Question

1. State the rationales for administering a cholinesterase inhibitor to a patient who has been intentionally paralyzed (e.g., for surgery) with a neuromuscular blocking drug. State which class of neuromuscular blockers causes effects that can be reversed by the cholinesterase inhibitor. State the other main drug that is given as part of the postoperative reversal procedure and explain when and why it is given.
2. Compare and contrast the cholinergic crisis and the myasthenic crisis in a hypothetical patient with myasthenia gravis, describe simple assessments that would help distinguish the two conditions, and state the rationale for using cholinesterase inhibitors to help confirm the diagnosis.

3. Give several reasons why acetylcholine itself is not used to produce selective muscarinic-activating effects and why other drugs generally are chosen.

4. List cholinergic responses not normally caused when the usual therapeutic doses of a muscarinic agonist are administered and explain why these effects do not occur.

Answer 1

1. Neuromuscular transmission is blockade when non depolarizing muscle relaxants compete with acetylcholine to bind to nicotinic cholinergic receptors . The cholinesterase inhi

bitors -

i)Indirectly increase the amount of acetylcholine available to compete with the nondepolarizing agent,thereby reestablishing neuromuscular transmission.

ii)It can potentiate a nondepolarizing neuromuscular blockade.

Thereby cholinesterase inhibitor given to the paralyzed patient for reestablishing neuromuscular transmission.

2.Atropine,neostigmine.

But atropine may be given because neostigmine is likely to elicit substantial muscarinic response s.

3.neostigmine

Cyclodextrins.