Why is physostigmine used in atropine poisoning not neostigmine?

Neostigmine, a quaternary ammonium compound, is unable to penetrate the CNS. Owing to cholinergic stimulation of the reticular activating system of the brainstem, physostigmine has nonspecific analeptic (arousal) effects.

How does physostigmine counter the effect of atropine?

Atropine causes anticholinergic toxicity; physostigmine reverses this by inhibiting acetylcholinesterase.

What is atropine toxicity?

Overdose can lead to increased antimuscarinic side effects presenting with dilated pupils, warm, dry skin, tachycardia, tremor, ataxia, delirium, and coma. In extreme toxicity, circulatory collapse secondary to respiratory failure may occur after paralysis and coma.

Why is neostigmine given with atropine?

At the end of surgery, neostigmine has been given for the reversal of neuromuscular blocking agents with several adverse effects such as bradycardia and profuse secretion. Atropine has been used to prevent those side effects of neostigmine.

What is the antidote for atropine?

The antidote to atropine is physostigmine or pilocarpine.

How many twitches does it take to reverse neostigmine?

In recent studies, it was found that as many as four twitches may be required to eliminate residual blockade with a standard reversal dose of neostigmine. Another study found that, with a TOF ratio of 0.2, even four twitches were insufficient to reverse the neuromuscular block with 70 μg/kg of neostigmine.

How much neostigmine should I take with atropine?

The routine dosages of the two drugs are 2.5 mg of neostigmine and 1.2 mg of atropine. Tribuddharat S ey al. (1) has demonstrated that after giving 0.9 mg atropine together with 2.5 mg of neostigmine the mean heart rate during 1-8 minutes after the administration was increase 2-26 beats/min (bpm).

How are neostigmine and atropine used to treat PDPH?

Conclusions: Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood-brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH.

Which is better atropine or neostigmine for pancuronium reversal?

Heinonen J et al. (3) has demonstrated that 80% of the patients after receiving 0.015 mg/kg of atropine 3 minutes before 0.03 mg of neostigmine for the reversal of pancuronium experienced bradycardia (heart rate < 50 bpm) compared with none in patients receiving alcuronium.

What should your heart rate be after taking atropine?

Salem MG et al. (2) has demonstrated that after receiving 1.2 mg of atropine and 5 mg of neostigmine the mean heart rate during 2-110 minutes was decrease 5-29 bpm with the lowest heart rate at 40 minutes after administration.

Why is physostigmine used in atropine poisoning not neostigmine? Neostigmine, a quaternary ammonium compound, is unable to penetrate the CNS. Owing to cholinergic stimulation of the reticular activating system of the brainstem, physostigmine has nonspecific analeptic (arousal) effects. How does physostigmine counter the effect of atropine? Atropine causes anticholinergic toxicity; physostigmine reverses this by inhibiting…