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We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care. These medications include HIV drugs, benzodiazepines, and cholesterol medications, as well as lifestyle drugs, such as diet pills and erectile dysfunction medications. In fact, one study demonstrated the efficacy of utilizing an accredited online pharmacy to prescribe Viagra. They also provided a more complete medical history 21. To manage the increased use of online pharmacies, however, more regulations are being proposed, including the Online Pharmacy Safety Act and the development of state-run online pharmacy programs 22, 23.

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There are two types of neuromuscular blocking drugs used during surgery: nondepolarizing neuromuscular blockers and depolarizing neuromuscular blockers. Non-depolarizing neuromuscular blockers are competitive antagonists of acetylcholine at the neuromuscular junction. Normally, binding of acetylcholine to its receptor triggers muscle contraction. These drugs produce a short-lasting paralysis that can be reversed by anticholinesterase drugs. They have no sedative action or analgesic effects. Examples of non-depolarizing neuromuscular blockers are pancuronium and atracurium.

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