Medications that affect nondepolarizing NMBAs

Recall the mechanism of action:
Nondepolarizing neuromuscular blocking agents (ndNMBAs) are competitive agonists to the nicotinic acetylcholine receptor → prevent ACh binding and NMJ depolarization
Affected by neuromuscular disease, age, burns, obesity, hepatic/renal dysfunction, hypothermia, electrolyte disturbance, acidosis, and medications:
Inhaled anesthetics:
Potentiate ndNMBA blockade
Combination of two nondepolarizing NMBAs:
Same class → additive effect
Different class → synergistic effect
Antibiotics: tetracyclines, aminoglycosides, polymyxins, and clindamycin:
Potentiate ndNMBA blockade
Anticonvulsants: phenytoin and carbamazepine
Acute: potentiate blockade
Chronic: attenuate blockade
Lithium:
Potentiate ndNMBA blockade
Local anesthetics:
Potentiate ndNMBA blockade

[@ruckmarch]

They are competitive antagonist not agonist.