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excessive sweating, salivation, diarrhea, bradycardia after treating with neostigmine for myasthenia gravis. therapy choice:
a. atropine
b. pralidoxime
c. either one is fine
A&Y
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| mjl1717
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As far as I know its an indirect cholinesterse inhibitor(inhibiiting tthe enzyme) [dont except every thing I say I make mistakes too!!!!!!]
I go with* atropine-to directly block Ach.
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| Malaysian
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i agree with mjl
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| sing
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yeah. atropine is the right answer. wonder how prolidoxime works? only know it can be used to anti-toxin as well. any help?
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| mjl1717
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As I remember I think PAM has something todo with binding or bonding affinity to the cholinergic receptor.
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| bakpity
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PRALIDOXIME (2-PAM) is a reactivator of acetylcholinesterase in the periphery.
Remember this!
Atropin acts on M receptors as an antagonist.
I would use both.
Correct?
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| mjl1717
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Using both is correct, but if the q says only one Id go with atropine.
Pralidoxamine as mani has said is only good for a few minutes!
Atrop-antimuscarinic
pralidoxamine -reversible anticholinesterase inhibitor (can reactivate as stated above.)
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| mdwannabe
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any oxime is there to nock off the P from cholinesterase, and actually accept it. That is the MOA.
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| mjl1717
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The term indirect cholinergic agonist is better said using the term "cholinesterase inhibitors" because we can further subclassify to reversible and irreversible
Irreversible (ingeneral more deadly) Parathion, Sarin/Isofluro phosphate and Echothiphate used in glaucoma and esotropia. (bind covalently to acetylcholinesterase thus irreversible)
Reversible (In general the Myathenia Gravis group) Edrophonium,
Physostigmine , Neostigmine, ** even Pralidoxamine{2-Pam} is in this group since they do not bind covalently to acetylcholinesterase they are termed reversible and we are lucky to have an immediate reactivation of acetylcholinesterase with 2-Pam.
interests:
The pneumonic for choinergeic stimulation: dumbells
diarrhea or decrease BP
urination
miosis
bronchoconstrict
excite skeletal m.
lacrimation
sweating, salivation
interests:
irreversible cholinesterase inhibitors and physotigmine can cause convulsions.
irreversible cholinesterase inhibitors versing 2PAM and atropine
neostigmine "fighting"d-tubocurarine
physostigmine "fighting" overdose of atropine, phenothiazines and old fashion tricyclics.
neostimine or physostigmine "fighting succinylmonocholine
In this case "fighting" is analagous to antagonize or antedote.
I rest my case
:shock:
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| Dr. Hussam
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PAM is only used to reverse the organophosphate effect on acetylcholinesterase, its not used with the reversible inhibitors like neostigmine, so the only answer is atropine
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| mjl1717
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Im just saying 2 PAM is sometimes classified as an irreversible cholinesterase inhibitor but its unique in that if used quickly enough it can reactivate cholinesterase! (Its the only one that can do this) For me I like to classify everything in pharm.
No question if your soldier buddy in Iraq appears somewhat lethargic for
3 or 4 hours from inhaling Sarin and your the medic youd give both knowing that it may be too late for 2PAM. If only one* no doubt 110% its ATROPINE. 
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