Pharm USMLE Flashcards by Mani Yavi

28 year old chemist presents with MPTP exposure

What NT is depleted?

Dopamine

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Woman taking tetracycline exhibits photosensitivity

What are the clinical manifestations?

Rash on sun-exposed regions of body

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Nondiabetic patient presents with hypoglycemia but low levels of C peptide

What is the diagnosis

Surreptitious insulin injection

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African American male who goes to Africa develops hemolytic anemia after taking malaria prophylaxis

What is the enzyme defficiency

Glucose 6 phosphate dehydrogenase

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27 year old female with history of psychiatric illness now has urinary retention due to neuroleptic

What do you treat it with?

Bethanechol

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Farmer presents with dyspnea, salivation, miosis, diarrhea, cramping and blurry vision

What caused this and what is the mechanism

Insecticide poisoning, inhibition of acetylcholinesterase

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Patient with recent kidney transplant is on cyclosporine for immunosuppresion, he requires antifungal agent for candidiasis

What antifungal drug would result in cyclosporine toxicity?

Ketoconazole

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Man on several medications including antidepressants and antihypertensives, has mydriasis and becomes constipated

What is the cause of symptoms?

TCA

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55 year old postmenopausal woman on tamoxifen therapy

What is she at increased risk of acquiring?

Endometrial carcinoma

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Woman on MAO inhibitor has hypertensive crisis after meal

What did she ingest?

Tyramine (wine or cheese)

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After taking clindamycin, patient develops toxic megacolon and diarrhea

What is the mechanism of diarrhea?

Clostridium difficile overgrowth

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Man starts a medication for hyperlipidemia. He then develops rash, pruritus and GI upset

What drug was it?

Niacin

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Patient is on carbamazepine

What routine workup should be done?

LFT’s

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23 year old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant

Why?

Rifampin augments estrogen metabolism in liver rendering it less effective

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Patient develops cough and must discontinue captopril

WHat is a good replacement drug and why doesnt it have the same side effects?

Losartan - an angiotensin II receptor antagonist, does not increase bradykinin as captopril does

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Relates the amount of drug in the body to plasma concentration

Vd - volume of distribution

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Formule for volume of distribution

Vd = amount of drug in the body/plasma drug concentration

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Vd of plasma protein-bound drugs can be altered by what disease?

Liver and kidney

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Relates the rate of elimination to plasma concentration

CLEARANCE

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Formula for clearance

Cl = rate of elimination of drug/plasma drug concentration

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The time required to change the amount of drug in the body by 1/2 during elimination (or during constant infusion) is called _

Half life T1/2

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After 1 half life concentration of drug equals _ %

50%

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After 2 half lifes concentration of drug equals_

75%

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A drug infused at constant rate reaches about _ % of steady state after 4 T1/2

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Formula for T1/2

T1/2 = 0.7 * Vd/CL

Loading dose formula

Loading dose = Cp * Vd/F Cp= target plasma concentration F = bioavailibility

Formula for maintenance dose

Cp * CL / F Cp = target plasma concentration F = bioavailibility

In patients with impaired renal or hepatic function, the loading dose decreases, increases or remains unchanged? Maintenance dose?

Loading dose remains unchanged Maintenance dose decreases

Rate of elimination is constant (constant amount of drug is eliminated per unit time) - what order elimination? What happens to target plasma concentration?

Zero order elimination Target plasma concentration decreases linearly with time

Rate of elimination is proportional to drug concentration (constant fraction of drug eliminated per unit time) - what order elimination? What happens to target plasma concentration?

First order elimination Cp decreases exponentially with time

Give examples of drugs with zero order elimination

Ethanol Phenytoin Aspirin (at high or toxic concentration)

Phase I metabolism (reduction, oxidation, hydrolysis) yields _ metabolites (often still active)

Slightly polar, water soluble

What phase of metabolism associated with cytochrome P450

Phase I

What phase of metabolism associated with conjugation

Phase iI

Phase II metabolism (acetylation, glucoronidation, sulfation) yields _ metanolites (renally excreted)

Very polar, inactive

Geriatric patients lose which phase of metabolism first?

Phase I

Is it safe? Pharmacokinetics? - which phase of clinical testing of the drug

Phase I

Does it work in patients?- which phase of clinical testing of the drug

Phase II

Does it work? Double blind - which phase of clinical testing of the drug

Phase III

What happens in phase IV of clinical testing of the drug

Postmarketing surveillance

A competitive antagonist shifts agonist curve where?

To the right

A noncompetitive antagonist (irreversible) shifts agonist curve where?

Downward

Name antibiotics that block cell wall synthesis by inhibition of peptidoglycan cross linking

Penicillin Ampicillin Ticarcillin Pipercarcillin Imipenem Aztreonam Cephalosporins

Name antibiotics that block peptidoglycan synthesis

Bacitracin Vancomycin Cycloserine

Name antibiotics that block protein synthesis at 50S ribosomal unit

Chloramphenicol Erythromycin/macrolides Lincomycin Clindamycin Streptogramins (quinupristin, dalfopristin) Linezolid

Name antibiotics that block protein synthesis at 30S ribosomal unit

Aminoglycosides Tetracyclines

Name antibiotics that block nucleotide synthesis

Sulfonamides Trimethoprim

Name antibiotics that block DNA topoisomerase

Quinolones

Name antibiotic that blocks mRNA synthesis

Rifampin

Name bactericidal antibiotics

Penicillin Cephalosporins Vancomycin Aminoglycosides Fluoroquinolones Metronidazole

Name drugs that disrupt bacterial/fungal cell membrane

Polymyxins

Name drugs that disrupt fungal cell membranes

Amphotericin B Nystatin Flucoconazole/azoles

Oral form of penicillin is called _ IV form?

Penicillin V Penicillin G

Mechanism of penicillin

- Binds penicillin binding proteins - Blocks transpeptidase cross linking of cell walls - Activates autolytic enzymes

This antibiotic is bactericidal for gram positive cocci, gram positive rods, gram negative cocci and spirochetes. Not penicillinase resistant

PENICILLIN

Toxicity of penicillin

Hypersensitivity reactions Hemolytic anemia

Methicillin, nafcillin, dicloxacillin - mechanism of action? Narrow or broad action? Penicillinase resistant or not?

Same as penicillin Narrow action Penicillinase resistant because of bulkier R groups

Methcillin, nafcillin and dicloxacillin are clinically used for treatment of what bug?

S. aureus

Methicillin toxicity

Interstitial nephritis

Methcillin, nafcillin, dicloxacillin toxicity

Hypersensitivity reactions

Ampicillin, Amoxicillin- mechanism of action Penicillinase sensitive or resistant? Spectrum narrow or wide?

SAME AS PENICILLIN Wide spectrum Penicillinase sensitive

Ampicillin, amoxicillin can be combined with _ to enhance spectrum

Clavulinic acid

Which has greater oral bioavailibility - amoxicillin or ampicillin

AmOxicillin has greater Oral bioavailibility

Name antibiotics that are extended-spectrum penicillins - against certain gram positive and gram negative rods Name rods

HELPS kill enterococci - H influenzae, E.coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci Ampicillin, amoxicillin

Toxicity for ampicillin and amoxicillin

Hypersensitivity reactions, ampicillin rash, pseudomembranous colitis

Mechanism for carbenicillin, pipercillin, ticarcillin | Spectrum?

Same as penicillin, extended spectrum

Name penicillins used for treatment of Pseudomonas, and gram negative rods Is it penicillinase resistant or sensitive Can it be used with clavulinic acid

Carbencillin, Piperacillin, Ticarcillin Penicillinase sensitive Use with clavulinic acid

Toxicity for carbencillin, piperacillin, ticarcillin

Hypersensitivity reactions

Beta lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases, bactericidal

CEPHALOSPORINS

Which cephalosporins target gram positive cocci + Proteus , E. coli,Klebsiella

1st generation

Which cephalosporins target gram positive cocci + H. flu, Enterobacter, Neisseria, Proteus, E coli Klebsiella, Serratia

2nd generation

Which cephalosporins target serious gram negative infections resitant to other beta lactams, meningitis (most penetrate BBB) - give examples

3d generation - ceftazidime, ceftriaxone

3d generation cephalosporin used for treatment of Pseudomonas

Ceftazidime

3d generation cephalosporin used for treatment of gonorrhea

Ceftriaxone

Which cephalosporins have increased activity agains Psedudomonas and gram positive organisms

4th generation

Is there cross hypersensitivity between cephalosporins and penicillin

Yes, 5-10%

Toxicity for cephalosporins

Hypersensitivity reactions Increase nephrotoxicity of aminoglycosides Disulfiram like reaction with ethanol (in cephalosporins with methylthiotetrazole group) - cefamandole

A monobactam resistant to beta lactamases. Inhibits cell wall synthesis (binds to PBP3), synergistic with aminoglycosides, no cross allerginicity with penicillins

AZTREONAM

This antibiotic is used for Gram negative rods (Klebsiella, Pseudomonas, Serratia), no activity agains gram positives or anaerobes, for penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides

AZTREONAM

Is there any toxicity associated with AZTREONAM

Usually nontoxic, occasional GI upset

Broad spectrum beta lactamase resistant carbapenem

Imipenem

Imipenem is ALWAYS administered with _ WHY?

CILASTATIN Inhibitor of renal dihydropeptidase I - to decrease inactivation of the drug in renal tubules

Drug of choice for Enterobacter, also active against gram positive cocci, gram negative rods and anaerobes

Imipenem + cilastatin

Toxicity associated with Imipenem/cilastatin

GI distress, skin rash, CNS toxicity (seizures) at high plasma levels

Inhibits cell wall mucopeptide formation by binding D ala D ala portion of cell wall precursors. Resistance occurs with amino acid change of D ala D ala to D ala D lac

VANCOMYCIN

This antibiotic is used for serious gram positive multi drug resistant organisms, including S aureus, and Clostridium difficile (pseudomembranous colitis)

VANCOMYCIN

Diffuse flushing ("red man syndrome") associated with vancomycin can be largely prevented by?

Pretreatment with antihistamines and slow infusion rate

Toxicity for Vancomycin

Nephrotoxicity Ototoxicity Thrombophlebitis Well tolerated in general - does NOT have many problems

Gentamicin, neomycin, amikacin, tobramycin, streptomycin - what class of antibiotics?

Aminoglycosides

Bactericidal, inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake, therefore ineffective against anaerobes

AMINOGLYCOSIDES

Which aminoglycoside is used for bowel surgery

Neomycin

Aminoglycosides are _ with beta lactams

Synergistic

Aminoglycosides are clinically used for treatment of _

Severe gram negative rod infections

Toxicity of aminoglycosides

Nephrotoxicity (especially with cephalosporins) | Ototoxicity (especially with loop diuretics)

Doxycycline, demeclocycline, minocycline - name class of antibiotics

Tetracyclines

Bacteriostatic, bind to 30S and prevent attachment of aminoacyl-tRNA, limited CNS penetration

Tetracyclines

Which tetracycline is fecally eliminated and can be used in patients with renal failure

Doxycycline

Must NOT take tetracyclines with _ Why?

Milk Antacids Iron containing preparations Divalent cations inhibit its absorption in gut

Clinical use of tetracyclines

``` Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumonia Borelia burgdorferi Riccketsia Tularemia ``` VACUUM your BedRoom Tonight

Toxicity of tetracyclines

GI distress, discoloration of teeth and inhibition of bone growh in children, photosensitivity

Erythromycin, azithromycin, clarithromycin- name class of antibiotics

Macrolides

Inhibit protein synthesis by blocking translocation - bind to 23S rRNA of 50S ribosomall subunit, bacteriostatic

Macrolides

Clinical use macrolides

URI Pneumonia STD gram positive cocci (streptococcal infections in patients allergic to penicillin), Mycoplasma, Legionella, Chlamydia, Neisseria

Toxicity macrolids

GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rashes

Patient on antibiotic therapy develops acute cholestatic hepatitis - which clas of drug?

Macrolides

Most common cause of non compliance with macrolides

GI discomfort

Inhibits 50S peptidyltransferase, bacteriostatic

Chloramphenicol

This drug is used for treatment of meningitis (H flu, N meningitidis, Strep pneumoniae) but conservatively used due to toxicities

Chloramphenicol

Toxicities with chloramphenicol

Anemia (dose dependent) Aplastic anemia (dose independent) Gray baby syndrome

Which drug causes gray baby syndrome and why

Chloramphenicol - premature infants because they lack liver UDP-glucuronyl transferase)

Blocks peptide bond formation at 50S ribosomal subunit, bacteriostatic

Clindamycin

Which antibiotic is used to treat anaerobic infections (Bacteroides fragilis, Clostridium perfringens)

CLindamycin

Toxicity associated with clindamycin

Pseudomembranous colitis (C. difficile overgrowth), fever, diarrhea

PABA antimetabolites inhibit dehydropteorate synthase, bacteriostatic

Sulfonamides

Which sulfonamides are used for treatment of simple UTI

Triple sulfas or SMX

Clinical use of sulfonamides

Gram positive Gram negative Nocardia Chlamydia

Toxicity with sulfonamides

Hypersensitivity reactions Hemolysis if G6PD deficient Nephrotoxicity (tubulointerstitial nephritis) Kernicterus in infants Displace other drugs from albumin (warfarin)

Antibiotic inhibits dihydropteorate synthase

Sulfonamides

Antibiotic inhibits dihydrofolate reductase

Trimethoprim, pyrimethamine

Inhibits bacterial dihydrofolate reductse, bacteriostatic

Trimethoprim

This drug is used in combination with sulfonamides causing sequential block of folate synthesis

Trimethoprim

This drug is used for recurrent UTI's, Shigella, Salmonella, Pneumocystis carinii pneumonia

TMP-SMX

Toxicity of trimethoprim

Megaloblastic anemia Leukopenia Granulocytopenia TMP - Treats Marrow Poorly

Toxicity connected with trimethoprim can be alleviated by _

Supplemental folinic acid

Ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin - name class

Fluoroquinolones

Antibiotics inhibit DNA gyrase (topoisomerase II), bactericidal

Fluoroquinolones

Used clinically for treatment of gram negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram positive organisms

Fluoroquinolones

Are fluoroquinolones safe in pregnant women

Contraindicated in pregnant women and in children because animal studies show damage to cartilage.

Fluoroquinolones toxicity

``` Tendonitis and tendon rupture in adults GI upset Superinfections Skin rashes Headache Dizziness ``` FluoroquinoLONES hurt attachments to your BONES

Forms toxic metabolites in bacterial cells, bactericidal

Metronidazole

Antiprotozoal, Giardia, Entamoeba, Trichomonas, Gardenrella vaginalis, anearobes (bacteroides, clostridium) - name drug

Metronidazole

This drug is used with bismuth and amoxicillin (or tetracycline) for "triple therapy" against H pylori

Metronidazole

Anaerobic infections above diaphragm - ? Anaerobic infections below diaphragm?

Above - clindamycin Below - metronidazole

Toxicity of metronidazole

Disulfiram like reaction with alcohol, headache

Bind to cell membranes of bacteria and disrupt their osmotic properties, cationic, basic proteins that act like detergents - treat resistant gram negativ infections

Polymyxins

Toxicity for polymyxins

Neurotoxicity | Acute renal tubular necrosis

Name anti TB drugs

``` RESPIre Rifampin Ethambutol Streptomycin Pyrazinamide Isoniazid ```

2nd line therapy for TB

Cycloserine

All anti TB drugs have same toxicity - name it

liver toxicity

Anti TB drug - decreases synthesis of mycolic acids

Isoniazid

The only agent used as solo prophylaxis against TB

Isoniazid

Toxicity for INH (Isoniazid)

Hemolysis if G6PD defficient Neurotoxicity Hepatoxocitiy SLE like syndrome INH - Injures Neurons and Hepatocytes

_ can prevent neurotoxicity caused by isoniazid

Pyridoxine (B6)

Which anti TB drug has different half lifes in fast vs slow acetylators

Isoniazid

Anti TB drug - inhibits DNA dependent RNA polymerase

Rifampin

Delays resistance to dapsone when used for leprosy

Rifampin

Used for meningococcal prophylaxis and chemoprophylaxis in contacts of children with H influenzae type B

Rifampin

Rifampin toxicity

Minor hepatoxicity and drug interactions (increases P450)

Rifampin 4 R's

RNA polymerase inhibitos Revs up P450 Red/orange body fluids Rapid resistance if used alone

Beta lactamase cleavage of beta lactam drug is a resistance mechanism against which drugs

Penicillins and cephalosporins

Modification via acetylation, adenylation, or phosphorylation is resistance mechanism against which drugs

Aminoglycosides

Terminal D ala component of cell wall replaced with D lac, decreases affinity - resistance mechanism against which drug

Vancomycin

Modification via acetylation - resistance mechanism against which drug

Chloramphenicol

Decreased uptake or increased transport out of cell is resistance mechanism against which drugs

Tetracyclines

Altered enzyme (bacterial dihdropteorate synthetase), decreased uptake or increased PABA synthesis is resistance against which drugs

Sulfonamides

Drug of choice for prophylaxis of meningococcal infections Alternative?

Rifampin Minocyclin

Prophylaxis of gonorrhea

Ceftriaxone

Prophylaxis of syphillis

Benzathine penicillin G

Prophylaxis in patients with history of recurrent UTI

TMP-SMX

Drug of choice for prophylaxis for pneumocystic carinii pneumonia Alternative

TMP-SMX Aerosolized pentamidine

Binds ergosterol (unique to fungi), forms membrane pores that allow leakage of electrolytes and disrupt homeostasis

Amphotericin B

Used for wide spectrum of systemic mycoses (Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor). Intrathecally for fungal meningitis, does NOT cross BBB

Amphotericin B

Toxicity of Amphotericin B

NEPHROTOXICITY Arrhythmias (amphoterrible) Fever/chills (shake and bake) Hypotension

Binds to ergosterol, disrupting fungal membranes, used as "swish and swallow" for oral candidiasis (thrush)

NYSTATIN

Inhibit fungal steroid (ergosterol) synthesis

AZOLES

Drug of choice for cryptococcal meningitis in AIDS patients and candidal infections of all types (i.e yeast infections)

FLuconazole

Drug of choice for Blastomyces, Coccidioides, Histoplasma, Candida albicans, hypercortisolism

Ketoconazole

Toxicity of azoles

Hormone synthesis inhibition (gynecomastia) Liver dysfuntion (inhibits cytochrome P450) Fever, chills

Inhibits DNA synthesis by conversion to fluorouracil which competes with uracil, used in systemic fungal infections (Candida, Cryptococcus), causes bone marrow suppression, n/v/d

FLUCYTOSINE

Antifungal medication, inhibits cell wall synthesis, clinically used for invasive aspergillosis, can cause GI upset and flushing

CASPOFUNGIN

Antifungal, inhibits fungal enzyme squalene epoxidase, used to treat dermatophytoses (especially onychomycosis)

TERBINAFINE

Anti fungal, interferes with microtubule function, disrupts mitosis, deposits in keratin containing tissues (nails) - oral treatment of superficial infections, inhibits growth of dermatophytes (tinea, ringworm)

GRISEOFULVIN

Toxicity Griseofulvin

``` Teratogenic Carcinogenic Confusion' Headache Increased warfarin metabolism ```

Antiviral drug used for prophylaxis for influenza A and treatment of Parkinsons

Amantadine

Derivative of Amantadine with fewer CNS side effects

Rimantidine

Anti viral medication, blocks biral penetration/uncoating, may buffer pH of endosome, also causes release of dopamine from intact nerve terminals

Amantadien

Toxicity of amantadine

Ataxia + dizziness+ slurred speech Amantadine causes problems with cerebellA

Two antiviral medications that inhibits influenza neuraminidase, both used for influenza A and B

Zanamivir | Oseltamivir

Antiviral - inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase, used for treatment of RSV and chronic hep C

Ribavirin

Toxicity for Ribavirin

Severe teratogen | Hemolytic anemia

THis antiviral medication preferentially inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase

Acyclovir

Antiviral medication used for treatment of VZV, HSV, EBV, mucocutaneous and genital herpes lesions, prophylaxis in immunocompromised patients

Acyclovir

Toxicity for acyclovir

Delirium Tremor Nephrotoxicity

Antiviral drug - works by phosphorylation viral kinase, preferentially inhibits CMV DNA polymerase, drug of choice for CMV especialy in immunocopromised patients

Ganciclovir

Which drug is more toxic - acyclovir or ganciclovir to host enzymes

Ganciclovir

Ganciclovir toxicity

Leukopenia Neutropenia Thrombocytopenia Renal toxicity

Viral DNA polymerase inhibitor that binds to the pyrophosphate binding site of the enzyme. Does not require activation by viral kinase

FOSCARNET = pyroFOSphate analog

Antiviral drug used for treatment of CMV retinitis in immunocompromised patients when ganciclovir fails

FOSCARNET

Patient is on foscarnet for CMV retinitis, which toxicity could be suspected?

Nephrotoxicity

Saquinavir, ritonavir, indinavir, nelfinavir, aprenavir - class of drugs

HIV therapy, protease inhibitors - inhibit assembly of new virus by blocking protease enzyme

HIV patient is taking anti HIV drugs, develops GI intolerance - nausea, diarrhea, hyperglycemia, lipid abnormalities, thrombocytopenia - which drugs was he taking

PROTEASE INHIBITORS

Zidovudine (AZT), didanosine, zalcitobine, stavudine, lamivudine, abacavir - what class of drugs

Reverse transcriptase inhibitors, nucleosides

Name non-nucleosides reverse transcriptase inhibitors

Nevirapine Delavirdine Efavirenz

Toxicity associated with reverse transcriptase inhibitors

``` Bone marrow suppression (neutropenia, anemia) Peripheral neuropathy Lactic acidosis (nucleosides) Megaloblastic anemia Rash (non-nucleosides) ```

Highly active antiretroviral therapy (HAART) generally entails combination of?

Protease inhibitors + reverse transcriptase inhibitors

Which antiretroviral drug is used during pregnancy to reduce risk of fetal transmission

AZT

Patient on anti HIV therapy develops megaloblastic anemia - which drug most likely caused it

AZT

When is HAART initiated?

When patients have low CD4 counts (<500 cell/mm3) or high viral load

Glycoproteins from human leukocytes that block various stages of viral RNA and DNA synthesis, used for treatment of chronic hep B and C, Kaposis sarcoma Name drug and what toxicity associated with it

Interferons Neutropenia

Antiparasitic drug from onchocerciasis

Ivermectin (rIVER blindness treated with IVERmectin)

Antiparasitic drug used to treat nematode/roundworm (pinworm, whipworm) infections

Mebendazole/thiabendazole

Antiparasitic drugs used to treat gian roundowrm (ascaris), hookworm (Necator/Ancylostoma) and pinworm (Enterobius)

Pyrantel pamoate

Antiparasitic used to treat trematode/fluke (shistosomes, Paragonimus, Clonorchis) and cysticercosis

Praziquantel

Niclosamide is used to treat?

Cestode/tapeworm infections except cysticercosis

Drug of choice for leishmaniasis

Pentavalent antimony

Name anti malaria drugs

``` Chloroquine Quinine Mefloquine Atovaquone Proguanil ```

Name drug used for treatment of latent hypnozoite (liver) forms of malaria (Plasmodium vivax, P.ovale)

Primaquine

Drug of choice agains giardiasis, amebic dysentery, bacteria vaginitis, Trichomonas

Metronidazole

Drug of choice for Chagas disease, American trypanosomiasis (trypanosoma cruzi)

Nifurtimox

Drug of choice for African trypanosomiasis (sleeping sickness)

Suramin

Cholinomimetic used for postoperative and neurogenic ileus and urinary retention - activates bowel and bladder smooth muscle

BETHANECHOL

Direct agonist, cholinomimetic used for treatment of glaucoma, activates ciliary muscle of eye (open angle), pupillary sphincter (narrow angle)

Carbachol, pilocarpine

Anticholinesterase, used in treatment of postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative), increases endogenous Ach

Neostigmine

Anticholinesterase used in treatment of myasthenia gravis - increases endogenous Ach, increases strength

Pyridostigmine

This anticholinesterase is used for diagnosis of myasthenia gravis (extremely short acting), increases endogenous Ach

Edrophonium

Anticholinesterase, used in treatment of glaucoma (crosses BBB to CNS) and atropine overdose, increases endogenous Ach

Physostigmine

Anticholinergic, used for treatment of glaucoma, increases endogenous Ach

Echothiophate

Name symptoms of cholinesterase inhibitor poisoning

``` DUMBBELSS Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal muscle Lacrimation Sweating Salivation (also abdominal cramping) ```

Name substances that can lead to cholinesterase inhibitor poisoning

Parathion and other organophosphates

Antidote used in treatment of organophosphate poisoning

Atropine (muscarinic antagonist) plus pralidoxime (chemical antagonist used to regenerate active cholinesterase)