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Antimuscarinic with neostigmine — FRCA Primary MCQ

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EasyPharmacologyAntimuscarinic with neostigmineFRCA Primary

Neostigmine reversal is planned and central anticholinergic effects are undesirable. Which drug is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Glycopyrronium

Glycopyrronium is a quaternary antimuscarinic often paired with neostigmine. Neostigmine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Magnesium sulphate is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Dantrolene is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. Phenylephrine is less appropriate because it would fit a different clinical clue or a separate anaesthetic problem. In Primary FRCA pharmacology, link the clinical effect to the receptor, distribution or elimination mechanism rather than memorising isolated facts.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF; Primary FRCA textbooks