Medicine & USMLE

Pyridostigmine, Neostigmine, Edrophonium

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Neuro Drugs
  1. Levodopa, Carbidopa
  2. Levetiracetam
  3. Valproic Acid
  4. Anticholinergic Syndrome
  5. Cholinergic Crisis
  6. Benztropine / Trihexyphenidyl
  7. Lidocaine
  8. Pyridostigmine, Neostigmine, Edrophonium
  9. Naltrexone
  10. Pregabalin
  11. Scopolamine
  12. Phenytoin
  13. Ethosuximide
  14. Succinylcholine
  15. Opioids
  16. Memantine
  17. Halothane / Flurane
  18. Donepezil
  19. Propofol
  20. Ergotamine
  21. Triptans
  22. Selegiline / Rasagiline
  23. Entacapone / Tolcapone
  24. Gabapentin
  25. Lamotrigine
  26. Carbamazepine
  27. Ramelteon

Summary

Pyridostigmine, neostigmine, and edrophonium are medications that treat myasthenia gravis by raising acetylcholine levels. However, if acetylcholine levels get too high, patients will experience cholinergic crisis, a syndrome caused by an overload of acetylcholine. This cholinergic overload can be reversed by administering atropine.

Key Points

  • Pyridostigmine, Neostigmine, Edrophonium
    • Mechanism
      • Acetylcholinesterase (AChE) inhibitor
        • Increases acetylcholine levels in the myoneural junctions
    • Clinical Use
      • Myasthenia Gravis
        • Increases muscle strength
        • Underdosing of pyridostigmine can lead to a myasthenic crisis
        • Pyridostigmine is given in divided doses throughout the day, and should be taken at the same time every day
      • Reversal of neuromuscular blockers after surgery
      • Exposure to nerve gas
    • Side Effects and Adverse Reactions
      • Cholinergic crisis
        • In overdose
        • Increased secretions, bradycardia, miosis (pupil constriction), abdominal cramping, hypotension
      • GI disturbances
        • Nausea, vomiting, diarrhea, abdominal cramping
    • Antidote
      • Atropine