Anticholinesterase

Question 1

Neostigmine Class

Answer 1

Anticholinesterase or Cholinesterase Inhibitor

Question 2

Neostigmine Uses

Answer 2

Reversal of non-depolarizing neuromuscular blockade

Produce parasympathetic effect to treat paralytic ileus and atonic bladder

Treat myasthenia gravis (neostigmine, pyridostigmine)

Postoperative analgesia (neostigmine, intrathecal or epidural)

Question 3

Neostigmine MOA

Answer 3

Inhibits destruction of Ach by acetylcholinesterase which facilitates transmission of impulses across the NMJ

Excess Ach displaces NMBAs adn

Produces direct muscarinic activation via increased Ach levels (parasympathetic effects)

Question 4

Neostigmine Dosing

Answer 4

25 – 50 mcg/kg, 5 mg maximum

Based on monitoring and clinical condition
2-3 TOF twitches 50 mcg/kg
4 TOF twitches with fade 40 mcg/kg
4 TOF twitches without fade 15-25 mcg/kg

Question 5

Neostigmine Onset and DOA

Answer 5

Onset: 15 minutes
DOA: 45 minutes

Question 6

Neostigmine Metabolism

Answer 6

Psuedocholinesterases (50%)

Question 7

Neostigmine Excretion

Answer 7

Eliminated by the kidneys (50% unchanged)

Question 8

Neostigmine Effects on Body (5)

Answer 8

Miosis
Bradycardia
Salivation
Bronchoconstriction
Peristalsis

Question 9

Neostigmine Administration Considerations

Answer 9

Administered with an antimuscarinic (eg glycopyrrolate)

Ex: I mg of neostigmine with 0.2 mg of glycopyrrolate