AChE Inihibitors

• Neostigmine
• Physostigmine
• Pyridostigmine
• Edrophonium (enlon)

• Echothiophate
• Malathion

Pralidoxime

• Muscarinic effects - same as muscarinic agonists
• Neuromuscular effects - strong contractions - paralysis
• CNS effects - depression of areas that regulate respiration

• Muscle cramps
• Weakness

DUMBELSS - excitation of skeletal muscle and CNS and respiratory depression (can be fatal)

• Myasthenia gravis - autoimmune disease where Nm receptors are inactive due to antibodies
• Allows ACh to function better

• Quaternay amine, can't cross BBB
• Inactivated by AChE
• Reverse NM blockade
• Prevents post-op abdominal distention and urinary retention

• Natural tertiary alkaloid, gets into CNS
• Reverses anticholinergic block in CNS
• Used topically for Glaucoma

Differential diagnosis of myasthenia gravis

• Contain a phosphorous
• Highly lipophilic
• Extremely dangerous (nerve gases)

Glaucoma (ecothiophate ONLY)

Pralidoxime

• Reactivates ChE
• Most effective at neuromuscular junction, less effective at muscarinic sites, ineffective in the CNS
• Must be given ASAP