Briefly outline the mechanisms by which drugs other than neuromuscular muscle relaxants affect neuro-muscular blockade

Briefly outline the mechanisms by which drugs other than neuromuscular muscle relaxants affect neuro-muscular blockade.

Most drugs that interact with neuromuscular muscle relaxants enhance the degree of block; however, some have the opposite effect. Some drugs have direct effects of their own on neuromuscular transmission, while some interact via alternate mechanisms at other sites. Sometimes, no sin-gle mechanism can account for the interaction. Sites of interference include motor nerves, nerve terminals, end-plates, nicotinic receptors, postsynaptic muscle membrane, and interference with excitation–contraction coupling.

Non-neuromuscular components include the central nervous system and metabolic mechanisms.