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106 SECTION II Autonomic Drugs

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C ASE STUD Y ANSWER

Blepharospasm and other manifestations of involuntary Release of ACh can be reduced or blocked by botulinum
muscle spasm can be disabling and, in the case of large toxin, which interferes with the fusion of nerve ending ACh
muscles, painful. Contraction of skeletal muscle is triggered vesicles with the nerve ending membrane (see text). Depend-
by exocytotic release of acetylcholine (ACh) from motor ing on dosage, botulinum blockade has an average duration
nerves in response to calcium influx at the nerve ending. of 1 to 3 months.