A. Nondepolarizing (competitive) blockers mechanism low dose

Nondepolarizing neuromuscular-blocking drugs interact with the nicotinic receptors to prevent the binding of ACh. Thus, these drugs prevent depolarization of the muscle cell membrane and inhibit muscular contraction. Because these agents compete with ACh at the receptor without stimulating it, they are called competitive blockers. Their action can be overcome by increasing the concentration of ACh in the synaptic gap, for example, by administration of such cholinesterase inhibitors as neostigmine, pyridostigmine, and edrophonium. Anesthesiologists often employ this strategy to shorten the duration of the neuromuscular blockade. In addition, at low doses the muscle will respond to direct electrical stimulation from a peripheral nerve stimulator to varying degrees, depending on the extent of neuromuscular blockade.