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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 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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Potassium-competitive acid blockers.

Trevor A Davis1, C Prakash Gyawali2

  • 1Division of Gastroenterology, Department of Pediatrics.

Current Opinion in Gastroenterology
|September 9, 2025
PubMed
Summary
This summary is machine-generated.

Potassium-competitive acid blockers (PCABs) offer rapid and sustained acid suppression for foregut disorders, outperforming proton pump inhibitors (PPIs) in clinical trials. PCABs provide an effective alternative with a reassuring safety profile for managing GERD and H. pylori.

Keywords:
acid suppressiongastroesophageal reflux diseasepeptic ulcer disease

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Area of Science:

  • Gastroenterology
  • Pharmacology

Background:

  • Acid suppression is crucial for managing foregut disorders like GERD.
  • Proton pump inhibitors (PPIs) are standard but have limitations including slow onset and nocturnal acid breakthrough.

Purpose of the Study:

  • To review the efficacy and safety of potassium-competitive acid blockers (PCABs).
  • To compare PCABs with existing acid suppressants.

Main Methods:

  • Review of randomized controlled trials and clinical data on PCABs.
  • Analysis of PCABs' pharmacokinetic and pharmacodynamic properties.

Main Results:

  • PCABs provide rapid, profound, and sustained acid suppression, controlling both daytime and nocturnal acid.
  • PCABs are non-inferior or superior to PPIs in treating GERD and H. pylori infections.
  • Long-term safety is reassuring, though hypergastrinemia and infection risk warrant consideration.

Conclusions:

  • PCABs represent a novel and effective class of acid suppressants.
  • Further real-world research will define the optimal clinical role for PCABs.