October 2006.

Neuromuscular blocking drugs (NMBDs) are considered “high-alert” medications since they can be associated with severe patient harm and death, and carry a high risk of causing injury and misuse. A review and analysis of the United States Pharmacopeia (USP) Medication Errors Reporting Program and MEDMARX program databases showed a continuing risk of patient harm or death due to errors with NMBDs.¹ Serious adverse events occur when NMBDs are used without adequate safeguards. Since each of the various neuromuscular blocking drugs have differing adverse events (with respect to the incidence of hypotension, bronchospasm, and allergic reactions), familiarity with the profiles of individual drugs is necessary to avoid serious adverse events. Drug-drug interactions can also be a problem¹, and pharmacists need to be aware of the potential drugs that can react with NMBDs.

The Institute for Safe Medication Practices (ISMP) recently issued recommendations for preventing errors with NMBDs, noting that an inadequate knowledge of drug action contributes to errors.² The interdisciplinary USP Safe Medication Use Expert Committee also recently issued a statement on handling NMBDs safely and effectively. An article in the American Journal of Health-System Pharmacy (January 2006) summarized the committee’s recommendations¹, citing the need for “focused education” and practitioner credentialing for the safe use of NMBDs. The article noted that “increased awareness and action on the part of . . . all practitioners involved in the entire medication use process are needed to improve the safety of this class of medications.” The authors recommended that these professionals “be trained to recognize NMBDs and to know their mechanisms of action and associated risks.”

The format and design of “Neuromuscular-Blocking Drugs” as a print-based, distance-learning activity has proven to be a credible and well-liked vehicle for the continuing education of pharmacists and to help improve overall patient care. This is evidenced by the rising numbers of pharmacists participating in such activities over the last two years, as evidenced by data compiled by the ACPE from its accredited providers’ Program Description Forms.

This CPE activity will include a CPE Pre-Test and a CPE Post-Test, which will allow participants to identify areas of educational need and to test their skills and knowledge of the material presented in the educational activity. An evaluation assessment questionnaire will provide participants with a means to assess the activity’s quality, fairness and balance, and value of the educational activity to their pharmacy practice.

Pharmacy Guest Editor/Peer Reviewer

Andrew J. Donnelly, PharmD, MBA
Director of Pharmacy
Clinical Professor of Pharmacy Practice
University of Illinois Medical Center at Chicago
Chicago, Illinois
Dr. Donnelly has disclosed that he had/has the following financial relationships/interests with
commercial companies pertaining to this educational activity:
Speakers Bureau: Baxter
Other: Abbott (short video)

Peer Reviewer

Julie A. Golembiewski, PharmD
Clinical Associate Professor
Department of Pharmacy Practice
University of Illinois Medical Center at Chicago
Chicago, IL
Dr. Golembewski has disclosed that she had/has the following financial relationships/interests with commercial companies pertaining to this educational activity:
Grant/Research Funding: Hospira
Consultant/Advisor: Baxter
Speakers Bureau: Baxter, Merck