Clinical application of neostigmine, the main clinical uses of neostigmine are:

Neostigmine, also known as proserin, progratusmine, is one of the anticholinesterase drugs in cholinergic drugs, is a synthetic substitute for physostigmine, there are two kinds of neostigmine methyl sulfate and neostigmine bromide, both are white crystalline powder, odorless, bitter taste, very soluble in water, soluble in ethanol, almost insoluble in ether. After neostigmine enters the body, it can reversibly inhibit cholinesterase activity, so that acetylcholine cannot be hydrolyzed, thereby increasing the concentration of acetylcholine at the receptor site in the body, strengthening and prolonging the action of acetylcholine, showing the effect of full cholinergic nerve excitation.

Indications. It is used to antagonize the residual muscle relaxant effect of non-depolarizing muscle relaxants at the end of surgery, and is used for myasthenia gravis, functional intestinal flatulence and urinary retention after surgery. It can also be used for the rescue of atropine overdose poisoning.

Adverse effects. This product can cause drug eruption, in large doses can cause nausea, vomiting, diarrhea, tearing, salivation, etc., in severe cases, ataxia, convulsions, coma, slurred speech, anxiety, fear and even cardiac arrest, that is, bradycardia, muscle tremor, severe to cause "cholinergic crisis".

Contraindication. 1) It is forbidden for people with allergies.

2) Patients with epilepsy, angina, ventricular tachycardia, mechanical intestinal obstruction or urinary tract obstruction and bronchial asthma are contraindicated. (3) Arrhythmia, sinus bradycardia, decreased blood pressure, and increased vagal tone are prohibited.

Clinical application of neostigmine. In the pathology book p67

1) Myasthenia gravis: an autoimmune disease that is a chronic disease caused by impaired transmission of the neuromuscular junction. Presents with progressive contractile weakness of skeletal muscles. Neostigmine is routinely used as a drug.

2) Postoperative bloating and urinary retention.

3) Paroxysmal supraventricular tachycardia.

4) Detoxification of non-depolarizing muscle relaxants (tube curusine).

a.Paroxysmal is supraventricular cardiac sensation Sun Yu Hongsu.

b.Atropine poisoning.

c.Glaucoma.

d.Severe branch muscle weakness.

e.Mechanical intestinal obstruction.

Correct answer: d

Answer]: Neostigmine can be used for the residual muscle relaxant effect of orange anti-non-depolarizing muscle relaxant at the end of surgery, for myasthenia gravis, postoperative functional intestinal distension and urinary retention. It can also be used for the rescue of overdose poisoning.

Except for the clinical use of the new Tong Daijin Stigmine ().

a.Severe local deficiency of muscle weakness.

b.Paroxysmal supraventricular tachycardia.

c.Intestinal paralysis after surgery.

d.Bronchial asthma.

Correct Answer: Bronchial asthma.

The effects of neostigmine are characterized by:It is a reversible anticholinesterase drug, which mainly exerts cholinergic effect by inhibiting cholinesterase activity;

Excitatory skeletal muscle had the strongest effect, followed by gastrointestinal and bladder smooth muscle, and weak effect on glandular, ocular, cardiovascular and bronchial smooth muscle.

It is a quaternary ammonium compound, which is orally absorbed and has less orange and irregularity, so the oral dose is larger;

It is not easy to penetrate the blood-cerebrospinal fluid barrier, and has no obvious central effect.

Clinical Uses of Neostigmine:myasthenia gravis;

postoperative abdominal bloating and urinary retention;

paroxysmal supraventricular tachycardia;

Rescue non-depolarizing muscle relaxant overdose poisoning.

Answer]: A neostigmine can be used for the rescue of non-depolarizing skeletal muscle relaxants such as tube curareine overdose poisoning, but it cannot be used for the rescue of depolarizing skeletal muscle relaxant succinylcholine overdose poisoning, this is because neostigmine can inhibit pseudocholinesterase activity, which can strengthen and prolong the effect of succinylcholine. Therefore, the correct answer is a.

Pharmacological action and mechanism

Neostigmine can inhibit the activity of Sun Shenyuan ACHE and exert a complete cholinergic effect, which can activate choline receptors. In addition, it can directly activate NM receptors on the motor endplate of skeletal muscle. Its action is characterized by weak effect on glandular, eye, cardiovascular and bronchial smooth muscle, and strong excitatory effect on skeletal muscle and gastrointestinal smooth muscle.

In vivo processes are stated.

It is a quaternary ammonium compound, and its bromide is absorbed orally with little and irregular absorption, and neostigmine can be hydrolyzed by ACHE in plasma, and can also be metabolized by the examination and large ** collected by the liver. It is not easy to enter the central nervous system.

Clinical applications: Myasthenia gravis, abdominal flatulence and postoperative urinary retention, paroxysmal supraventricular tachycardia, anti-competitive neuromuscular blockade overdose, etc.

Adverse effects are similar to those of cholinergic neurologic hyperexcitability, including progressive salivation, nausea, vomiting, abdominal pain, and diarrhoea. Overdose can lead to cholinergic crisis with profuse sweating, urinary incontinence, miosis, ciliary spasm, forehead pain, and cardiac arrhythmias; Chest tightness and stridor may also occur. The cause of death from poisoning is respiratory failure or cardiac arrest.

It is contraindicated in patients with mechanical bowel or urinary tract obstruction.

Answer]: The first way to judge the clinical use of neostigmine is: Luchang **Myasthenia gravis, using its excitatory skeletal muscle effect; Slow accompaniment to relieve postoperative abdominal distension and urinary retention, and use its effect of stimulating gastrointestinal smooth muscle and detrusor muscle; **Paroxysmal supraventricular tachycardia, which uses its effect of suppressing the heart and slowing down the heart rate; The detoxification of rescue non-depolarizing muscle relaxants is related to their action on stimulating skeletal muscles.