Final answer:
The metabolism of pancuronium, rocuronium, vecuronium, and mivacurium involves the liver, kidneys, and for mivacurium, plasma cholinesterases. These agents block acetylcholine receptors at the neuromuscular junction causing paralysis. Atropine, an anticholinergic drug, is used to manage symptoms of excessive acetylcholine due to nerve agent poisoning.
Step-by-step explanation:
The metabolism of neuromuscular blocking agents is crucial for their pharmacokinetics and pharmacodynamics. Pancuronium is primarily eliminated by the kidneys, and to a lesser extent by the liver. Rocuronium is mainly metabolized by the liver and is also subject to biliary excretion. Vecuronium, like rocuronium, is metabolized by the liver and excreted in bile and urine. Mivacurium, however, is unique as it is hydrolyzed rapidly by plasma cholinesterases. All these agents interfere with the neuromuscular transmission by blocking the acetylcholine receptors at the neuromuscular junction, resulting in muscle paralysis needed during surgery. Anticholinergic drugs such as atropine are often used to counter the effects of excessive acetylcholine due to nerve agent poisoning and can alleviate the increase in bronchial secretions.