Neuromuscular Blocking Drug Puns

"do not affect the autonomic NN receptors " This is a Zanki card, can someone explain it? Thanks

Today in class we learned about the role of anticholinesterases in the reversal of Nondepolarizing NMBs. I have a few questions:

If I understand correctly, the ultimate mechanism of action is to flood the neuromuscular junction with Ach, overcoming the NMB at the nAChR sites.

My questions are:

1. why can't we use Ach derivative drugs like bethanechol, or metacholine, carbachol as reversal agents? do they not have affinity to the right type of receptors? It seems to me that we can avoid the need for concurrent administration of glycopyrrulate, in this case.

2. How come the same agents (i.e. neostigmine, edrophonium) have "unreliable" effects on the reversal of succinylcholine? (stoelting 5th edition) From my understanding, they should be doing the same thing they do against nondepolarizing NMB, since they all competitively bind the same postsynaptic nAchRs in the neuromuscular junction. Is the reversal of nondepolarizers more involved at the presynaptic nAChRs?

3rd question slightly unrelated to the first two: Why does succinylcholine show up as phase 1 block on train of four?

thanks

I'm writing a movie script where I need someone to be limp and appear dead, but he's actually alert. What is a Neuromuscular blocking agent or other drug that could paralyze someone but allow them to still see and hear? And would like for it to be able to be taken orally so it can be slipped in someone's drink. Also, the person needs to be able to breathe on their own. Does this exist? Any help would be greatly appreciated. Sorry for the random question.

My mom:

Smoker (finally recently quit), alcohol dependency (has reduced from a pint of gin to ~1-2 cans of Guinness a day). Rheumatoid arthritis, osteoporosis. Had to have gallbladder removed ~10 years ago, constant issues with digestion/BM ever since then.

In 2017 she had a "thrombotic stroke involving left posterior artery" which caused some weakness on the right side of her body and occasionally caused her right knee to go out. Besides the knee, another lasting issue was that her circadian rhythm was really thrown out of whack, so she's barely been able to sleep more than a few hours at a time and has relied on Unisom a lot. Now she takes .25mg Xanax to fall asleep. After about a year after the stroke, we slowly started to notice progressing symptoms. She fell three times last year and has broken her arm, rotator cuff, ribs, nose, and teeth.

Her symptoms are:

whole-body muscle weakness

• difficulty chewing, swallowing (coughs and drools during meals), no longer able to speak coherently (relies on text-to-speech app)
• face seems stiff and puffy, not expressive
• muscles wasting away, she looks like skin and bones, says she feels tingling sometimes
• can no longer get in and out of bed without help, every week losing a capability like opening the fridge
• foot drop, compensated by lifting legs higher but is sometimes unable to lift right leg
• uses walker around the house but otherwise relies on wheelchair
• no improvement after weeks of PT ST and OT

incontinence

behavior

• mood swings, rapid fluctuations in mood, depression (how could she not be depressed? this shit sucks)
• confabulates
• used to have very little appetite, now eats much more but not gaining weight
• food preferences more childlike - fried fish and french fries with ketchup (used to be quite a fancy cook), craves more sweets than she used to
• short attention span, sometimes poor memory (ex. forgets what color combo makes green), other times memory is fine
• can't sleep more than a few hours at a time

MRI on her spine and brain were normal

EEGs normal

reflex test normal

neurologist is currently puzzled

waiting on xrays and a swallow study

we're really sad and scared

Hello, I have had TMJ/D for about 10 months now. My symptoms began with facial pain and sinus pressure so I got a day and night guard from an Ora facial surgeon/TmJ specialist. I wore the day and night guard for about a month and my symptoms cleared, however about 5 months ago I got sharp ear pain (sharp stabbing pain least about 1 second). The pain subsided after a month However just last week it came back in full throttle. At this point I want to treat the problem and hopefully ease the symptoms. I went to see a Neuromuscular Dentist that treats TmJ with a phase 1/ phase 2 system (splint to find correct bite then braces/teeth restoration to keep corrected bite). My number one pain and issue has been the ear pain. Has anyone had their ear pain subside after having treatment with a Neuromuscular Dentist? Thank you!

Just out of interest as I have an essay on this and was wondering where to start...

What underlying mechanisms do chronic neurodegenerative diseases share in common with neuromuscular diseases (in particular multiple sclerosis and Duchenne/Becker muscular dystrophy), and also epilepsy?

I know the genetic hypotheses can be seen as similar, of course Huntington’s is genetic but the arguments for PD and AD maybe being genetic correspond with some of the ideas of muscular dystrophy being caused by mutations.

Are there any similarities between the mechanisms of neurodegeneration with neuromuscular disorders? In particular the stuff to do with protein accumulation and dyshomeostasis?

Same with epilepsy - I’m trying to think how the mechanism are similar in any ways?

Not neurology. Not physiatrist. Not chiropractor (lol). 3 year neuromuscular Medicine residency. How does it differ from Physical therapy? What do they do and what is their salary? Seems like faux medicine but don’t want to be quick to judge.