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Related Concept Videos

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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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.
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Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action01:17

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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.
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics01:11

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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.
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Depolarizing Blockers: Pharmocokinetics01:19

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Updated: Jun 15, 2025

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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RimabotulinumtoxinB: An Update.

Teresa Song1,2, Ellen S Marmur1,2

  • 1Marmur Medical, New York, New York.

Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.]
|August 28, 2024
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Summary

RimabotulinumtoxinB offers a safe and effective alternative for treating conditions like facial wrinkles and hyperhidrosis, particularly for patients resistant to type A. Common side effects include dry mouth and dysphagia, with a faster onset of action compared to type A.

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Area of Science:

  • Neurology
  • Dermatology
  • Pharmacology

Background:

  • Botulinum type-A toxin is a widely used medical and aesthetic treatment.
  • Botulinum type-B toxin (rimabotulinumtoxinB) is gaining interest, especially for treatment-resistant cases.

Purpose of the Study:

  • To review the FDA-approved and emerging clinical uses of rimabotulinumtoxinB.
  • To assess its efficacy and safety in various indications.

Main Methods:

  • Literature review of PubMed database.
  • Analysis of Food and Drug Administration guidelines.

Main Results:

  • Specific conversion ratios for type B toxin were noted for facial rhytids, cervical dystonia, hyperhidrosis, and sialorrhea.
  • Type B toxin demonstrated efficacy in treating facial rhytids, cervical dystonia, sialorrhea, and hyperhidrosis.

Conclusions:

  • RimabotulinumtoxinB is safe and effective for several conditions, with potential new applications.
  • Dry mouth and dysphagia are the most common side effects.
  • Type B toxin exhibits a faster onset and dose-dependent effects and adverse events.