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Anticholinesterase agents
Physostigmine (ERERINE)
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Indication
- Glaucoma, accommodative esotropia. Physostigmine is also used for
- louse and mite infestation of lashes.
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MoA
- Increase parasympathetic activity by inhibiting cholinesterase, thereby
- permitting the accumulation of acetylcholine and prolonging the activity on
- the effector end organs of the eye.
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SEs
- Vitreous hemorrhaging, contact dermatitis, allergic conjunctivitis.
- Echothiophate produces the most severe symptoms including discomfort
- associated with bright lights and close-up work, affected eye is extremely
- myopic. Systemic absorption of the long acting agents may produce GI
- disturbances (nausea, diarrhea, and abdominal pain), muscle spasm,
- weakness, sweating, lacrimation, salivation, hypotension, bradycardia,
- bronchial constriction, respiratory failure. Most systemic effects reverse
- rapidly after drug has been discontinued. In severe toxicity give atropine
- sulfate (2mg) or pralidoxime chloride 25mg/kg iv or sc with no effect on
- glaucoma.
- These agents are no longer commonly used in clinical practice, but may
- play a role in the management of selected patients.
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