metabolism = Hofmann Elimination
	\| duration = 45 minutes		\| duration = 45 minutes
	\| time_onset =		\| time_onset = 3 to 5 minutes
	\| dosage_calculation = cisatracurium		\| dosage_calculation = cisatracurium
	\| mechanism = Nicotinic acetylcholine antagonism		\| mechanism = Nicotinic acetylcholine antagonism
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	}}		}}

	Cisatracurium is a benzylisoquinolinium intermediate acting ~~non-depolarizing~~ neuromuscular blocking ~~agents~~ used for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.		'''Cisatracurium''' is a benzylisoquinolinium intermediate acting nondepolarizing neuromuscular blocking agent used for tracheal intubation and surgical relaxation. Unlike agents such as [[rocuronium]] or [[vecuronium]], cisatracurium is metabolized via Hofmann elimination, making it a safer choice for patients with severe renal or hepatic dysfunction. However, due to its longer onset of action, it is rarely used outside this population, and is not considered appropriate for use in a [[rapid sequence induction]]. It is also used as an infusion to provide paralysis in intubated patients with acute respiratory distress syndrome in the intensive care unit.

	==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==		==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==

	* ~~Optimizing tracheal~~ intubation ~~condition among~~ patients with renal or hepatic dysfunction		* Muscle relaxation for intubation
	** ~~Abduction~~ of ~~vocal cords~~		**Primarily used in patients with severe renal and/or hepatic dysfunction
	** Opening of ~~mouth~~		**Not appropriate for RSI due to longer onset of action
	** Reduction in coughing and gagging		* Maintenance of surgical relaxation
	* Provide surgical relaxation ~~mainly in patients with renal or hepatic dysfunction.~~
	* Optimizing mechanical ventilation conditions
	** Reduction in bucking/coughing
	** Reduction in breath stacking

	* ~~Provide paralysis~~ in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering ~~trans-pulmonary~~ pressure reducing barotrauma.		* Paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion
			**Used early in the course of ARDS for patients with a PaO2/FiO2 less than 150
			**The proposed mechanism of the beneficial effect is possibly by lowering transpulmonary pressure reducing barotrauma

	==Contraindications<!-- List contraindications and precautions for use of the drug. -->==		==Contraindications<!-- List contraindications and precautions for use of the drug. -->==
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	* Muscular dystrophy (Duchenne type)		* Muscular dystrophy (Duchenne type)
	* Myotonia including dystrophic, congenital,, and paramyotonia		* Myotonia including dystrophic, congenital,, and paramyotonia
	* ~~Patient~~ may have resistance include:		* Patients who may have resistance include:
	** Burn injury		** Burn injury
	** Cerebral palsy		** Cerebral palsy
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	===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===		===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===

	* Eliminated via Hofmann elimination
	* Roughly about 3 times the potency of atracurium		* Roughly about 3 times the potency of atracurium

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	===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===		===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===

	* Duration of action after 2 x ED<sub>95</sub> is 45 minutes <ref name=":1">{{Citation\|last=Lien\|first=Cynthia A.\|title=Neuromuscular Blockers and Reversal Drugs\|date=2013\|url=http://dx.doi.org/10.1016/b978-1-4377-1679-5.00019-3\|work=Pharmacology and Physiology for Anesthesia\|pages=325–348\|publisher=Elsevier\|access-date=2023-01-05\|last2=Eikermann\|first2=Matthias}}</ref>		* Eliminated via Hofmann elimination
			*Duration of action after 2 x ED<sub>95</sub> is 45 minutes <ref name=":1">{{Citation\|last=Lien\|first=Cynthia A.\|title=Neuromuscular Blockers and Reversal Drugs\|date=2013\|url=http://dx.doi.org/10.1016/b978-1-4377-1679-5.00019-3\|work=Pharmacology and Physiology for Anesthesia\|pages=325–348\|publisher=Elsevier\|access-date=2023-01-05\|last2=Eikermann\|first2=Matthias}}</ref>
	* With prolonged infusion, elimination half life is 20 minutes <ref name=":1" />		* With prolonged infusion, elimination half life is 20 minutes <ref name=":1" />

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	==References==		==References==

	* Strawbridge AD, Khanna NR, Hauser JM. Cisatracurium. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK539842/</nowiki><ref name=":0" />
	* Anita Gupta, Nina Singh-Radcliff. ''Pharmacology in Anesthesia Practice''. Oxford University Press; 2013. Accessed January 5, 2023. <nowiki>https://search-ebscohost-com.laneproxy.stanford.edu/login.aspx?direct=true&db=nlebk&AN=603930&site=ehost-live</nowiki><ref>{{Cite book\|last=Nina.\|first=Gupta, Anita. Singh-Radcliff,\|url=http://worldcat.org/oclc/940638246\|title=Pharmacology in anesthesia practice\|date=2013\|publisher=Oxford University Press\|isbn=978-0-19-978267-3\|oclc=940638246}}</ref>
	* Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", ''Pharmacology and Physiology for Anesthesia'', Elsevier, pp. 325–348, retrieved 2023-01-05<ref name=":1" />

	[[Category:Drug reference]]		[[Category:Drug reference]]
	[[Category:Neuromuscular blockers]]		[[Category:Neuromuscular blockers]]
	[[Category:Nondepolarizing neuromuscular blockers]]		[[Category:Nondepolarizing neuromuscular blockers]]

Cornel.Chiu at 16:31, 5 January 2023

2023-01-05T16:31:39Z

← Older revision		Revision as of 09:31, 5 January 2023
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	\| halflife_elimination =		\| halflife_elimination =
	\| adverse_effects = Anaphylactic reaction, histamine release, muscle weakness from prolong use, PTSD if adequate sedation is not used, respiration depression if incomplete reversal		\| adverse_effects = Anaphylactic reaction, histamine release, muscle weakness from prolong use, PTSD if adequate sedation is not used, respiration depression if incomplete reversal
	\| metabolism =		\| metabolism = Hofmann Elimination
	\| duration = 45 minutes		\| duration = 45 minutes
	\| time_onset =		\| time_onset =

Cornel.Chiu at 16:21, 5 January 2023

2023-01-05T16:21:33Z

← Older revision		Revision as of 09:21, 5 January 2023
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	{{Infobox drug reference		{{Infobox drug reference
	\| trade_names =		\| trade_names = Nimbex
	\| drug_class = Neuromuscular blocker		\| drug_class = Neuromuscular blocker
	\| drug_class_color = neuromuscular_blocker		\| drug_class_color = neuromuscular_blocker
	\| uses =		\| uses = Tracheal intubation, surgical relaxation, optimizing mechanical ventilation, patients with ARDS
	\| contraindications =		\| contraindications = Known hypersensitivity
	\| routes = IV		\| routes = IV
	\| dosage =		\| dosage =
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	\| clearance =		\| clearance =
	\| halflife_elimination =		\| halflife_elimination =
	\| adverse_effects =		\| adverse_effects = Anaphylactic reaction, histamine release, muscle weakness from prolong use, PTSD if adequate sedation is not used, respiration depression if incomplete reversal
	\| metabolism =		\| metabolism =
	\| duration =		\| duration = 45 minutes
	\| time_onset =		\| time_onset =
	\| dosage_calculation = cisatracurium		\| dosage_calculation = cisatracurium
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	}}		}}

	Cisatracurium is a benzylisoquinolinium intermediate acting non-depolarizing neuromuscular blocking agents used ~~commonly~~ for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.		Cisatracurium is a benzylisoquinolinium intermediate acting non-depolarizing neuromuscular blocking agents used for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.

	==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==		==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
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	* Known hypersensitivity		* Known hypersensitivity

	===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===		===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. --><ref name=":0">{{Citation\|last=Strawbridge\|first=Andrew D.\|title=Cisatracurium\|date=2022\|url=http://www.ncbi.nlm.nih.gov/books/NBK539842/\|work=StatPearls\|place=Treasure Island (FL)\|publisher=StatPearls Publishing\|pmid=30969664\|access-date=2023-01-05\|last2=Khanna\|first2=Niloufar R.\|last3=Hauser\|first3=Joshua M.}}</ref>===

	* Patients with myasthenia gravis/myathenic syndrome		* Patients with myasthenia gravis/myathenic syndrome
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	====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====		====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====
	Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.
			* Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.

	====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====		====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====
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	===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===		===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===

			* Duration of action after 2 x ED<sub>95</sub> is 45 minutes <ref name=":1">{{Citation\|last=Lien\|first=Cynthia A.\|title=Neuromuscular Blockers and Reversal Drugs\|date=2013\|url=http://dx.doi.org/10.1016/b978-1-4377-1679-5.00019-3\|work=Pharmacology and Physiology for Anesthesia\|pages=325–348\|publisher=Elsevier\|access-date=2023-01-05\|last2=Eikermann\|first2=Matthias}}</ref>
			* With prolonged infusion, elimination half life is 20 minutes <ref name=":1" />

	==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==		==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==
	1 R-cis 1'R-cis stereoisomer of the 10 stereoisomers that comprise atracurium		1 R-cis 1'R-cis stereoisomer of the 10 stereoisomers that comprise atracurium<ref name=":0" />

	==History<!-- Describe the historical development of the drug. -->==		==History<!-- Describe the historical development of the drug. -->==
	The development involved isolation and testing of individual stereoisomers from the mixture found in atracurium		The development involved isolation and testing of individual stereoisomers from the mixture found in atracurium<ref name=":1" />

	==References==		==References==

			* Strawbridge AD, Khanna NR, Hauser JM. Cisatracurium. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK539842/</nowiki><ref name=":0" />
			* Anita Gupta, Nina Singh-Radcliff. ''Pharmacology in Anesthesia Practice''. Oxford University Press; 2013. Accessed January 5, 2023. <nowiki>https://search-ebscohost-com.laneproxy.stanford.edu/login.aspx?direct=true&db=nlebk&AN=603930&site=ehost-live</nowiki><ref>{{Cite book\|last=Nina.\|first=Gupta, Anita. Singh-Radcliff,\|url=http://worldcat.org/oclc/940638246\|title=Pharmacology in anesthesia practice\|date=2013\|publisher=Oxford University Press\|isbn=978-0-19-978267-3\|oclc=940638246}}</ref>
			* Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", ''Pharmacology and Physiology for Anesthesia'', Elsevier, pp. 325–348, retrieved 2023-01-05<ref name=":1" />

	[[Category:Drug reference]]		[[Category:Drug reference]]
	[[Category:Neuromuscular blockers]]		[[Category:Neuromuscular blockers]]
	[[Category:Nondepolarizing neuromuscular blockers]]		[[Category:Nondepolarizing neuromuscular blockers]]

Cornel.Chiu: Chemistry, History, and brief summary

2023-01-03T14:53:21Z

Chemistry, History, and brief summary

← Older revision		Revision as of 07:53, 3 January 2023
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	}}		}}

	Cisatracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocking agents used commonly for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.		Cisatracurium is a benzylisoquinolinium intermediate acting non-depolarizing neuromuscular blocking agents used commonly for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.

	==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==		==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
Line 81:		Line 81:

	==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==		==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==
			1 R-cis 1'R-cis stereoisomer of the 10 stereoisomers that comprise atracurium

	==History<!-- Describe the historical development of the drug. -->==		==History<!-- Describe the historical development of the drug. -->==
			The development involved isolation and testing of individual stereoisomers from the mixture found in atracurium

	==References==		==References==

Cornel.Chiu: Adverse effects

2023-01-03T14:41:23Z

Adverse effects

← Older revision		Revision as of 07:41, 3 January 2023
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	* Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.		* Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
	* Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.		* Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.
			*Incomplete reversal of neuromuscular blocking agent leading to respiratory depression

	===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===		===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===

Cornel.Chiu: Brief summary, Uses, contraindication, precautions, pharmacodynamics, adverse effects

2023-01-03T03:31:20Z

Brief summary, Uses, contraindication, precautions, pharmacodynamics, adverse effects

← Older revision		Revision as of 20:31, 2 January 2023
Line 20:		Line 20:
	}}		}}

	~~Provide~~ a ~~brief summary of this drug here~~.		Cisatracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocking agents used commonly for tracheal intubation and surgical relaxation in patients with renal or hepatic dysfunction. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.

	==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==		==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
	~~Facilitate tracheal intubation and provide surgical relaxation mainly in patients with renal or hepatic dysfunction.~~

	Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit		* Optimizing tracheal intubation condition among patients with renal or hepatic dysfunction
			** Abduction of vocal cords
			** Opening of mouth
			** Reduction in coughing and gagging
			* Provide surgical relaxation mainly in patients with renal or hepatic dysfunction.
			* Optimizing mechanical ventilation conditions
			** Reduction in bucking/coughing
			** Reduction in breath stacking

			* Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering trans-pulmonary pressure reducing barotrauma.

	==Contraindications<!-- List contraindications and precautions for use of the drug. -->==		==Contraindications<!-- List contraindications and precautions for use of the drug. -->==

	===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===		===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===

			* Known hypersensitivity

	===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===		===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===

			* Patients with myasthenia gravis/myathenic syndrome
			* Amyotrophic lateral sclerosis
			* Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous
			* Familial periodic paralysis hyperkalemia
			* Guillain-Barré syndrome
			* Muscular dystrophy (Duchenne type)
			* Myotonia including dystrophic, congenital,, and paramyotonia
			* Patient may have resistance include:
			** Burn injury
			** Cerebral palsy
			** Hemiplegia (on the affected side)
			** Muscular denervation
			** Severe chronic infection such as tetanus and botulism

	==Pharmacology==		==Pharmacology==

	===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===		===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===

			* Eliminated via Hofmann elimination
			* Roughly about 3 times the potency of atracurium

	====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====		====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====
			Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.

	====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====		====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====

			* Anaphylactic reaction
			* Histamine release leading to hypotension, bronchospasm, rash
			* Bradycardia

			* Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm
			* Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
			* Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.

	===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===		===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===

Cornel.Chiu: Uses

2023-01-02T15:22:42Z

Uses

← Older revision		Revision as of 08:22, 2 January 2023
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	==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==		==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
			Facilitate tracheal intubation and provide surgical relaxation mainly in patients with renal or hepatic dysfunction.

			Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit

	==Contraindications<!-- List contraindications and precautions for use of the drug. -->==		==Contraindications<!-- List contraindications and precautions for use of the drug. -->==

Chris.Rishel: Added embedded dosage calculation

2022-03-30T07:32:17Z

Added embedded dosage calculation

← Older revision		Revision as of 00:32, 30 March 2022
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	{{Infobox drug reference		{{Infobox drug reference
	\| trade_names =		\| trade_names =
	\| drug_class =Neuromuscular blocker		\| drug_class = Neuromuscular blocker
	\| drug_class_color =neuromuscular_blocker		\| drug_class_color = neuromuscular_blocker
	\| uses =		\| uses =
	\| contraindications =		\| contraindications =
	\| routes =IV		\| routes = IV
	\| dosage =		\| dosage =
	\|halflife_redistribution=\|protein_binding=\|clearance=\|halflife_elimination=\|adverse_effects=\|metabolism=\|duration=\|time_onset=\|mechanism=Nicotinic acetylcholine antagonism\|image_file=Cisatracurium.svg}}		\| halflife_redistribution =
			\| protein_binding =
			\| clearance =
			\| halflife_elimination =
			\| adverse_effects =
			\| metabolism =
			\| duration =
			\| time_onset =
			\| dosage_calculation = cisatracurium
			\| mechanism = Nicotinic acetylcholine antagonism
			\| image_file = Cisatracurium.svg
			}}

	Provide a brief summary of this drug here.		Provide a brief summary of this drug here.

Chris.Rishel at 11:25, 12 November 2021

2021-11-12T11:25:35Z

← Older revision		Revision as of 04:25, 12 November 2021
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	[[Category:Drug reference]]		[[Category:Drug reference]]
			[[Category:Neuromuscular blockers]]
			[[Category:Nondepolarizing neuromuscular blockers]]

Chris.Rishel: Created page with "{{Infobox drug reference | trade_names = | drug_class =Neuromuscular blocker | drug_class_color =neuromuscular_blocker | uses = | contraindications = | routes =IV | dosa..."

2021-11-12T10:55:38Z

Created page with "{{Infobox drug reference | trade_names = | drug_class =Neuromuscular blocker | drug_class_color =neuromuscular_blocker | uses = | contraindications = | routes =IV | dosa..."

New page

{{Infobox drug reference
| trade_names =
| drug_class =Neuromuscular blocker
| drug_class_color =neuromuscular_blocker
| uses =
| contraindications =
| routes =IV
| dosage =
|halflife_redistribution=|protein_binding=|clearance=|halflife_elimination=|adverse_effects=|metabolism=|duration=|time_onset=|mechanism=Nicotinic acetylcholine antagonism|image_file=Cisatracurium.svg}}

Provide a brief summary of this drug here.

==Uses==

==Contraindications==

===Absolute contraindications===

===Precautions===

==Pharmacology==

===Pharmacodynamics===

====Mechanism of action====

====Adverse effects====

===Pharmacokinetics===

==Chemistry and formulation==

==History==

==References==

[[Category:Drug reference]]