Carbamates

Carbamates is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Epidemiology

Carbamates are reversible AChE inhibitors that also lead to ACh excess in the synaptic junction. They are occasionally found in pesticides. However, their most common use in this country is medicinal.

  • Physostigmine is a naturally occurring methyl carbamate found in the Calabar bean. Other common carbamates are pyridostigmine and neostigmine.
  • Pyridostigmine has been used in the treatment of myasthenia gravis.

Pathophysiology

  • Inhibition of ACh breakdown through blockage of AChE leads to accumulation of ACh at nicotinic and muscarinic receptors with excess cholinergic stimulation.
  • Carbamates are reversible enzyme inhibitors; they release AChE spontaneously. There is no “aging” phenomenon with carbamates.

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General Principles

Epidemiology

Carbamates are reversible AChE inhibitors that also lead to ACh excess in the synaptic junction. They are occasionally found in pesticides. However, their most common use in this country is medicinal.

  • Physostigmine is a naturally occurring methyl carbamate found in the Calabar bean. Other common carbamates are pyridostigmine and neostigmine.
  • Pyridostigmine has been used in the treatment of myasthenia gravis.

Pathophysiology

  • Inhibition of ACh breakdown through blockage of AChE leads to accumulation of ACh at nicotinic and muscarinic receptors with excess cholinergic stimulation.
  • Carbamates are reversible enzyme inhibitors; they release AChE spontaneously. There is no “aging” phenomenon with carbamates.

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