Table 9-1 summarizes the pharmacological properties of various neuromuscular blocking agents. The anatomy, physiology, and pharmacology of the motor end plate are shown in Figure 9-3.
SKELETAL MUSCLE Competitive antagonists competitively block the binding of ACh to the nicotinic ACh receptor at the end plate. The depolarizing agents, such as succinylcholine, act by a different mechanism: initially, they depolarize the membrane by opening channels in the same manner as ACh. However, they persist for longer durations at the neuromuscular junction because of their resistance to AChE. The depolarization is thus longer-lasting, resulting in a brief period of repetitive excitation (fasciculations), followed by block of neuromuscular transmission (and flaccid paralysis). Paralysis occurs because released ACh binds to receptors on an already depolarized end
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