Which NMBA is contraindicated in crush injuries, eye injuries, history of malignant hyperthermia, burns > 24 hours old, hyperkalemia, or any nervous system disorder?
Added by Jesse S.
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NMBA stands for Neuromuscular Blocking Agents, which are drugs used to induce muscle relaxation by blocking the transmission of nerve impulses to the muscles. Show more…
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Botulinums are potent neurotoxins produced by the bacillus, Clostridium botulinum. The toxins are proteins that bind to a receptor on the presynaptic membrane of neurons in peripheral cholinergic synapses. Botulinum toxins act at four different sites in the body: The neuromuscular junction, autonomic ganglia, postganglionic parasympathetic nerve endings, and postganglionic sympathetic nerve endings that release acetylcholine (such as sweat glands). Botox blocks neuromuscular transmission by binding to sites on motor or autonomic nerve terminals. The toxin-receptor complex is trafficked into the cell. Once released from the receptor, it cleaves SNAP-25, a protein critical to the successful docking and release of acetylcholine from vesicles situated within nerve endings. Typically, effects take a few days to manifest and persist for up to a few months. The affected nerve terminals do not degenerate, but the blockage of neurotransmitter release is irreversible. Function can be recovered by the sprouting of nerve terminals and formation of new synaptic contacts; this usually takes two to three months. Classified as a skeletal muscle relaxant, BOTOX (onabotulinumtoxin A) is a medication approved by the FDA for a number of indications. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to other medical treatments. The list of possible new indications is rapidly expanding. An unlicensed preparation of botulinum toxin A, intended for research purposes, was illegally administered by a Florida physician to himself and three patients, including his girlfriend. The doctor was practicing without a medical license at the time. Within days, all four reported blurry vision, trouble swallowing, trouble speaking, and labored breathing. All were hospitalized and survived due to prompt emergency care. Identify the cranial nerves affected by the BOTOX that resulted in blurry vision, trouble swallowing, and trouble speaking clearly. Identify the muscles involved in blurry vision.
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