Page 137 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 7 Cholinoceptor-Activating & Cholinesterase-Inhibiting Drugs 123

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A V AIL ABLE Brito-Zerón P et al: Primary Sjögren syndrome: An update on current phar-
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GENERIC NAME AVAILABLE AS Cahill K et al: Pharmacological interventions for smoking cessation: an overview
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Carbachol Corradi J, Bourzat C: Understanding the bases of function and modulation of
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Ophthalmic (intraocular) Miostat, Carbastat Dineley KT, et al: Nicotinic ACh receptors as therapeutic targets in CNS disorders.
Cevimeline Generic, Evoxac Trends Pharmacol Sci 2015;36:96.
Nicotine Ehlert FJ: Contractile role of M2 and M3 muscarinic receptors in gastrointestinal,
Transdermal Generic, Nicoderm CQ, Nicotrol airway and urinary bladder smooth muscle. Life Sci 2003;74:355.
Inhalation Nicotrol Inhaler, Nicotrol NS Ferré S et al: G protein-coupled receptor oligomerization revisited: Functional and
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Gum Generic, Commit, Nicorette Giacobini E (editor): Cholinesterases and Cholinesterase Inhibitors. London: Martin
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Varenicline Chantix Lazartigues E et al: Spontaneously hypertensive rats cholinergic hyper-responsiveness:
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C ASE STUD Y ANSWER

The patient’s presentation is characteristic of poisoning by confusion) subside. To treat nicotinic excess, infuse 2-PAM
organophosphate cholinesterase inhibitors (see Chapter 58). (initially a 1–2% solution in 15–30 minutes) followed by infu-
Ask the coworker if he can identify the agent used. Decontami- sion of 1% solution (200–500 mg/h) until muscle fasciculations
nate the patient by removal of clothing and washing affected cease. Respiratory support is required because 2-PAM does not
areas. Ensure an open airway and ventilate with oxygen. For enter the central nervous system and may not reactivate “aged”
muscarinic effects, administer atropine (0.5–5 mg) intrave- organophosphate-cholinesterase complex. If needed, decon-
nously until signs of muscarinic excess (dyspnea, lacrimation, taminate the coworker and isolate all contaminated clothing.