Paper I
2021 December (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Neostigmine

Q53 marksShort Notes

Answer

Neostigmine is a reversible anticholinesterase.

Mechanism of action

  • Reversibly inhibits acetylcholinesterase, increasing acetylcholine at cholinergic synapses; also has direct nicotinic agonist action at the neuromuscular junction
  • Quaternary compound — does not cross the blood-brain barrier

Uses

  • Reversal of non-depolarizing neuromuscular blockade
  • Myasthenia gravis (diagnosis and treatment)
  • Paralytic ileus, postoperative urinary retention (non-obstructive)

Adverse effects

  • Muscarinic effects: bradycardia, salivation, bronchospasm, GI cramps, diarrhoea
  • Cholinergic crisis with overdose
  • Given with atropine to counteract muscarinic side effects when used for neuromuscular block reversal

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