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120 Cards in this Set
- Front
- Back
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Four classes of Agents? |
1. Sympathomimetics (for decongestion) 2. Antihistamines ( To reduce dry secretions) 3. Expectorants ( To increase mucus clearance) 4. Antitussives (To suppress cough reflex) |
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Vasoconstriction causes decongestant effect (sympathomimetic adrenergic decongestants) what does that stimulate? |
Alpha stimulating properties |
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What is Pseudoephedrine a Sympathomimetic (Adrenergic) decongestant ? |
- Now sold over the counter (OTC), most states require you to present identification to purchase - Phenylephrine used as a substitute, little effect on nasal decongestion when used orally because of high first-pass effect, no more effective than placebo |
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What the applications for topical application of sympathomimetic (Adrenergic) decongestant? |
Topical Application Faster onset (should only be used for short periods 1-2 days) Rebound congestion (Afrin - increased tolerance and withdrawal symptoms) Systemic application Affects deeper blood vessels Systemic side effects- increased BP (patients with high BP are advised against these drugs), and increased HR |
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What are the nasal decongestant drugs? |
Phenylephrine, Epinephrine, Pseudoephedrine, Ephedrine, Xylometazoline (Do not need to know), Oxymetazoline |
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What should you know about Phenylephrine? |
It’s a nasal decongestant drug, a Neo-Synephrine, a topical (oral) off market |
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What should you know about epinephrine ? |
A nasal decongestant drug, also called Adrenalin CL, it’s topical |
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What should you know about Pseudoephedrine? |
It’s also called sudafed, various, and is oral |
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What should you know about ephedrine? |
It’s also called (Pretz-D) and it’s topical |
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What should you know about Xylometazoline ? |
It’s also called Otrivin, it’s topical |
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What should you know about Oxymetazoline? |
It’s also called Afrin, it’s topical |
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What is the effect of histamine? |
- Mediator of local inflammatory response, causes smooth muscle contraction, increased capillary permeability and dilation, itching and pain. - Wheal and flare - Triple response (local redness, welt formation, reddish white border) |
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What the purpose of the H1 receptors? |
- nerve endings, smooth muscle, glandular cells - involved in inflammation/allergic reaction producing bronchoconstriction, mucus secretion, nasal congestion, irritation |
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What is the purpose of H2 receptors? |
-Gastric region- regulate gastric acid secretion - H2 agonist- Zantac, Tagamet |
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What is the purpose of H3 receptors? |
- Located primarily in the central nervous system - maybe autoreceptors for cholinergic neurotransmission in airway |
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What should you know about antihistamine agents? |
All antihistamine agents considered in this chapter are H1 receptor antihistamines |
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What are three main effects of antihistamines? |
- Antihistaminic (Blocks the increased vascular permeability, pruritus, and bronchial smooth muscle constriction - sedative (penetration of the agents into the brain) - anticholinergic (upper airway drying) |
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What should you know about first- generation antihistamines? |
First - generation antihistamines readily penetrate into the CNS and cause drowsiness (BENADRYL) Note: Newer agents (nonsedating) do not cross the blood- brain barrier |
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How to treat seasonal allergic rhinitis? |
- second generation H1 antagonists are more effective (Astepro) Astemizole, (Claritin) loratadine, (Allegra) fexofenadine, (Zyrtec) cetirizine, (Clarinex) desloratadine - less drowsiness - longer duration of action - relieves: sneezing, rhinorrhea; itchy nose, palate and throat; watery eyes |
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What antihistamine drugs? |
Ethanolamine derivatives, phenothiazine derivatives, and second generation nonsedating, long acting |
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What are ethanolamine derivatives? |
Are antihistamine drugs, another name is diphenhydramine HCL (Benadryl; Clemastine (Tavist)) |
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What are phenothiazine derivatives? |
Antihistamine drugs also called Promethazine HCL (Phenergen) also used for N/V |
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What are second generation nonsedating, long acting? |
Loratadine (Claritin); Fexofenadine (Allegra); Cetirizine (Zyrtec) |
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What are expectorants? |
-Facilitate removal of mucus from lower respiratory tract - mucolytic expectorants ( facilitates removal of mucus by lysing or mucolytic action) Example: dornase alfa and acetylcystine - stimulant expectorants increase production of mucus and reduces the adhesiveness and surface tension of the mucus. Example: guaifenesin |
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What are examples of expectorant agents? |
1. Guaifenesin or (glycerylguaiacolate) also called Robitussin, Mytussin, Humbid L. A., Mucinex 2. Iodinated glycerol also called Iophen 3. Potassium iodide also called SSKI, various |
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What is Guaifenesin? |
An expectorant classified as a Category l agent which is safe and effective. |
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What should you know about expectorants? |
- mucus incorporates water as it is produced - An adequate intake of plain water or other nondiuresing liquids (milk, fruit juices) can help preserve normal mucus viscosity and clearance |
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What are mode of action for cough suppressants (antitusive agents) ? |
- depress the cough center in the medulla |
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Examples of cough suppressants (antitusive agents)? |
- Narcotics (codeine, hydrocodone), and nonnarcotic (Dextromethorphan, Benzonatate) |
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Name antitusive agents? |
Codeine sulfate, hydrocodone, dextromethorphan, benzonatate, various brands, tussonex, delsym, tessalon |
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What are uses for cough suppressants? |
- suppress dry, hacking, non reproductive coughs - do not suppress cough in presence of copious secretions - combination of expectorant and antitussive is questionable (Robitussin DM, Robitussin Cough & Allergy, Robitussin Cold, Cough & Congestion) - use of single entity cough preparation, such as Robitussin Pediatric to treat a dry, irritating cough is recommended |
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Why use cold compounds? |
- May use significant amount of alcohol as solvent. - Real risk of abuse and overdose since many of these compounds are available OTC (Over The Counter). OD on Tylenol or any other drug when using combination drugs |
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For treating a cold is there a cure? |
There is no cure for the common cold. |
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What are treating a cold, side effects? |
Side effects: - Sympathomimetics: tremor, tachycardia, increased BP, rebound congestion - Antihistamines: drowsiness, impaired response, drying of secretions may suppress a needed defense reaction of the airway - Expectorants: questionable efficacy in a cold; best bet is increased intake of non diuretic fluids, avoid caffeinated beverages like teas or colas and beer or other alcoholic mixtures - Antitussives: never suppress productive cough Fluids and rest remain a basic and rational approach to surviving a cold |
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API is used to treat what? |
API also known as alpha 1- antitrypsin is used to treat alpha 1 antitrypsin deficiency. |
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API is used to treat what? |
API also known as alpha 1- antitrypsin is used to treat alpha 1 antitrypsin deficiency. |
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What percentage of emphysema is in the US? |
2% of all emphysema in the US |
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What is alpha 1 antitrypsin deficiency? |
1. Genetic defect that leads to development of severe panacinar emphysema 2. Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. 3. Imbalance between proteases and antiproteases 4. 2% of all emphysema in the US (60,000 to 100,000 Americans) |
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What is alpha 1 antitrypsin deficiency? |
1. Genetic defect that leads to development of severe panacinar emphysema 2. Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. 3. Imbalance between proteases and antiproteases 4. 2% of all emphysema in the US (60,000 to 100,000 Americans) |
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Drug therapy for congenital API deficiency? |
Four agents: Aralast, Prolastin, Zemaira, Glassia Medications cannot reverse damage or improve lung function Extremely expensive ($25,000 to $40,000/ year) Not indicated for cigarette smoking- related emphysema |
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What is alpha 1 antitrypsin deficiency? |
1. Genetic defect that leads to development of severe panacinar emphysema 2. Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. 3. Imbalance between proteases and antiproteases 4. 2% of all emphysema in the US (60,000 to 100,000 Americans) |
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Drug therapy for congenital API deficiency? |
Four agents: Aralast, Prolastin, Zemaira, Glassia Medications cannot reverse damage or improve lung function Extremely expensive ($25,000 to $40,000/ year) Not indicated for cigarette smoking- related emphysema |
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When does alpha 1 occur ? |
Alpha 1 occurs when there is a lack of a alpha l antitrypsin in the blood and subsequently in the lungs. |
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What is alpha 1 antitrypsin deficiency? |
1. Genetic defect that leads to development of severe panacinar emphysema 2. Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. 3. Imbalance between proteases and antiproteases 4. 2% of all emphysema in the US (60,000 to 100,000 Americans) |
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Drug therapy for congenital API deficiency? |
Four agents: Aralast, Prolastin, Zemaira, Glassia Medications cannot reverse damage or improve lung function Extremely expensive ($25,000 to $40,000/ year) Not indicated for cigarette smoking- related emphysema |
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When does alpha 1 occur ? |
Alpha 1 occurs when there is a lack of a alpha l antitrypsin in the blood and subsequently in the lungs. |
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What is congenital alpha 1? |
Antitrypsin deficiency leads to emphysema due to an imbalance between proteases (neutrophil electase) and proteases (alpha 1 proteinase inhibitor - API) |
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What is alpha 1 antitrypsin deficiency? |
1. Genetic defect that leads to development of severe panacinar emphysema 2. Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. 3. Imbalance between proteases and antiproteases 4. 2% of all emphysema in the US (60,000 to 100,000 Americans) |
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Drug therapy for congenital API deficiency? |
Four agents: Aralast, Prolastin, Zemaira, Glassia Medications cannot reverse damage or improve lung function Extremely expensive ($25,000 to $40,000/ year) Not indicated for cigarette smoking- related emphysema |
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When does alpha 1 occur ? |
Alpha 1 occurs when there is a lack of a alpha l antitrypsin in the blood and subsequently in the lungs. |
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What is congenital alpha 1? |
Antitrypsin deficiency leads to emphysema due to an imbalance between proteases (neutrophil electase) and proteases (alpha 1 proteinase inhibitor - API) |
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What is protease neutrophil electase? |
Host defense but also destructive enzyme - degrades elastic fiber in the lung by solubilizing elastin |
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What is alpha 1 antitrypsin deficiency? |
1. Genetic defect that leads to development of severe panacinar emphysema 2. Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs. 3. Imbalance between proteases and antiproteases 4. 2% of all emphysema in the US (60,000 to 100,000 Americans) |
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Drug therapy for congenital API deficiency? |
Four agents: Aralast, Prolastin, Zemaira, Glassia Medications cannot reverse damage or improve lung function Extremely expensive ($25,000 to $40,000/ year) Not indicated for cigarette smoking- related emphysema |
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When does alpha 1 occur ? |
Alpha 1 occurs when there is a lack of a alpha l antitrypsin in the blood and subsequently in the lungs. |
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What is congenital alpha 1? |
Antitrypsin deficiency leads to emphysema due to an imbalance between proteases (neutrophil electase) and proteases (alpha 1 proteinase inhibitor - API) |
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What is protease neutrophil electase? |
Host defense but also destructive enzyme - degrades elastic fiber in the lung by solubilizing elastin |
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Alpha 1 - antitrypsin is mainly produced by what organ? |
Alpha 1 - antitrypsin is a protein that is mainly produced by the liver |
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What is the risks for the agents (aralast, prolastin, Zemaira, and glassia)? |
Risk of disease transmission because agents are derived form human plasma. Common reactions are fever, exacerbation, and flulike symptoms |
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What are the signs for strong physical addiction or dependence to nicotine? |
1. Smokes more than 15 cigarettes per day 2. Prefers brands with nicotine’s levels above 0.9 mg 3. Smokes within 30min of rising 4. Smokes even when ill enough to bedridden 5. Finds it difficult to give up first morning cigarette and smokes more frequently in the morning |
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What are physical symptoms of withdrawal for strong physical addiction and dependence to nicotine? |
Craving for nicotine, nervousness, irritability, anxiety, drowsiness, sleep disturbance, impaired concentration, increased appetite and weight gain |
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What are physical symptoms of withdrawal for strong physical addiction and dependence to nicotine? |
Craving for nicotine, nervousness, irritability, anxiety, drowsiness, sleep disturbance, impaired concentration, increased appetite and weight gain |
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What are the indications for smoking cessation drug therapy? |
Goal: allow initial replacement, then gradual withdrawal Should be part of comprehensive program: increases compliance and reduces relapse Smokers with signs of strong dependence on nicotine benefit the most |
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What are physical symptoms of withdrawal for strong physical addiction and dependence to nicotine? |
Craving for nicotine, nervousness, irritability, anxiety, drowsiness, sleep disturbance, impaired concentration, increased appetite and weight gain |
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What are the indications for smoking cessation drug therapy? |
Goal: allow initial replacement, then gradual withdrawal Should be part of comprehensive program: increases compliance and reduces relapse Smokers with signs of strong dependence on nicotine benefit the most |
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The drug formulations that are nicotine polacrilex? |
Chewing gum (Nicolete), lozenge, nasal spray (nicontrol Ns), inhaler |
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What are physical symptoms of withdrawal for strong physical addiction and dependence to nicotine? |
Craving for nicotine, nervousness, irritability, anxiety, drowsiness, sleep disturbance, impaired concentration, increased appetite and weight gain |
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What are the indications for smoking cessation drug therapy? |
Goal: allow initial replacement, then gradual withdrawal Should be part of comprehensive program: increases compliance and reduces relapse Smokers with signs of strong dependence on nicotine benefit the most |
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The drug formulations that are nicotine polacrilex? |
Chewing gum (Nicolete), lozenge, nasal spray (nicontrol Ns), inhaler |
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Drug formulations nicotine transdermal system? |
Nicotine transdermal system: 24-hour delivery, and NicoDerm, Nicontrol CQ. Easy, convenient, discreet |
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What are physical symptoms of withdrawal for strong physical addiction and dependence to nicotine? |
Craving for nicotine, nervousness, irritability, anxiety, drowsiness, sleep disturbance, impaired concentration, increased appetite and weight gain |
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What are the indications for smoking cessation drug therapy? |
Goal: allow initial replacement, then gradual withdrawal Should be part of comprehensive program: increases compliance and reduces relapse Smokers with signs of strong dependence on nicotine benefit the most |
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The drug formulations that are nicotine polacrilex? |
Chewing gum (Nicolete), lozenge, nasal spray (nicontrol Ns), inhaler |
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Drug formulations nicotine transdermal system? |
Nicotine transdermal system: 24-hour delivery, and NicoDerm, Nicontrol CQ. Easy, convenient, discreet |
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Drug formulations that are non-nicotine aid to smoking cessation? |
Bupropion, Wellbutrin (Zyban), Varenicline (Chantix), Clonidine (Catapres), Nortriptyline (Aventyl, Pamelor) |
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Precautions with products to treat nicotine dependent patients? |
- contains active nicotine; continued smoking may produce toxic concentrations - transfer of dependence from tobacco to replacement product - healthcare workers should avoid handling active nicotine products If exposed wash only with water, washing with soap will increase absorption |
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Precautions with products to treat nicotine dependent patients? |
- contains active nicotine; continued smoking may produce toxic concentrations - transfer of dependence from tobacco to replacement product - healthcare workers should avoid handling active nicotine products If exposed wash only with water, washing with soap will increase absorption |
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Is Nitric Oxide an orphan drug? |
Nitric oxide is considered an orphan drug. Product of endothelial cells in the body. NO is a Gas that is inhaled in conjunction with ventilator support (iNO) FDA approved used to treat persistent pulmonary hypertension in newborns (PPHN) |
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Precautions with products to treat nicotine dependent patients? |
- contains active nicotine; continued smoking may produce toxic concentrations - transfer of dependence from tobacco to replacement product - healthcare workers should avoid handling active nicotine products If exposed wash only with water, washing with soap will increase absorption |
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Is Nitric Oxide an orphan drug? |
Nitric oxide is considered an orphan drug. Product of endothelial cells in the body. NO is a Gas that is inhaled in conjunction with ventilator support (iNO) FDA approved used to treat persistent pulmonary hypertension in newborns (PPHN) |
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What are the indications of use for Nitric Oxide? |
- persistent pulmonary hypertension of the newborn is caused by increased PVR ( Pulmonary Vascular Resistance) Should not be used in neonates who are known to be dependent on right-to-left shunt |
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What should you know about Nitric Oxide ? |
- NO produces smooth muscle relaxation - NO diffuses into the bloodstream, where it is inactivated by binding to hemoglobin, producing methemoglobin - NO has a short half-life of 5 seconds because it is quickly bound by hemoglobin - In presence of oxygen, NO is converted to nitrogen dioxide (NO2), a nitrate toxic to the lungs |
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What should you know about Nitric Oxide ? |
- NO produces smooth muscle relaxation - NO diffuses into the bloodstream, where it is inactivated by binding to hemoglobin, producing methemoglobin - NO has a short half-life of 5 seconds because it is quickly bound by hemoglobin - In presence of oxygen, NO is converted to nitrogen dioxide (NO2), a nitrate toxic to the lungs |
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What is the dosage and administration for NO? |
- Recommended dose 20 ppm - Treatment should be maintained for up to 14 days or until underlying problem has been resolved - No response shown at higher concentrations - Risks of methemoglobinema and elevated NO2 increase at concentrations > 20 ppm - weaning from NO should be gradual |
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What does NO (Nitric Oxide) do in PPHN (Persistent Pulmonary Hypertension in Newborns) ? |
- NO dilates the pulmonary vasculature to distribute blood flow to areas of better ventilation - improved ventilation- perfusion matching yields increased arterial oxygen pressures - NO binds to hemoglobin, causing no systemic vasodilation |
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What does NO (Nitric Oxide) do in PPHN (Persistent Pulmonary Hypertension in Newborns) ? |
- NO dilates the pulmonary vasculature to distribute blood flow to areas of better ventilation - improved ventilation- perfusion matching yields increased arterial oxygen pressures - NO binds to hemoglobin, causing no systemic vasodilation |
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What are prostacyclin analogs? |
- an inhaled prostacyclin on the market in the US - available as an inhalation solution to treat PPHN - dilates the systemic and pulmonary arterial vascular beds - delivered by ( l- neb Adaptive Aerosol Delivery (AAD) system, Prodose AAD system, Ultrasonic) |
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What does NO (Nitric Oxide) do in PPHN (Persistent Pulmonary Hypertension in Newborns) ? |
- NO dilates the pulmonary vasculature to distribute blood flow to areas of better ventilation - improved ventilation- perfusion matching yields increased arterial oxygen pressures - NO binds to hemoglobin, causing no systemic vasodilation |
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What are prostacyclin analogs? |
- an inhaled prostacyclin on the market in the US - available as an inhalation solution to treat PPHN - dilates the systemic and pulmonary arterial vascular beds - delivered by ( l- neb Adaptive Aerosol Delivery (AAD) system, Prodose AAD system, Ultrasonic) |
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Name prostacyclin analogs? |
1. Ventavis (llprost) - l- neb to treat pulmonary hypertension 2. Orenitram/ Tyvaso (Treprostinil)- delivered by ultrasonic to treat pulmonary hypertension 3. Flolan ( Epoprostenol)- used to treat pulmonary hypertension |
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Precautions and Respiratory Care Assessment: Inhaled Human Insulin ( Afrezza)? |
- Afrezza is not recommended for use in patients with lung disease - patients should not smoke when taking Afrezza - should be used in combination with patients with type 1 diabetes - monitor for bronchospasm |
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What should you remember about babies breathing? |
Babies are obligatory nose breathers |
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What to know about off- labeled use of drugs? |
- off- label use = not approved by FDA - off- label prescribing is commonly used and is accepted medical practice - example: Aspirin used for pain but off- label used as a blood thinner |
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What to know about off- labeled use of drugs? |
- off- label use = not approved by FDA - off- label prescribing is commonly used and is accepted medical practice - example: Aspirin used for pain but off- label used as a blood thinner |
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What is the selection of delivery devices for off- labeled drug use? |
3 categories: Nebulizers (jet or ultrasonic), pMDIs, DPIs SVN’s, MDI’s, and DPI’s are equally effective in delivering short acting beta agonist |
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What to know about off- labeled use of drugs? |
- off- label use = not approved by FDA - off- label prescribing is commonly used and is accepted medical practice - example: Aspirin used for pain but off- label used as a blood thinner |
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What is the selection of delivery devices for off- labeled drug use? |
3 categories: Nebulizers (jet or ultrasonic), pMDIs, DPIs SVN’s, MDI’s, and DPI’s are equally effective in delivering short acting beta agonist |
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What are the advantages and disadvantages with a MDI? |
Advantages: small, portable, short treatment time, reduced oropharyngeal deposition Disadvantages: drug delivery can vary greatly |
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What ages are not appropriate for DPI? |
Usually not appropriate for children <5 or 6 years of age because they are driven by peak Inspiratory flow. Fast, deep breath flow rate from 60 to 80 for DPI |
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What ages are not appropriate for DPI? |
Usually not appropriate for children <5 or 6 years of age because they are driven by peak Inspiratory flow. Fast, deep breath flow rate from 60 to 80 for DPI |
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Aerosol administration in Intubated Patients? |
- Less efficient than in spontaneously breathing patients May effect: Volume, pressure, positive end- expiratory pressure (PEEP), sensitivity, Fraction of inspired oxygen |
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What are Neuromuscular Blocking Agents (NMBAs)? |
- Drugs that cause skeletal muscle weakness or paralysis - Also termed paralytics or muscle relaxants - Produce their effect at The neuromuscular junction by interfering with Ach |
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What are Neuromuscular Blocking Agents (NMBAs)? |
- Drugs that cause skeletal muscle weakness or paralysis - Also termed paralytics or muscle relaxants - Produce their effect at The neuromuscular junction by interfering with Ach |
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What are the clinical uses for NMBAs (Neuromuscular Blocking Agents)? |
- NMBAs are lipophilic and do not penetrate into fat tissue or across the blood brain barrier and are not reabsorbed from GI tract, Given via IV - facilitate intubation - to obtain muscle relaxation during surgery - Enhance patient- ventilator synchrony - Terminate status epilepticus (seizures) and tetanus (lockjaw) - keep patients immobile (trauma patients) |
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What makes up the Autonomic nervous system? |
- The CNS that has the brain and spinal cord - The PNS that has voluntary control ( somatic motor nervous system ) and involuntary (autonomic nervous system). |
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What are the parts of the neuron? |
Cell body, axons, dendrites |
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What are the parts of the neuron? |
Cell body, axons, dendrites |
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The transmission of nerve conduction in the skeletal muscle is chemically mediated by ______? |
Acetylcholine |
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What are the parts of the neuron? |
Cell body, axons, dendrites |
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The transmission of nerve conduction in the skeletal muscle is chemically mediated by ______? |
Acetylcholine |
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What breaks down acetylcholine? |
Acetylcholinesterase (AChE) |
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What happens during depolarization? |
Action potential occurs |
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What happens during repolarization? |
Membrane potential returns to baseline |
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What are the two ways to block muscle contraction? |
1. Nondepolarizing agent competitive inhibition, the binding and blocking of Ach receptors without depolarization = prevents muscle contraction 2. Depolarizing agent Prolonged occupation and persistent binding, results in sustained depolarization of the neuromuscular junction, preventing repolarization = flaccid paralysis |
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Nondepolarizing agents what is the mode of action? |
- competitive inhibition - block acetylcholine receptors without activating them - mode of action Affect postsynaptic cholinergic receptors at the neuromuscular junction Compete against endogenous acetylcholine Effect is dose related Acetylcholinesterase inhibitors (neostigmine) can reverse blockade |
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What should you know about nondepolarizing agents: pharmacokinetics? |
- Chemically resemble acetylcholine - Poorly lipophilic - Poorly absorbed one GI tract, must be given IV - onset of paralysis and duration of action vary widely and are dose dependent - longer duration of action (35-60 mins) - Duration can be increased by: advanced age, hepatic or renal failure |
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Nondepolarizing agents usually have what endings ? |
Usually end in “-onium” or “-urium” - Pancuronium - Pavulon - Vercuronium - Norcuron - Rocuronium - Cisatracurium- Nimbex - Atracurium When normal conduction returns 75% of receptors May still be occupied by blocker. These agents are metabolized in the liver and excreted by the kidneys Are inactivated by PH and temperature |
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Nondepolarizing agents usually have what endings ? |
Usually end in “-onium” or “-urium” - Pancuronium - Pavulon - Vercuronium - Norcuron - Rocuronium - Cisatracurium- Nimbex - Atracurium When normal conduction returns 75% of receptors May still be occupied by blocker. These agents are metabolized in the liver and excreted by the kidneys Are inactivated by PH and temperature |
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Name reversal of nondepolarizing agents? |
- Reversal of nondepolarizing blockade with an indirect- acting agent Agents (cholinergic) - Neostigmine, Edrophonium, Pyridostigmine |
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Name the only depolarizing agent? |
- Only one agent is succinylcholine - Shorter acting than nondepolarizing agents - paralysis in 60-90 seconds with a clinical duration from 10 to 15 minutes - ideal for patients requiring intubation |
