Drug interactions- summary-

Anticholinesterase stimulants + succinyl chloine-

neuromuscular action may be increased. prolonged respiratory depression with extended
periods of apnea may occur

Aminoglycosides antibiotics eg neomycin,, streptomycin, kanamycin
+ anticholinesterase musle relaxants-

aminoglycosides have a mild but definite nondeplolarizing action

Local and general anesthesitics antiarrhythmtics + anticholineseterase muscle stimulants

use cautiously if at all, in patients with myasthenia gravis

Atropine belladonna derivatives + anticholinesterase stimulants-

routine administration of these agents may suppress the parasympthomimetics symptoms
of excessive GI stimulants.

Corticosteroids + anticholinesterase muscle stimulants

may decrease the antichlinesterase effects of these agents. Conversely, Anticholinesterase
effects may be increased after stopping corticosteroids. Provide respiratory support if needed

magnesium + anticholineterase muscle stimulants

magnesium has a direct depressant effect on skeletal muscle and antagonise beneficial
efect of anticholesterase  therapy

Mecamylamine + anticholinesterase muscle stimulants

do not administer to patients receiving gangrene blocking agents

Parkinsonism

Cardiovascular -   arrhythmias, (especially bradycardia ) fall in cardiac ouput leading to hypotension,
                               AV block, nodal rhythm, cariac arrest

CNS-    convulsions, dysarthia, dizziness, loss of consciousness, drowsiness, headache

Dermatologic-   skin rash, ( pyridostigmine and neostigmine ) subsides after discontinuance

GI -      increased salivary , gastric and intestinal secreations , nausea, vomiting,dysphagia.
             increased peristalsis,  diarrhea, abdominal cramps

Hypersensitivity - allergic reactions and anaphylaxis

Respiratory - increasered tracheobronchial secretions, laryngospasm , bronchiolar constriction.
                       respiratory muscle paralysis, central respiratory paralysis, respiratory depression

Miscellaneous- urinary frequency and incontinence, urinary urgency, diaphoresis, rash,
                            urticaria, flushing, alopecia( pyridostigmine )

Hypersensitivity to anticholinesterases

Special precautions-

Use with caution-  in patients with bronchial asthma, epilepsy, bradycardia, recent coronary
occlusion, hyperthyroidism, cardiac arrhythmias or peptic ulcer. treat transcient bradycardia
with atropine sulphate

Cholinergic/myasthetic crisis-  overdosage may result in cholinergic risis. characterized by
muscle weakness  through involvement of  the respiratory muscle may lead to death.

Supervision- great care and supervision are required with ambenonium chloride

Hypersensitivity -    because of the possible hypersensitivity in an occasional patient
have atropine and epinephrine readily available when using parentral therapy

Pregnancy- use only when clearly needed and when the potential benefits outweighs potential
hazard to the fetus.

Lactation- Use ith caution and only if required

Children- safety and efficacy in children are not established

Indication-

Parkinsonism

Dosage-
Usual dosage- 0.3 to .6ml ( to 6mg )
Prescribed dose of apomorphine should always be expressed in millimiliters to avoid confusion

1. Inform your doctor if nausea, vomiting, diarrhea, sweating, increased salivary secretions,
    irregular heart beats, muscle weakness, severe abdominal pain or difficulty in breathing occur.

Pregnancy-
Use only when clearly needed and when the potential benefits outweighs potential
hazard to the fetus.

Lactation-
Use ith caution and only if required

Children-
Safety and erfficacy in children are not established