피조스티그민

콜린에스테라아제 억제제

피조스티그민은 가역적 **콜린에스테라아제 억제제**로, 수의학에서는 주로 이버멕틴 중독의 보조 치료, 개와 말의 기면증/탈력발작 진단을 위한 유발제, 그리고 중추성 항콜린성 독성의 해독제로 사용됩니다. **임상 요점:** * 4차 아민계 콜린에스테라아제 억제제(예: 네오스티그민)와 달리 피조스티그민은 **3차 아민**입니다. * 이러한 구조적 차이로 인해 **혈액뇌장벽(BBB)**을 쉽게 통과할 수 있어 '중추성' 항콜린성 독성 치료에 특히 효과적입니다. * 중추신경계로 진입하기 때문에 중추성 독성 부작용(예: 발작)의 위험이 더 높습니다. * 치료 지수가 좁고 심각한 부작용의 가능성이 있어, 일반적으로 생명을 위협하는 중추신경계 독성 치료에만 제한적으로 사용됩니다.

작용 기전: Physostigmine reversibly inhibits the enzyme **acetylcholinesterase** → prevents the hydrolysis and destruction of **acetylcholine (ACh)** → increases the concentration of ACh at both muscarinic and nicotinic receptor sites. Because it is a lipophilic tertiary amine, it crosses the blood-brain barrier and exerts its cholinergic effects both **centrally** and **peripherally**. This widespread cholinergic stimulation leads to miosis, bronchoconstriction, hypersalivation, and increased gastrointestinal motility.

동물 종별 용량

Cattle

For reversal of tall larkspur (Delphinium barbeya) poisoning · 0.04-0.08 mg/kg · IV · As needed · Administer rapidly; serial injections may be necessary.

Horses

Provocative test in diagnosing cataplexy or narcolepsy · 0.05-0.1 mg/kg · IV · Once · Administer slow IV. Will precipitate a cataplectic attack within 3-10 minutes. Untoward effects may include colic or cholinergic stimulation. Note: RCI Class 3 drug.
Provocative test in diagnosing cataplexy or narcolepsy · 0.06-0.08 mg/kg · IV · Once · Lack of positive response does not rule out diagnosis. Diarrhea can occur and caution is advised as horse can cause colic.

Dogs

To temporarily reverse the CNS effects of ivermectin toxicosis in support of the diagnosis · 1 mg (total dose) · IV · Once
To temporarily reverse the CNS effects of ivermectin toxicosis in support of the diagnosis · 1 mg (total dose)/12 hours · IV · q12h · May reverse ivermectin-induced coma for 30-90 minutes. In comatose patients, it does not appear to induce seizures, but seizure-like activity can be observed in patients with only minor ataxia and confusion.
Provocative test for narcolepsy/cataplexy · 0.025 mg/kg · IV · Once · Wait 9-15 minutes and observe response to stimulus. If clinical signs do not appear, may try a higher dose of 0.05 mg/kg. Subsequent testing can be done at doses of 0.075 mg/kg and 1 mg/kg. Increased severity of signs persisting for 15-45 minutes is indicative of cataplexy/narcolepsy.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

IVIMSC

금기

Prior hypersensitivity reactions to physostigmine or sulfites
Bronchoconstrictive disease (asthma)
Gangrene
Diabetes mellitus
Cardiovascular disease
Mechanical obstruction of the GI or urinary tract
Any vagotonic state
Concurrent use of choline esters or depolarizing neuromuscular blocking agents

이상반응

Miosis
Bronchial constriction
Hypersalivation
Muscle weakness
Sweating (in species with sweat glands)
Seizures
Bradycardia
Tachycardia
Asystole
Nausea
Vomiting
Diarrhea
Depolarizing neuromuscular block
Pulmonary edema
Respiratory paralysis

약물 상호작용

Choline esters (bethanechol, carbachol, methacholine) · May cause additive adverse cholinergic effects.
Organophosphates · May cause additive adverse cholinergic effects.
Succinylcholine · High doses of physostigmine may cause muscle fasciculations or depolarization block, which may be additive to the effects of succinylcholine-like neuromuscular blockers.

모니터링

Direct patient supervision is required
Heart rate
Blood pressure
ECG/Heart rhythm (especially if heart rate is abnormal)
Signs of cholinergic crisis (salivation, lacrimation, urination, defecation, dyspnea, emesis)

과용량

Overdoses or acute toxicity can be **life-threatening** and may result in a severe cholinergic crisis (seizures, bradycardia, asystole, respiratory paralysis). * **Supportive Care:** Because of the short duration of effect, supportive care (including mechanical ventilation and repeated bronchial aspiration) may be sufficient in some cases. * **Antidote (Muscarinic):** Administration of **IV atropine** is the primary treatment for cholinergic toxicity. Re-administration may be required. * **Antidote (Nicotinic):** **Pralidoxime (2-PAM)** may be useful in reversing the ganglionic and skeletal muscle effects of physostigmine. * Contact an animal poison control center for case management assistance.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.