More anti-cholinesterase dugs

Question 1

What are nicotinic effects?

Answer 1

Neuromuscular transmission

Question 2

What are muscarinic effects?

Answer 2

Miosis
Lacrimation
Salivation
Decreased HR
Bronchial constriction 
Enhanced urination

Question 3

Anticholinergic= anti-______ and ________—> PONV

Answer 3

Rest and digest

Question 4

What happens once AchE is maximally inhibited?

Answer 4

Additional AchE does not further antagonize NMB

• administer reversal agent only after twitch height recovered >10%
• if not, keep pt sedated and incubated

Question 5

What are factors that influence reversal of NMB?

Answer 5

• NDNMB drug being reversed
• intensity of blockade at time of reversal
• antagonism ay be prevented by or inhibited by:
  
  • antibiotics, especially aminoglycosides, quinolones, tetracyclines
  • hypothermia
  • respiratory or metabolic acidosis
  • hypokalemia

Question 6

What is physostigmine?

Answer 6

An anticholinesterase drug—->(pro- Ach)
* NH3(tertiary amine) that crosses the BBB
- antagonizes adverse CNS effects of certain drugs
(Used for OD of scopolamine or atropine)

Question 7

Physostigmine will reverse:

Answer 7

• anticholinergics: atropine and scopolamine
  
  • reverses their restlessness and confusion
• opioids:
  
  • reverses ventilatory depression,NOT analgesia
• anesthetics.
  
  • decreases post-op somnolence after volatile anesthetics
  • reverses CNS effects of ketamine

Question 8

What are other uses for physostigmine?

Answer 8

• glaucoma
• Alzheimer’s
• chronic fatigue syndrome
• post op analgesia and shivering
• dx and management of cardiac arhythmias

Question 9

What happens during an anticholinesterase O.D?

Answer 9

(can happen at any dose)
Muscarinic:
- miosis/difficulty focusing
- salivation—>aspiration
- bronchoconstriction—>difficulty breathing
- significant bradycardia—> can lead to asystole
- abdominal cramps
- loss of bowel and bladder control
Nicotinic:
- skeletal muscle weakness, paralysis, apnea
CNS:
- confusion, ataxia, seizures, coma, hypoventilation

Question 10

What is the treatment for anticholinesterase OD?

Answer 10

• atropine for muscarinic effects
• pralidosime: AchE reactivator
• mainly supportive measures

Question 11

What are organophosphate anticholinesterases?

Answer 11

• insecticides and nerve agents —> created to kill people
• rapid absorption through skin, GI tract and alveoli
• highly lipid soluble—>will cross the BBB and produce intense CNS effects