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MindMap Gallery Pharmacology 9th Edition Chapter 7 Anticholinesterase Drugs and Cholinesterase Reactivating Drugs

Pharmacology 9th Edition Chapter 7 Anticholinesterase Drugs and Cholinesterase Reactivating Drugs

Anticholinesterase drugs and cholinesterase reviving drugs, acetylcholinesterase mainly exists in the terminal synaptic gap of cholinergic nerves, and also exists in cholinergic neurons and red blood cells.

Edited at 2023-11-25 16:16:41

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Pharmacology 9th Edition Chapter 7 Anticholinesterase Drugs and Cholinesterase Reactivating Drugs

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Outline

Egressive nervous system-choline chemoline drug
- 23
Mason·Carter

Chapter 7 Anticholinesterase Drugs and Cholinesterase Reviving Drugs

Overview: Acetylcholinesterase mainly exists in the synaptic cleft of cholinergic nerve terminals, but also in cholinergic neurons and red blood cells.

Section 1 Cholinesterase (ChE)

Classification

Acetylcholinesterase (AChE): also known as true cholinesterase. Neurons red blood cells High specificity for ACh

Butyrylcholinesterase (BChE): also known as pseudocholinesterase. plasma Liver, kidney, intestines Low specificity for AChE

Section 2 Anticholinesterase Drugs

Overview: This type of drug can combine with AChE, and the binding is relatively strong, which inhibits the activity of AChE, leading to the accumulation of ACh released from cholinergic nerve terminals, resulting in a cholinomimetic effect.

1. Refractory anticholinesterase drugs (physostigmine, neostigmine)

neostigmine

internal processes

Poor oral effect

Difficult to enter the nervous system

Not easy to penetrate the cornea

Pharmacological effects

Exciting skeletal muscles has powerful effects: (-)AChE ( )N2-R ( ) Motor nerve terminals release ACh

It has a strong effect on stimulating the smooth muscle of the gastrointestinal tract and bladder muscles, promoting exhaust and urination.

Depresses the heart: slows heart rate, decreases cardiac output

Clinical application

1. Myasthenia gravis: an autoimmune disease in which the body produces an immune response to its own Nm receptors on the postsynaptic motor end plate.

2. Abdominal bloating and urinary retention (mostly after surgery)

3. Detoxification of overdose of competitive neuromuscular blocking drugs

Expansion: Is neostigmine detoxification contraindicated in succinylcholine poisoning? Answer: Succinylcholine - hydrolysis by pseudocholinesterase - muscle relaxant effect Neostigmine – which inhibits cholinesterase – greatly prolongs its muscle relaxant effect

Physostigmine

Process in the body: It is highly fat-soluble and easily penetrates the cornea. Its effect on the eyes is more durable than pilocarpine, but it is highly irritating and can be used to treat glaucoma.

Pharmacological effects

Opposite eyes: cholinergic receptor agonists. Conjunctival use of this class of drugs can cause conjunctival congestion and contraction of the pupillary sphincter and ciliary muscles located at the edge of the iris, resulting in miosis and ciliary muscle accommodation spasm.

Expansion: Detoxification Treatment

Competitive muscle relaxant poisoning: neostigmine

M-R blocker (atropine) poisoning: physostigmine

2. Irreversible anticholinesterase drugs (organophosphates)

Poisoning mechanism: Organophosphates strongly bind to AChE, causing AChE to lose its ability to degrade ACh. ACh accumulates in large amounts in the body, causing poisoning.

Poisoning manifestations: acute cholinergic crisis

acute poisoning

Chronic poisoning: AChE activity in the blood continues to decrease significantly

Treatment of acute poisoning

(1) Eliminate poisons: When oral poisoning occurs with metrelfosate (trichlorfon), gastric lavage with alkaline solution cannot be used because it can be converted into the more toxic dichlorvos in the alkaline solution.

(2) Detoxification drugs: 1) Atropine: quickly antagonizes the M-like effect of ACh in the body (linked with pralidoxime chloride) 2) AChE reactivation drugs: such as pralidoxime chloride and pralidoxime iodide. Restore activity of AChE inhibited by organophosphates

Section 3 Cholinesterase Reactivation Drug

Overview: Drugs that can restore activity to AChE inhibited by organophosphates. Not only can it rescue severe poisoning that cannot be controlled by atropine alone, but it can also significantly shorten the poisoning process.

Pralidoxime chloride (relieves N-like symptoms)

Pharmacological effects

1. Restore the activity of AChE

2. Direct detoxification: directly combines with free organic phosphates in the body

Clinical application: It can significantly reduce N-like symptoms and inhibit muscle tremors. Combined with atropine (to reduce M-like effects) to control symptoms (adequate, early, and combined use should be noted)

pralidoxime iodide