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Glycopyrronium central effects — FRCA Primary MCQ

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HardPharmacologyGlycopyrronium central effectsFRCA Primary

A confused older patient requires an antimuscarinic during reversal of neuromuscular blockade. The consultant favours glycopyrronium over atropine to minimise central effects. Which property explains this?

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Correct answer: B — Quaternary ammonium structure

Glycopyrronium is a quaternary ammonium compound and crosses the blood-brain barrier poorly, reducing central anticholinergic effects. Atropine is more lipid soluble and more likely to cause central effects. Renal metabolism and nicotinic blockade do not explain the distinction. This is why glycopyrronium is commonly paired with neostigmine in anaesthetic practice.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care