Solution-Clinical usage of neuromuscular blocking agents

1) Briefly present the significance and clinical usage of neuromuscular blocking agents.

2) Describe the difference between centrally active muscle relaxants and directly acting skeletal muscle relaxants.

3) Describe and compare the mechanism of action of depolarizing and nondepolarizing agents. What type of receptors are they interacting with?

4) Using baclofen as an example of antispasticity drug, explain the mechanism of action on muscle fibers and reflexes. How different is the action of benzodiazepines, such as diazepam which also has antispasticity effect?

5) Does baclofen cross blood-brain-barrier or not? What is a major clinical application for baclofen?

6) Briefly present the most common side effects of neuromuscular blocking drugs. Why some of them can cause hypertension or arrhythmias?

7) What side effects are directly related to long-term use of neuromuscular blocking agents?

8) Present the most common drug-drug interactions between neuromuscular blocking agents and other drugs.

9) Briefly describe the mechanism of action of local anesthetics. Can they act on neurons in PNS?

10) Briefly describe the major factors affecting the rate of onset of clinical anesthesia? What is a benefit using vasoconstrictors with local anesthetics?

11) Analyze the process of synthesis, metabolism, storage and release of histamine.

12) Briefly present the action of inhibitors of degranulation and histamine release from mast cells and basophils. Why classic antihistamines are called selective H1 receptor antagonist?

13) Describe the major characteristics and actions of antihistamines. What is a difference between first and second generation of antihistamines?

14) Compare the actions of H1 and H2 receptor antagonists.

15) Analyze the process of synthesis, metabolism, storage and release of eicosanoids.

16) Briefly describe the mechanism of action and pharmacokinetics of eicosanoids.

17)What side effects are directly related to long-term use of eicosanoids?


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The common side effects of long term usage of the neuromuscular agents include following toxicity or alteration in the physiological conditions:Prolonged apnoea in many cases, which leads to respiratory paralysis in many a cases Flushing in the patients taking neuromuscular blocking agents for long term usage. This includes release of heat from facial region, warming of nose and ear pinna. The symptom is more common in d tubocurarine and occasionally appearing in case of agents such as mivacurium and atracurium.

The most common side effect include reduction in blood pressure and collapse of cardiovascular functioning. The form of symptom is more common in case of patients having a history of hypovolemic condition. Cardiac arrhythmias is more common in patients taking depolarizing effects such as suxamethonium (depolarizing agents). The reason is associated with the release of intracellular K+ ions, when the patient is either having hyperkalemia condition or is having soft tissue injury related

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