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Related Concept Videos

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
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Myasthenia Gravis: Diagnostic Tests01:15

Myasthenia Gravis: Diagnostic Tests

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Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
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Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action

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Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
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Disorders of the Skeletal Muscle01:28

Disorders of the Skeletal Muscle

939
The clinical conditions affecting the skeletal muscle tissue are broadly categorized as musculoskeletal and neuromuscular disorders.
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
939
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics

450
All neuromuscular blocking agents are injected intravenously because they are poorly absorbed from the GI tract. Rapid onset is achieved with intravenous administration, although absorption is also adequate from an intramuscular injection. Since these agents are highly ionized, they do not readily penetrate cell membranes or cross the blood-brain barrier.
Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
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Polymyxin-induced neuromuscular weakness: a case report.

Amanda X Y Chin1,2, Kay W P Ng1,2, Yee Cheun Chan1,2

  • 1Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.

Frontiers in Neurology
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Polymyxin antibiotics can cause rare neuromuscular blockade, leading to respiratory failure. Early recognition and drug discontinuation rapidly reverse this potentially fatal condition.

Keywords:
multi-drug resistanceneuromuscular blockadeneurotoxicitypolymyxinrenal impairmentrespiratory failure

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Area of Science:

  • Pharmacology
  • Neurology
  • Infectious Diseases

Background:

  • Polymyxins are critical antibiotics for treating multi-drug resistant Gram-negative infections.
  • Polymyxin-induced neuromuscular blockade is a rare adverse effect, historically reported in the mid-20th century.

Observation:

  • A patient developed hypercapnic respiratory failure after starting polymyxin therapy for *Escherichia coli* bacteremia.
  • The patient exhibited neuromuscular dysfunction, including ptosis, consistent with polymyxin toxicity.

Findings:

  • Discontinuation of polymyxin led to rapid recovery of muscle strength and resolution of respiratory failure.
  • The patient was successfully extubated following cessation of the antibiotic.

Implications:

  • This case highlights the importance of recognizing polymyxin-induced neuromuscular blockade, especially with the resurgence of polymyxin use.
  • Prompt diagnosis and drug withdrawal are crucial for managing this reversible, life-threatening complication.