Special considerations: Alzheimer’s disease
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Outpatient drug therapy for alleviating some of the memory problems associated with AD is a new and changing field. Increasingly, patients on either the N-methyl-D-aspartate receptor (NMDA) antagonist, memantine, or one of the three acetylcholinesterase inhibitors, galantamine, rivastigmine, and donepezil, are presenting for surgery. No specific interactions with common anesthetic drugs have been discovered, and a comprehensive review of these drugs in anesthesiology practice has not been undertaken. The acetylcholinesterase inhibitors are associated with signs of increased cholinergic signaling in the periphery: vomiting and nausea. In the case of galantamine, bradycardia is also possible (44). It has been suggested that donepezil be used more routinely in the post-anesthesia care unit (PACU) to aid in recovery as an attempt to remedy a potential anticholinergic cause, either by undiagnosed dementia or as a consequence of administering drugs known to contribute to anticholinergic situations perioperatively (e.g., diphenhydramine) (45).
Clinical pharmacology of opioids: adverse effects of opioids
Nigel Sykes, Michael I Bennett, Chun-Su Yuan in Clinical Pain Management, 2008
Regarding pharmacological interventions, haloperidol is widely considered to be the drug of choice for tranquilization in delirium. Haloperidol is a high-potency, relatively low-toxic neuroleptic, with a wide safety margin and great administration versatility (p.o., p.r., s.c., i.m., i.v.). Adverse effects are rare, except for extrapyramidal reactions. Titration of the dosage against the clinical state is feasible, and oral starting doses are around 0.5–1.5 mg (parenteral doses should be between half and two-thirds of the oral dose). Doses are repeated at regular intervals (2–5 mg at 1 mg/min every 30 minutes i.v. maximum, if rapid tranquilization is necessary), and increased as needed with most advanced cancer patients settling down with a 1.5–20 mg oral total daily dose either every 24, 12, or 8 hours.109, 110 The newer atypical antipsychotics risperidone and olanzapine might be useful in the setting of complicated delirium when extrapyramidal side effects develop with haloperidol.111[V] Recently, the use of acetylcholinesterase inhibitors, such as physostigmine and donepezil, has been reported.112[V]
Diagnosis and classification
Stephen Curran, John P. Wattis in Practical Management of Dementia, 2018
Both the progression of the illness and the treatment will vary according to the cause of the dementia. An accurate diagnosis has become particularly important over the last few years with the introduction of acetylcholinesterase inhibitors for use in Alzheimer’s disease. It is also an important issue in the treatment of Lewy body dementia where extreme sensitivity to the side-effects of neuroleptic medication is common. Consequently, the cause of the dementia needs to be clarified so that appropriate medication can be used and the course and prognosis better understood. A thorough history and examination of the patient, including relevant investigations (blood tests, brain scans, etc.), will help to determine the cause, and also help to differentiate it from other common conditions such as depression or delirium, which may present in a similar fashion.
Therapeutic options in thymomas and thymic carcinomas
Published in Expert Review of Anticancer Therapy, 2022
MG is the most common paraneoplastic syndrome in patients with TETs. While 24.5%–40% of patients with thymoma either present or are eventually diagnosed with MG, 15–20% of patients with MG have thymoma [26]. Although thymectomy is beneficial for the control of symptoms in MG, there is a risk for developing respiratory failure during surgery. NCCN guideline recommends that serum anti-acetylcholine receptor antibody levels should be checked when patients could have thymoma and that patients with MG should receive treatment by a neurologist prior to surgical procedure [21]. Acetylcholinesterase inhibitors are useful to relieve the symptoms. In addition, corticosteroids are the most common immunosuppressive treatment for MG and sometimes contribute to regression of thymoma as well [90]. Other immunosuppressive agents such as tacrolimus and azathioprine are used for refractory cases. If a myasthenic crisis develops, plasma exchange and intravenous immunoglobulins are sometimes used.
Neuropathogenesis of HIV and emerging therapeutic targets
Published in Expert Opinion on Therapeutic Targets, 2022
Alina Siddiqui, Celestine He, Gina Lee, Alex Figueroa, Alexander Slaughter, Jessica Robinson-Papp
Acetylcholine is the main neurotransmitter of the parasympathetic nervous system and is also used by preganglionic neurons within the SNS. Acetylcholine is degraded in synapses by acetylcholinesterase, thus peripherally acting acetylcholinesterase inhibitors, such as pyridostigmine, have been proposed as a means of augmenting neurotransmission in autonomic neuropathies. Our group conducted a pilot study of pyridostigmine in PLWH treated with cART who had small intestinal bacterial overgrowth (SIBO), which is a common correlate of autonomic neuropathy in HIV presumably due to alteration of motility and immune function in the gut. We found that pyridostigmine substantially decreased SIBO as well as plasma levels of the inflammatory biomarkers TNFα and sCD14 [127]. Additionally, other investigators have demonstrated that the addition of pyridostigmine to cART significantly increased CD4+ T-cells [128].
Acute and sublethal effects of organophosphate insecticide chlorpyrifos on freshwater fish Oreochromis niloticus
Published in Drug and Chemical Toxicology, 2019
Rajib Majumder, Anilava Kaviraj
Reduction in acetylcholinesterase activity in hepatic tissues of O. niloticus due to chlorpyrifos exposure observed in the present study bear similarity with the findings of previous workers studying the same in different fish tissues viz. brain of Gambusia affinis (Rao et al.2005), brain, gill (Rao et al.2003), and gonad (Oruç 2010) of O. niloticus, brain of Tandanus tandanus (Huynh and Nugegoda 2012), liver of Chanos chanos (Palanikumar et al. 2014), brain of Anabas testudineus (Tam et al. 2015), and brain of Rainbow trout (Topal et al. 2016) exposed to chlorpyrifos. Chlorpyrifos like other organophosphate insecticides can disrupt the activities of acetylcholinesterase by irreversible binding to its serine hydroxyl group and thus inactivate the enzyme (Oruç 2010). Acetylcholinesterase inhibition in neuromuscular junctions and cholinergic synapses induces accumulation of acetylcholine, which finally leads to disturbances related to nerve impulse propagation and interferes energy metabolism in the nervous system (Thompson and Richardson 2004, Da Cuna et al. 2011).
Related Knowledge Centers
- Acetate
- Acetylcholine Receptor
- Acetylcholinesterase
- Autonomic Ganglion
- Central Nervous System
- Choline
- Hydrolysis
- Neuromuscular Junction
- Neurotransmitter
- Acetylcholine