Question

The two types of neuromuscular junction are nondepolarizing neuromuscular blockers and depolarizing neuromuscular blockers. Constrict a table that compares and contrasts the therapeutic actions, indications, pharmacokinetics, contraindications, and important drug-drug interactions for each type of neuromuscular junction blocking agents.

Answer 1

	DEPOLARIZING BLOCKERS	NON-DEPOLARIZING N.M BLOCKERS
THERAPUTIC ACTION	act as Ach receptor agonist binds with cholinergic receptors and deplolarize it and thus neuromuscular transmission is blocked and leads to paralysis of the patient. provide skeltal muscle relaxation	act as competitive Ach antagonists act on post-junctional receptors by inhibiting Ach binding there
INDICATION	surgery[ with general anesthesia] mechanical ventillation during ECT used to facilitate intubation	used to facilitate tracheal intubation relaxaton of skeltal muscles during surgery
PHARMACOKINETICS	administered intravenously succinylcholine metalbolised to succynyl-monocholine and choline.succnyl monocholine metabolised slowly to succinic acid and choline elimination half life is 47 sec.	hoffmann elimination clearence range from total elimination by kidney[gallamine] to substatial hepatic clearance cross placental barrier in a trace amount but not significant
CONTRAINDICATION	hypersensitivity to drugs malignant hyperthermia non-availability of mech.ventillation relative contraindication in patients with bradycardia CVA and spinalcord injury eye condtions like close angle glucoma,ocular surgery,penetrating eye injuries myopathies associated with elevated CK multiple trauma,severe burns upper motor neuron injury disorders of plasma pesudocholinesterase	hypersensitivity mysthenia gravis,GBS,SLE,polymyositis. causious use in hepatic failure/renal failure cerebral palsy burn injuries hemiplegia[on the same side] chronic infection of botulism or tetani
DRUG-DRUG INTERACTIONS	drugs which inhibit acetylcholine release or synthesis may cause prolonged respiratory paralysis when given with succinyl choline promazine,oxytocin,lidocaine,lithium carbonate,quinine will enhane neuromuscular blocking action when combined	inhaled anesthetics like desflurane,isoflurane may cause respiratory distress antibiotics like aminoglycosides,clindamycin,tetracycline augment activity of drugs antiarrythmics like calcium channel blokers and anti convulsants like phenytoin also augment activity