d-Tubocurarine blocks nicotinic AChRs in muscle end plates and autonomic ganglia but has no effect on mus-
carinic AChRs. It does not affect nerve or muscle excitability or conduction of action potentials. Because it is charged, it penetrates cells poorly and does not enter the CNS. However, if applied directly to brain or spinal cord, it will block nicotinic AChR in those tissues. In humans, d-tubocurarine has a moderate onset of action (34 minutes) followed by progressive flaccid paralysis. The head and neck muscles are affected initially, then the limb muscles, and finally the muscles of respiration. Recovery from paralysis is in the reverse order.
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