MECHANISM AND CLINICAL IMPORTANCE OF RESPIRATORY FAILURE INDUCED BY ANTICHOLINESTERASES
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Датум
2017
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Издавач
University of Kragujevac, Faculty of Medical Sciences, Kragujevac
Апстракт
Respiratory failure is the predominant cause of death in humans and animals poisoned with anticholinesterases. Organophosphorus and carbamate anticholinesterases inhibit acetylcholinesterase irreversibly and reversibly, respectively. Some of them contain a quaternary atom that makes them lipophobic, limiting their action at the periphery, i.e. outside the central nervous system. Th ey impair respiratory function primarily by inducing a desensitization block of nicotinic receptors in the neuromuscular synapse. Lipophilic anticholinesterases inhibit the acetylcholinesterase both in the brain
and in other tissues, including respiratory muscles. Th eir doses needed for cessation of central respiratory drive are signifi cantly less than doses needed for paralysis of the neuromuscular transmission. Antagonist of muscarinic receptors atropine blocks both the central and peripheral muscarinic receptors and eff ectively antagonizes the central respiratory depression produced by anticholinesterases. To manage the
peripheral nicotinic receptor hyperstimulation phenomena, oximes as acetylcholinesterase reactivators are used. Addition of diazepam is useful for treatment of seizures, since they are cholinergic only in their initial phase and can contribute to the occurrence of central respiratory depression. Possible involvement of central nicotinic receptors as well as the other neurotransmitter systems – glutamatergic, opioidergic – necessitates further research of additional antidotes
Опис
Кључне речи
Anticholinesterase, Acetylcholinesterase, Acetylcholine, Atropine, Oxime, Diazepam, Respiratory depression, Muscarinic receptors, Nicotinic receptors