Neuromuscular-blocking agents also known as paralytics block neuromuscular transmission at neuromuscular junction, causing loss of motion of skeletal muscles. This is accomplished similarly by acting presynaptically through the inhibition of acetylcholine (ACh) synthesis and by acting postsynaptically at the acetylcholine receptors of the motor nerve end-plate. While a few medications act presynaptically, (for example, botulinum toxin and tetanus poison), those of current clinical significance work postsynaptically. Because the appropriate dose of neuromuscular-blocking medication may paralyze muscles required for breathing (i.e., the diaphragm), mechanical ventilation should to be provided to maintain adequate respiration.


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