Agents which inhibit enzyme Cholinesterase
They potentiate cholinergic system
CLASSIFICATION
Reversible & irreversible
Reversible : Carbamate & Acridine
Carbamate: physostigimine, neostigimine, pyridostigimine, edrophonium, rivastigimine, donepezil, galantamine
Acridine: tacrine
Irreversible: organophosphate & carbamate
Organophosphates: Dyflos, Echothiophate, Parathion, Malathion, Diazinon, Tabun, sarin, Soman
Carbamate: Carbaryl, Propoxur
MECHANISM
They inhibit the a/c of enzyme ChE by covalently binding with the esteratic site of enzyme
USES
As miotic
Myasthenia gravis
Postoperative paralytic ileus or urinary retention
Postoperative decurarization
Cobra bite
Belladona poisoning
Other drug overdosages
Alzheimers disease
MANIFESTATIONS
Manifestations :
Iacrimation, salivation, sweating, tracheobronchial secretions, miosis, blurring of vision, colic, involuntry defecation & urination
Fall in BP, bradycardia or tachycardia, cardiac arrythmia & vascular collapse
M. fasciculations, weakness & respiratory paralysis
Excitement, tremor, ataxia, convulsion, coma & death
Death is d/t respiratory failure
Treatment:
Termination of exposure:
ABCD
A AIRWAY
B BREATHING
C CIRCULATION
D DRUGS
Drugs used as antidote are atropine & Pralidoxim (Cholinesterse reactivator)
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